Elevation of Prostate-Specific Markers After Cardiopulmonary Resuscitation

Abstract

BACKGROUND-Prostate-specific antigen (PSA), acid phosphatase (AP), and prostatic acid phosphatase (PAP) are serum markers for adenocarcinoma of the prostate gland. Previous studies indicated that prostatic ischemia may also produce elevations of PSA. Cardiopulmonary resuscitation (CPR) is frequently associated with profound tissue hypoperfusion. The present study investigated whether PSA, AP, and PAP are influenced by prolonged CPR. METHODS AND RESULTS-PSA, AP, and PAP were assessed immediately, 12 hours, 24 hours, 2 days, 3 days, 5 days, and 7 days after prolonged CPR (>5 minutes) in 14 male and 5 female patients. No changes were noted in women. In men, serum levels increased significantly after CPR and gradually decreased to near baseline values after 7 days. PSA, AP, and PAP values above the normal range were observed in 63%, 71%, and 64% of all patients, respectively. Compared with survivors, nonsurvivors exhibited higher peak serum levels of PSA (98.6+/-14.3 versus 1.1+/-2.2 mcg/L; P<0.03), AP (57.0+/-71 versus 8.6+/-8.8 U/L; P<0.05), and PAP (47.0+/-62 versus 5.7+/-8.0 U/L; P=NS). Patients with poor neurological outcome exhibited higher peak serum levels of PSA (86.4+/-135.5 versus 12.0+/-23.8 mcg/L; P<0.05), AP (50.9+/-68.1 versus 8.7+/-9.6 U/L; P=NS), and PAP (41.6+/-59.5 versus 5.8+/-8.8 U/L; P=NS) than patients with good neurological outcome. CONCLUSIONS-Prolonged CPR is frequently associated with increases of PSA, AP, and PAP serum levels. Therefore, PSA cannot be used for diagnosis of adenocarcinoma of the prostate during the first weeks after CPR. Further evaluation of these parameters as additional prognostic markers after CPR is warranted.

Does Ischemia-Induced Prostate Damage during Cardiac Surgery Involving Cardiopulmonary Bypass Cause Bladder Outlet Obstruction?

“…This problem has also been linked with the pelvic ischemia that is presumed to occur after cross-clamping of the aorta for coronary or aortic surgery, as well as with hypotensive myocardial infarction, and with septic shock [11] . Koller-Stramez et al [12] showed that cardiopulmonary resuscitation is frequently associated with profound tissue hypoperfusion and leads to elevated serum PSA, an accepted marker of ischemia-induced prostate damage. This mechanism has been supported by several studies that have documented elevated serum PSA levels after cardiac surgery involving CPB.…”

Prostate-specific antigen kallikrein and acute myocardial infarction: Where we are. Where are we going?

“…The gene coding for PSA was designated hKLK3 [5]. Such nonmalignant diseases as benign prostatic hyperplasia, acute or chronic prostatitis, prostatic trauma, acute urinary retention, and prostatic infarction, however, are also known to be associated with increased PSA serum levels [6][7][8][9][10]. The discovery that PSA was present also in female periurethral glands ended the notion that PSA was absolutely specific to prostate, semen, and gender [11][12][13].…”

“…Increased PSA serum levels, are a common finding in patients with nonprostatic illnesses [14,15] including AMI [16][17][18][19][20][21]. Prolonged cardiopulmonary resuscitation(CPR) is frequently associated with increases of PSA [10,22] interpreted as marker for ischemic prostatic cell damage during CPR [10]. Cardiac surgery and extracorporeal cardiopulmonary bypass are also frequently associated with increases of PSA [8] and although several factors may contribute to elevated PSA levels in this postoperative setting, evidence strongly suggests intraoperative prostatic ischemia [10].…”

Prostate-specific antigen kallikrein and non-ST elevation myocardial infarction

“…Increasing evidence suggests that PSA relates to the cardiovascular system [3]. Of note, increased PSA serum levels have been reported after prolonged cardiopulmonary resuscitation [4,5], cardiac surgery [6], extracorporeal cardiopulmonary bypass [7,8], cardiogenic shock due to acute myocardial infarction (AMI) [9], AMI [10][11][12][13][14][15][16][17][18][19] and coronary artery stenting [20]. However, also decreased PSA serum levels have been reported during AMI [2,21,22] and this latter finding has opened a new possible intriguing scenario [1,16,18,21,23].…”