Serum Prostat-Spesifik Antijen Düzeyi 2,5-10 Ng/Ml Arasındaki Erkeklerde İki Kadeh Testinin Prostat Biyopsisi ve Asemptomatik Prostat İnflamasyonu Varlığı ve Derecesiyle İlişkisinin Araştırılması

Abstract

Amaç: Prostat-spesifik antijen (PSA) prostat kanserini belirlemede kullanılan bir belirteçtir. Yüksek PSA değerleri saptandığında prostat kanseri olasılığı düşünülerek prostat biyopsisi uygulanmaktadır. PSA yüksekliği, prostat kanserine spesifik olmayıp benign prostat hiperplazisi (BPH) , idrar yolu enfeksiyonu ve kronik prostatit gibi durumlardan da kaynaklanabilmektedir. .Biyopsi yapılan hastaların yaklaşık %66’sında prostat kanseri saptanmayıp, hastalar gereksiz biyopsiye ve biyopsi komplikasyonlarına maruz kalmaktadır. Bu biyopsilerin yaklaşık % 40’ında kronik prostatit saptanmaktadır.İki kadeh testi kronik prostatit tanısında kullanılan rektal tuşe öncesi ve sonrası idrarın incelenmesine dayanır. Biz bu çalışmamızda PSA değeri 2,5-10 ng/ml arasında olan ve prostat iğne biyopsisi uygulanmış hastalarda prostatit insidansını ve infalamasyonu öngörmesi açısından iki kadeh testinin etkinliğini ortaya çıkarmayı amaçladık. Materyal ve Yöntem: Kliniğimize başvuran yaşları 50 ile 78, PSA değerleri 2.5-10 ng/ml arasında olan 52 erkek hasta çalışmaya alındı. Tüm hastalara EPS –iki kadeh testi incelemesi ve prostat biyopsisi uygulandı. EPS; prostat masajı sonrası üretraya gelen sıvının alınması ile elde edilen örneği; VB-3; masajdan sonra işenen yaklaşık 10 ml’lik idrarın alınması İle Sağlanan İdrarı Gösterir. EPS Ve VB3 Prostat İnfeksiyonunu Saptar. Mikroskop Altında ≥10 lökosit prostat inflamasyonu için anlamlı kabül edildi. Hastalar çıkan patoloji sonucuna göre Prostat kanseri, BPH ve Kronik prostatit şeklinde 3 gruba ayrıldı. Kronik prostatitli grup Nickel’in tanımladığı histopatolojik kalsifikasyonuna göre sınıflandırıldı. Bulgular: Bu çalışmada kronik prostatit prevelansı %38 olarak bulundu. VB3 pozitifliği diğer gruplara göre kronik prostatit grubunda istatistiksel olarak anlamlı bulundu ( p = 0,028). İnflamasyon yaygınlığı ile PSA yüksekliği arasında istatistiksel olarak anlamlılık saptanmasa da PSA multifokal inflamasyonlu alt grupta fokal inflamasyonlu hasta grubuna göre daha yüksek bulunmuştur. Sonuç: Kronik prostatit ile PSA yüksekliği arasındaki ilişki halen gizemini korumaktadır. Bu çalışmada inflamasyon ile PSA yüksekliği arasında istatistiksel bir ilişki saptanmasa da kronik prostatit ile VB3 pozitifliği arasındaki anlamlı korelasyon bu ilişkinin olabileceği hususunu güçlendirmektedir. Bizim sonuçlarımızın gereksiz biyopsiden kaçınmak için yapılacak daha ileri çalışmalar için temel verileri oluşturacağına inanıyoruz.

Keywords

• PSA yüksekliği
• Prostat kanseri
• Kronik prostatit
• İki kadeh testi

Investıgatıon of the Relatıonshıp of Two-Glass Test Wıth Prostate Bıopsy and the Presence and Grade of Asymptomatıc Prostate Inflammatıon In Men Wıth Serum Prostate-Specıfıc Antıgen Level Between 2.5-10 Ng/Ml

Abstract

Objective: Prostate-specific antigen (PSA) is a marker used to detect prostate cancer. When high PSA values are detected, a prostate biopsy is performed considering the possibility of prostate cancer. PSA elevation is not specific to prostate cancer, but may also be caused by conditions such as benign prostatic hyperplasia (BPH), urinary tract infection, and chronic prostatitis. Prostate cancer is not detected in approximately 66% of patients undergoing a biopsy, and patients are exposed to unnecessary biopsy and biopsy complications. Chronic prostatitis is detected in approximately 40% of these biopsies. The two-glass test is based on examining urine before and after rectal examination, which is used in diagnosing chronic prostatitis. In this study, we aimed to reveal the two-glass test’s effectiveness in predicting the incidence of prostatitis and inflammation in patients with a PSA value of 2.5-10 ng/ml and who underwent prostate needle biopsy. Methods: Fifty-two male patients, aged between 50 and 78 years, with PSA values between 2.5 and 10 ng/ml, who applied to our clinic were included in the study. EPS-two-glass test and prostate biopsy were applied to all patients. EPS; is a sample obtained by removing the fluid from the urethra after a prostate massage; VB-3; shows the urine produced by taking about 10 ml of urine voided after massage. EPS and VB3 detect prostate infection. Under the microscope, ≥10 leukocytes were considered significant for prostate inflammation. According to the pathology results, the patients were divided into 3 groups; prostate cancer, BPH, and chronic prostatitis. The chronic prostatitis group was classified according to the histopathological calcification described by Nickel. Results: In this study, the ratio of chronic prostatitis was found to be 38%. VB3 positivity was found to be statistically significant in the chronic prostatitis group compared to the other groups (p = 0.028). Although there was no statistically significant difference between the prevalence of inflammation and PSA elevation, PSA was found to be higher in the multifocal inflammation subgroup than in the focal inflammation patient group. Conclusion: The relationship between chronic prostatitis and PSA elevation remains a mystery. Although no statistical relationship was found between inflammation and PSA elevation in this study, the significant correlation between chronic prostatitis and VB3 positivity reinforces the possibility of this relationship. We believe that our results will form the basis for further studies to avoid unnecessary biopsies.

Keywords

• PSA elevation
• Prostate cancer
• Chronic prostatitis
• Two glass test

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