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Kobayashi M, Kijima T, Yashi M, Kamai T. Prostate-specific antigen kinetics contributes to decision making for biopsy referral: the predictive implication for PSA retest in patients with elevated PSA levels. Prostate Int 2023; 11:27-33. [PMID: 36910897 PMCID: PMC9995685 DOI: 10.1016/j.prnil.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background It is common to repeat prostate-specific antigen (PSA) measurements for men with PSA elevation before prostate biopsy. In this scenario, they may have considerable psychological distress in fear of the presence of cancer until retests. We assessed possible clinical factors causing transient PSA rise and explored the parameters predictive of subsequent PSA change. Methods As interfering conditions, the history of ejaculation, bicycling, and any types of infections were assessed using the questionnaire. The pattern of PSA change was compared in association with the various clinical factors. Predictive significance of PSA kinetics such as coefficient of variation (CV) and PSA velocity (PSAV) for PSA values at retest was evaluated. Results The rate of reversion to the normal range was 38.3% at retest. The rate of 12.8% of men showed a large increase by ≥20%, whereas 38.2% of men showed a large decline by ≥20% from the baseline. Men with younger age (≤60 years), small prostate (<20 cc), and prior history of ejaculation or infections showed significantly larger PSA decrease than their counterparts. Those with large CV or PSAV before the baseline more frequently showed PSA decrease below the age-specific cutoff or decline by ≥10% from the baseline at retest. These parameters associated with PSA kinetics had independent predictive values for relevant PSA change at retest. Conclusions Ejaculation and any types of infections should be avoided before PSA tests. Men with large PSA fluctuation before the baseline are likely to show a significant PSA decrease at retest. This predictive information may help both physicians to determine whether to proceed to an immediate biopsy and patients to reduce their psychological burden.
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Affiliation(s)
- Minoru Kobayashi
- Department of Urology, Utsunomiya Memorial Hospital, Tochigi, Japan
| | - Toshiki Kijima
- Department of Urology, Dokkyo Medical University, Tochigi, Japan
| | - Masahiro Yashi
- Department of Urology, Dokkyo Medical University, Tochigi, Japan
| | - Takao Kamai
- Department of Urology, Dokkyo Medical University, Tochigi, Japan
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Lunacek A, Tischler M, Mrstik C, Hebenstreit D, Oeser R, Bektic J, Klocker H, Horninger W, Plas E. Effects of cycling and rowing on serum concentrations of prostate-specific antigen: A randomized study of 101 male subjects. Prostate 2022; 82:804-808. [PMID: 35192201 DOI: 10.1002/pros.24322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/07/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the effects if cycling and rowing on serum prostate-specific antigen (PSA) levels. METHODS Male volunteers (n = 101), aged 20-80 (mean, 49.9) years were randomized to exercise at the first or second study visit. They performed 1 h of either cycling or rowing on a stationary machine. To determine exercise-induced effects on the PSA level, serum total PSA (tPSA) and free PSA (fPSA) concentrations were evaluated before and after exercise and another sampling was performed at the second study visit. Pre-exercise and postexercise tPSA and fPSA concentrations were compared using the Wilcoxon matched-pairs test. The results were analyzed using the Mann-Whitney U-test. RESULTS A significant (p < 0.001) average increase in tPSA after exercise (1.14 ± 1.11 ng/ml to 1.24 ± 1.26 ng/ml [mean, +8.8%]) was observed after both cycling and rowing, without significant differences between the sports (p = 0.54). The exercise-induced increase in PSA concentration affected participants aged ≥50 years (difference, 0.16 ± 0.37; p < 0.001), but not those aged <50 years (difference, 0.01 ± 0.06; p = 0.23). The effect size was clinically irrelevant in all except two outliers, in whom a distinct increase of PSA level by averages of 1.80 ng/ml (+55%) for tPSA and 1.25 ng/ml (+227%) for fPSA following cycling was observed. CONCLUSION Rowing and cycling generally do not have a clinically relevant effect on PSA levels. However, outliers exist. Our findings do not support abstaining from exercise during the days approaching PSA sampling.
