前列腺癌的早期诊断

目的：评价前列腺癌早期诊断的方法及提高对一些基本诊断方法的认识。方法：对１９９１－１９９９年诊治的７０例早期前列腺癌所应用的基本诊断技术进行分析。结果：７０例患者中,６４例（９１．４％）ＤＲＥ（直肠指诊）发现前列腺异常。６６例患者接受ＰＳＡ（前列腺特异抗原）检查,其中ＰＳＡ〉４ｎｇ／ｍｌ者５２例（７８．８％）。６６例患者接受ＴＲＵＳ（经直肠前列腺Ｂ超）检查,其中５４例（８１．８％）发现异常。若将２     

Detection of prostatic carcinoma: the role of TRUS, TRUS guided biopsy, digital rectal examination, PSA and PSA density

The purpose of this study was to evaluate the efficacy of various diagnostic tests including transrectal ultrasound (TRUS), TRUS guided biopsy, digital rectal examination (DRE), prostate specific antigen (PSA), and prostate specific antigen density (PSAD) in detecting prostatic carcinomas. One hundred and thirty-four men underwent TRUS guided random, or directed and random sonographic biopsies of the prostate. The mean age was 64.67 (range, 31- 88) years. Indications for biopsy were abnormal findings suggesting prostatic carcinoma on DRE or increased levels of PSA, defined as 4.0 ng/ml or greater in a monoclonal antibody assay. PSAD was calculated by dividing the serum PSA in ng/ml to the volume of the entire prostate in cm3. The biopsy results were grouped as benign, malign and, prostatitis. The patients were also divided into three groups according to their PSA values. Of the 134 patients evaluated, 31 (23.1%) had prostate adenocarcinoma, 89 (66.4%) had benign prostatic tissue, hyperplasia or prostatic intraepithelial neoplasia, and 14 (10.4%) had prostatitis. The mean PSA and PSAD of the carcinoma group were significantly higher than those of the noncancer group. In the group of patients with PSA levels between 4 and 10 ng/ml, abnormal TRUS or DRE increased cancer detection rate, where neither PSA nor PSAD was capable of discriminating the patients with and without cancer. PSAD did not prove to be superior to the other diagnostic tests in this study. We recommend biopsy when either TRUS or DRE is abnormal in patients with PSA levels between 4 and 10 ng/ml. In the patients with PSA levels greater than 10 ng/ml, biopsy is indicated whatever the findings on TRUS or DRE are, since cancer detection rate is high.     

Diagnostic Role of Serum Free-to-Total Prostate Specific Antigen (PSA) Ratio in Prostate Cancer with Serum Total Concentration of PSA below 4 ng/mL

Purpose: To examine the effectiveness of serum free-to-total prostate specific antigen ratio (%fPSA) forthe detection of prostate cancer (PCa) in men with different serum total PSA (tPSA) categories. Materials andMethods: From January 2010 to December 2013, a total of 225 patients with lower urinary tract symptoms(LUTS) underwent tPSA and %fPSA measurements. Histological examination with calculation of Gleasonscore and whole body bone scans were performed in identified cases of PCa. Results: PCa was diagnosed in 44(19.6%) patients and the remaining 181 patients had benign prostate disease. PCa was detected in 5 (23.8%),13 (8.7%) and 26 (47.3%) cases with tPSA level ranges ≤4 ng/ml, 4 to 10 ng/ml and >10 ng/ml, respectively. Theaverage Gleason score was 7.2±0.2. Some 6 (13.6%) out of 44 PCa patients had bone metastases. The sensitivitywas 80% and specificity was 81.3% at the cut-off %fPSA of 15% in PCa patients with a tPSA level below 4 ng/mL. A lower %fPSA was associated with PCa patients with Gleason score ≥7 than those with Gleason score≤6 (11.7±0.98 vs. 16.5±2.25%, P=0.029). No obvious relation of %fPSA to the incidence of bone metastasis wasapparent in this study. Conclusions: The clinical application of %fPSA could help to discriminate PCa frombenign prostate disease in men with a tPSA concentration below 4 ng/mL.     

