J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website http://www.journalmc.org

Case Report

Volume 4, Number 7, July 2013, pages 507-510

Value of Prostate-Specific Antigen Elevated in Transudative Pleural Effusion for Diagnosis of Prostate Cancer-Induced Paramalignant Pleural Effusion

Figure 1. Imaging studies on admission. A) Plain chest radiography showed the cardiothoracic ratio was 55%, bilateral costophrenic angles were dull, and diffuse bilateral reticulonodular opacification was present. B, C) Plain chest computed tomography showed bilateral large amounts of pleural fluid, slight pericardial effusion, patchy consolidation sparing the subpleural regions, and thickenings of both the interlobular septum and pleura.

Figure 2. Possible mechanisms of prostate cancer-induced paramalignant pleural effusion. Lymphatic obstruction causes transudative pleural effusion (TPE), and usually exhibits negative cytology. When there is prostate tumor-related lymphatic obstruction, prostate-specific antigen (PSA) will be high in TPE. Blood-borne metastases cause pulmonary parenchymal or pleural involvement, resulting in exudative pleural effusion in most cases. Atelectasis attributed to bronchial obstruction either due to parenchymal or pleural involvement could increase PSA levels in TPE of some cases.

**Table 1.** Summary of the Investigations Performed: All Positive and Relevant Negative Results are Shown
Urinalysis:	Biochemistry:	Pleural effusion analysis:
Abbreviations; CBC: complete blood count, PSA: prostate-specific antigen, HD: hospital day, AD: after discharge, FPG: fasting plasma glucose, BNP: brain natriuretic peptide, ADA: adenosine deaminase, LAD: left atrium diameter, LVDd: left ventricular end-diastolic diameter, LVDs: left ventricular end-systolic diameter, EF: ejection fraction, TEI index: left ventricular total ejection isovolume index, E/A: peak early diastolic LV filling velocity/peak atrial filling velocity ratio, DT: deceleration time
Urinary protein	-		TP	6.9	g/dL	Color of fluid	Pale yellow
Occult blood	-		Alb	3.4	g/dL	Cloudiness	Slightly turbid
CBC:	T-Bil	0.55	mg/dL	Specific gravity	1.025
WBC	7,270	/µL	AST	29	U/L	pH	7.2
RBC	585×10⁴	/µL	ALT	17	U/L	Protein	3.4	g/dL
Hb	15.5	g/dL	LDH	204	U/L	Glucose	172	mg/dL
Plt	39.6×10⁴	/µL	CK	115	U/L	LDH	101	U/L
Serum PSA series:	ALP	274	U/L	ADA	6.4	IU/L
HD 1	166.0	ng/mL	CRP	0.17	mg/dL	Cell numbers	320	/µL
HD 30 (discharge)	65.0	ng/mL	Na	140	mmol/L	Cytology	Class II
30 days AD	21.6	ng/mL	K	4.2	mmol/L	Echocardiogram:
120 days AD	4.4	ng/mL	Cl	105	mmol/L	LAD	33	mm
Pleural PSA series:	BUN	19	mg/dL	LVDd	46	mm
HD 1	192.0	ng/mL	Cr	1.06	mg/dL	LVDs	24	mm
HD 30 (discharge)	109.0	ng/mL	FPG	104	mg/dL	EF	79	%
BGA under room air on admission:	BNP	44.1	pg/mL	TEI index	0.4
pH	7.475					E/A	0.71
PaO₂	49.4	mmHg				DT	190	msec
PaCO₂	29.2	mmHg				Pathology of prostate:
HCO₃^-	21.0	mmol/L				adenocarcinoma (positive PSA stain)

Table 1. Summary of the Investigations Performed: All Positive and Relevant Negative Results are Shown

Urinalysis:

Biochemistry:

Pleural effusion analysis:

Abbreviations; CBC: complete blood count, PSA: prostate-specific antigen, HD: hospital day, AD: after discharge, FPG: fasting plasma glucose, BNP: brain natriuretic peptide, ADA: adenosine deaminase, LAD: left atrium diameter, LVDd: left ventricular end-diastolic diameter, LVDs: left ventricular end-systolic diameter, EF: ejection fraction, TEI index: left ventricular total ejection isovolume index, E/A: peak early diastolic LV filling velocity/peak atrial filling velocity ratio, DT: deceleration time

Urinary protein

6.9

g/dL

Color of fluid

Pale yellow

Occult blood

Alb

3.4

g/dL

Cloudiness

Slightly turbid

CBC:

T-Bil

0.55

mg/dL

Specific gravity

1.025

WBC

7,270

/µL

AST

U/L

7.2

RBC

585×10⁴

/µL

ALT

U/L

Protein

3.4

g/dL

15.5

g/dL

LDH

204

U/L

Glucose

172

mg/dL

Plt

39.6×10⁴

/µL

115

U/L

LDH

101

U/L

Serum PSA series:

ALP

274

U/L

ADA

6.4

IU/L

HD 1

166.0

ng/mL

CRP

0.17

mg/dL

Cell numbers

320

/µL

HD 30 (discharge)

65.0

ng/mL

140

mmol/L

Cytology

Class II

30 days AD

21.6

ng/mL

4.2

mmol/L

Echocardiogram:

120 days AD

4.4

ng/mL

105

mmol/L

LAD

Pleural PSA series:

BUN

mg/dL

LVDd

HD 1

192.0

ng/mL

1.06

mg/dL

LVDs

HD 30 (discharge)

109.0

ng/mL

FPG

104

mg/dL

BGA under room air on admission:

BNP

44.1

pg/mL

TEI index

0.4

7.475

E/A

0.71

PaO₂

49.4

mmHg

190

msec

PaCO₂

29.2

mmHg

Pathology of prostate:

HCO₃^-

21.0

mmol/L

adenocarcinoma (positive PSA stain)