Publication:

Effect of rigid cystoscopy and Foley urethral catheterisation on serum prostate-specific antigen levels: a prospective observational study

Background Serum prostate-specific antigen (PSA) is the cornerstone biomarker for prostate cancer detection, but its interpretation is complicated by transient elevations from non-malignant causes including mechanical urinary-tract manipulation. How much rigid cystoscopy and Foley catheterisation raise serum PSA individually and combined in one sitting remains poorly defined in the Indian setting. This study evaluated the magnitude and persistence of procedure-induced PSA elevation.

Methods This prospective observational study was conducted at RNT Medical College and Maharana Bhupal Government Hospital, Udaipur, over one year (January–December 2025). Sixty male patients were grouped by procedure: Group 1 diagnostic rigid cystoscopy alone (n=39); Group 2 Foley catheterisation alone (n=14); Group 3 Foley catheterisation followed immediately by cystoscopy in the same sitting (n=7). Serum total PSA was measured by ELISA at baseline, 1 hour and 24 hours. Paired t-tests and one-way ANOVA with Bonferroni correction were applied.

Results In Group 1, PSA rose from 1.96±1.51 to 2.72±1.81 ng/ml at 1 hour (ΔPSA 0.76 ng/ml; 38.7% rise; p<0.001) with no recovery at 24 hours (p<0.001). Group 2 showed only a small rise (ΔPSA 0.54 ng/ml; p=0.035). Group 3 showed the largest elevation (ΔPSA 3.97±5.17 ng/ml; 69.1% rise) and was significantly greater than Group 1 at 1 hour (Bonferroni p=0.001) and 24 hours (p=0.024). BPH patients had greater ΔPSA than non-BPH (1.95 vs 0.54 ng/mL; p=0.011); baseline PSA correlated strongly with ΔPSA (r=0.753; p<0.001).

Conclusions Rigid cystoscopy causes a clinically significant, sustained PSA elevation that does not recover within 24 hours. Combining Foley catheterisation and cystoscopy in one sitting produces a markedly greater rise. PSA should be deferred at least 48–72 hours after these procedures and longer in BPH patients, to avoid misleading results and unnecessary biopsies.