Clinical Study On The Relationship Between Preoperative Serum PSA Levels In BPH Patients And The Clinical Features Of BOO

Objective:To study the relationship between preoperative serum prostate specific antigen(PSA) levels in benign prostatic hyperplasia(BPH) patients and the clinical features of bladder outlet obstruction(BOO).Methods:Serum PSA and free PSA levels of 159 BPH cases were tested with chemiluminesent microparticle immunoassay(CMIA).All BPH cases were pathologically proved and the possibility of nervous system abnormality,prostate gland cancer,and history of lower urinary tract trauma were ruled out.Based on their serum PSA levels,the patients were divided into two groups:the elevated PSA group(70 cases) and the normal PSA group(89 cases).All 159 patients were examed with transabdominal B-ultrasonography to test for the size of prostate gland, the gland protuberance toward the bladder lumen,residual urine volume, bladder stone,and abnormality of bladder wall.Cystoscopy was performed to measure the distance between seminal colliculus and internal urethral orifice,and to observe the elevation of posterior lip of cervix vesicae,feasibility of seeing bilateral ureteral openings,spatial relationship between seminal colliculus and the prostate apex,bladder trabeculation,and formation of bladder diverticula and stones.The clinical data and the ultrasonic and cystoscopic observation results between two groups were analyzed.Data regarding patient age,prostate volume(PV),distance between seminal colliculus and internal urethral orifice,elevation degree of posterior lip of cervix vesicae,residual urine volume,and abnormality of bladder wall were also compared between the two groups.Statistical analyses were done by using SPSS11.5 software. Measurement data was treated with the t-test and enumeration data was treated with the chi-square test.Some data were also treated with correlation test.P＜0.05 is considered significant.Results:1.In the normal PSA group,89 cases(56%) were those whose serum PSA levels were below 4ng/ml,with an average of(2.87±1.98)ng/ml.The free PSA level was(0.73±0.51)ng/ml.In the normal PSA group,there was a positive correlation between PSA levels and PVs,but the difference was not significant(r=0.21,P＞0.05).Difference between free PSA levels and PVs was not significant either(r=0.23,P＞0.05).In the elevated PSA group,70 cases(44%) were those whose serum PSA levels were over 4ng/ml,with an average of(8.41±7.75)ng/ml,of whom 48 cases(30%) ranged 4-10ng/ml and 22 cases(14%) were higher than 10ng/ml.The average levels of PSA and free PSA were (8.41±7.75)ng/ml and(2.01±1.56)ng/ml,respectively.In the elevated PSA group,the PSA levels were positively correlated with the PVs,and the difference was significant(r=0.52,P＜0.01).Difference between free PSA levels and PVs was also significant(r=0.63,P＜0.01).Compared with PSA,the free PSA was more closely correlated with the PV.2.The age difference between two groups was not significant (P=0.31＞0.05).3.The PV difference between two groups was significant (P=0.048＜0.05).4.Difference in the incidence of prostate protuberance toward the bladder lumen between two groups was not significant(P=0.53＞0.05).5.Difference in the residual urine volumes between two groups was significant(P=0.04＜0.05).6.Difference in the incidence of bladder stones between two groups was not significant(P=0.75＞0.05).7.Difference in the distance between seminal colliculus and internal urethral orifice between two groups was not significant(P=0.15＞0.05). 8.Difference in the elevation degrees of posterior lips of cervix vesicae between two groups was generally not significant(P=0.12＞0.05), but the difference in the infeasibility of seeing bilateral ureteral openings between two groups was significant(P=0.03＜0.05).9.Difference in the spatial relationship between seminal colliculus and the prostate apex between two groups was significant(P=0.01＜0.05).10.Difference in the incidence of bladder trabeculation and bladder diverticula between two groups was not significant(P=0.76＞0.05).11.Differences in the PVs,residual urine volumes,the spatial relationship between seminal colliculus and the prostate apex,and the feasibility of seeing bilateral ureteral openings between two groups were statistically significant(P＜0.05).The spatial relationship between seminal colliculus and the prostate apex was positively correlated to a moderate extent with PV and residual urine volume.The Pearson correlation coefficients were 0.401 and 0.342,and the P values were 0.013 and 0.023, respectively.The infeasibility of seeing bilateral ureteral openings was strongly positively correlated with PV and residual urine volume.The Pearson correlation coefficients were 0.532 and 0.516,and the P values were 0.005 and 0.007,respectively.Conclusion:1.The transabdominal B-ultrasonography for determining the PV and residual urine volume,evaluating the features of bladder and the degree of prostate protuberance toward the bladder lumen can be used as a screening test for BOO diagnosis.2.Cystoscopic examination can exactly determine the degree and region of prostate urethral obstruction,and help to evaluate the state of bladder function.3.Serum PSA levels might be positively correlated with the length of prostate urethral obstruction,but an increase in serum PSA does not indicate the degree of BOO.4.Serum PSA levels are positively correlated with PV,residual urine volume,infeasibility of seeing bilateral ureteral openings,and distance between seminal colliculus and the prostate apex,suggesting that the operation indication may be strengthened with the increase of serum PSA.5.Serum PSA levels are positively correlated with PV and the distance between seminal colliculus and the prostate apex,suggesting that it may be advisable to relieve the apex obstruction during surgical intervention.