Evaluation of the role of digital rectal examination and prostate specific antigen in diagnosis of prostate cancer

Abstract

Objectives: In this study, we examined the value of prostate specific antigen (PSA) and digital rectal examination (DRE) in prostate cancer detection among men. Materials and methods: Between January 2006 and July 2011, transrectal prostate needle biopsy was performed in 349 patients with abnormal DRE and/or >4ng/ml serum total PSA level were involved in the study. According to the histopathological examination, the patients were divided into two groups as without and with prostate cancer and their data were compared. Results: At the end of the histopathological examination, 121 (32.4%) cases had prostate cancer and 252 (67.6%) cases found without prostate cancer. Mean age and mean PSA values were higher and prostate volume was lower in the prostate cancer group than the other group. Prostate cancer was detected in 73 of the patients (66.4%) whose DRE was abnormal. In prostate cancer group, Gleason scores of 47 patients\' (38.8%) were “6”, Gleason scores of 42 patients\' (34.7%) were “ 7” and Gleason scores of 32 patients\' (26.5%) were between 8 and 10. Positive predictive values for high serum total PSA level (>4 ng/ml) and abnormal DRE were found as 39.7% and 66.4% respectively. Conclusions: Only serum total PSA measurement or only DRE is inadequate differential methods for differentiation of benign and malign prostate diseases. When DRE was assessed with serum total PSA level, cancer detection rate and reliability increases.

Keywords

• Prostate cancer, prostate biopsy, prostate specific antigen, digital rectal examination

Prostat kanseri tanısında prostat spesifik antijen ve parmakla rektal muayene bulgularının rolünün değerlendirilmesi

Öz

Amaç: Çalışmada, prostat spesifik antijen (PSA) ve parmakla rektal muayene (PRM)\'nin erkeklerde prostat kanserini saptamadaki değerini araştırdık. Gereç ve yöntem: Ocak 2006-Temmuz 2011 tarihleri arasında normal olmayan PRM ve/veya total PSA değeri 4 ng/ml üzerinde saptanan ve transrektal prostat iğne biyopsisi yapılan 373 hasta çalışmaya alınmıştır. Hastalar histopatolojik inceleme sonuçlarına göre; prostat kanseri saptanan ve saptanmayan olarak iki gruba ayrılmıştır. Her iki grubun verileri karşılaştırılmıştır. Bulgular: Histopatolojik inceleme sonucunda, 121 (%32.4) hasta prostat kanseriyken 252 (%67.6) hasta prostat kanseri değildi. Ortalama yaş ve ortalama PSA değeri prostat kanseri grubunda diğer gruba göre yüksek iken, ortalama prostat hacmi daha düşük saptandı. PRM bulguları normal olmayan 110 hastanın 73\'ünde (%66.4) prostat kanseri saptandı. Prostat kanseri grubunda, 47 hastanın (%38.8) Gleason skoru “6”, 42 hastanın (%34.7) Gleason skoru “7”, 32 hastanın (%26.5) Gleason skoru “8-10” arasında bulundu. Serum total prostat spesifik antijen (PSA) yüksekliğinin (>4 ng/ml) ve normal olmayan parmakla rektal muayene (PRM) bulgularının pozitif öngörü değerleri sırasıyla %39.7 ve %66.4 olarak bulundu. Sonuç: Serum total PSA değeri veya PRM tek başına iyi ve kötü huylu prostat hastalıklarının ayrımında yeterli değildir. PRM, serum total PSA değeri ile beraber değerlendirildiğinde kanser yakalama oranı ve güvenilirliği artmaktadır.

Anahtar Kelimeler

• Prostat kanseri, prostat biyopsisi, prostat spesifik antijen, parmakla rektal muayene

Kaynakça

1. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2008. CA Cancer J Clin 2008;58(2):71-96.
2. Sandblom G, Varenhorst E, Rosell J, Löfman O, Carls- son P. Randomised prostate cancer screening trial: 20 year follow-up. BMJ 2011;31(2);342-9.
3. Makarov DV, Loeb S, Magheli A, et al. Significance of preoperative PSA velocity in men with low serum PSA and normal DRE. World J Urol 2011;29(1):11-4.
4. Lee F, Littrup PJ, Torp-Pederson ST. Prostate can- cer: comparison of transurethral US and digital rectal exam on screening. Radiology 1988;168(2): 389-94.
5. Bergstralh EJ, Roberts RO, Farmer SA, Slezak JM, Lieber MM, Jacobsen SJ. Population-based case- control study of PsA and DRE screening on prostate cancer mortality. Urology 2007;70(5):936-41.
6. Cooner WH, Mosley BR, Rutherford CL Jr, et al. Pros- tate cancer detection in a clinical urological practice by ultrasonography, digital rectal examination and prostate specific antigen. J Urol 1990;143(6):1146-52.
7. Tuncel A, Ağraş K, Aslan Y, Tekdoğan ÜY, Akbulut Z, Atan A. Tranrektal prostat iğne biyopsisi sonrasında prostat kanseri saptanmayan ve saptanan hastaların verilerinin analizi: retrospektif bir çalışma. Turk J Urol 2004;30(2):148-54.
8. Catalona WJ, Richie JP, Ahmann FR, et al. Compari- son of digital rectal examination and se-rum prostatic- specific antigen in the early detecti-on of prostate can- cer: Results of a multicenter tri-al of 6630 men. J Urol 1994;151(5): 1283-90.

9. Carter HB, Pearson JD, Metter EJ, et al. Longitudi- nal evaluation of prostate-specific antigen levels in men with and without prostate disease. JAMA 1992; 267(16):2215-20.
10. Catalona WJ, Smith DS, Ornstein DK. Prostate can- cer detection in men with serum PSA concentrations of 2.6 to 4.0 ng/mL and benign prostate examination. Enhancement of specificity with free PSA measure- ments. JAMA 1997;277(18):1452-5.
11. Arcangeli CG, Ornstein DK, Keetch DW, et al: Pros- tate-specific antigen as a screening test for prostate cancer. Urol Clin North Am 1997;24(2):299-306.
12. Babaian JR, Johnston DA, Naccarato W, Ayala A, Bhadkamkar VA, Fritsche HA. The incidence of pros- tate cancer in a screening population with a serum prostate specific antigen between 2.5 and 4.0 ng/ml: relation to biopsy strategy. J Urol 2001;165(3):757-60.
13. Akdaş A, Tarcan T, Türkeri L, Cevik I, Biren T, Gürmen N. The diagnostic accuracy of digital rectal examina- tion, transrectal ultrasonography, prostate specific an- tigen and PSA density in prostate carcinoma. Br J Urol 1995;76(1): 54-6.
14. Makinen T, Tammela TL, Hakama M, et al. Prostate cancer screening within a prostate speci-fic antigen range of 3 to 3.9 ng/ml: a comparison of digital rectal examination and free prostate specific antigen as sup- plemental screening tests. J Urol 2001;166(4):1339- 42.
15. Masieri L, Lanciotti M, Nesi G, et al. Prognostic role of perineural invasion in 239 consecutive patients with pat-hologically organ-confined prostate cancer. Urol Int 2010;85(4):396-400.
16. Partin AW, Mangold LA, Lamm DM, et al. Contem- porary update of prostate cancer staging nomograms (Partin tables) for the new millennium. Urology 2001; 58(6):843-8.