A new Model Consists of Intravesical Prostatic Protrusion,Prostate Volume and Serum Prostatic-Specific Antigen in the Evaluation of Prostate Cancer

The Prostate-specific antigen (PSA) level is largely used to diagnose prostate cancer (PCa) in last decades. However, its specificity is low in patients with a PSA level ranging from 4.0 to 10.0 ng/ml. This study aims to define the correlation between intravesical prostatic protrusion (IPP) and PSA and to establish a new model to predict PCa. A total of 339 patients order than 45 years examined between October 2010 and June 2012 were enrolled. Eligible patients were recommended for transrectal ultrasonography (TRUS)-guided prostate biopsies after measuring total prostate volume (TPV), tranzisional zone volume (TZV) and IPP. The levels of total PSA (tPSA), free PSA (fPSA) were analyzed by using Hybritech calibrated Access tPSA and fPSA assays. A new mathematical model, named IPP removed PCa predicting score (IRPPS), consists of tPSA, TZV and IPP was established. The predictive accuracy of IRPPS, PSA density (PSAD), %PSA and tPSA were compared using receiver-operator characteristic (ROC) analysis. Eighty-six patients had PSA levels of 4.0–10.0 ng/ml. Twenty of them were diagnosed as PCa. Using ROC curves, the areas under the curve for IRPPS, PSAD and %PSA and tPSA were 0.786, 0.768 and 0.664 and 0.585, respectively. We suggested IPP grade had a significant relationship with serum tPSA levels. The predictive accuracy of IRPPS was higher than the other 3 indictors.     

The role of prostate-specific antigen as part of the diagnostic triad and as a guide when to perform a biopsy.

The authors reviewed the results and relationship of prebiopsy prostate-specific antigen (PSA) assay, digital rectal examination (DRE), and transrectal ultrasound (TRUS) in 124 consecutive patients who underwent a prostate biopsy because of abnormal results of either DRE or TRUS. Results of the three tests (PSA, DRE, and TRUS) showed abnormalities in 54%, 75%, and 84.6% of patients, respectively; biopsy results were positive for cancer in 45.2%. Cancer detection rate increased as the PSA value increased from less than or equal to 4 ng/ml (17.5%) to more than 4 ng/ml (68.7%) to more than 20 ng/ml (83.3%), and as the number of positive tests increased (6.9% for one, 32.7% for two, and 82.6% for three). The PSA assay was the most important parameter of the diagnostic triad. These results suggested that regardless of DRE and TRUS findings, PSA less than or equal to 4 ng/ml confers a low prostate cancer risk, PSA more than 4 ng/ml but less than or equal to 10 ng/ml confers an intermediate prostate cancer risk, and PSA more than 10 ng/ml confers a high prostate cancer risk. Regardless of other findings, all patients with a PSA value more than 10 ng/ml require biopsy because of the high likelihood of cancer. All patients with abnormal DRE or TRUS results still require biopsy despite a low index of suspicion of prostate cancer when the PSA value is less than or equal to 4 ng/ml.     

Transrectal ultrasound in detecting prostate cancer compared with serum total prostate-specific antigen levels

We carried out a retrospective study to review the efficiency of grey-scale transrectal ultrasonography (TRUS) in detecting prostate cancer compared with the data in recent published work, including alternative imaging methods of the prostate gland. Our study group consisted of 830 patients who underwent TRUS-guided biopsy of the prostate between May 2000 and June 2004. The relation between abnormal TRUS findings and serum total prostate-specific antigen (tPSA) levels was evaluated in patients with prostate cancer who were divided into three different groups according to serum tPSA levels. Group I included patients with tPSA levels of 4-9.9 ng/mL, group II included tPSA levels of 10-19.9 ng/mL and group III included patients with tPSA levels of 20 ng/mL or more. In general, TRUS detected 185 (64%) of 291 cancers with a specificity of 89%, a PPV of 76% and an accuracy of 80%. TRUS findings enabled the correct identification of 22 (56%) of the 39 cancers in group I, 28 (30%) of the 93 cancers in group II and 135 (85%) of the 159 cancers in group III. In conclusion, TRUS alone has a limited potential to identify prostate cancer, especially in patients with tPSA levels lower than 20 ng/mL. Therefore, increased numbers of systematically placed biopsy cores must be taken or alternative imaging methods are required to direct TRUS-guided biopsy for improving prostate cancer detection.     

