Diagnostic value of serum prostate‐specific antigen in hemodialysis patients

Abstract

Background : The value of serum prostate-specific antigen (PSA) screening was examined to detect prostate cancer in men receiving hemodialysis. Methods : Forty-one male patients age 60-95 (median age, 70 years) receiving hemodialysis were investigated for PSA levels. We set the cut-off point at 4 ng/mL (the usual reference range). Digital rectal examination (DRE) and transrectal ultrasonography (TRUS) of the prostate were performed in patients whose PSA was more than 4 ng/mL and/or who expected further examination of the prostate. When prostate cancer was suspected, biopsy of the prostate was performed. In patients with prostate cancer, magnetic resonance imaging, computed tomography and bone scintigraphy were performed to diagnose the clinical stage. Results : The mean serum level of PSA was 2.10 ± 0.49 ng/mL. In this screening study, four of 41 men required further examinations for prostate cancer. Two of four refused further examinations. The other two were diagnosed with prostate cancer. The incidence of prostate cancer was at least 5% in our hemodialysis patients. One man, whose clinical stage was T2aN0M0, was treated with radical retropubic prostatectomy. Another man, whose clinical stage was T2bN0M0, was treated with luteinizing hormone-releasing hormone analogue. Conclusion : In our preliminary study, prostate cancer screening with PSA was useful for the early detection of prostate cancer in hemodialysis patients. If possible, DRE and TRUS should be performed in conjunction with PSA tests.

Effect of renal function and hemodialysis on the serum tumor markers in patients with chronic kidney disease

“…It was reported that the serum levels of AFP, CA 153 and PSA in CKD patients did not differ significantly compared with normal population [2,3,[5][6][7][8][9]. Our results were consistent with their findings.…”

Mass screening for prostate cancer in patients with end‐stage renal disease: a comparative study

“…Screening for prostate cancer is widespread, with a greater prevalence of prostate cancer in the general population, although this type of screening is used rarely in patients with ESRD [1]. Although there is reportedly a greater risk of prostate cancer on PSA screening in patients with ESRD, and levels of PSA and associated markers in patients on dialysis have been reported, most studies were too small to obtain accurate findings [9][10][11][12][13][14]. The present findings suggested that the serum PSA level was higher in the ESRD than in the control group, and among men with PSA levels of > 10 ng/mL the cancer detection rate was higher in the ESRD than in the control group.…”

Screening for prostate cancer using prostate-specific antigen testing in Japanese men on hemodialysis

“…In this series as well, prostate biopsy was recommended for patients with serum PSA of >4.0 ng/ml, and prostate cancer was detected in five of eight patients on hemodialysis undergoing prostate biopsy; that is, the rate of positive prostate biopsy in these patients was 62.5%, which is extremely high despite the lack of significant difference compared to that in men participating in a PSA mass screening test. Some previous studies also presented a high rate of positive prostate biopsy in patients with end-stage renal disease [13,16]. For example, Wada et al reported that prostate biopsy was performed in 26 patients on hemodialysis whose serum PSA of >4.0 ng/ml, and that 13 of these patients (i.e., 50.0%) were diagnosed as having prostate cancer [16].…”

“…Some previous studies also presented a high rate of positive prostate biopsy in patients with end-stage renal disease [13,16]. For example, Wada et al reported that prostate biopsy was performed in 26 patients on hemodialysis whose serum PSA of >4.0 ng/ml, and that 13 of these patients (i.e., 50.0%) were diagnosed as having prostate cancer [16]. Furthermore, in this series, the cancer detection rate in patients on hemodialysis was significantly greater than that in those participating in a PSA mass screening test.…”

“…However, a serum PSA level of 4.0 ng/ml is widely accepted as a cutoff value for PSA screening irrespective of renal function [9,13,16], which may result in a higher detection rate of prostate cancer in men on hemodialysis than in the general population, if there is any excess risk of prostate cancer among the population with end-stage renal disease. In this series as well, prostate biopsy was recommended for patients with serum PSA of >4.0 ng/ml, and prostate cancer was detected in five of eight patients on hemodialysis undergoing prostate biopsy; that is, the rate of positive prostate biopsy in these patients was 62.5%, which is extremely high despite the lack of significant difference compared to that in men participating in a PSA mass screening test.…”