B.C.G بررسي ارزشهاي تشخيصي آنتي ژن اختصاصي پروستات در مردان مبتلا به كانسر سطحي مثانه يا درمان داخل مثانه اي

Evaluation of Serum Prostatic Antigen in Patients With Superficial Bladder Cancer after Interavesiceal Bacollus Callmete Guerin (BCG)Treatment

We determined whether intravesical bacillus callmete Guerin (BCG) is associated with variated level of prostate - specific- Antigen (P.S.A.). We treated 60 men with superficial bladder cancer that candidated intravesical immunotherapy with B.C.G. Clinical examination (DRE), blood samples for PSA and transrectal ultrasonography were obtained before and one, two and three months after BCG instillation. PSA level greater than four ng/cc was considered clinically significant. Each patient with PSA>4 or nodule in clinical examination or lesion in ultrasonography were candidated for biospy. We observed elevated PSAin 19 men (30%) after B.C.G. therapy, of which 17 men (28.3%) had 2-fold elevated level. Overall average PSA increased 1.7 ng/cc (1.17 SD) before BCG instillation to 3.63ng/cc (2.76SD) one month after treatment and then decreased 2.09 ng/cc (0.89SD) three months after treatment (P<0.05). Histological examination of prostate in 13 patients has done (patient with PSA>4ng/cc or nodule) and results consiste of: 6(54%) Granolomatous prostatitis, 3(27.3%) BPH and 2 (18.2%) normal. Hypoecho lesion is the most common finding in sonography ofGranolumatous prostatitis. There are significant relationships between ultrasonographic finding, PSA level and result of biopsy (P<0.05). Our findings indicate that intravesiacal B.C.G. therapy was associated with clinically significant increase in serum PSA in 30% of men. This effect is self - limited and PSA returns to normal level within 3 months after instillation. Most common lesion of prostate after B.C.G. theraphy is Granolomatous prostatitis. If the patient is candidated for biopsy we recommend delaying biopsy at least for 3 months while monitoring PSA.