Is Systemic Inflammation Associated With Elevated PSA Serum Levels In Patients Submitted Chronic Hemodialysis?

PSA Level and Systemic Inflammation

  • Gilmar Pereira Silva University of Brasilia
  • Vitor Pereira Xavier Grangeiro João Pessoa, Paraiba, Brazil


Backgroundː whereas that systemic inflammation (SI) affects 40–60% of patients on hemodialysis (HD) is characterized by serum C-reactive protein (CRP) level elevation or proinflammatory interleukin production or both. We evaluated the association between SI and total (tPSA) and free PSA (fPSA) in patients on HD with tPSA <4ng / ml.

Methodsː Sixty patients with chronic kidney disease (CKD) undergoing HD and 20 controls were included. Inclusion criteria were patients aged 18-60 years; tPSA < 4 ng/mL without clinically detectable prostate cancer; and patients undergoing HD for >6 months. Patients were excluded if they had local infections or SI. Hs-CRP was measured using turbidimetry, and tPSA and fPSA levels using immunochemoluminescence. Overall, 27 patients had inflammation (hs-CRP >5 mg/L) and 33 had no inflammation (hs-CRP was ≤5 mg/L). In the control group, hs-CRP was ≤ 1 mg/L.

Resultsː there was no significant difference in mean levels among groups 3 and 4 for age (p=0,058), tPSA (p=0,74) and fPSA (p=0,30). The SI did not promote differences between groups 1, 2 and 4 for the levels of tPSA (0,71 ± 0,18  vs   0,67 ± 0,15  vs  0,67 ± 0,11; p=0,69) and fPSA (0,34  ±  0,01  vs  0,34  ±  0,01  vs   0,35  ±  0,01, p= 0,59) . As well as maintained no correlation with tPSA and fPSA (p>0,05).

Conclusionː The systemic inflammation in hemodialytic patients without clinically detectable cancer (PSA<4ng/ml) is no associated with changes fractions of tPSA and fPSA.

Author Biographies

Gilmar Pereira Silva, University of Brasilia
Department of Medicine
Vitor Pereira Xavier Grangeiro, João Pessoa, Paraiba, Brazil

Academic of the Medical Course of the School of Medical Sciences, João Pessoa, Paraiba, Brazil


