PSA density as a predictor of long-term infectious complications during transurethral resection of the prostate: determining an optimal cut-off value

Abstract

Introduction. Infectious complications (ICs) after transurethral resection of the prostate (TURP) are significant and potentially life-threatening conditions with an incidence 0.5% – 20.0%. Most publications provide data regarding early infectious complications. At the same time, there are currently no studies aimed at a comprehensive assessment of long-term infectious complications after TURP. The problem of prevention and treatment of ICs is also accompanied by insufficient understanding of the role of undiagnosed inflammation in prostate tissues and the lack of representative laboratory markers.Objective. To assess the prostate-specific antigen density (PSAd) as a predictor of long-term infectious complications after transurethral resection of the prostate and to determine the optimal cut-off value.Materials & methods. This single-center study included 162 patients who underwent mono- and bipolar TURP between 2016 – 2023. Inclusion criteria for the study: prostate volume 30–80 cm3, no history of urinary tract infections (UTIs) at the time of hospitalization and antibiotic treatment at least one month before surgery, possible presence of latent UTIs before surgery, no prostate cancer. Exclusion criteria were failure to meet inclusion criteria. Infectious complications assessed included upper and lower UTIs, as well as epididymitis, orchitis and prostatitis, confirmed by clinical and laboratory data. Prostate-specific antigen (PSA) assessment was performed < 2 days before surgery.Results. The median PSAd value was 0.04 [0.03; 0.08] ng/ml2, the variable was significantly different in non-infection and infection groups (0.04 and 0.08 ng/ml2, respectively, p = 0.009). The area under the curve (AUC) was 0.67 (95% CI [0.546 – 0.791]). The optimal cut-off value of the PSAd in prediction of long-term ICs was > 0.07 ng/ml2, sensitivity / specificity: 58.3% and 76.1%, respectively. The analysis showed more than 4 times higher odds of developing an infectious complication in PSAd > 0.07 ng/ml2 patients: OR 4.3 (95% CI [1.7 – 10.5], p = 0.001).Conclusion. This study demonstrates data that defines a new clinical non-oncological significance of PSAd as a predictor of the development of long-term infectious complications after TURP.