THE EFFECT OF DIGITAL RECTAL EXAMINATION, FLEXIBLE CYSTOSCOPY AND PROSTATIC BIOPSY ON FREE AND TOTAL PROSTATE-SPECIFIC ANTIGEN, AND THE FREE-TO-TOTAL PROSTATE-SPECIFIC ANTIGEN RATION IN CLINICAL-PRACTICE
Gn. Collins et al., THE EFFECT OF DIGITAL RECTAL EXAMINATION, FLEXIBLE CYSTOSCOPY AND PROSTATIC BIOPSY ON FREE AND TOTAL PROSTATE-SPECIFIC ANTIGEN, AND THE FREE-TO-TOTAL PROSTATE-SPECIFIC ANTIGEN RATION IN CLINICAL-PRACTICE, The Journal of urology, 157(5), 1997, pp. 1744-1747
Purpose: We evaluated the effects of common urological maneuvers on se
rum free prostate specific antigen (PSA) and established guidelines fo
r clinical practice. Materials and Methods: Total and free PSA, and fr
ee-to-total PSA ratio were determined in 82 men with lower urinary tra
ct symptoms before and 30 minutes after 3 different prostatic manipula
tions: 1) digital rectal examination (36 cases), 2) flexible cystoscop
y (26) and 3) transrectal ultrasound guided prostatic biopsy (20). PSA
forms were measured with Hybritech Tandem-R assays. Results: Cystosc
opy had no effect on total PSA, while digital rectal examination had a
slight, statistically significantly positive effect and biopsy unifor
mly increased total PSA (geometric mean ratio 2.43, t = 5.08, p < 0.00
1). Free PSA was increased by digital rectal examination (geometric me
an ratio 1.67, t = 4.25, p < 0.001), prostatic biopsy (geometric mean
ratio 4.80, t = 7.48, p < 0.001) and cystoscopy (geometric mean ratio
1.21, t = 2.51, p = 0.019). There was a significant increase in free-t
o-total PSA ratio after each maneuver. The rate of change in free PSA
and free-to-total PSA ratio after biopsy differed between patients wit
h benign and malignant histological findings. Conclusions: Free PSA an
d free-to-total PSA ratios are altered by all forms of prostatic manip
ulation. The PSA response to manipulation may be different in patients
with prostatic malignancy. Phlebotomy must precede digital rectal exa
mination in the clinical and research setting to avoid misleading resu
lts.