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Affiliation(s)
| | | | | | | | - Reinhard Oeser
- Department of Urology, Hanusch Krankenhaus, Vienna, Austria
| | - Jasmin Bektic
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Helmut Klocker
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Horninger
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Eugen Plas
- Department of Urology, Hanusch Krankenhaus, Vienna, Austria
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Abstract
Cycle use has grown rapidly over the last few years in the UK. British Cycling membership has increased threefold since the 2012 Olympic and Paralympic Games, and this is likely to rise in the wake of the Coronavirus pandemic. As urologists, day-to-day encounters with cyclists are commonplace, who may present with acute traumatic injuries or chronic overuse injuries. The aim of this literature review was to evaluate the effect of cycling on conditions presenting to the urology clinic, in particular those of raised prostate-specific antigen (PSA), haematuria and soft-tissue lesions (‘cyclist nodules’). Furthermore, the review aimed to summarize the relationship between cycling and pudendal nerve entrapment (PNE) syndromes. A PubMed search of the literature on cycling and genitourinary disorders was performed. The literature suggests no significant change in PSA levels after a bout of cycling. Age appears to have no effect on the change in PSA experienced following a bout of cycling, in particular when comparing those <50 years of age to those >50 years of age. Haematuria appears to be rare with cycling but has been described, even with stationary bike riding. It is imperative to exclude coexisting urinary-tract pathological conditions, and cycling-induced haematuria should always be considered a diagnosis of exclusion. Perineal nodular induration (‘cyclist nodules’) is a rare condition, related to pressure and repetitive micro-trauma between the perineum and saddle. Pudendal Nerve Entrapment (PNE) represents the most common bicycling-associated urogenital complaint. Numbness in the perineum, penis, scrotum or buttocks—‘genital numbness’—is the most common and most recognized symptom of pudendal compression. Despite several studies demonstrating a link between elite cyclists and erectile dysfunction, for the average cyclist riding may actually have a protective effect on sexual function.
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Affiliation(s)
- J Peacock
- Cheltenham General Hospital, Gloucestershire Hospitals NHS Trust, UK
| | - J Cobley
- Cheltenham General Hospital, Gloucestershire Hospitals NHS Trust, UK
| | - B Patel
- Cheltenham General Hospital, Gloucestershire Hospitals NHS Trust, UK
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Molina-Torres G, Ochandorena-Acha M, Echazarreta-Aparicio Y, Sánchez-Labraca N, González-Sánchez M, Terradas-Monllor M, Varela-Vásquez LA, Merchán-Baeza JA, Minobes-Molina E. Is Cycling Practice Related to Men's Pelvic Floor Dysfunctions? A Hypothesis-Generating Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041923. [PMID: 33671183 PMCID: PMC7922672 DOI: 10.3390/ijerph18041923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/08/2021] [Accepted: 02/12/2021] [Indexed: 11/16/2022]
Abstract
Background: There is a lack of consensus with regards to the consequences of cycling practice on urogenital and sexual problems in men. The aim of the study was to analyse the relationship between intensity of cycling practice and urinary tract symptoms, erectile dysfunction, and urinary incontinence. Methods: Observational hypothesis-generating design. Cyclists, men, between 25 and 70 years who had been cycling for more than one year were included. During the statistical analysis, a multiple linear regression model, partial correlation and Spearman’s correlation were carried out. Results: Fifty-eight men participated in the study. Results showed that there is a correlation between years of cycling and prostate symptoms (p = 0.041), and between age and erectile dysfunction (p = 0.001). The multiple linear regression model and the partial correlation analysis showed a correlation between the years of cycling and prostate symptoms (p = 0.007 and p = 0.018). Conclusions: The results have shown that there is a slight correlation between the years of cycling and the presence of lower urinary tract symptoms, independently of the man’s age. Therefore, the results display that high-intensity cycling practice might impact negatively in some men’s pelvic floor functions. Further research is needed to analyse the impact of cycling on urogenital problems in this population group.
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Affiliation(s)
- Guadalupe Molina-Torres
- Department of Nursing Science, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almeria, 04120 Almeria, Spain; (G.M.-T.); (Y.E.-A.); (N.S.-L.)
| | - Mirari Ochandorena-Acha
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, University of Vic-Central University of Catalonia (UVIC-UCC), C. Sagrada Familia, 7, 08500 Vic, Spain; (M.O.-A.); (M.T.-M.); (L.A.V.-V.); (E.M.-M.)
| | - Yune Echazarreta-Aparicio
- Department of Nursing Science, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almeria, 04120 Almeria, Spain; (G.M.-T.); (Y.E.-A.); (N.S.-L.)
| | - Nuria Sánchez-Labraca
- Department of Nursing Science, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almeria, 04120 Almeria, Spain; (G.M.-T.); (Y.E.-A.); (N.S.-L.)
| | - Manuel González-Sánchez
- Department of Psychiatry and Physiotherapy, Institute of Biomedical Research of Malaga (IBIMA), University of Malaga, 29071 Malaga, Spain;
| | - Marc Terradas-Monllor
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, University of Vic-Central University of Catalonia (UVIC-UCC), C. Sagrada Familia, 7, 08500 Vic, Spain; (M.O.-A.); (M.T.-M.); (L.A.V.-V.); (E.M.-M.)
| | - Luz A. Varela-Vásquez
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, University of Vic-Central University of Catalonia (UVIC-UCC), C. Sagrada Familia, 7, 08500 Vic, Spain; (M.O.-A.); (M.T.-M.); (L.A.V.-V.); (E.M.-M.)
| | - Jose Antonio Merchán-Baeza
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, University of Vic-Central University of Catalonia (UVIC-UCC), C. Sagrada Familia, 7, 08500 Vic, Spain; (M.O.-A.); (M.T.-M.); (L.A.V.-V.); (E.M.-M.)
