Nontraumatic Elevation of Prostate Specific Antigen Following Cardiac Surgery and Extracorporeal Cardiopulmonary Bypass

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Abstract
We recently treated a number of patients with markedly elevated prostate specific antigen (PSA) levels associated with acute urinary retention in a post-cardiac surgery setting. A controlled study was conducted to determine if this elevation is secondary to trauma from urethral catheterization or more directly associated with the cardiac surgery and extracorporeal bypass. In 68 patients undergoing cardiac surgery serum PSA levels were determined preoperatively and 12 to 18 hours postoperatively (after urethral catheterization). The control patients were 23 men undergoing evaluation for chest pain in the cardiac care unit. The serum PSA level was markedly elevated in 38 patients (56%) after cardiac surgery. In contrast, only 1 control patient (4.3%) had an elevated level after urethral catheterization (p = 0.0001). The mean post-cardiac surgery PSA concentration was 9.14 +/- 16.08 ng./ml. (range 0.1 to 94.8) with a mean elevation of 528% (range -50 to 5,155%). This finding was statistically different from the mean post-catheterization level of 1.86 +/- 2.26 ng./ml. (range 0.2 to 9.1, p = 0.034) and mean elevation of 6% (range -50 to 100%, p = 0.0001) in the control patients. We conclude that cardiac surgery and extracorporeal cardiopulmonary bypass can cause a marked elevation in serum PSA that appears to be unrelated to urethral catheterization. Presently, the etiology of this elevation is unknown, although PSA measurements may eventually find use as a marker for prostatic damage associated with acute urinary retention in the postoperative setting.