ISCHEMIC DAMAGE TO THE PROSTATE DURING CARDIAC-SURGERY - A CLINICAL-MODEL

BACKGROUND. To determine if altered tissue perfusion during cardiac su rgery results in ischemic tissue damage to the prostate, as suggested by a rise in prostatic-specific antigen (PSA). METHODS. Twenty-nine ma le patients undergoing elective coronary artery bypass grafting were s tudied. Ten male patients undergoing elective gastrointestinal surgery served as controls. PSA levels were determined preoperatively and six hourly intervals postoperatively for 48 hr. All patients underwent ur ethral catheterization at induction of anesthesia. RESULTS. All patien ts (100%) who had undergone cardiac bypass surgery showed rises in ser um PSA during 48 hr of postoperative follow-up. At the 6-hr postoperat ive interval, the mean PSA was significantly different from the mean b aseline value (paired two tailed Student's t test, P < 0.001) in 27 of the 29 (93%) patients. In contrast, the PSA values in the 10 gastroen terological controls did not change at 6 hr (P > 0.2) or during the ne xt 48 hr. One patient in the cardiac group showed a very marked elevat ion in serum PSA of greater than 50 times normal preoperative levels. CONCLUSIONS. Statistically significant rises in PSA levels are seen fo llowing coronary bypass surgery. This rise may be caused by ischemic n ontrauma related damage to the prostate and suggests a possible pathop hysiological mechanism for the clinically episodic symptoms of prostat ism seen in elderly men. (C) 1997 Wiley-Liss, Inc.