Prostate-specific antigen, digital rectal examination, and transrectal ultrasound in predicting the probability of cancer.

Over a 4 1/2 year period, 1,940 asymptomatic men were entered in a prostate cancer detection program consisting of digital rectal examination (DRE), prostate-specific antigen (PSA), and transrectal prostate ultrasound (TRUS). Four hundred and sixteen biopsies were performed resulting in the diagnosis of 79 cancers; 82% had clinically organ confined tumors. A recommendation for biopsy was made in 260 (62%) based on the TRUS alone, 55 (13%) by DRE alone, 92 (22%) when the DRE and TRUS were both abnormal, and in 9 (2.2%) cases when only PSA levels were elevated. The DRE, PSA, and TRUS were abnormal in 1,261 (65%), 989 (51%), and 1,552 (80%) of the patients with cancer, respectively. Prostate cancer detection increased as the serum PSA level increased above 4 ng/ml. The positive predictive value of both DRE and TRUS were significantly influenced by an elevated PSA, (P = .042 and P less than .00005, respectively). The results of this study support the idea that, although the prostate cancer detection rate is influenced by these three modalities and the detection rate of localized disease can be improved by early detection programs, its effect on mortality rates remains undefined at this time.     

Population-based screening for prostate cancer by measuring free and total serum prostate-specific antigen in Iran.

PURPOSE: To evaluate the natural background of prostate cancer in Iran a large population-based study of screening using total prostate-specific antigen (tPSA) and per cent free PSA (fPSA) as the initial test was performed. MATERIALS AND METHODS: For 9 years (1996 to 2004) in Tehran, Iran, 3670 Iranian men older than 40 years were mass checked by PSA-based screening. They were invited to have a digital rectal examination (DRE), serum PSA assay and transrectal ultrasonography (TRUS)-guided sextant prostate biopsy to see if the DRE was clinically suspicious of malignancy, the serum PSA was > or =2.1 ng/ml or free-to-total PSA (f/tPSA) ratio < or=15%. RESULTS: In 433 (11.8%) of screened males, tPSA levels exceeded the cut-off value of > or =2.1 ng/ml and 128 prostate cancers were diagnosed [positive predictive value (PPV) 29.6%] corresponding to an overall detection rate of 3.5%. Altogether 138 cancers were detected (detection rate 3.8%); none were stage M(1), three were stage N(+) and 4 stage T(3). A threshold tPSA of > or =2.1 ng/ml would have detected 128 cancers in 447 biopsied men (PPV 29%). There were 109 of 138 (79%) men with cancer who had an f/tPSA of < or =15%, while 152 of 305 (49.8%) with benign biopsies had a f/tPSA of < or =15%, which corresponds to a PPV of 30.8%. CONCLUSION: PSA-based screening with low PSA cut-off values increase the detection rate of clinically significant, organ confined and potentially curable prostate cancer. Further studies are warranted in order to determine the incidence and prevalence of prostate cancer in different ethnic groups.     

The relationship of prostate-specific antigen to digital rectal examination and transrectal ultrasonography. Findings of the American Cancer Society National Prostate Cancer Detection Project.

The participating institutions of the American Cancer Society National Prostate Cancer Detection Project did 520 biopsies on 2425 men over a 3.5-year period. A total of 88 cancers were confirmed pathologically, 93% of which clinically were organ confined. In 324 men (62.3%), a recommendation for biopsy was made based solely on the results of transrectal ultrasonography (TRUS); in 69 patients (13.3%), solely on the digital rectal examination (DRE); in 116 patients (22.3%), on abnormal DRE and TRUS examinations; and in 11 patients (2.1%), in whom DRE and TRUS were normal, on elevated prostate-specific antigen (PSA) levels. The TRUS was abnormal in 80.6% of men found to have cancer, and the PSA level and DRE were abnormal for 67% and 50% of cancers, respectively. The influence of PSA level on cancer detection increased as the serum level increased above 4 ng/ml. The positive predictive values of both the DRE and TRUS were influenced significantly by the presence of an elevated PSA level (P = 0.044 and P less than 0.001, respectively). The results of this ongoing multicenter study support the following statements: (1) the prostate cancer detection rate is influenced by this diagnostic triad and (2) the detection rate of organ-confined disease can be improved substantially by early detection programs.     

