International Journal of Urology (2006) 13, 234–237 Blackwell Publishing AsiaMelbourne, AustraliaIJUInternational Journal of Urology0919-81722006 Blackwell Publishing Asia Pty LtdMarch 2006133234237Original Article Effect of coronary bypass on prostate-specific antigen BS Parlaktas et al. Correspondence: Bekir Süha Parlaktas MD, Mevlana Sitesi, 2 Blok, Kat 2 No. 5, 60100 Tokat, Turkey. Email: bsuha@mynet.com Received 14 April 2005; accepted 18 August 2005. Original Article Comparison of the effects of on-pump versus off-pump coronary artery bypass surgery on serum prostate-specific antigen levels BEKIR S PARLAKTAS, 1 ERDINC NASERI, 2 NIHAT ULUOCAK, 1 ALTAY O ELALMIS, 2 FIKRET ERDEMIR 1 AND ILKER ETIKAN 3 1 Department of Urology, 2 Department of Cardiovascular Surgery, and 3 Department of Biostatistics, Gaziosmanpasa University, School of Medicine, Tokat, Turkey Aim: To compare the effects of coronary artery bypass operation with or without extracorporeal circulation on serum total prostate- specific antigen levels. Methods: Seventy-six men with a mean age of 57.04 ± 9.27 years (range 44–77 years), who underwent coronary artery bypass surgery were enrolled to the study. In 50 patients (Group I), coronary revascularization was performed using extracorporeal circulation, and in 26 patients (Group II) coronary bypass grafting was performed on the beating heart without using extracorporeal circulation. All the patients had serum total prostate-specific antigen levels measured preoperatively and twice postoperatively in the first and fifth postoperative days. Differences in mean total prostate-specific antigen levels between the two groups in the postoperative period were analysed. Results: The mean preoperative total prostate-specific antigen levels in Group I and Group II were 1.28 ± 1.13 ng/mL and 1.11 ± 0.93 ng/mL, respectively, and there was no significant difference in the preoperative total prostate-specific antigen values between the two groups (P = 0.519). In Group I, postoperative means were 4.96 ± 6.29 ng/mL and 5.86 ± 9.09 ng/mL in the first and fifth days, respectively (P = 0.0001, P = 0.0001). Total prostate-specific antigen means in the same postoperative period for Group II were 2.13 ± 2.72 ng/mL and 2.00 ± 2.20 ng/mL, respectively (P = 0.014, P = 0.024). The comparison of total postoper- ative prostate-specific antigen levels between the groups showed significantly higher elevation in Group I (postoperative day 1: P = 0.013; day 5: P = 0.05). Conclusions: Coronary revascularization can cause a statistically significant rise in serum total prostate-specific antigen levels. This rise is more marked in patients undergoing conventional coronary revascularization. Key words coronary bypass, off-pump, on-pump, prostate-specific antigen, prostate. Introduction Prostate-specific antigen (PSA) is a kallikrein-like serine protease, which is produced by the epithelial cells of the acinar and ductal elements of the prostate gland. 1–3 The serum level of PSA is a widely used tumor marker for the diagnosis and follow up of prostate cancer. 1,2 It is not specific for prostate cancer and may be elevated in some benign diseases of prostate gland such as benign prostatic hyperplasia, prostatic and urinary system infections, prostatic abscess, and after urologic manipulations such as cystoscopy, prostate biopsy and transurethral resection of prostate gland. 2–6 Elevation of serum PSA levels due to prostatic ischemia and/or infarction has been demonstrated in some previous studies. 1,3 Pelvic ischemia due to cross clamping of the aorta during coronary artery bypass graft- ing (CABG), aortic and iliac arterial surgery, hypotensive shock and acute myocardial infarction is presumed to be the reason for prostatic ischemia and/or infarction leading to elevation of serum PSA levels. 1–3,7,8 Significant stenosis of the coronary arteries has tradi- tionally been treated with conventional coronary artery bypass (CCAB) which utilizes extracorporeal circulation (ECC), 9,10 The flow of blood through ECC circuits induces a generalized inflammatory reaction in the body which has been postulated as the main cause of morbidity and mor- tality in these patients. 9 In order to avoid the deleterious effects of ECC, off-pump or beating-heart coronary artery bypass (OPCAB) has regained popularity in the last few years. 11,12 The objective of the present study was to inves- tigate the early postoperative impacts of two different CABG procedures on serum PSA levels. Methods Seventy-six men with a mean age of 57.04 ± 9.27 years (range 44–77 years), who underwent CABG in the cardio- vascular surgery department between January 2004 and December 2004, were enrolled to this prospective study. The patients were divided into two groups. Those under- going CCAB surgery constituted Group I and those who