- Correspondence: ; Tel.: +34-938-886-12-22
| | - Eduard Minobes-Molina
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, University of Vic-Central University of Catalonia (UVIC-UCC), C. Sagrada Familia, 7, 08500 Vic, Spain; (M.O.-A.); (M.T.-M.); (L.A.V.-V.); (E.M.-M.)
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Diamandis EP. Significant increase of serum prostate-specific antigen after exercise. Clin Chem Lab Med 2017; 54:e245-6. [PMID: 26910748 DOI: 10.1515/cclm-2016-0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 01/11/2016] [Indexed: 11/15/2022]
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Influence of Long-Distance Bicycle Riding on Serum/Urinary Biomarkers of Prostate Cancer. Int J Mol Sci 2016; 17:377. [PMID: 26999116 PMCID: PMC4813236 DOI: 10.3390/ijms17030377] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 02/17/2016] [Accepted: 03/03/2016] [Indexed: 12/24/2022] Open
Abstract
Herein, we present a study focused on the determination of the influence of long-distance (53 km) bicycle riding on levels of chosen biochemical urinary and serum prostate cancer (PCa) biomarkers total prostate-specific antigen (tPSA), free PSA (fPSA) and sarcosine. Fourteen healthy participants with no evidence of prostate diseases, in the age range from 49-57 years with a median of 52 years, underwent physical exercise (mean race time of 150 ± 20 min, elevation increase of 472 m) and pre- and post-ride blood/urine sampling. It was found that bicycle riding resulted in elevated serum uric acid (p = 0.001, median 271.76 vs. 308.44 µmol/L pre- and post-ride, respectively), lactate (p = 0.01, median 2.98 vs. 4.8 mmol/L) and C-reactive protein (p = 0.01, 0.0-0.01 mg/L). It is noteworthy that our work supports the studies demonstrating an increased PSA after mechanical manipulation of the prostate. The subjects exhibited either significantly higher post-ride tPSA (p = 0.002, median 0.69 vs. 1.1 ng/mL pre- and post-ride, respectively) and fPSA (p = 0.028, median 0.25 vs. 0.35 ng/mL). Contrary to that, sarcosine levels were not significantly affected by physical exercise (p = 0.20, median 1.64 vs. 1.92 µmol/mL for serum sarcosine, and p = 0.15, median 0.02 µmol/mmol of creatinine vs. 0.01 µmol/mmol of creatinine for urinary sarcosine). Taken together, our pilot study provides the first evidence that the potential biomarker of PCa-sarcosine does not have a drawback by means of a bicycle riding-induced false positivity, as was shown in the case of PSA.
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Jiandani D, Randhawa A, Brown RE, Hamilton R, Matthew AG, Kuk JL, Alibhai SMH, Tufts E, Santa Mina D. The effect of bicycling on PSA levels: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2015; 18:208-12. [DOI: 10.1038/pcan.2015.16] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 03/06/2015] [Accepted: 03/17/2015] [Indexed: 11/09/2022]
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Baran C, Mitchell GC, Hellstrom WJ. Cycling‐Related Sexual Dysfunction in Men and Women: A Review. Sex Med Rev 2014; 2:93-101. [DOI: 10.1002/smrj.32] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Mejak SL, Bayliss J, Hanks SD. Long distance bicycle riding causes prostate-specific antigen to increase in men aged 50 years and over. PLoS One 2013; 8:e56030. [PMID: 23418500 PMCID: PMC3572135 DOI: 10.1371/journal.pone.0056030] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 01/04/2013] [Indexed: 12/02/2022] Open
Abstract
Objectives To investigate whether bicycle riding alters total prostate-specific antigen (tPSA) serum concentrations in healthy older men. Methods 129 male participants, ranging in age from 50 to 71 years (mean 55 years), rode in a recreational group bicycle ride of between 55 and 160 kilometers. Blood samples for tPSA analysis were drawn within 60 minutes before starting, and within 5 minutes after completing the ride. The pre-cycling and post-cycling tPSA values were log transformed for normality and compared using paired t-tests. Linear regression was used to assess the relationship between changes in tPSA with age and distance cycled. Results Bicycle riding caused tPSA to increase by an average of 9.5% (95% CI = 6.1–12.9; p<0.001) or 0.23 ng/ml. The number of participants with an elevated tPSA (using the standard PSA normal range cut-off of 4.0 ng/ml) increased from two pre-cycle to six post-cycle (or from five to eight when using age-based normal ranges). Univariate linear regression analysis revealed that the change in tPSA was positively correlated with age and the distance cycled. Conclusions Cycling causes an average 9.5% increase in tPSA, in healthy male cyclists ≥50 years old, when measured within 5 minutes post cycling. We considered the increase clinically significant as the number of participants with an elevated PSA, according to established cut-offs, increased post-ride. Based on the research published to date, the authors suggest a 24–48 hour period of abstinence from cycling and ejaculation before a PSA test, to avoid spurious results.
