Application of serum PSA to identify acute bacterial prostatitis in patients with fever of unknown origin or symptoms of acute pyelonephritis.

BACKGROUND: Exclusion of prostatitis in screening for prostate cancer (Cap) is a matter of concern in the prostate-specific antigen (PSA) era. Yet, the identification of acute bacterial prostatitis (ABP), intentionally utilizing PSA in patients with pyrexia has been scarcely reported.
METHODS: In total, 39 men, who presented at our department with a fever higher than 38.3 degrees C, were randomly selected. We investigated the fraction of patients who had serum PSA levels higher than 4.0 ng/ml and categorized them according to an initial diagnosis of pyelonephritis, ABP, other urogenital infections, and fever of unknown origin (FUO).
RESULTS: Six of nine cases initially diagnosed as pyelonephritis, presented with elevated PSA levels between 9.5 and 75.1 ng/ml. All six cases of clinically diagnosed prostatitis had PSA elevated between 4.1 and 13.6 ng/ml. In 8 of 18 FUO cases, PSA was elevated between 5.1 and 77.0 ng/ml. PSA levels significantly correlated with age (P < 0.005). All 20 patients with elevated PSA received antibiotics, and serum PSA was significantly reduced in all cases (P < 0.001) together with the alleviation of fever and normalization of CRP.
CONCLUSIONS: PSA is a prompt and steady diagnostic tool for identifying ABP that might be missed or misdiagnosed. We recommend the measurement of PSA in cases not only with urologic infection but also puzzling pyrexia.