Role of Prostate Specific Antigen, Digital Rectal Examination and Trans Rectal Ultrasonography in the diagnosis of prostate cancer in patients with Lower Urinary Tract Symptoms (original) (raw)
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2013
The aim of this study is to compare the role of prostate specific antigen [PSA], digital rectal examination [DRE] and Trans rectal Ultrasonography [TRUS] in detection of prostate cancer among patients presenting with lower urinary tract symptoms [LUTS] and having International Prostate Symptoms Score [IPSS] not less than 7. This study was carried out in I.P.G.M.E.R and S.S.K.M Hospital, Kolkata, West Bengal, India, from March 2011 to March 2012.Sixty patients presenting with LUTS and with IPSS not less than 7, had been screened for prostate cancer using PSA estimation, DRE and TRUS. Trans rectal sextant prostate biopsy was performed in all patients. The PSA estimation revealed 85% sensitivity and 72.5% specificity for the patients with serum total PSA level >10 ng/ml. The positive predictive value [PPV] was 60.7%. If 4 ng/ml is taken as lower cut off value for serum total PSA, the sensitivity increases to 95% whereas specificity reduces to 46.66% and PPV becomes 50%.DRE alone sho...
2015
Abstract: The aim of this study is to compare the role of prostate specific antigen [PSA], digital rectal examination [DRE] and Trans rectal Ultrasonography [TRUS] in detection of prostate cancer among patients presenting with lower urinary tract symptoms [LUTS] and having International Prostate Symptoms Score [IPSS] not less than 7. This study was carried out in I.P.G.M.E.R and S.S.K.M Hospital, Kolkata, West Bengal, India, from March 2011 to March 2012.Sixty patients presenting with LUTS and with IPSS not less than 7, had been screened for prostate cancer using PSA estimation, DRE and TRUS. Trans rectal sextant prostate biopsy was performed in all patients. The PSA estimation revealed 85 % sensitivity and 72.5 % specificity for the patients with serum total PSA level>10 ng/ml. The positive predictive value [PPV] was 60.7%. If 4 ng/ml is taken as lower cut off value for serum total PSA, the sensitivity increases to 95 % whereas specificity reduces to 46.66 % and PPV becomes 50%....
Cancer, 2010
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
Asian Pacific Journal of Cancer Prevention, 2014
Purpose: To determine the utility of digital rectal examination (DRE), serum total prostate specific antigen (tPSA) estimation, and transrectal ultrasound (TRUS) for the detection of prostate cancer (PCa) in men with lower urinary tract symptoms (LUTS). Materials and Methods: All patients with abnormal DRE, TRUS, or serum tPSA >4ng/ml, in any combination, underwent TRUS-guided needle biopsy. Eight cores of prostatic tissue were obtained from different areas of the peripheral prostate and examined histopathologically for the nature of the pathology. Results: PCa was detected in 151 (50.3%) patients, remaining 149 (49.7%) showed benign changes with or without active prostatitis. PCa was detected in 13 (56.5%), 9 (19.1%), 26 (28.3%), and 103 (74.6%) of patients with tPSA <4 ng/ml, 4-10 ng/ml, 10-20 ng/ml and >20 ng/ml respectively. Only 13 patients with PCa had abnormal DRE and TRUS with serum PSA <4 ng/ml. The detection rate was highest in patients with tPSA >20 ng/ml. The association between tPSA level and cancer detection was statistically significant (p<0.01). Among 209 patients with abnormal DRE and raised serum PSA, PCa was detected in 128 (61.2%). Conclusions: The incidence of PCa increases with increasing serum level of tPSA. The overall screening and detection rate can be further improved by using DRE, TRUS and TRUS-guided prostate needle biopsies.
Saudi medical journal, 2011
OBJECTIVE To assess the significance of serum total prostate specific antigen (tPSA) and digital rectal examination (DRE) in the diagnosis of prostate cancer (PC). METHODS One hundred and eighteen patients with serum tPSA ranging between 2.5 and 10 ng/ml with lower urinary tract symptoms presented at the Urology Clinic of Soba University Hospital, Khartoum, Sudan from August 2008 and January 2010 were included in the study. Serum tPSA was measured using enzyme immunoassay method, and accordingly, the patients were classified into 2 groups: patients that had tPSA between 2.5-4.0 ng/ml; and patients that had tPSA between 4.1-10 ng/ml. The DRE was performed on all patients by a qualified urologist, and were recorded as a group with suspicion of PC, and a group with no suspicion of PC. All patients underwent transrectal sextant prostate biopsy. RESULTS The DRE alone showed 63.8% sensitivity and 68% specificity with 46.9% positive predictive value (PPV) for the diagnosis of PC. The tPSA ...
Collegium antropologicum, 2003
This study compares the value of digital rectal examination (DRE) and prostate specific antigen (PSA) determination in the detection of prostate cancer. 1,000 men aged > or = 50 from the Osijek surroundings were examined. The subjects with prostatitis were excluded from the study. The subjects with elevated concentration of total prostate specific antigen and/or digital rectal examination suspect of carcinoma underwent prostate biopsy. The rate of prostate cancer detection showed to be 3.3% for PSA > 4 ng/ml, 2% for abnormal finding of DRE, and 3.7% for combination of the two methods. Out of 35 patients with prostate cancer detected, 19 had suspect DRE finding and 32 had PSA exceeding 4 ng/ml. Thus, PSA pointed to the diagnosis of prostate cancer in 91.4%, and abnormal finding of DRE in 54.2% of cases, the difference being statistically significant. The positive predictive value was 48.7% for abnormal finding of DRE, 47% for PSA > 4 ng/ml, and 80.0% for the combination of b...
