THE EFFECT OF INTRAVESICAL BCG THERAPY ON SERUM PSA LEVEL.

Prostate cancer is the most common male malignancy. Today, patients are screened with PSA and DRE, and in the presence of high PSA level (>4 ng/ml) or abnormal DRE finding, TRUS guided biopsy of prostate is performed for definitive diagnosis. Since multiple factors cause serum PSA to rise such as prostate massage, biopsy, inflammation we evaluated the effect of intravesical BCG therapy on serum PSA level.

Material & Methods: 66 patients with a history of superficial bladder tumor who had primary normal PSA level (<4 ng/ml) and normal DRE findings entered the study and underwent TURBT. Two weeks after the surgery intravesical BCG therapy was conducted weekly for 6 weeks, PSA level was checked before each session and after 3 months of the last one. Any rise in PSA level 2 folds of the baseline or PSA level more than 4 ng/ml was considered significant and the patients followed by TRUS guided biopsy of prostate

Results: 15 patients (22%) had significant rise in serum PSA level with mean of 2.3 ng/ml (range 0.1-10.3 ng/ml). In 10 patients (15.1%) PSA increased to more than 4 ng/ml but returned to basal level within 3 months. In the remaining 5 patients, doubled PSA level did not return to normal level after 3 months but finally decreased in 2 of them. Mean time of PSA level rise was 1.8 weeks (range 1-3 weeks). DRE findings were normal in 7 of 10 patients with PSA more than 4 ng/ml and all of 5 patients with doubled PSA. One patient had right lobe nodule and two had enlarged prostate gland. Six of the patients underwent TRUS guided biopsy, while the results were granulomatous prostatitis in 2 and normal prostatic tissue in the rest.

Conclusion: Intravesical BCG therapy increases serum PSA level transiently which usually normalizes within 3 months. For PSA rising to last longer, TRUS guided biopsy looks wise.