Editorial comments

Ninety-nine of 105 consecutive men who underwent transrectal prostatic ultrasound (TRUS) at Highland Park Hospital had the results correlated with digital rectal examination (DRE), serum prostate specific antigen (PSA), and biopsy results. Ninety-six cases had evaluable ultrasound studies. Thirty-two of the 99 who underwent biopsy had primary carcinoma of the prostate. Prostate volume, predicted PSA, a ratio of observed/predicted PSA, and Gleason score were examined. There was no correlation between age and prostate volume, volume and the presence of carcinoma, or PSA and Gleason score. Thirty-one point six percent of the abnormal DREs, 36.6% of the abnormal TRUSs, and 40.6% of the elevated PSAs occurred in men with prostatic carcinoma (PCa). If PSA was normal (less than or equal to 4.0 ng/ml) and either DRE or TRUS was abnormal, then the risk of carcinoma was 2.9%. If PSA was elevated, regardless of the other two tests, the risk of finding PCa was at least 38%. If all three tests were abnormal, the risk of carcinoma was 38% in our series and 68% in a meta-analysis. Many men with PSA values between 4 and 10 ng/ml have benign biopsies. However, close future follow-up with consideration of repeat biopsy should be strongly considered. © 1994 Wiley-Liss, Inc.     

经直肠超声引导前列腺穿刺活检方案的合理选择

目的 分析经直肠超声(TRUS)和前列腺特异性抗原(PSA)及其相关参数在前列腺穿刺活检中的作用,探讨个体化前列腺穿刺方案的可行性。方法 回顾性分析195例患者的首次穿刺活检资料,所有患者均采用系统8点穿刺方案,并对可疑病灶增加1~2点。依据穿刺病理结果,分析前列腺癌(PCa)检出率与TRUS、PSA及其相关参数的关系。结果 195例患者中检出PCa 98例(50.3%),其中PSA 4~10 ng/mL组45例,检出PCa 16例(35.6%),其中TRUS(+)且PSATZ≥0.35 ng/mL² 210例均证实为PCa;PSA＞10 ng/mL组150例,检出PCa 82例(54.7%)。PSA 4~10 ng/mL与PSA＞10 ng/mL两组患者PCa检出率差异有统计学意义(P＜0.05),且两组中TRUS(+)与TRUS(-)患者相较PCa检出率差异均有统计学意义(P＜0.01)。结论 依据TRUS、PSA及其相关参数制定个体化前列腺穿刺方案是可行的。     

前列腺肿物检查方法的临床评价

目的评价血清前列腺特异性膜抗原（PSA）和各项物理检查对指导前列腺活检的意义。方法结合血清PSA、直肠指诊（DRE）、直肠B超（TRUS）及磁共振成像（MRI）检查,对148例可疑前列腺病变患者,经直肠B超引导下行前列腺穿刺活检。结果前列腺活检阳性率为43.9%（65/148）。DRE和PSA对前列腺癌的诊断有意义(P＜0.05),其中PSA加DRE、TRUS及MRI对前列腺癌的诊断明显高于PSA或DRE（P<0.01）,但前述三者之间对前列腺癌的诊断差异无显著性（P=0.46,P＝0.16,P＝0.52）。MRI的敏感性高于DRE和TRUS（P=0.05,P=0.01）,TRUS的特异性高于PSA或MRI（P=0.02,P=0.001）。结论前列腺活检是诊断前列腺癌的重要手段,其初步筛选以DRE加PSA为主,同时结合TRUS及MRI,可提高筛选的敏感性和特异性,避免不必要的活检。DRE或PSA加TRUS或MRI在前列腺活检筛选中可提高前列腺活检的阳性率。     

Prostate cancer screening: current trends and future implications.

