Forum Πρωτοβάθμιας Φροντίδας Υγείας
ΠΦΥ -Εκπαίδευση => Συζητήσεις πάνω σε ιατρικά θέματα => Μήνυμα ξεκίνησε από: Argirios Argiriou στις 18 Οκτωβρίου 2013, 10:47:15
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Επηρεάζεται το S- PSA αν προηγηθεί δακτυλική εξέταση;
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J Urol. 1992 Jul;148(1):83-6.
The effect of digital rectal examination on the serum prostate specific antigen concentration: results of a randomized study.
Chybowski FM, Bergstralh EJ, Oesterling JE.
Source
Department of Urology, Mayo Clinic, Rochester, Minnesota 55095.
Abstract
To determine the effect of digital rectal examination on the serum prostate specific antigen (PSA) concentration a prospective, randomized, controlled trial involving 143 patients was conducted. Of the patients 86 (60%) had benign prostatic hyperplasia (BPH), 47 (33%) had prostate cancer and 10 (7%) had chronic prostatitis. The study group consisted of 71 men, all of whom had a serum PSA determination followed by a digital rectal examination and then a second serum PSA determination. The control cohort consisted of 72 men, all of whom had 2 serum PSA determinations without an intervening digital rectal examination. The median change in the serum PSA level for the study group was 0.4 ng./ml. compared to -0.1 ng./ml. for the control cohort (p less than 0.0001). For 76% of the study patients the second serum PSA level was greater than the initial value; only 32% of the control patients exhibited a higher second serum PSA level than the initial level (p less than 0.0001). However, only 4 patients with an initial PSA value in the reference range (0.0 to 4.0 ng./ml.) had a post-digital rectal examination value greater than 4.0 ng./ml. and only 1 patient whose presenting serum value was less than 10.0 ng./ml. had a serum PSA level greater than this cutoff point after digital rectal examination. This minimal change in serum PSA after digital rectal examination was independent of the diagnosis (BPH, cancer or chronic prostatitis), initial serum PSA concentration and examiner. Thus, although digital rectal examination had a statistically significant effect on the serum PSA concentration, the clinical significance of a 0.4 ng./ml. median increase appears inconsequential. Based on these findings, physicians should be confident that the serum PSA concentration in the immediate post-digital rectal examination period is accurate and does not compromise clinical use of the tumor marker.
http://www.ncbi.nlm.nih.gov/pubmed/1377290
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up2date
DRE may cause minor transient elevations that are clinically insignificant. As an example, one study of 2750 healthy men over the age of 40 undergoing DRE divided patients into four groups based upon their initial serum PSA [ 43 ]. The two groups with the lowest initial serum PSA values (0.1 to 4 and 4.1 to 10 ng/mL) had statistically insignificant changes in the serum PSA after DRE, while PSA increases in the group with an initial serum PSA 10.1 to 20 ng/mL showed a trend toward statistical significance, and those with an initial serum PSA greater than 20 ng/mL had statistically significant increases after DRE. The PSA increase in the two groups with the highest serum values was not clinically relevant, since they did not change ultimate management. Thus, it is reasonable to perform PSA testing without regard to whether a patient has had a recent DRE.
A study of PSA measurements 30 minutes after one minute of prostatic massage found that massage increased total PSA and free PSA levels to a greater extent than complexed PSA levels [ 44 ]. Thus, it is advisable to check PSA levels prior to performing a prostate massage.
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Tarhan F, Orçun A, Küçükercan I, et al. Effect of prostatic massage on serum complexed prostate-specific antigen levels. Urology 2005; 66:1234.
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A study of PSA measurements 30 minutes after one minute of prostatic massage found that massage increased total PSA and free PSA levels to a greater extent than complexed PSA levels [ 44 ]. Thus, it is advisable to check PSA levels prior to performing a prostate massage.
Η ακόμα πιο εύκολα advisable είναι να πεις τον ασθενή να κάνει αύριο (μετά τη μάλαξη) ή έστω μεθαύριο την εξέταση αίματος, όπως γίνεται πάντοτε στην Ελλάδα (γράφεις το παραπεμπτικό και κάνει την επομένη ή πιο μετά τις εξετάσεις). Τελικά στην Ελλάδα είμαστε πολύ μπροστά...
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up2date
DRE may cause minor transient elevations that are clinically insignificant. As an example, one study of 2750 healthy men over the age of 40 undergoing DRE divided patients into four groups based upon their initial serum PSA [ 43 ]. The two groups with the lowest initial serum PSA values (0.1 to 4 and 4.1 to 10 ng/mL) had statistically insignificant changes in the serum PSA after DRE, while PSA increases in the group with an initial serum PSA 10.1 to 20 ng/mL showed a trend toward statistical significance, and those with an initial serum PSA greater than 20 ng/mL had statistically significant increases after DRE. The PSA increase in the two groups with the highest serum values was not clinically relevant, since they did not change ultimate management. Thus, it is reasonable to perform PSA testing without regard to whether a patient has had a recent DRE.
A study of PSA measurements 30 minutes after one minute of prostatic massage found that massage increased total PSA and free PSA levels to a greater extent than complexed PSA levels [ 44 ]. Thus, it is advisable to check PSA levels prior to performing a prostate massage.
44
Tarhan F, Orçun A, Küçükercan I, et al. Effect of prostatic massage on serum complexed prostate-specific antigen levels. Urology 2005; 66:1234.
Άρα, αν πρόκειται για απλή δακτυλική εξέταση (= Digital rectal exam = DRE ), τότε το S-PSA δεν αυξάνεται, κλινικώς, σημαντικά.
Αντίθετα αν πρόκειται για μάλαξη του προστάτη (διάρκειας π.χ. ενός λεπτού), τότε το S-PSA μπορεί να αυξηθεί τόσο που να επηρεάσει την κλινική εκτίμηση.
( Τα ίδια μου είπε και φίλος Ουρολόγος που τον ρώτησα σήμερα).
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Δείτε επίσης και κάτι που φαντάζει άσχετο αλλά δεν είναι εντελώς άσχετο παρόλα αυτά:
Before having a PSA test, men should not have ejaculated during the previous 48 hours.
Semen released during sexual activity can cause PSA levels to rise temporarily, which may affect the test results.
For the same reason, before having a PSA test men should not have:
exercised vigorously in the previous 48 hours
an active urinary infection (UTI) or had a UTI in the past 6 weeks
had a prostate biopsy in the previous 6 weeks
https://www.nhs.uk/common-health-questions/mens-health/why-should-i-avoid-sexual-activity-before-a-psa-test/ (https://www.nhs.uk/common-health-questions/mens-health/why-should-i-avoid-sexual-activity-before-a-psa-test/)
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Δεν είναι καθόλου άσχετο!Το ξέρω από πρώτο χέρι όταν σε μια εξέταση ρουτίνας με παίρνει πανικόβλητη η μικροβιολόγος πως βρήκε psa 6.5 και το free παθολογικό. Ο ουρολόγος όμως με ρώτησε αμέσως αν είχε προηγηθεί επαφή την προηγούμενη ημέρα. Σε 15 ημέρες 0.46!!Εντυπωσιακό!