Effects of ejaculation on serum prostate-specific antigen levels

Abstract

Objective: The aim of this study is to evaluate the effect of ejaculation on serum total, free and complex prostate-specific antigen (PSA) levels and their effect on biopsy decisions. Material and methods:Our study includes 47 men older than 45 years with symptomatic benign prostatic hyperplasia (BPH). Patients' PSA levels were under 2.5 ng/mL, and there were no known conditions to preclude ejaculation. Eight patients with similar demographic, and clinical characteristics were chosen as a control group. With three days of sexual abstinence, blood samples were drawn for the measurement of baseline PSA levels, and then the patients were told to ejaculate. One, 5, 24 and 72 hours after ejaculation, serum total, free and complexed PSA levels were measured. Serum PSA sampling was performed at the same intervals in the control group without ejaculation. Results:The mean age of the patients was 59.13±1.38 years in the study group, and 63.75±3.13 years in the control group. The mean international prostate symptom scores (IPSS) were 11.78±1.12 and 11.63±3.32 in the study, and the control groups, respectively. The mean baseline total, free, and complexed PSA values were 1.07±0.09, 0.31±0.03, and 0.71±0.08 ng/mL, respectively. In the study group, total PSA value was found to be 1.29±0.12 ng/mL (p=0.008) at first hour after ejaculation, and this change was statistically significant when compared with baseline values. Mean total PSA level rose up to 1.28±0.13 ng/mL (p= 0.05) by the 5 th hour after ejaculation, but this change was not statistically significant relative to the baseline values. Mean free PSA level rose after the first hour postejaculation to 0.37±0.04 ng/mL (p= 0.01) and after the fifth hour postejaculation to 0.37±0.04 ng/mL (p= 0.002), and these changes were statistically significant relative to the baseline values. There were no statistically significant changes at the other sampled times as for the total, free or complexed PSA serum levels. When all three values were considered individually, in only 2.12% of the patients, biopsy decisions could be affected by the elevation in PSA levels. Conclusion:When the PSA value is borderline with respect to biopsy decisions, the effect of ejaculation on serum PSA levels may be clinically important. In these patients, ejaculation must be questioned, and repeated. PSA levels should be evaluated 24 hours after ejaculation. There were no statistically significant changes in the levels of complex PSA values. Further studies are needed to clarify the relationship between complexed PSA and ejaculation.

Ejaculation Effect on Canine Prostatic Specific Esterase Serum Concentration

“…A basement membrane and a cellular layer separate these cells from lymphatic vessels and capillaries. Then, PSA and CPSE are transported through ejaculatory ducts to the urethra to reach and constitute seminal plasma [6,20]. It can be hypothesized that, as reported in human medicine regarding PSA [20], during its transportation, CPSE can enter into the systemic circulation and its increase might be due to a CPSE wash-back into the bloodstream.…”

“…Also in human medicine, ejaculation has been claimed to be one of the factors affecting PSA values, and its effect has been evaluated in several studies, reporting at first conflicting results with increased, unchanged, or decreased PSA concentrations after ejaculation [20][21][22][23][24][25][26][27][28][29][30][31][32][33]. Nevertheless, in works reporting decreased or unchanged PSA concentrations, sampling time intervals after ejaculation were too long (1 to 7 days after ejaculation) to detect early PSA elevations, which are instead observed during the very first hours [21].…”

“…Nevertheless, in works reporting decreased or unchanged PSA concentrations, sampling time intervals after ejaculation were too long (1 to 7 days after ejaculation) to detect early PSA elevations, which are instead observed during the very first hours [21]. Recently, it was definitively stated that the serum concentration of PSA increases at 1 h after ejaculation and returns to baseline values at 24 h [20,21,29] in 92% of patients [27]. The present study demonstrated that 24 h after ejaculation, increased serum CPSE came back to basal values in 90% of tested animals, following a trend similar to that reported for PSA in human medicine [20,21,27,29].…”

“…Recently, it was definitively stated that the serum concentration of PSA increases at 1 h after ejaculation and returns to baseline values at 24 h [20,21,29] in 92% of patients [27]. The present study demonstrated that 24 h after ejaculation, increased serum CPSE came back to basal values in 90% of tested animals, following a trend similar to that reported for PSA in human medicine [20,21,27,29]. The relationship between basal and post-ejaculation CPSE is the same in negative dogs (group A), and in positive animals, i.e., those either suspected to have or diagnosed with glandular BPH-related diseases (group B); no statistically significant differences were found in CPSE mean concentrations for both groups between T0 and T2.…”

“…In fact, serum biomarker concentrations are dependent on the production of the biomarker itself, and its passage into the bloodstream [6,20]. Normal prostatic epithelium is constituted of PSA-(in men) and CPSE (in dogs)-secreting acinar tissue.…”