Correspondence

Increased Serum Prostate-Specific Antigen in a Man and a Woman with Hepatitis A

N Engl J Med 1997; 337:1849-1850December 18, 1997

Article

To the Editor:

Although prostate-specific antigen (PSA) was originally thought to be a prostate-epithelium–specific marker,1 it has now been described in other tissues and body fluids, including liver, colon, lung, kidney, breast, ovarian, and parotid tumors; normal breast; salivary gland and endometrium; breast milk; and amniotic fluid.2-4 Likewise, the prostate-specific membrane antigen is a novel biomarker that can be detected in a variety of healthy and malignant non-prostate tissues.3,5 A quantitative assessment of the tissue expression of this glycoprotein seems to indicate that high levels of prostate-specific membrane antigen transcripts are present in normal liver, brain, and small intestine and that such tissue levels are only about one fifth of those in prostate tissue.5 We describe a man and woman in whom increased serum PSA levels were detected during acute viral hepatitis.

In February 1996, a 21-year-old man (Patient 1) and his 18-year-old wife (Patient 2) were given a diagnosis of severe acute hepatitis A, which developed a few days after they had eaten shellfish. They had marked jaundice, splenomegaly, and high peak levels of aminotransferases and bilirubin within two weeks after the onset of jaundice (Table 1Table 1Characteristics of Two Patients with Hepatitis A and Increased Serum PSA Levels.). Clinical and biochemical recovery began in the third and fourth weeks, with complete recovery within two and three months in Patients 1 and 2, respectively.

When the patients were first seen because of jaundice, the hospital's newly implemented complex request sheets for serum tests were marked incorrectly, which led to the measurement of PSA. The serum PSA level was 28.6 ng per milliliter in Patient 1 and 16.8 ng per milliliter in Patient 2, with similar results on repeated determinations. Patient 1 denied having any prostatic symptoms, and the results of a digital rectal examination were normal. The serum PSA levels remained stable during the first three to four weeks after the onset of jaundice. Thereafter, weekly PSA determinations showed progressive slow declines: from 22.4 ng per milliliter (week 4) to 0.2 ng per milliliter (week 10) in Patient 1, and from 14.4 ng per milliliter (week 5) to undetectable levels (week 15) in Patient 2.

In both patients, the serum PSA concentrations paralleled the clinical and biochemical activity of the disease. This observation supports the hypothesis that the extensive acute hepatocellular injury caused by hepatitis A virus was responsible for the increased serum PSA levels in both the man and the woman. In view of these cases and the other reports,3-5 we believe that underlying liver disease should be considered as a possible cause in patients with unexplained increases in PSA.

Xavier Bosch, M.D., Ph.D.
Oscar Bernadich, M.D.
Hospital Casa Maternitat, 08028 Barcelona, Spain

5 References

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Citing Articles (3)

Citing Articles

1. 1

   Jaume Trapé, Xavier Filella, Montse Alsina-Donadeu, Lluïsa Juan-Pereira, Àngels Bosch-Ferrer, Raül Rigo-Bonnin. (2011) Increased plasma concentrations of tumour markers in the absence of neoplasia. Clinical Chemistry and Laboratory Medicine 49:10, 1605-1620
   CrossRef

2. 2

   J.a Hyeon Ku, Min Eui Kim, Nam Kyu Lee, Young H.o Park, Jae Ouk Ahn. (2003) Influence of age, anthropometry, and hepatic and renal function on serum prostate-specific antigen levels in healthy middle-age men. Urology 61:1, 132-136
   CrossRef

3. 3

   Bernard Malavaud, Marcel Midoug, Jean-Louis Payen, Jacques Izopet, Pascal Rischmann, Jean-Pierre Pascal, Jean-Pierre Sarramon, Guy Serre. (1999) Prostate-specific antigen in acute hepatitis and hepatocellular carcinoma. The Prostate 41:4, 258-262
   CrossRef