1. Printz C. Early-stage prostate cancer, PSA screening rates decline. Cancer. 2016 Mar 15;122(6):825.
2. Trapé J, Filella X, Alsina-Donadeu M, Juan-Pereira L, Bosch-Ferrer Á, Rigo-Bonnin R, et al. Increased plasma concentrations of tumour markers in the absence of neoplasia. Clin Chem Lab Med. 2011;49(10):1605–20.
3. Akchurin OM, Kaskel F. Update on inflammation in chronic kidney disease. Blood Purif. 2015 Jan 20;39(1-3):84–92.
4. Cannizzo ES, Clement CC, Sahu R, Follo C, Santambrogio L. Oxidative stress, inflamm-aging and immunosenescence. J Proteomics. 2011 Oct 19;74(11):2313–23.
5. Cheung CY, Chan GCW, Chan SK, Ng F, Lam MF, Wong SSH, et al. Cancer Incidence and Mortality in Chronic Dialysis Population: A Multicenter Cohort Study. Am J Nephrol. 2016 Apr 12;43(3):153–9.
6. Lin MY, Kuo MC, Hung CC, Wu WJ, Chen LT, Yu ML, et al. Association of dialysis with the risks of cancers. PLoS One. 2015 Apr 13;10(4):e0122856.
7. Stephan C, Miller K, Jung K. Is there an optimal prostate-specific antigen threshold for prostate biopsy? Expert Rev Anticancer Ther. 2011 Aug;11(8):1215–21.
8. Liu X, Tang J, Fei X, Li QY. Prostate-specific Antigen (PSA) Density and Free to Total PSA Ratio in Diagnosing Prostate Cancer with Prostate-Specific Antigen Levels of 4.0 ng/ml or Less. Iran J Public Health. 2015;44(11):1466–72.
9. Choi S-K, Song C, Shim M, Min GE, Park J, Jeong IG, et al. Prevalence of high-grade or insignificant prostate cancer in Korean men with prostate-specific antigen levels of 3.0-4.0 ng/mL. Urology. 2015 Mar;85(3):610–5.
10. KDOQI. KDOQI Clinical Practice Guideline and Clinical Practice Recommendations for anemia in chronic kidney disease: 2007 update of hemoglobin target. Am J Kidney Dis. 2007 Sep;50(3):471–530.
11. Willerson JT, Ridker PM. Inflammation as a cardiovascular risk factor. Circulation. 2004 Jun 1;109(21 Suppl 1):II2–10.
12. Kirsch AH, Lyko R, Nilsson L-G, Beck W, Amdahl M, Lechner P, et al. Performance of hemodialysis with novel medium cut-off dialyzers. Nephrol Dial Transplant [Internet]. 2016 Sep 1; Available from:
13. Carney EF. Chronic kidney disease. Walking reduces inflammation in predialysis CKD. Nat Rev Nephrol. 2014 Jun;10(6):300.
14. Lippi G, Montagnana M, Guidi GC. Epidemiological association between C-reactive protein and prostate-specific antigen. Cancer. 2009 Mar 1;115(5):1132.
15. McDonald AC, Vira MA, Vidal AC, Gan W, Freedland SJ, Taioli E. Association between systemic inflammatory markers and serum prostate-specific antigen in men without prostatic disease - the 2001-2008 National Health and Nutrition Examination Survey. Prostate. 2014 May;74(5):561–7.
16. García-Sánchez C, Corchuelo-Maillo C, Congregado-Ruiz CB, Ocón-Revuelta EM, Osman-García I, Conde-Sánchez JM, et al. PSA levels in patients on hemodialysis treatment. Arch Esp Urol. 2013 Dec;66(10):939–44.
17. Rodríguez Collar TL, Guzmán Cayado M, Rodríguez Batista R, Zamora González Y. Influencia de la hemodiálisis en los niveles del antígeno prostático específico. Revista Habanera de Ciencias Médicas. 2015;14(6):774–86.
18. Maoujoud O, El Machtani S, Asseraji M, Atbib Y, Zajjari Y, Taoufik A, et al. Serum tumor markers in hemodialysis patients. Int J Artif Organs. 2014 Feb;37(2):126–32.
19. Zhang X, Wang N, Xue Q, Jian G, Gao X. Impact of hemodialysis nd uremia on serum levels a of tumor markers. Journal of Integrative Nephrology and Andrology. 2015;2(1):23.
20. İnci M, Çetinkaya A, Yengil E, Oguzhan N, Ulutaş T, Davarcı M. HEMODİYALİZ HASTALARINDA TOTAL VE SERBEST PSA DÜZEYLERİNİN ARAŞTIRILMASI. Mustafa Kemal Üniversitesi Tıp Dergisi [Internet]. 2011;2(8). Available from:
21. Stephan C. Interchangeability of Measurements of Total and Free Prostate-Specific Antigen in Serum with 5 Frequently Used Assay Combinations: An Update. Clin Chem. 2006;52(1):59–64.
22. Wenten IG, Aryanti P, Khoiruddin K, Hakim AN, Himma NF. Advances in Polysulfone-Based Membranes for Hemodialysis. Journal of Membrane Science and Research. 2016;2(2):78–89.
How to Cite
SILVA, Gilmar Pereira; GRANGEIRO, Vitor Pereira Xavier. Is Systemic Inflammation Associated With Elevated PSA Serum Levels In Patients Submitted Chronic Hemodialysis?. International Archives of Medicine, [S.l.], v. 10, sep. 2017. ISSN 1755-7682. Available at: <>. Date accessed: 26 june 2019. doi:

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