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Nikhil Prasad  Fact checked by:Thailand Medical News Team Jan 18, 2024  1 month, 6 days, 16 hours, 39 minutes ago

Medical News: Singapore Doctors Warn That Acute COVID-19 Infections Can Cause Elevated PSA Levels, Complicating Prostate Cancer Diagnosis

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Medical News: Singapore Doctors Warn That Acute COVID-19 Infections Can Cause Elevated PSA Levels, Complicating Prostate Cancer Diagnosis
Nikhil Prasad  Fact checked by:Thailand Medical News Team Jan 18, 2024  1 month, 6 days, 16 hours, 39 minutes ago
Medical News: In a recent revelation, Singaporean doctors have sounded an alarm about the unforeseen consequences of acute COVID-19 infections on prostate cancer patients. A doctor form the Department of Neurology at the Singapore General Hospital highlights a critical learning point for clinicians, indicating that the SARS-CoV-2 virus can induce elevated Prostate-Specific Antigen (PSA) levels, even in individuals who have undergone prostatectomy, thus complicating the surveillance of prostate cancer recurrence. This Medical News report delves into a compelling case study, shedding light on the intricacies of this phenomenon and urging healthcare providers to exercise caution in interpreting PSA measurements during active COVID-19 infections.

COVID-19 Infections Can Also Cause Elevated PSA Levels
Case Study: Navigating the Complexities of PSA Levels during COVID-19
The focal point of concern revolves around a 69-year-old male who had previously undergone a radical prostatectomy more than a year ago for prostatic acinar adenocarcinoma. Post-surgery, he maintained undetectable total PSA levels. However, during a routine visit to his family physician, a startling revelation unfolded. Four days before the consultation, the patient tested positive for SARS-CoV-2 through an Antigen Rapid Test (ART) of his nasal swab, coinciding with the development of mild respiratory symptoms.
Remarkably, the patient's PSA levels exhibited a significant increase from less than 0.01ug/L to 0.046ug/L within a short span. Despite his compliance with leuprorelin injections and the absence of other potential causes for elevated PSA, concerns arose regarding treatment failure and disease recurrence. A subsequent visit to his urologist, undertaken on the ninth day of COVID-19 (with a negative nasal swab ART), revealed a notable decline in PSA levels to 0.014ug/L. The patient's serum testosterone levels remained suppressed, indicating a plausible link between the transient increase in PSA and the SARS-CoV-2 infection.
Understanding the Mechanisms: SARS-CoV-2 and PSA Elevation
While previous studies have hinted at PSA elevations in COVID-19 patients, this case stands out as one of the first reports of falsely-elevated PSA levels specifically in individuals with a history of prostatectomy. The discussion underscores the intricate mechanisms through which SARS-CoV-2 may increase PSA levels, drawing attention to the viral S-glycoprotein's interaction with the transmembrane serine protease 2 (TMPRSS2) and angiotensin-converting enzyme 2 (ACE2).
The prostatic columnar epithelium, responsible for PSA production and expressing both ACE2 and TMPRSS2, emerges as a key player in this interplay. The down-regulation of ACE2's modulatory effects on angiotensin II during SARS-CoV-2 infection triggers pro-inflammatory processes within susceptible organs, potentially including the prostate. The report raises unsettling possibilities, suggesting that remnants of prostatic tissue or adenocarcinoma might persist post-prostatectomy.
  /> Furthermore, the study explores the potential involvement of non-prostatic PSA-producing tissues, such as salivary and urethral glands, in PSA elevation during COVID-19 infections. ACE2 and TMPRSS2, present in human saliva, could contribute to SARS-CoV-2 entry into salivary glands, rendering them potential sources of PSA. While the scientific evidence for the infection of urethral glands remains inconclusive, the report emphasizes the challenge of pinpointing the exact tissue responsible for the PSA elevation induced by COVID-19.
Clinical Implications and Recommendations
In light of these findings, clinicians are urged to exercise caution when interpreting PSA measurements during active COVID-19 infections, particularly in post-prostatectomy patients. The transient nature of PSA elevation observed in the presented case underscores the need for a nuanced approach. Recommendations include avoiding PSA measurements during active infections and, if necessary, repeating them two weeks later to prevent unnecessary worry and premature alterations to existing treatment plans.
As the medical community grapples with the multifaceted impact of COVID-19 on various organ systems, this case study from Singapore serves as a crucial addition to the evolving understanding of the virus's effects on prostate cancer surveillance. The intricate interplay between SARS-CoV-2 and PSA levels underscores the need for vigilant clinical interpretation and reinforces the importance of tailored approaches in managing prostate cancer patients during the ongoing pandemic. Healthcare providers worldwide must remain attuned to such nuances, continually updating their knowledge base to ensure optimal patient care in these challenging times.
The study case findings were published in the peer reviewed journal: QJM (Oxford Journals)
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