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

Introduction/Aim: Many factors can cause an increase of PSAindependently from the presence of prostate cancer . Theobjective was to evaluate the fluctuation of the serum levels ofPSA during adjuvant intravesical chemotherapy orimmunotherapy. An increase of PSA due to intravesical BCGand up to 3 months later has been reported (1). Patients andMethods: Patients treated with intravesical chemotherapy orimmunotherapy for non- muscle invasive bladder cancer (NMIBC)were entered in the study. Serum samples were collectedbefore starting intravesical therapy, during therapy (within 3rdand 6th instillation) and 30 days after the end of the 6-weekinduction regimen and during maintenance regimen whengiven. Patients with urinary tract infections, history of chronicprostatitis, elevated PSA before starting intravesical therapy,palpable prostate nodule or prostate cancer were not included.Results: Forty-five patients were studied, 34 receivingchemotherapy and 11 BCG. Thirty-three patients completed theinduction regimen and in 12 more patients the research isongoing. Out of the 33 evaluable patients, 23 receivedchemotherapy (mitomycin or epirubicin), while 10immunotherapy (BCG Connaught). The pre-induction PSAmean level was 2.9 ng/ml.We observed a median PSA increaseof 33,5% (p<0.0001) during therapy, in 18 (54.5%) patients. Twelve patients (36.3%) showed a median PSA decrease of31.4% (p=0.3638). In two patients only (6%) PSA remainedunchanged.We also observed a median increase of serum PSAlevels of 87.4% at one month after the end of inductionregimen. No significant difference between serum PSA levelfluctuations induced by chemotherapy or BCG was detected:median increases during therapy and 30 days after the end were91.7% and 149, 7% and 91.7% and 133% respectively(p<0.001). Discussion and Conclusion: Our preliminary studyshows a clinically relevant increase of serum PSA levels in menundergoing both adjuvant intravesical BCG or chemotherapy.We confirm the results of the few studies reporting the increaseof PSA during intravesical therapy with BCG or chemotherapy(2). The above mentioned variations should be consideredwhen selecting patients undergoing prostate biopsy.