PRELIMINARY DATA ON PSA CHANGES DURING INTRAVESICAL THERAPY FOR NON-MUSCLE INVASIVE BLADDER CANCER

Introduction/Aim: Many factors can cause an increase of PSA independently from the presence of prostate cancer . The objective was to evaluate the fluctuation of the serum levels of PSA during adjuvant intravesical chemotherapy or immunotherapy. An increase of PSA due to intravesical BCG and up to 3 months later has been reported (1). Patients and Methods: Patients treated with intravesical chemotherapy or immunotherapy for non- muscle invasive bladder cancer (NMIBC) were entered in the study. Serum samples were collected before starting intravesical therapy, during therapy (within 3rd and 6th instillation) and 30 days after the end of the 6-week induction regimen and during maintenance regimen when given. Patients with urinary tract infections, history of chronic prostatitis, elevated PSA before starting intravesical therapy, palpable prostate nodule or prostate cancer were not included. Results: Forty-five patients were studied, 34 receiving chemotherapy and 11 BCG. Thirty-three patients completed the induction regimen and in 12 more patients the research is ongoing. Out of the 33 evaluable patients, 23 received chemotherapy (mitomycin or epirubicin), while 10 immunotherapy (BCG Connaught). The pre-induction PSA mean level was 2.9 ng/ml.We observed a median PSA increase of 33,5% (p<0.0001) during therapy, in 18 (54.5%) patients. Twelve patients (36.3%) showed a median PSA decrease of 31.4% (p=0.3638). In two patients only (6%) PSA remained unchanged.We also observed a median increase of serum PSA levels of 87.4% at one month after the end of induction regimen. No significant difference between serum PSA level fluctuations induced by chemotherapy or BCG was detected: median increases during therapy and 30 days after the end were 91.7% and 149, 7% and 91.7% and 133% respectively (p<0.001). Discussion and Conclusion: Our preliminary study shows a clinically relevant increase of serum PSA levels in men undergoing both adjuvant intravesical BCG or chemotherapy. We confirm the results of the few studies reporting the increase of PSA during intravesical therapy with BCG or chemotherapy (2). The above mentioned variations should be considered when selecting patients undergoing prostate biopsy.