engleski

Diagnostic value of age specific prostate specific antigen in prostate cancer patients.

The aim of the study was to analyze age distribution in patients undergoing early diagnosis procedures within the scope of the prostate cancer program, and to compare diagnostic accuracy of total prostate specific antigen (tPSA) test and age specific PSA range test in differentiating prostate cancer from benign prostate hyperplasia in order to reduce the number of unnecessary biopsies. Age distribution was analyzed in 394 patients with negative digitorectal examination, and diagnostic accuracy was analyzed in 80 patients with negative digitorectal and tPSA of 4.0-9.9 ng/mL. All 80 patients underwent prostate biopsy under transrectal ultrasound guidance obtaining at least six cores. Statistical analysis included t-test, Mann-Whitney rank sum test, specificity and sensitivity, positive and negative predictive value, and detection rate. The patient mean age was 67.0 years. Only 22% were self referred to the early diagnosis program seeking PSA and urologist consultation while being free from any other urologic difficulties. This population was significantly younger in comparison with patients referred to urologist by general practitioner for their micturition difficulties (Mann-Whitney test, p<0.001). Total PSA differentiated significantly prostate cancer from benign prostate hyperplasia (p=0.007, t-test). Positive predictive value for tPSA and age specific PSA range test did not differ significantly (16.2 vs. 17.6%). The sensitivity and specificity of agespecific PSA range test was 92.3% and 16.41%, respectively. It is concluded that there is the need of additional public health education about prostate cancer since only 22% of the respective population seek urology consultation and PSA testing, being aware of the benefits of the early diagnosis of prostate cancer. Up to 38% of patients included in the early diagnosis program are beyond target population since no curable treatment could be offered to them even if the diagnosis of prostate cancer was established. Although age specific PSA range test reduces the rate of biopsies by 16.4%, 7.6% of prostate cancers are thus missing, whereas false positive results account for as many as 83.58% of cases, clearly calling for search for the potentially better ways of reducing the number of unnecessary prostate biopsies.

Prostatic neoplasms - diagnosis; Prostate specific antigen; Prostati neoplasms - pathology; Neoplasms staging - methods

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