Screening for prostate cancer represents a clinical dilemma with no clear evidence to suggest decreased mortality from any diagnostic test. We now possess new knowledge regarding optimal combinations of DRE, TRUS, and PSA. While DRE and TRUS may be too subjective and PSA too nonspecific, their combined predictive values identify not only men at high risk but also those for whom continued frequent screening may not be cost effective. A monoclonal PSA decision level of no more than 4.0 ng/ml should be used, since 40 percent of cancers detected from 4.0 to 10.0 ng/ml already have extracapsular extension. Assuming that DRE is performed by experienced examiners, the combination of PSA and DRE should produce cost-effective early detection and minimize missed cancers below 4.0 ng/ml. TRUS should be reserved for those patients with either PSA elevations and/or DRE abnormalities. The use of TRUS gland volume data to further modify PSA decision levels, such as the "predicted" PSA concept, may also improve TRUS biopsy criteria and predictive values. Prostate cancer detection can then be objectively limited to a small percentage of the population and better selected for earlier, more localized disease. The ultimate decrease in mortality from screening remains to be demonstrated in randomized trials or observed only after decades of increased public awareness about prompt early detection combined with effective, definitive therapy.     

经直肠超声阴性前列腺癌患者的临床病理特征分析

目的 探讨穿刺病理证实为前列腺癌而经直肠超声（TRUS）检查阴性患者的临床病理特征。方法 选择2015年1月至2017年1月TRUS引导下经会阴途径前列腺穿刺后病理诊断为前列腺癌患者73例,根据TRUS图像特征分为TRUS阴性组31例与TRUS阳性组42例,比较两组患者的临床病理特征。结果TRUS阳性组血清PSA水平为（71.27±9.71）ng／ml,高于TRUS阴性组的（41.62±6.43）ng／ml,差异有统计学意义（P<0.05）,而两组的年龄、主要区域与次要区域的Gleason评分、微血管计数、癌组织长度占穿刺组织长度比例（最典型一针）、临床分期、无明显自觉症状例数、血管淋巴管侵犯例数、神经侵犯例数及浸润周围组织例数的差异均无统计学意义（P＞0.05）。结论TRUS阴性前列腺癌患者较TRUS阳性患者,除血清PSA水平明显较低外,临床特征、病理特征和侵袭性并无明显区别。对伴血清PSA水平或（和）临床症状异常而TRUS阴性者,仍需积极行前列腺系统穿刺病理检查,以免贻误临床治疗。     

Screening for prostate cancer using prostate-specific antigen alone as a first-line checkup parameter: results of the health checkup system

Background: The incidence of prostate cancer in Japan is notvery high but it is the most increasing malignant tumor form.To decrease the mortality from cancer, detection of early cancerand early treatment are most effective. As a primary screeningfor prostate cancer, measurement of serum prostate-specificantigen(PSA) added to the health checkup system has not beenassessed. Methods: Among males who received a health checkup during a30-month period, serum PSA levels were measured in males whodesired prostate cancer screening. The cut-off value for PSAwas 4.0 ng/ml. Males with serum PSA levels exceeding this valuewere referred for further screening by digital rectal examination(DRE) and transrectal ultrasonography (TRUS). In secondary screening,in all males with PSA levels of 10.0 ng/ml or more and in malesin whom PSA levels were within the gray zone (4.0-10.0 ng/ml)and either DRE or TRUS showed abnormal findings, systematicprostate sextant needle biopsy was performed. Results: Of 24 528 males who received a health checkup, 1125(4.6%) underwent prostate cancer screening. In 60 (5.3%) ofthese males, PSA levels exceeded the cut-off value. In 34 of50 males who received further screening, prostate biopsy wasperformed. Seventeen males were diagnosed as having prostatecancer. Detection rates of prostate cancer were 1.53% (17/1125)in males overall and 2.1% (17/819) in males     

The clinical utility of measuring total PSA, PSA density, gamma-seminoprotein and gamma-seminoprotein/total PSA in prostate cancer prediction

