Objective: To evaluate the effect of hemo dialysis on serum
total, free and percent free prostate specific antigen (PSA).
Patients and Methods: This study included 34 men with chronic renal failure
(mean age 58 years, range 45-80) who received hemodialysis with low flux
membranes. We measured pre- and post-hemodialy sis total PSA (tPSA), free PSA
(fPSA) and hematocrit (Hte) at one dialysis session. Additionally, the percent
fPSA to tPSA (fit PSA) ratio was calculated before and after dialysis. Htc was
measured before and after dialysis to determine the degree of hemoconcentration
and the correlation between PSA levels and Htc.
Results: There were statistically significant increments in the mean values of
tPSA (pre-dialysis 1.2, post-dialysis 1.4 ng/ml) and f/tPSA ratio (pre-dialysis
28.2%, post dialysis 35.2%). In addition, a significant increase in Htc was
noted after dialysis. The mean pre-dialysis fPSA was 0.4 and the post-dialysis
value was 0.43 ng/ml (difference not statistically significant). The degree of
hemoconcentration was not statistically correlated with the elevation in the
values of tPSA, fPSA and f/tPSA
Conclusions: Although the increment in tPSA was statistically significant, it
was not clinically meaningful. The most likely explanation for the increment in
tPSA and fPSA after hemodialysis is volume con traction, and hemodialysis with
low flux membranes appears to have no effect on PSA clearance. Pre-dialysis
determina tion of tPSA probably provides no false positive results.
Therefore, we advocate that serum PSA determination is done in conjunction with
digital rectal examination (ORE) and/or transrectal ultrasonography (TRUS) in
patients on dialysis, especially those who are candidates for renal trans plantation,
to rule out prostate cance
Objective: To evaluate the effect of hemodialysis
on serum total, free and percent free prostate specific antigen (PSA).
Patients and Methods: This study included 34 men with chronic renal failure
(mean age 58 years, range 45-80) who received hemodialysis with low flux
membranes. We measured pre- and post-hemodialy sis total PSA (tPSA), free PSA
(fPSA) and hematocrit (Hte) at one dialysis session. Additionally, the percent
fPSA to tPSA (fit PSA) ratio was calculated before and after dialysis. Htc was
measured before and after dialysis to determine the degree of hemoconcentration
and the correlation between PSA levels and Htc.
Results: There were statistically significant increments in the mean values of
tPSA (pre-dialysis 1.2, post-dialysis 1.4 ng/ml) and f/tPSA ratio (pre-dialysis
28.2%, post dialysis 35.2%). In addition, a significant increase in Htc was
noted after dialysis. The mean pre-dialysis fPSA was 0.4 and the post-dialysis
value was 0.43 ng/ml (difference not statistically significant). The degree of
hemoconcentration was not statistically correlated with the elevation in the
values of tPSA, fPSA and f/tPSA.
Conclusions: Although the increment in tPSA was statistically significant, it
was not clinically meaningful. The most likely explanation for the increment in
tPSA and fPSA after hemodialysis is volume con traction, and hemodialysis with
low flux membranes appears to have no effect on PSA clearance. Pre-dialysis
determination of tPSA probably provides no false positive results. Therefore,
we advocate that serum PSA determination is done in conjunction with digital
rectal examination (ORE) and/or transrectal ultrasonography (TRUS) in patients
on dialysis, especially those who are candidates for renal Trans plantation, to
rule out prostate cancer.