Rapidly rising PSA levels could indicate BPH

San Antonio--A rapid increase in PSA level could be indicative of progressive benign prostatic hyperplasia if prostate cancer is ruled out. With the push for testing PSA levels in men at earlier ages, keeping BPH in mind when tracking results over time makes sense.

Researchers at the Mayo Clinic, Rochester, MN, analyzed data obtained from a clinical study of men in Olmstead County, MN. They tracked how PSA, prostate volume, and lower urinary tract symptoms changed over a 12-year period. Annual changes were correlated and dichotomized, as well as examined in age-adjusted logistic regression models predicting high increases in symptoms. The study was presented in a poster session at the AUA annual meeting here.

"We looked at changes in measures of BPH over time, and we looked to see whether those changes were tracking together over time," said lead author Jennifer L. St. Sauver, PhD, assistant professor of epidemiology at the Mayo Clinic College of Medicine, working with Steven J. Jacobsen, MD, and colleagues. "We actually found that overall, the changes have very modest correlations.

The researchers drew their data from a 25% random subsample of 2,115 men randomly selected from the population to complete validated questionnaires in 1990. Men in the subsample underwent clinical evaluation including transrectal ultrasonography, serum PSA levels, and assessment of peak urinary flow rates. Examinations and questionnaires were repeated biennially through 2002.

Correlations between changes in prostate volume, PSA levels, peak flow rates, and changes in urinary symptoms were not dramatic (Spearman correlation coefficients: 0.08 for volume and symptoms, p=.06; 0.06 for PSA and symptoms, p=.20; and -0.08 for peak flow rates and symptoms, p=.05). Significant increases in prostate volume were, however, associated with greater increases in urinary symptoms (OR=2.14, 95% CI=1.31-3.49); higher increases in PSA levels were also associated with high increases in symptoms (OR=2.07, 95% CI=1.28-3.34); and higher decreases in peak flow rates were associated with greater changes in symptoms (OR=1.75, 95% CI=1.08-2.85).

The data are useful for practicing urologists now that men are more often being encouraged to have their PSA levels checked at younger ages and monitored over a longer period of time to determine PSA velocity, Dr. St. Sauver said.

"Based on some of the talks I was hearing [at the meeting], people seem to be advocating testing PSA levels at much earlier ages and over much longer periods of time to look for these rapid increases," Dr. St. Sauver said. "Obviously, the first thing people think of when they see these rapid increases is prostate cancer. However, it seems obvious that once you rule out prostate cancer, it's also possible that the patient may have progressive BPH. [In this case] some of the other tests for BPH could then be done."