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Affiliation(s)
- Sandra L Mejak
- Department of Sports Medicine, Victorian Institute of Sport, Melbourne, Victoria, Australia.
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Sutcliffe S, Pakpahan R, Sokoll LJ, Elliott DJ, Nevin RL, Cersovsky SB, Walsh PC, Platz EA. Prostate-specific antigen concentration in young men: new estimates and review of the literature. BJU Int 2012; 110:1627-35. [DOI: 10.1111/j.1464-410x.2012.11111.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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[Influencing of the PSA concentration in serum by physical exercise (especially bicycle riding)]. Urologe A 2011; 50:188-96. [PMID: 21246346 DOI: 10.1007/s00120-010-2489-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Sports and in particular cycling are assumed to influence PSA in serum. Controversial scientific results were the motivation to examine the influence of a standardized test on a cycling ergometer and a treadmill on PSA concentrations in elderly men with elevated PSA levels and a benign prostate hyperplasia. MATERIAL AND METHODS A total of 21 male volunteers (aged 61 ± 5 years, tPSA 7.7 ± 3.0 ng/ml and benign prostate hyperplasia with a prostate volume of 54 ± 18 ml) performed a 1 h cycling test on a cycling ergometer. A subgroup of 15 volunteers also performed a 1 h test on a treadmill. Blood samples were drawn before and several times after the cycling stress test up to 7 days afterwards (up to 120 min after the test on the treadmill) to determine total PSA (tPSA), complexed PSA (cPSA) and free PSA (fPSA). RESULTS The average increase in tPSA of 1.9 ± 1.7 ng/ml (25%) after the cycling exercise test was significant. After the treadmill exercise the PSA increase was not as high, but with 1.0 ± 1.0 ng/ml (12%) was also significant. On average the levels of PSA returned to the basic level 48 h after the cycling test, but in individual cases it took longer. fPSA showed the most noticeable increase after cycling with 92% on average. There was no correlation between increase in PSA and prostate volume. CONCLUSIONS Men should abstain from physical exercise, especially from cycling for several days and at least for 24 h before PSA measurements are carried out. This applies to patients with elevated PSA levels (>4 ng/ml) when a PSA follow-up is being carried out.
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Kim DG, Kim DW, Park JK. Does bicycle riding impact the development of lower urinary tract symptoms and sexual dysfunction in men? Korean J Urol 2011; 52:350-4. [PMID: 21687396 PMCID: PMC3106169 DOI: 10.4111/kju.2011.52.5.350] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 04/13/2011] [Indexed: 12/04/2022] Open
Abstract
Purpose This study was designed to determine whether men who engaged in recreational bicycle riding are more likely to be affected by lower urinary tract symptoms (LUTS) and sexual dysfunction than are man who exercised by amateur marathon running with less perineal impact. Materials and Methods A total of 22 healthy male amateur bicyclists and 17 healthy male amateur marathoners were enrolled in the study. We evaluated questionnaires including the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function (IIEF), serum prostate-specific antigen (PSA), uroflowmetric values, postvoid residual (PVR) urine volume, and transrectal ultrasound of the prostate in all subjects. We also compared the prevalence of urination disorders (UD) and erectile dysfunction (ED). Results There were no significant differences between the two groups in age, body mass index, comorbidities, or exercise habits (p>0.05). Mean total and subscale scores of the IPSS and IIEF and the prevalence of UD (8/22 vs. 4/17, p=0.494) and ED (11/22 vs. 10/17, p=0.748) were not significantly different between the two groups. Also, there were no significant differences between the two groups in uroflowmetric parameters such as peak urinary flow rates, voided urine volume, PVR urine volume, prostate volume, or serum PSA level. Conclusions Bicycle riding seems to have no measurable hazardous effect on voiding function or sexual function in men who cycled recreationally.
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Affiliation(s)
- Dong Gon Kim
- Department of Urology, Chonbuk National University Medical School , Jeonju, Korea
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