THE PERIURETHRAL GLANDS DO NOT SIGNIFICANTLY INFLUENCE THE SERUM PROSTATE-SPECIFIC ANTIGEN CONCENTRATION

Purpose: The periurethral glands are known to produce prostate specifi c antigen (PSA). With ultra-sensitive assays now routinely available, it is necessary to determine if the periurethral glands significantly influence serum PSA concentration after radical prostatectomy. Materia ls and Methods: Serum PSA levels of 46 men, 51 to 89 years old (median age 67) who underwent radical cystoprostatectomy and total urethrecto my, were compared with those of 92 men 46 to 91 years old (median age 67) who underwent radical cystoprostatectomy only. All men had transit ional cell carcinoma of the bladder without gross or microscopic evide nce of prostate cancer and all underwent ileal conduit diversion. Seru m was obtained at least 1 year postoperatively. Each specimen was anal yzed using the Tosoh,dagger Immulite,double dagger and Yu and Diamandi s ultra-sensitive PSA assays with analytical detection limits of 0.02 ng./ml., 0.004 ng./ml. and 0.002 ng./ml., respectively. Results: Media n PSA for the radical cystoprostatectomy with urethrectomy group was 0 .00 ng./ml. (range 0.00 to 0.14) for each of the 3 assays. For the rad ical cystoprostatectomy only group the median Tosoh and Immulite PSA a ssay levels were 0.01 ng./ml. (range 0.00 to 0.22), and median Yu and Diamandis PSA assay level was 0.00 ng./ml. (range 0.00 to 0.31). Concl usions: The greatest difference in median PSA levels that could be fou nd between men with and without periurethral glands when using 3 diffe rent ultra-sensitive assays was 0.01 ng./ml., indicating that the peri urethral glands do not have a clinically significant effect on serum P SA concentration after radical prostatectomy. Thus, a serum PSA level above the residual cancer detection limit following radical prostatect omy, even if obtained with an ultra-sensitive assay, reflects either m alignant or benign residual prostatic tissue, rather than the presence of periurethral glands.