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Prostatitis Foundation

Third International Chronic Prostatitis Network

High PSA prostatic inflammation

N.F. Wasserman
Department of Veterans Affairs Medical Center, Minneapolis, MN
To report an unusual form of chronic prostatitis simulating adenocarcinoma because of an extremely high serum prostate specific antigen (PSA) level.
Materials & Methods
From a referral cohort of 3200 urology patients for transrectal ultrasound (TRUS) and biopsy, there were 10 with serum PSA greater than 20 ng/ML. One had an abnormal digital rectal examination, 1 had previous history of urinary tract infection, but none had a history of clinical prostatitis or urinary tract infection. Baseline data included the following mean, range, median values: Age 71.6 (59-77), 74, Total Prostate Volume 82.5 (19.9-199), 72.2, PSA 33.1 (21.9-51.5), 31.9, PSAD 0.61 (0.16-1.61), 0.45, PSA-TZ 1.28 (0.21-4.45), 0.69. TRUS volume measurements were made using the prolate ellipsoid model. Two to three biopsies were taken from suspicious foci plus six to twelve bilateral random cores including transition zone and anterior peripheral zone.
Biopsies were negative for carcinoma and positive for acute and/or chronic inflammation in all patients. One patient later underwent suprapubic prostatectomy pathologically showing prostatic intraepithelial neo-plasia, infarction , and acute and chronic inflammation. Mean, range and median follow-up was 34.7 months (15-65), 31.5. No follow-up PSA is available for 2 patients. PSA increased in 2 patients who have not been referred for repeat biopsy, and decreased by a mean of 21.1 ng/ML in the remaining 6 patients.
Subclinical histologic prostatitis may be the only etiology for some patients with with PSA > 20 ng/ML. Our follow-up in some patients does not allow us to rule out occult cancer. If initial repeat biopsies are negative for malignancy, these patients should be followed to assure stable or falling PSA values to determine the need for subsequent biopsies.

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