Elsevier

Urology

Volume 53, Issue 3, March 1999, Pages 473-480
Urology

Rapid Communications
Serum prostate-specific antigen concentration is a powerful predictor of acute urinary retention and need for surgery in men with clinical benign prostatic hyperplasia1

https://doi.org/10.1016/S0090-4295(98)00654-2Get rights and content

Abstract

Objectives. Prostate-specific antigen (PSA) is produced exclusively in the prostate gland and is currently the most useful clinical marker for the detection of prostate cancer. In this report, we examine whether serum PSA is also a predictor of important benign prostatic hyperplasia (BPH)-related outcomes, acute urinary retention (AUR), and the need for BPH-related surgery.

Methods. Three thousand forty men were treated with either placebo or finasteride in a double-blind, randomized study of 4-year duration. Serum PSA was measured at baseline, and baseline prostate volume was measured in a 10% subset of 312 men. Probabilities and cumulative incidences of AUR and BPH-related surgery, as well as reduction in risk of events with finasteride, were calculated for the entire patient population, stratified by treatment assignment, baseline serum PSA, and prostate volume.

Results. The risk of either needing BPH-related surgery or developing AUR ranged from 8.9% to 22.0% during the 4 years in placebo-treated patients stratified by increasing prostate volume and from 7.8% to 19.9% when stratified by increasing serum PSA. In comparison with symptom scores, flow rates, and residual urine volume, receiver operating characteristic curve analyses showed that serum PSA and prostate volume were the most powerful predictors of spontaneous AUR in placebo-treated patients (area under the curve 0.70 and 0.81, respectively). Finasteride treatment reduced the relative risk of needing surgery or developing AUR by 50% to 74% and by 43% to 60% when stratified by increasing prostate volume and serum PSA, respectively.

Conclusions. Serum PSA and prostate volume are powerful predictors of the risk of AUR and the need for BPH-related surgery in men with BPH. Knowledge of baseline serum PSA and/or prostate volume are useful tools to aid physicians and decision makers in predicting the risk of BPH-related outcomes and choosing therapy for BPH.

Section snippets

Subjects

Three thousand forty men with clinical BPH diagnosed on the basis of moderate-to-severe symptoms, a decreased peak urinary flow rate (less than 15 mL/s with a voided volume of 150 mL or more; Urodyn 1000, Dantec, Mahway, NJ), and an enlarged prostate gland by DRE were enrolled in a 4-year study comparing finasteride with placebo. Men receiving alpha-blocking agents or antiandrogens and men with a history of chronic prostatitis, recurrent urinary tract infections, prostate or bladder cancer or

Results

At baseline, men assigned to finasteride and placebo were similar in terms of age, demographics, symptom severity, peak flow rate, prostate volume, and serum PSA (Table I).

Baseline characteristics of the subset with prostate volume measurements were similar to those in the entire study group.

The overall incidence of AUR was 7% with placebo and 4% with finasteride (spontaneous AUR 4% with placebo and 1% with finasteride; precipitated AUR 3% with placebo and 2% with finasteride) and of

Comment

Serum PSA is currently the most widely used marker for prostate cancer detection, and a yearly measurement is recommended in men older than 50 years to aid in the early detection of prostate cancer. The observation that there is a strong log-linear relationship between serum PSA and prostate volume in men with BPH10 has led us to consider that PSA may also predict those men at increased risk of developing AUR or needing BPH-related surgery.

In the longitudinal community-based Olmsted County

Conclusions

Serum PSA strongly correlates with prostate volume in men with BPH, and both parameters predict equally well the risk of AUR and the need for BPH-related surgery. The incidence of both untoward outcomes increases nearly linearly with increasing serum PSA and prostate volume in men treated with placebo—or watched conservatively—and it is reduced by 50% or more in men on finasteride independent of baseline serum PSA and prostate volume. The predictable risk of retention and need for surgery, and

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1

A complete list of the members of the PLESS Study Group is given in the Appendix.

2

Dr. Waldstreicher and Thomas J. Cook are employees of Merck & Co., Inc., the sponsor of the study.

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