PSA Testing In Men Who Present With Hematuria

UroToday.com - Hematuria is a non-specific symptom mandating an evaluation of the upper and lower urinary tract. Hematuria by itself is not considered a standard indication for PSA testing. However, in the on-line version of the British Journal of Urology International, Dr. Bromage and associates from the Manchester Royal Infirmary, UK present their retrospective data supporting PSA testing in men who present with hematuria.

Between 2002 and 2005, 637 available cases of men who presented with either microscopic or macroscopic were analyzed. Mean patient age was 57 years, digital rectal examination was documented in 73% and PSA measured in 355 men. The study focused on men aged 50-79 and PSA levels were available in 278 by this definition.

An abnormal PSA level was identified in 50/278 men, and 28 proceeded to prostate biopsy. Prostate cancer was found in 22: 5.9% of all men presenting with hematuria and 71% (20/28) of those age 50-79 who proceeded to biopsy. Clinical stage for the 22 men was T1c in 9, T2 in 4, T3 in 8 and T4 in 1. Three men had metastasis on bone scans.

Analysis of microscopic vs. macroscopic hematuria revealed that 65% of those who had PSA testing had macroscopic and 35% had microscopic hematuria. While the authors' conclusion is to perform prostate biopsy in all men presenting with hematuria, this should be validated in a prospectively designed study as the limitations of the present report are numerous.

Stephen J. Bromage, Richard D. Napier-Hemy, Stephen R. Payne, Ian Pearce, Iain G. McIntyre
BJU Int 2006; Early Online

Reviewed By UroToday.com Contributing Editor Christopher P. Evans, M.D.

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