Importance of Prostate-Specific Antigen Screening before and after Bacillus Calmette-Guérin Intravesical Bladder Instillation Treatment to Avoid Unnecessary Prostate Biopsy

Several side effects have been documented following the use of Bacillus Calmette-Guérin (BCG) intravesical instillation therapy for the treatment of non-muscle invasive bladder cancer (NMIBC), AbstractObjective: The adverse effects of Bacillus Calmette-Guérin (BCG) intravesical instillation therapy for non-muscle invasive bladder cancer (NMIBC) vary widely, and can include BCG-induced prostatitis.In contrast, prostate cancer may occasionally develop along with bladder cancer.Therefore, if prostate-specific antigen (PSA) levels increase after BCG therapy, a prostate biopsy should be performed to exclude prostate cancer.Methods: PSA values were determined in 114 men who had undergone intravesical BCG instillation at our institution between 2000 and 2012.The mean age of the patients was 69.2 years (range, 40-87 years).All cases had NMIBC; the histological classification was G1 in 9 patients, G2 in 74 patients, G3 in 17 patients, and carcinoma in situ in 14 patients.PSA was measured more than once in 37 out of 100 cases, excluding the cases wherein prostate cancer had already been diagnosed.Results: Patients showed an increase in PSA levels in 7 cases, and 3 patients showed an increase in PSA levels after BCG treatment.Two cases developed granulomatous prostatitis after BCG treatment, and a definitive diagnosis was made via biopsy.Conclusions: Our results confirm that PSA examination is essential both before and after BCG treatment.PSA level elevation in patients treated with intravesical BCG is self-limiting; prostate biopsies are not essential in these patients and could be delayed while the PSA levels are monitored.