Characteristics of prostatc infarcts and their effect on serum prostate-specific antigen and prostatc acid phosphatase

Brawn, Peter N.; Johnson, Ernest H.; Foster, Donald M.; Coffield, K. Scott; Jay, Dennis W.; Lind, Mary L.; Kuhl, Daniel; Karl, Richard C.; Weaver, Brandi

doi:10.1016/s0090-4295(94)80012-x

Cited by 20 publications

(8 citation statements)

References 15 publications

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“…Immunohistochemical expression of PSA is useful for distinguishing high‐grade prostate cancer from urothelial carcinoma, colonic carcinoma, granulomatous prostatitis, and lymphoma 29,30 . PSA also facilitates identification of the site of tumor origin in metastatic adenocarcinoma.…”

Section: Handling Specimens and Reporting Findings Of Needle Biopsymentioning

confidence: 99%

Evaluating prostate needle biopsy: therapeutic and prognostic importance

Bostwick

1997

CA: A Cancer Journal for Clinicians

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Section: Handling Specimens and Reporting Findings Of Needle Biopsymentioning

confidence: 99%

Evaluating prostate needle biopsy: therapeutic and prognostic importance

Bostwick

1997

CA: A Cancer Journal for Clinicians

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“…That urethral catheterisation contributed to the elevation of serum markers in our patient might be suspected but the effect of routine atraumatic urethral catheterisation on PSA levels is usually considered to be minimal [2]. Prostatic infarcts have been described after cardiovascular surgery and are associated with elevated serum levels of PSA and PAP [2,3,4]. Only recently our group has shown that prolonged cardiopulmonary resuscitation with occurrence of profound tissue hypoperfusion is frequently associated with a significant increase of PSA, AP and PAP levels [5].…”

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confidence: 72%

Elevation of prostatic markers following cardiogenic shock

et al. 2001

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Sir: Prostate-specific antigen (PSA), acid phosphatase (AP) and prostatic acid phosphatase (PAP) are markers for adenocarcinoma of the prostate gland. Furthermore, elevated serum levels will be observed with non-malignant conditions such as prostatitis, prostatic hyperplasia and infarction [1]. Elevation in cardiogenic shock has not been described yet. We report a patient with highly elevated values of PSA, AP and PAP after cardiogenic shock due to acute myocardial infarction.A 74-year-old man with a long-standing history of type II diabetes was admitted to the emergency department with acute chest pain. On admission the patient presented in cardiogenic shock with acute inferior wall infarction and a third-degree heart block with a slow ventricular escape rhythm. Intravenous thrombolysis was initiated. The patient was intubated and an intra-aortic balloon pump (IABP) was inserted. Urethral catheterisation was performed. Coronary angiography revealed severe threevessel disease and coronary artery bypass surgery was scheduled after stabilisation. During continuous epinephrine infusion (0.37 mg/kg/min) cardiac index was 2.5±2.7 l/min/m 2 . Over the following days epinephrine was reduced to 0.06 mg/kg/min and the patient was weaned from IABP on day 6.Initially, severe metabolic acidosis (lactate 16.5 mmol/l) and hyperglycaemia (22.4 mmol/l) were present, which normalised within 24 h. Routine assessment of PSA, AP and PAP revealed markedly pathological values on day 3 (Table 1) and urological advice strongly recommended prostate biopsy. However, the values declined again over the following days to near normal levels on day 10 and biopsy was deferred. Twelve days after admission re-infarction with asystole occurred and the patient died despite cardiopulmonary resuscitation. Owing to the patient's Mosaic confession autopsy was not performed.This patient had no history of adenocarcinoma or any other non-malignant disease of the prostate gland. Furthermore, the spontaneous return of pathological serum values to near normal rendered a chronic or neoplastic process unlikely. That urethral catheterisation contributed to the elevation of serum markers in our patient might be suspected but the effect of routine atraumatic urethral catheterisation on PSA levels is usually considered to be minimal [2]. Prostatic infarcts have been described after cardiovascular surgery and are associated with elevated serum levels of PSA and PAP [2, 3, 4]. Only recently our group has shown that prolonged cardiopulmonary resuscitation with occurrence of profound tissue hypoperfusion is frequently associated with a significant increase of PSA, AP and PAP levels [5]. Accordingly, it seems reasonable to believe that cardiogenic shock might have resulted in ischaemic lesions of the prostate producing transient high elevations of PSA, AP and PAP serum levels.This case documents for the first time that increased serum levels of PSA, AP and PAP might also occur in the setting of cardiogenic shock. It may be presumed that diminished perfusion of the pros...

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“…Prostatic infarcts have been shown to elevate serum prostatic acid phosphatase levels by enzymatic and immunoradiometric assay [13][14][15][16]. Recently, Brawn et al [4] demonstrated that prostatic infarcts elevate PSA levels more frequently than prostatic acid phosphatase (PAP) levels and that prostatic infarcts may be responsible for unexplained elevations of serum PSA seen in some patients [4]. It seems reasonable to believe that patients undergoing surgical procedures that involve temporary aortic cross clamping would be most at risk of prostatic ischemia and infarction which would manifest itself clinically with a rise in PSA.…”

Section: Discussionmentioning

confidence: 99%

“…Elevated serum PSA levels are seen in inflammatory and neoplastic diseases of the prostate [3]. Elevated serum levels have also been shown to occur in association with prostatic infarction [4]. The reference range for PSA is generally accepted to be 0-4 ng/ml and serum levels have only a small diurnal variation [5].…”

Section: Introductionmentioning

confidence: 99%