Effect of Transurethral Surgery on Serum Percent Free Prostate-Specific Antigen Levels / 대한비뇨기과학회지

PURPOSE: Transurethral surgery can cause an elevation of the total serum prostate- specific antigen (PSA); however, the effect on the free (PSA-F) and free-to-total PSA (f/t PSA) ratio is still unknown. The aim of this study was to investigate the effect of transurethral surgery on the serum total PSA (PSA-T), PSA-F and the f/t PSA ratio, in patients with benign prostatic hyperplasia (BPH) or a bladder tumor. MATERIALS AND METHODS: Thirty-five patients with BPH and 48 with a bladder tumor, who had undergone transurethral surgery, were included in this study. The serum PSA-T and PSA-F levels were determined before, and at 1 and 7 days after, the transurethral surgery, using an immunoradiometric assay. The Pre- and postoperative PSA-T, PSA-F and f/t PSA ratios were statistically compared. RESULTS: On the first postoperative day, the PSA-T and PSA-F levels increased significantly compared with the preoperative values (p0.05). In contrast, a mean 1.4-fold increase (29.13%) in f/t PSA ratio was noted 1 day after the TURP, but a mean 0.7-fold decrease (13.71%) was noted 7 day after, compared to preoperative mean value (20.24%). CONCLUSIONS: Both TURB and TURP caused an immediate increase in the serum PSA level, which was related to the resected volume of the prostate in the BPH patients. Our recommendation is that a serum f/t PSA ratio should not be obtained for at least 1 week after a TURP. For the purpose of improving the clinical availability of PSA, the f/t PSA ratio determination could be accurate and reliable following a TURB.

Clinical Experience and Indication of Transurethral Microwave Thermotherapy (TUMT) in Benign Prostatic Hyperplasia / 대한비뇨기과학회지

Transurethral microwave thermotherapy (TUMT) is a new treatment modality for benign prostatic hyperplasia (BPH). From October 1992 to May 1993. among patients with BPH who are treated by TUMT (50watt. 915MHz), 40 patients who are followed up appropriately for 3 months are selected to analyze the effectiveness and indication of TUMT. Patients were divided into 4 groups according to voiding symptom and prostatic volume by transrectal ultrasonography (TRUS) : prostatism group (Group A, 27 cases) and urinary retention group (Group B, 13 cases), prostatic volume 40gm and less (Group I, 27 cases) and more than 40gm (Group II, 13 cases). We reviewed subjective symptoms of patients with Madsen & Iversen symptom score and examined urine analysis, PAP, PSA, uroflowmetry and TRUS beforeand after TUMT. The patients underwent 1 hour session on an out-patient basis with local anesthesia. The average age of patients was 70.9. Significant differences in symptom score, maximal flow rate and residual urine volume were observed in Group A and Group I compared with Group B and Group II (p<0.05). Complications were minimal, consisting of bladder spasm(7), urinary retention(4), hematuria(4) and urinary tract infection(1). We could observe the improvement of subjective symptoms and objective parameters after TUMT. Patients without urinary retention or with relatively small prostate ( <40gm) had a superiority in effectiveness. However. we failed in the cases of old age (more than 80 years old), poor in general condition and associated neurogenic bladder. Though TUMT is effective alternative treatment on patients with BPH, we considered that the selection of patient is very important to get better effectiveness.