BACKGROUND: To evaluate whether serum total prostate-specific antigen (PSA), PSA density (serum total PSA level divided by prostate volume), gamma-seminoprotein and gamma-seminoprotein/total PSA ratio could predict prostate cancer (PCa) prior to biopsy. METHODS: A total of 316 consecutive patients who had undergone transrectal prostate biopsy and/or transurethral resection were examined. The prostate volume was determined by transrectal ultrasonography (TRUS) and the ability of the above-mentioned four variables to distinguish PCa from benign prostatic hyperplasia (BPH) was evaluated. RESULTS: PCa was detected in 61 cases. Receiver-operating characteristic (ROC) analysis revealed that both the PSA density and serum total PSA were the most useful predictors of PCa among the four variables. For the patients with a serum total PSA level of 4.1-10.0 ng/ml, PSA density was significantly more accurate than total PSA (p < 0.005). An optimum PSA density value of 0.18 was chosen as a cutoff because it showed the highest sum of sensitivity and specificity, 92 and 54%, respectively. Using this PSA density cutoff, the number of biopsies could have been reduced to 57 from 63% when compared with a PSA density of 0.15. CONCLUSIONS: PSA density was significantly more accurate than other variables in predicting PCa. To avoid unnecessary biopsies, the PSA density cutoff value of 0.18 would be recommendable for determining a prostate biopsy for Japanese males with a serum total PSA level of 4.1-10.0 ng/ml.     

High prevalence of screening-detected prostate cancer among Afro-Caribbeans: the Tobago Prostate Cancer Survey.

Risk for prostate cancer is high among African Americans.We hypothesized that risk for prostate cancer is also high in other populations of African descent. Our objective was to determine the screening-detected prevalence of prostate cancer in the predominantly Afro-Caribbean population on the island of Tobago. Male residents, ages 40-79 years, were invited to participate in a population-based screening for prostate cancer using serum prostate-specific antigen (PSA) and digital rectal exam (DRE). Men with elevated PSA (>or=4 ng/ml) or abnormal DRE were offered an ultrasound-guided sextant biopsy of the prostate gland. Men (2484), ages 40-79 years, underwent prostate cancer screening between September 1997 and June 2001. Mean age was 55.9, SD was 10.6 years, and median was 54 years. Mean serum PSA was 14.8 ng/ml, SD was 376 [excluding 4 values >or= 2 SD above the mean (1,112, 1,317, 1,818, and 18,330 ng/ml) mean PSA was 5.5 ng/ml and SD was 29.6], and median PSA was 1.2 ng/ml. Elevated PSA and/or abnormal DRE were observed in 31% (759 of 2484) overall, and in age groups 40-49 (87 of 843, 10%), 50-59 (201 of 729, 28%), 60-69 (262 of 584, 45%), and 70-79 (209 of 328, 64%). Of 681 men biopsied, 259 (38%, or 10% of the 2484 screened) were diagnosed with prostate cancer. Age-specific rates of screening detected prostate cancer were: 1%, ages 40-79 years; 7%, ages 50-59 years; 18%, ages 60-69 years; and 28%, ages 70-79 years. These screening results indicate a very high screening-detected prevalence of prostate cancer in this population of West African descent. These data support the hypothesis that populations of African descent share genetic and/or lifestyle factors that contribute to their elevated risk for prostate cancer.     

Value of Prostate Cancer Screening in a Comprehensive Community Cancer Center

Early detection of prostate cancer may help decrease cancer deaths from this disease despite the increased incidence of prostate cancer. In 1990 and 1991 we conducted one-day “screens” for prostate cancer. This analysis was undertaken to determine the value of the screening procedures for detecting prostate cancer in the community. A total of 579 men, aged 39-84 years (mean 58 years), were evaluated by digital rectal examination (DRE) by a urologist, serum prostate specific antigen (PSA) determination by monoclonal antibody assay, and completion of a detailed questionnaire. Forty-eight percent had not seen a physician in over 2 years; 17% had a 1st- or 2nd-degree relative with prostate cancer. There was a 25% “suspicious” rate including 76 (13%) men with abnormal DRE only, 48 (8%) with abnormal PSA only, and 21 (4%) with abnormal DRE and PSA. Patients with findings suspicious for cancer were recontacted by telephone at 2-month intervals for 6 months to determine outcome because subsequent diagnostic management was at the discretion of practicing physicians. By 6 months, 84% of patients with abnormal findings had seen a physician as recommended. Of the 76 with abnormal DRE only, 11 were biopsied and only one cancer was found (9%). Of 48 with an elevated PSA only, 19 were biopsied; 11 (58%) had cancer (9/9 positive transrectal ultrasound) and 8 had no cancer at biopsy (5/5 negative transrectal ultrasound). Of 21 with both tests suspicious, 11 were biopsied and 9 had cancer (82%). Thus, by 6 months after each screen there was a 3.5% overall cancer detection rate for the whole population screened, a 67% positive biopsy rate among those with an elevated PSA, a 45% positive biopsy detection rate among those with an abnormal DRE, and a 51% positive biopsy rate among all those biopsied. Eighty percent of the PSA elevations were between 4.1 and 10.0 ng/ml. This screening experience yielded several new diagnoses of prostate cancer, and the use of serum PSA levels and ultrasoundguided biopsy was associated with a high positive biopsy rate for cancer.     

