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Objective Prostate-specific antigen (PSA) is widely used as a tumor marker in the early detection of prostate cancer. However, its value is limited by several factors such as not being specific for the cancer tissue, diurnal variations of the secretion, and changes in the serum levels observed following rectal manipulations. The effect of digital rectal examination (DRE) on serum PSA levels is still debatable. Methods A prospective study is conducted by utilizing the IRMA count (monoclonal) PSA assay in order to determine the effect of DRE on PSA serum levels. A total of 50 men (median age 61, range 42-75 years) who presented to our outpatient clinic for the first time with lower urinary tract outflow obstruction symptoms were included in this study. Further evaluation revealed prostate cancer in 5 patients (10%) and benign prostate hyperplasia in the others. Blood samples were drawn for a PSA assay from all patients prior to and 30 min and 24 h following DRE (PSA 1-3). Results The mean PSA values prior to and 30 min and 24 h following DRE were 4.09 +/- 0.67 range 0.2-19.47) ng/ml, 4.50 +/- 0.63 (0.15-17.75), and 4.28 +/- 0.68 (0.23-24.12) ng/ml, respectively. The median PSA levels for PSA 1, PSA 2, and PSA 3 were 2.49 +/- 4.74, 3.22 +/- 4.48, and 2.62 +/- 4.82 ng/ml, respectively. Although, there was a statistically significant increase in serum PSA levels 30 min after DRE, the clinical significance of this increase in PSA values with a mean difference of 0.4 ng/ml remains to be clarified. Conclusion Although the effect of DRE on PSA levels does not appear to be clinically significant, in order to prevent any confusion, it may be the best approach to perform DRE after obtaining serum for PSA analysis.

In an attempt to enhance the success of prostate-specific antigen (PSA) in the diagnosis and staging of prostate carcinoma (PCa) the concept of PSA density (PSAD) has been introduced by Benson et al. Likewise a study to investigate the role of PSAD in 53 patients with PCa and 47 patients with benign prostatic hyperplasia (BPH) has been done. PSADs seemed to increase directly proportional to the grade in PCa and differed significantly between patient groups with BPH and localized+metastatic PCa, BPH and localized PCa, and localized PCa and metastatic PCa. Although 0.6 level for PSAD seemed to be a rational cut-off level in our study, this issue needs to be studied in multiple centers involving an increased number of patients for resolution.

Introduction and Objectives: Transrectal ultrasound guided biopsy is an essential part in the diagnosis of prostate cancer. Although this procedure is well tolerated by most patients, sometimes it can result in some uneasiness. In this randomised double-blind placebo controlled study, we evaluated the effectiveness of intrarectal lidocaine during TRUS guided biopsy. Materials and Methods: 100 consecutive eligible patients who had elevated total prostate specific antigen (tPSA) and/or abnormal digital rectal examination (DRE) were included into this study. Patients were randomised into two groups. Group I received 20 cc of 2% intrarectal lidocaine 20 minutes before transrectal ultrasound guided biopsy and Group II received same amount of serum physiologic. Pain was assessed using a 10 point modified visual analog scale. Results: Mean patient age was 65.5±2.5 and 64.5±11.5 years, mean tPSA was 12.3±3.6 and 11.3±1.7 ng/ml, mean biopsy duration was 6.8±2.5 and 6.6±2.2 minutes, mean pain score during transrectal ultrasound guided biopsy was 4.8±2.2 and 4.4±2.1 in Groups I and II, respectively. No statistically significant difference was observed with respect to age, tPSA, mean biopsy duration and pain score between these groups. There was only one patient who could not tolerate the procedure at all, and he was paradoxically in the lidocaine group. Conclusion: The use of intrarectal lidocaine is not superior to placebo during transrectal prostate biopsy for pain control.