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| Year : 2010 | Volume
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| Issue : 2 | Page : 354-356 |
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| Prostate specific antigen levels in pre-dialysis chronic kidney disease patients |
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Shahid Hussain1, Ghulam Abbas2
1 National Institute of Kidney Diseases, Shaikh Zayed Medical Complex, Lahore, Pakistan
2 Department of Nephrology, Bahawalpur Victoria Hospital, Quaid -E- Azam Medical College, Bahawalpur, Pakistan
Click here for correspondence address and email
| Date of Web Publication | 9-Mar-2010 |
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How to cite this article:
Hussain S, Abbas G. Prostate specific antigen levels in pre-dialysis chronic kidney disease patients. Saudi J Kidney Dis Transpl 2010;21:354-6 |
How to cite this URL:
Hussain S, Abbas G. Prostate specific antigen levels in pre-dialysis chronic kidney disease patients. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2021 Aug 4];21:354-6. Available from: https://www.sjkdt.org/text.asp?2010/21/2/354/60212 |
To the Editor,
The prostate specific antigen (PSA) remains the best and most widely used tumor marker for prostate in clinical practice these days. [1],[2] It is a glycoprotein with a molecular weight of 33KD. PSA is commonly used in the diagnosis and follow-up of prostate disease especially prostatic cancer. [3],[4] Acid phosphatase (ACP) and prostatic acid phosphatase (ACP prost) have also been used in the past to detect prostatic disease. [5] Since PSA was introduced into clinical practice in 1986, the early diagnosis and management of prostate cancer has been revolutionized and much has been learnt about the strengths and weaknesses of this assay. [6] The PSA test is the most effective test currently available for the early detection, diagnosis and follow-up of prostate cancer in kidney disease (CKD) patients. [7],[8],[9]
Men with chronic renal failure evaluated for transplantation are often tested for PSA to detect prostate cancer. Middle and higher molecular weight substances that are filtered through kidney accumulate in the body in CKD. Therefore, it was suspected that PSA level may be higher in CKD making the diagnostic validity of PSA and ACP prost uncertain in CKD patients.
44 men above the age 50 having a creatinine clearance < 15 mL/min but not yet on dialysis and no clinical suggestion of prostate disease were recruited from pre-dialysis nephrology clinic. 25 men age > 50 years: 7 with definite history of prostate disease (control 1) and 18 with no history of prostate disease and followed up in urology clinic for other than prostate disease (control 2) were included as controls. Total PSA was measured in serum with immunoradiometric assay technique (TANDEM-R PSA). Total acid phosphatase and prostatic acid phosphatase were measured by colorimetric method. SPSS 13 was used for all analysis.
The mean age of the patient was 62 ± 8 (50 - 92) years in the study group [Table 1]. Only five patients out of 44 had raised PSA levels above the reference range (< 4.1 ug/L). Further detailed investigations of these patients showed them to have prostate disease [Table 2]. Mean total acid phosphatase was was not significantly different among the groups (P value 0.174). However, as expected prostatic acid phosphatase was significantly higher (P value 0.01) in control 1 group [Table 1].
The incidence of malignancy is increased in chronic kidney disease especially patients on hemodialysis compared to general population. [10] The symptoms of prostatic disease may be minimal or absent in patients with chronic kidney disease since most of the patients are oliguric and eventually may become anuric. Early detection of prostatic malignancy is of great importance as it can decrease the death rate of prostatic cancer by one third. [11] Patients with advanced CKD (CKD V) may be candidates for renal transplantation with subsequent introduction of immunosupression and exclusion of prostatic cancer is important in this population. There have been conflicting reports about the validity of tPSA levels in patients with CKD. [9],[12],[13],[14] Our results however, show that the recommended reference ranges for tPSA are also applicable to patients with advanced kidney disease (CKD V) for the detection of prostatic diseases, both benign prostatic hypertrophy (BPH) and prostatic cancer.
Overall levels of tPSA and ACP in our study group were similar to controls with no evidence of prostatic disease confirming the lack of sensitivity of ACP in diagnosing prostate cancer. [5],[15]
Chronic kidney disease and benign prostatic hypertrophy are both common in elderly males with a possibility of bladder outlet obstruction as a contributing cause. [16] In our study group two patients turned out to have BPH and other three had prostatic cancer.
The measurement of tPSA is a helpful tool in the diagnosis and follow up of patients. Although there are conflicting reports regarding the levels of tPSA in hemodialysis patients, nevertheless, its levels are not affected significantly by either method of dialysis or type of membrane used during hemodialysis. [8],[9],[13],[17],[18] Some studies have determined that free PSA (fPSA)levels may be significantly higher in dialysis patients compared to tPSA levels and should help in differentiating benign from malignant disease. [9],[17],[19] As far as we know there are no published studies in literature to determine the level of PSA in males over the age of 50 at different degree of renal failure. [20] Our study therefore is important to confirm the use of tPSA for diagnosis of prostate cancer and benign prostatic hypertrophy in patients with CKD stage V who have not started dialysis yet compared to controls. ACP prostate was done due to its historic use, low cost and easy availability in most laboratories although it has never been proven to be a valid tumor marker for prostate.
The limitations of our study are relatively small number of patients studied and our inability to do fPSA levels due to nonavailability of these tests in our laboratory; although recent data showed the lack of sensitivity of fPSA in detecting prostatic disease. [20]
In conclusion our study suggests that CKD stage V does not have significant impact on total PSA levels. Those individuals with abnormal values of PSA either had or were at risk to develop prostatic disease.
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Correspondence Address:
Shahid Hussain
National Institute of Kidney Diseases, Shaikh Zayed Medical Complex, Lahore
Pakistan
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PMID: 20228531 
[Table 1], [Table 2] |
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