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PSA LEVELS AND PROSTATE VOLUME CAN PREDICT PROSTATE COMPLICATIONS
DALLAS - A routine test already in use to diagnose prostate cancer and enlarged prostate could also predict the likelihood of a patient requiring surgery or developing acute urinary retention.
In a national study published in the March issue of Urology, UT Southwestern Medical Center at Dallas researchers and colleagues report that the prostate-specific antigen (PSA) level test allows physicians to identify patients with benign prostatic hyperplasia (BPH), or enlarged prostate, who are at high risk for problems like acute urinary retention or who may need surgery.
Physicians could then prescribe a drug to lower that risk.
The study, a further analysis of four years of research published in The New England Journal of Medicine (Feb. 26, 1998), shows that higher PSA levels indicate larger prostate volume, which in turn predicts a higher risk of negative outcomes of BPH.
"When we started the four-year study, no one knew outcomes such as retention or surgery could be predicted by PSA," said Dr. Claus Roehrborn, associate professor of urology at UT Southwestern. "But when we looked at the results, we saw the higher the PSA, the worse the outcome."
The original study showed that the drug finasteride reduced by more than half the risk of a need for surgery or of acute urinary retention, a painful blockage of the urinary tract that prevents urination and requires catheterization. The 1998 study, conducted over four years with 3,040 men, included researchers from 95 medical centers.
The risk of such negative outcomes is relatively low overall in men with BPH, and physicians looked for a way to identify patients at higher risk for retention or surgery.
"In men with mid- to high-range PSA values over 2 nanograms per milliliter, the drug merits consideration," Roehrborn said. "Our aim is to reduce the risk for those at highest risk."
The risk of a man developing acute urinary retention or needing surgery as a result of BPH with a PSA less than 1.3 nanogram/milliliter is 6 percent over four years. But for a man with a PSA level of 3.3 or higher, the risk is 20 percent over four years.
In the original study, 75 percent of men experiencing retention later underwent surgery for their condition, some due to worsening symptoms. Sixty percent of men in their 60s who were in the 1998 study had BPH, though many did not require surgery or treatment.
"These findings are definitely a step in the right direction," said Roehrborn, the lead author of the publications. "By selecting men at greatest risk for these outcomes, we get the best value from the medication and the biggest return on the health-care dollar."
Dr. John McConnell, chairman of urology at UT Southwestern, headed the first trial.
Merck and Co., which markets the drug finasteride under the name Proscar, helped fund the studies.
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This news release is available on our World Wide Web home page at http://www.swmed.edu/home_pages/news/
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