Evaluation of prostatic cancer prevalence in patients with prostatic-specific antigen between 4 and 10 and normal digital rectal examination

Tadayon, Farhad; Arezegar, Hamid Reza; Khorrami, Mohammad Hatef; Juzdani, Rasoul Hashemi; Shahdoost, Amir Abbas; Mellat, Mehdi

Evaluation of prostatic cancer prevalence in patients with prostatic-specific antigen between 4 and 10 and normal digital rectal examination

Authors

Department of Urology, Isfahan University of Medical Science, Isfahan, Iran

Abstract

Background: Prostate cancer is one of the most common male cancers. The prevalence of prostate cancer is different due to genetic and environmental factors. Diagnosis of prostate cancer is by biopsy due to prostate-specific antigen (PSA) and Digital Rectal Examination (DRE). Controversy about decision making for prostate biopsy in PSA between 4 and 10 and normal DRE, is one of the problems in this time. In this study we evaluated the prevalence of prostate cancer in males with PSA between 4 and 10 and normal DRE. We also evaluated the PSA density and percent of free PSA in patients with prostate cancer.
Materials and Methods: A total of 121 males with PSA between 4 and 10 and normal DRE, were evaluated. Then, transrectal ultrasonography (TRUS) andprostate biopsy from 12 points of peripheral zone, was done.These data were analyzed by Chi-square, t-test and ANOVA and Roc curve.

Results: In this study, the prevalence of prostate cancer in PSA between 4 and 10 and normal DRE, was evaluated, 29.8%. With use of Roc curve, PSA density cutoff point was calculated 0.12 and percent of free PSA cutoff point, was calculated, 18%.

Conclusion: In males with PSA between 4 and 10 and normal DRE, PSA density smaller than 0.12-0.15, and percent of free PSA greater than 18%, the prevalence of prostate cancer is very few and we can safely ignore the TRUS and prostate biopsy in these males and eliminate its costs and side effects.

Keywords

References

1.	Ballentine H. Diagnosis and staging of prostate cancer. In: Allaf ME, Carter HB, editors. Textbook of urology.Wein-Campbell-Walsh Urology. Philadelphia: Saunders Company; 2007. p. 291231.
2.	Partin AW, Kattan MW, Subong EN, Walsh PC, Wojno KJ, Oesterling JE, et al. Combination of prostate-specific antigen, clinical stage, and gleason score to predict pathological stage of localized prostate cancer. JAMA 1997;277:1445-51.
3.	Catalona WJ. PSA testing: Who, what, and when. School of Medicine in Chicago. Available from: http://www.ajaxpro.info. 2006 [Last accessed on 2006 Jan].
4.	Luboldt HJ, Swoboda A, Börgermann C, Fornara P, Rübben H. Early Detection Project Group of the German Society of Urology. Clinical usefulness of free PSA in early detection of prostate cancer. Onkologie 2001;24:33-7.
5.	Klingler HC, Woo H, Rosario D, Cutinha PE, Anderson J, Ward AM, et al. The value of prostate specific antigen (PSA) density and free: Total PSA ratio in selecting patients with a normal digital rectal examination and intermediate total PSA levels for further investigation. Br J Urol 1998;82:393-7.
6.	Catalona WJ, Partin AW, Slawin KM, Brawer MK, Flanigan RC, Patel A, et al. Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: A prospective multicenter clinical trial. JAMA 1998;279:1542-7.
7.	Ozen H, Aygün C, Ergen A, Sözen S, Aki FT, Uygur MC. Combined use of prostate-specific antigen derivatives decreases the number of unnecessary biopsies to detect prostate cancer. Am J Clin Oncol 2001;24:610-3.
8.	Han M, Potter SR, Partin AW. The role of free prostate-specific antigen in prostate cancer detection. Curr Urol Rep 2000;1:78-82.
9.	Karazanashvili G, Managadze L. Prostate-specific antigen (PSA) value change after antibacterial therapy of prostate inflammation, as a diagnostic method for prostate cancer screening in cases of PSA value within 4-10 ng/ml and nonsuspicious results of digital rectal examination. Eur Urol 2001;39:538-43.
10.	Shtricker A, Shefi S, Ringel A, Gillon G. PSA levels of 4.0-10 ng/mL and negative digital rectal examination. Antibiotic therapy versus immediate prostate biopsy. Int Braz J Urol 2009;35:551-5.

Advanced Biomedical Research