Histological diagnosis of prostate cancer in Korean men aged 70-79 years

BACKGROUND: The objective of this study was to evaluate the value of the prostate-specific antigen (PSA) in the diagnosis of prostate cancer in elderly Korean men, aged 70-79 years. METHODS: Patients with an abnormal digital rectal examination (DRE) and/or a serum PSA level greater than 2.0 ng/ml underwent a biopsy. A total of 344 men (median age 73 years) constituted the study cohort. RESULTS: Of 344 men, 163 (47.4%) were diagnosed with prostate cancer upon initial biopsy. The positive predictive value (PPV) for cancer was 48.4% for a PSA cutoff of 4 ng/ml, 65.3% for a cutoff of 10 ng/ml, and 87.0% for a cutoff of 20 ng/ml. When combined with an abnormal DRE, the predictive values for these PSA cutoffs increased to 79.3, 87.3 and 100%, respectively. When 10 ng/ml was chosen as a PSA cutoff level, about 50% of patients were found to have a Gleason score of 7 or higher. When 4 ng/ml was chosen as a PSA cutoff level, more than 50% of patients with an abnormal DRE were found to have a Gleason score of 7 or higher. CONCLUSIONS: In elderly men, more than 50% of patients are found to have cancers with a Gleason score of 7 or higher when their PSA level is greater than 10 ng/ml. This threshold may be lowered to 4 ng/ml in the presence of an abnormal DRE. Our findings provide a rationale for recommending a prostate biopsy in elderly patients with an abnormal DRE and/or an elevated serum PSA level. However, at present, it is not clear whether elderly men have better outcomes when they undergo cancer screening.     

Changing role of 3 screening modalities in the European randomized study of screening for prostate cancer (Rotterdam).

A randomized screening trial was started in Europe to show the effect of early detection and treatment of prostate cancer on mortality (European Study on Screening of Prostate Cancer). In one centre (Rotterdam), the screening protocol initially consisted of 3 screening tests for all men: prostate-specific antigen (PSA), digital rectal examination (DRE) and transrectal ultrasonography (TRUS). A PSA value of >/=4 ng/ml and/or an abnormality on DRE and/or TRUS were taken to indicate that biopsy was required. In this study, we examined the possibilities for a more efficient screening protocol. A logistic-regression model was used to predict the number of cancers for PSA < 4 ng/ml if all men were biopsied (predictive index, PI). Effects of a change in PSA cut-off on the screening results were explored. Weights were applied to procedures and cancers to explore the possibility of expressing differences between protocols in one overall figure. Biopsies in men with PSA < 1 ng/ml and a positive DRE or TRUS were very inefficient. Applying DRE and TRUS only in the PSA ranges 1.5 to 3.9 and 2 to 3.9 ng/ml to determine whether a biopsy was required would result in a decrease of 29 to 36% in biopsies and a decrease of 5 to 8% in cancers. However, the results of DRE and TRUS could not be duplicated entirely. A protocol with only PSA >/= 3 ng/ml as a direct biopsy indicator resulted in a decrease of detected cancers by 7.6% and of biopsies by 12%, also a much simpler screening procedure. Use of the PI would give more efficient protocols, but this should be viewed as a preliminary finding, with the disadvantage of necessitating many additional screening visits. Since the results of DRE and TRUS could not be duplicated, a change in protocol towards PSA >/= 3 ng/ml appears acceptable. If this proves effective, a final judgement about the optimal combination of screening tests may be made. Int. J. Cancer (Pred. Oncol.) 84:437-441, 1999.