Medical & Surgical Urology
Open Access

Benign Prostatic Hyperplasia in 69 Years Old Man with Highest Serum PSA Level >3500 ng/mL

Fouad Kolawalé Yde Soumanou^1*, Josué Dédjinin Georges Avakoudjo², Dètondji Fred Hodonou³ and Khadidjatou Ouake^{4 *}Correspondence: Fouad Kolawalé Yde Soumanou, Department Head of Urology, University Hospital of CNHU-HKM, Cotonou, Benin, Tel: 00229 96880788, Email:

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Introduction

Older men usually have a shorter life expectancy, a higher risk of competing causes of mortality, and a greater risk of potential harm from screening for prostate cancer (PCa) [1]. It is evident that there is an increasing proportion of individuals aged 70 years and older, as well as an increasing life expectancy worldwide [2]. Although use of the Prostate Specific Antigen (PSA) as a diagnostic marker has improved the detection of PCa, its low sensitivity and specificity for PCa makes early finding of PCa difficult. PSA level is frequently increase in Benign Prostatic Hyperplasia (BPH) [3].

We described a case report of elevated serum PSA in 69 years old man with BPH.

Clinical Case

A 69-years-old man was admitted for difficult voiding, marcroscopic haematuria and irritative voiding symptoms. The symptoms were started since 5 years. International Score of Prostatic Symptom (IPSS) was 25 (severe symptom). Medical prescription was alpha-blocker. He had hypertension and diabetes in past history. His father died of prostate cancer. General state was satisfactory. Digital rectal examination found soft, smooth, enlarged and painless prostate. Serum PSA test was done in three various hospital and level was >3500 ng/mL. Sonogram found prostate of 152 g of weight, middle lobe enlargement and bladder decompensation.

Computed tomography chest-abdominal-pelvic revealed: integrity of prostate capsule and bladder decompensation; neither iguinaliliac lymph nodes nor bones damage were not found; prostate volume was 140 g. Transrectal ultrasound prostate biopsy done. Anatomopathological screening of prostate biopsy was negative.

Urine culture identified enterocoque bacterium sensible to these antibiotics groups: Aminoglycoside and ß-lactamine.

Prostatectomy was successfull realized. Prostate weight was 120 g. Postoperative aftercare were simple. Anatomopathological screening of prostatectomy piece confirmed benign prostatic hyperplasia. Serum PSA test done two weeks later. The result was 0.48 ng/mL. IPSS was 3.

Discussion

Serum Prostate-Specific Antigen (PSA) is one of the most influential and controversial biomarkers in oncology. Although using PSA for screening and the early detection of prostate cancer (PCa) is hotly debated, using PSA is not as controversial in patients with a known diagnosis of PCa. We would argue that an overreliance on PSA in a patient with a known diagnosis of PCa can lead to suboptimal care through unnecessary and potentially harmful treatments and early discontinuation of potentially helpful treatments [4]. PSA is one of several factors (PSA kinetics, American Joint Committee on Cancer staging, Gleason score, and patient characteristics) used to guide staging and treatment decisions for men with newly diagnosed disease [5]. Despite these valuable contributions of the PSA test after a PCa diagnosis, PSA has significant limitations that often are not discussed [6].

Second-generation PSA tests have better diagnostic accuracy for high-grade disease than earlier tests. Two such tests, the Prostate Health Index (Beckman Coulter) and the 4Kscore (Opko Health), are commercially available though not usually covered by commercial insurers. A third test, IsoPSA (Clevel and Diagnostics), is under development [7].

A PSA Volatility Index (PVI) was used to assess PSA variability over time. A high PVI derived from a highly variable PSA with a flat or negative PSA slope and predicted for BPH. In contrast, a low PVI predicted for PCa and derived from PSAs which trended upward with little variation around the regression. PVI is a useful method to assess for prostate cancer risk in men with highly variable PSAs over >6 months study time [8].

There is, therefore, an urgent need for novel biomarkers that can effectively distinguish PCa from BPH. PSA, and PDW (Platelet Distribution Width) are markedly higher and MPV (Mean Platelet Volume) is significantly reduced in PCa patients than in BPH patients [3]. In addition, PSA, MPV, and PDW in combination significantly enhance the ability to distinguish PCa from BPH. Recent studies confirmed that low levels of MPV are associated with high-grade inflammatory diseases and reverse in the course of anti-inflammatory therapy [9]. Aksoy et al. [10] observed that solid tumors with bone marrow metastasis were more likely to have low MPV levels. On the other hand, high PSA levels are frequently detected in BPH patients [11]. Therefore, identification of new biomarkers to correctly identify PCa patients would help to prevent individuals with BPH from getting unnecessary biopsies and from the side effects of overtreatment [3].

Conclusion

Serum PSA test can misleading. Anatomopathological screening of prostate biopsy was negative. Anatomopathological of prostatectomy piece confirmed BPH. Elevated serum PSA can be associated with BPH.

Conflict of Interest

None

Source of Funding

None

References

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