Kadir Demir, Department of Urology, Dr. The aim of this study is to evaluate the effect of ejaculation on serum total, free and complex prostate-specific antigen PSA levels and their effect on biopsy decisions. Our study includes 47 men older than 45 years with symptomatic benign prostatic hyperplasia BPH. Eight patients with similar demographic, and clinical characteristics were chosen as a control group.
With three days of sexual abstinence, blood samples were drawn for the measurement of baseline PSA levels, and then the patients were told to ejaculate. One, 5, 24 and 72 hours after ejaculation, serum total, free and complexed PSA levels were measured. Serum PSA sampling was performed at the same intervals in the control group without ejaculation. The mean age of the patients was The mean international prostate symptom scores IPSS were The mean baseline total, free, and complexed PSA values were 1.
In the study group, total PSA value was found to be 1. Mean total PSA level rose up to 1. Mean free PSA level rose after the first hour postejaculation to 0. There were no statistically significant changes at the other sampled times as for the total, free or complexed PSA serum levels.
When all three values were considered individually, in only 2. When the PSA value is borderline with respect to biopsy decisions, the effect of ejaculation on serum PSA levels may be clinically important. In these patients, ejaculation must be questioned, and repeated. PSA levels should be evaluated 24 hours after ejaculation.
There were no statistically significant changes in the levels of complex PSA values. Further studies are needed to clarify the relationship between complexed PSA and ejaculation. Ejaculation, prostate, PSA Introduction Although prostate cancer is the most frequently encountered type of cancer in men, it ranks sixth among cancer-related deaths.
Main increase occurred with the introduction of prostate-specific antigen PSA in urology practice in Prostate-specific antigen belongs to the family of human kallikrein gene. It is released into the seminal fluid in higher concentrations, and its conjugated complex form , and free forms are found in the circulation.
Under normal conditions, it is found in serum at lower concentrations. In the serum conjugated or complexed PSA is bound to alpha macroglobuline, and alphaantichymotrypsin. Macroglobulin-bound PSA can not be detected with most of the available tests. Controversial publications concerning the impact of ejaculation on PSA are available. To refrain from unnecessary biopsies, and increase cancer-specificity of PSA, various PSA derivatives, and auxillary parameters were defined.
In the prostate cancer, production of PSA does not increase. The factor which induces increases in PSA levels, is deterioration of the architecture of the prostate gland caused by prostate cancer. Increased rates of PSA might be released into serum together with disruption of the basal layer, and baseline membrane caused by prostate cancer. Patients carrying a suspicion of prostate cancer for any reason digital rectal examination which raises the suspicion of prostate cancer, and doubtful metastatic lesions etc.
For the study, approval of the Ethics Committee was obtained from Dr. Written informed consent was received from all patients participating in the study. All patients were interrogated using International Prostate Symptom Scoring System IPSS , and subjected to complete urinalysis, digital rectal examination, serum total, free, and complexed PSA, and residual urine measurements, and uroflowmetric examinations.
Besides, prostate volumes were calculated by means of suprapubically applied ultrasound transducer. From a total of 47 patients which comprise the study group, blood samples were drawn after a 3-day sexual abstinence period at baseline before ejaculation PSA0 , and at 1 PSA1 hr , 5. PSA5 hrs , PSA 24hrs , and PSA72 hrs hours after ejaculation.
In the control group blood samples were also drawn at aforementioned 5 time points for PSA measurements. All analyses were performed by the same urologist. Data were evaluated statistically using GraphPad Prism 5. Results Mean age, IPSS, prostate volume, post-mictional residual urine volume, and Q max values in the study, and the control groups are given in Table 1.