The Prostate, 2000
BACKGROUND. The 11,811 first visits and 46,751 annual follow-up visits performed since 1988 were analyzed in order to assess the efficacy of serum prostatic specific antigen (PSA) and digital rectal examination (DRE) for diagnosis of prostate cancer. METHODS. At first visit, screening included DRE and measurement of PSA using 3.0 ng/ml as upper limit of normal, demonstrated as optimal value in the course of the study. Transrectal echography of the prostate (TRUS) was performed only if PSA and/or DRE was abnormal. For elevated PSA, biopsy was performed only if PSA was above the value predicted from prostatic volume measured by TRUS. At follow-up visits, it was decided during the course of the study to use PSA alone. RESULTS. PSA was above 3.0 ng/ml in 16.6% and 15.6% of men at first and follow-up visits, respectively. Prostate cancer was found in 2.9% of men invited for screening at first visit and in only 0.4% of men at follow-up visits for a 7.1-fold decrease at follow-up visits done up to 11 years. PSA alone allowed to find 90.5% and 90.0% of cancers at first and follow-up visits, respectively, compared to 41.1% and 25.0% by DRE alone. In the presence of normal PSA, 344 and 1,919 DREs are needed to find one prostate cancer at first and follow-up visits, respectively. A significant improvement in stage of the disease is found at follow-up (215 cancers) compared to first visits (337 cancers). Comparison made between men invited for screening and those who were not invited but screened showed no significant difference in terms of incidence and prevalence of prostate cancer as well as diagnosis of cancer as a function of age or as a function of PSA, DRE, and TRUS data. The cost for finding one case of prostate cancer is estimated at Can 2,420andCan2,420 and Can 2,420andCan7,105 (first and follow-up visits, respectively, when PSA is used as prescreening). CONCLUSIONS. PSA used as prescreening and followed by DRE and TRUS when PSA is abnormal is highly efficient in detecting prostate cancer at a localized (potentially curable) stage since 99% of the cancers diagnosed were at such a localized stage, thus practically eliminating the diagnosis of metastatic and noncurable prostate cancer. The approach used is highly reliable, sensitive, efficient, and acceptable by the general population. The detection of All dollar amounts in article are given in Canadian currency.
Journal of Postgraduate Medicine, 2009
Background: Need for undertaking prostate biopsies for detection of prostate cancer is often decided on the basis of serum levels of prostate specific antigen (PSA). Aim: To evaluate the case detection rate of prostate cancer among patients presenting with lower urinary tract symptoms (LUTS) on the basis of PSA levels and to assess the scope of prostate biopsy in these patients. Setting and Design: A retrospective study from a tertiary care center. Materials and Methods: The clinical and histopathological data of 922 patients presenting with LUTS in the last five years was obtained from the medical record section. They had been screened for prostate cancer using PSA and /or digital rectal examination examination followed by confirmation with prostate biopsy. Statistical Analysis Used: Detection rate and receiver operating characteristic curve were performed using SPSS 16 and Medcalc softwares. Results: The detection rate of prostate cancer according to the PSA levels was 0.6%, 2.3%, 2.5%, 34.1% and 54.9% in the PSA range of 0-4, 4-10, 10-20, 20-50 and >50 ng/ ml, respectively. Maximum prostate cancer cases were detected beyond a PSA value of 20 ng/ml whereas no significant difference in the detection rate was observed in the PSA range of 0-4, 4-10 and 10-20 ng/ml. Conclusion: A low detection rate of prostate cancer observed in the PSA range of 4-20 ng/ml in LUTS patients indicates the need for use of higher cutoff values of PSA in such cases. Therefore we recommend a cutoff of 20 ng/ml of PSA for evaluation of detection rate of prostate cancer among patients presenting with LUTS.
Screening for prostate cancer by digital rectal examination and prostate-specific antigen
Urology, 1994
To evaluate the use of digital rectal examination (DRE), prostate specific antigen (PSA), and age-specific reference values for PSA when screening for prostate cancer in a national screening program. Methods. Data collected during Prostate Cancer Awareness Week (PCAW), 1989-1992, were used for comparing DRE and PSA. Results. More than 1,000,000 men were screened at 4141 sites from 1989-1992. The rate of abnormal DRE for all 4 years was 13.1%, and the rate of elevated PSA (>4.0 ng/mi) was 14.4% for the same period. PSA proved superior to DRE insensitivity, positive predictive value, and accuracy in making a cancer diagnosis. Screening resulted in 77.7% of diagnosed cases being determined as clinically localized disease. Age-specific PSA reference values added a slight improvement in sensitivity at lower age s and an improvement in positive predictive value in older men. Conclusions. Data from PCAW establish the success of national prostate cancer screening and suggest that further refinements with age-specific PSA reference values may improve overall results.
Arab Journal of Urology, 2013
To investigate the role of an abnormal prostate-specific antigen (PSA) level and abnormal findings on a digital rectal examination (DRE) in the detection of prostate cancer in men in Qatar. Patients and methods: Between June 2008 and September 2012, 651 patients had a transrectal ultrasonography-guided biopsy of the prostate (TRUSBP) at our centre. The indications for a biopsy were a high PSA level (>4 ng/mL), or an abnormal DRE result. Patients were assessed by a thorough history, clinical examination and routine laboratory investigations. Data, including age, DRE findings, TRUS findings, total PSA level, prostate volume and the pathology results, were evaluated. Results: The mean (SD) age of the 651 patients was 64.1 (7.4) years. Prostate cancer was detected in 181 men (27.8%), benign prostatic hyperplasia in 275 (42.2%) and prostatitis in 236 (36.4%). The sensitivity and specificity for detecting prostate cancer were 93.9% and 8.5% for an abnormal PSA level (>4 ng/mL), 46.1% and 84.7% for