Inpatient PSA levels ‘should be disregarded’ for prostate monitoring

Researchers from Korea say that inpatient prostate-specific antigen (PSA) levels should be ignored for the purposes of serial monitoring, after finding that they are significantly reduced compared with outpatient levels.

Se Joong Kim (Ajou University School of Medicine, Suwon) and colleagues analyzed data on 416 patients without prostate cancer who were hospitalized for prostate biopsy and had an outpatient PSA level recorded at a mean interval of 22 days prior to inpatient admission.

They found that the mean PSA level just after admission was significantly lower, at 6.69 ng/mL, than the pre-admission outpatient level of 8.01 ng/mL.

And, these results remained true after stratifying for age, presence of chronic prostatitis, serum PSA level, and prostate size. The only exceptions were in men aged 20 to 39 years and those with PSA levels below 4.0 ng/mL, in whom post-admission PSA was nonsignificantly lower than the pre-admission outpatient level, probably due to the small sample size of these subgroups.

“Various physiologic and benign pathologic processes can lead to elevations of the serum PSA level,” say Kim et al, writing in the Korean Journal of Urology. These include nonmalignant disease of the prostate, urinary retention, ejaculation, and procedures involving manipulation of the prostate, while lack of activity can result in a decrease.

Previous reports have shown decreased PSA values within 24 to 72 hours of hospital admission, which the authors say may be due to bed rest. By contrast, in their study, PSA values were measured immediately after admission, leading them to conclude that hospitalization in itself leads to decreased levels. However, the reasons for this are not known.

On the basis of the findings, Kim et al say that “serum PSA values should be measured on an outpatient basis for the serial monitoring of PSA.” However, they add that a large, prospective, multicenter study will be needed to confirm their results.

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