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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 2  |  Page : 354-356
Prostate specific antigen levels in pre-dialysis chronic kidney disease patients

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

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Date of Web Publication9-Mar-2010

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 2023 Feb 9];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.

   References Top

1.Carroll P, Coley C, McLeod D, et al. Prostate­specific antigen best practice policy--part II: Prostate cancer staging and post-treatment follow-up. Urology 2001;57:225-9.  Back to cited text no. 1  [PUBMED]    
2.Higashihara E, Nutahara K, Kojima M, et al. Significance of serum free prostate specific antigen in the screening of prostate cancer. J Urol 1996;156:1964-8.  Back to cited text no. 2  [PUBMED]    
3.Polascik TJ, Oesterling JE, Partin AW. Prostate specific antigen: A decade of discovery-what we have learned and where we are going. J Urol 1999;162:293-306.  Back to cited text no. 3  [PUBMED]    
4.Partin AW, Oesterling JE. Clinical usefulness of prostatic specific antigen: Update 1994. J Urol 1994;152:1358-68.  Back to cited text no. 4  [PUBMED]    
5.Ercole CJ, Lange PH, Mathisen M, et al. Pros­tatic specific antigen and prostatic acid phos­phatase in the monitoring and staging of pa­tients with prostatic cancer. J Urol 1987;138: 1181-4.  Back to cited text no. 5  [PUBMED]    
6.Reissigl A, Bartsch G. Prostate-specific antigen as a screening test. The Austrian experience. Urol Clin North Am 1997;24:315-21.  Back to cited text no. 6      
7.Oesterling JE. Prostatic specific antigen: A critical assessment of the most useful tumour marker for adenocarcinoma of the prostate. J Urol 1991;145:907-23.  Back to cited text no. 7  [PUBMED]    
8.Tzanakis I, Kazoulis S, Girousis N, et al. Prostate-specific antigen in hemodialysis pa­tients and the influence of dialysis in its levels. Nephron 2002;90:230-3.  Back to cited text no. 8  [PUBMED]    
9.Djavan B, Shariat S, Ghawidel K, et al. Impact of chronic dialysis on serum PSA, free PSA, and free/total PSA ratio: Is prostate cancer detection compromised in patients receiving long-term dialysis? Urology 1999;53:1169-74.  Back to cited text no. 9  [PUBMED]    
10.Marple JT, MacDougall M. Development of malignancy in the end stage renal disease patients. Semin Nephrol 1993;13:306-14.  Back to cited text no. 10  [PUBMED]    
11.Jemal A, Siegel R, Ward E, et al. Cancer Sta­tistics, 2008. CA Cancer J Clin 2008;58:71-96.  Back to cited text no. 11  [PUBMED]    
12.Morton JJ, Howe SF, Lowell JA, Stratta RJ, Taylor RJ. Influence of end stage renal disease and renal transplantation on serum prostatic antigen. Br J Urol 1995;75:498-501.  Back to cited text no. 12  [PUBMED]    
13.Sasagawa I, Nakada T, Hashimoto T, et al. Se­rum prostatic acid phosphatase, gamma­seminoprotein and prostatic specific antigen in hemodialysis patients. Urol Int 1992;48:181-3.  Back to cited text no. 13  [PUBMED]    
14.Arick N, Adam B, Akpolat T, Hasil K, Tabak S. Serum tumour markers in renal failure. Int Urol Nephrol 1996;28:601-4.  Back to cited text no. 14      
15.Watson RA, Tang DB. The predictive value of prostatic acid phosphatase as a screening test for prostatic cancer. N Eng J Med 1980;303: 497-9.  Back to cited text no. 15      
16.Rule AD, Jacobson DJ, Roberts RO, et al. The association between benign prostatic hyperpla­sia and chronic kidney disease in community­dwelling men. Kidney Int 2005;67:2376-82.  Back to cited text no. 16  [PUBMED]    
17.Bruun L, Bjork T, Lilja H, Becker C, Gusta­fsson O, Christensson A. Percent-free prostate specific antigen is elevated in men on haemo­dialysis or peritoneal dialysis treatment. Nephrol Dial Transplant 2003;18:598-602.  Back to cited text no. 17      
18.Catalona WJ, Partin AW, Slawin KM, et al. Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: A pros­pective multicenter clinical trial. JAMA 1998; 279:1542-7.  Back to cited text no. 18  [PUBMED]    
19.Douville P, Tiberi M. Effect of terminal renal failure on the ratio of free to total prostate­specific antigen. Tumor Biol 1998;19:113-7.  Back to cited text no. 19      
20.Bruun L, Savage C, Cronin AM, Hugosson J, Lilja H, Christensson A. Increase in percent free prostate-specific antigen in men with chronic kidney disease. Nephrol Dial Transplant 2009; 24(4):1238-41.  Back to cited text no. 20      

Correspondence Address:
Shahid Hussain
National Institute of Kidney Diseases, Shaikh Zayed Medical Complex, Lahore
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Source of Support: None, Conflict of Interest: None

PMID: 20228531

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