Abstract

Background: In clinical practice, biopsies are generally performed only when the results of a prostate specific antigen,(PSA) test or digital rectal examination (DRE) are abnormal. This leads to misdiagnosis of most small prostatic cancers,present in many older men. Patients with lower urinary tract symptoms (LUTS) who have serum PSA levels higher,than 4 ng/ml are primarily advised to undergo prostate biopsy to rule out cancer. However, PSA is organ specific but not,cancer specific, so the presence of other prostate diseases such as benign prostatic hyperplasia (BPH), and prostatitis,may influence its effectiveness for cancer detection. Hence, the PSA-based prostate cancer detection is fraught with,high false-positive rate. Objectives: The use of Serum PSA levels for the early detection of prostate cancer and,evaluate its role with other modalities for diagnosis of prostate cancer and to diagnose different diseases of prostate,,i.e., prostatitis, BPH in prostatomegaly, and its correlation with serum PSA levels.
Materials and Methods: This,prospective descriptive study was conducted in Command Hospital (EC), Kolkata, West Bengal, India, in the period,of June 2011 to June 2013. The patients were selected from the outdoor of Department of Urology and General,Surgery. Institutional Ethical Committee Clearance and informed consent of all patients were obtained. 101 men at or,>50 years of age presenting with LUTS specifically attributed to prostate problems were included in the study. Men,with calcified or fibrotic prostate, with skeletal or distant metastasis or LUTS caused by any urological malignancy,and who had previous prostatic surgery or pelvic radiotherapy or complications of urinary obstruction, were excluded,from the study.
Results: A total of 101 male patients presenting with LUTS were included. Their mean age was,68.66 years. The majority, i.e., 49 (48.5%) of the study group were in the age group of 61-70 years. 52 (51.5%),of patients had serum PSA <4 ng/ml. Biopsy proven adenocarcinoma cases 40% of the cases are in the age group,of 71-80 years. Out of the biopsy proven adenocarcinoma cases, DRE was suspicious of malignancy in 90%. The,mean serum PSA values for mild, moderate, and severe International Prostate Symptoms Score were 6.15, 12.33,,and 7.67 ng/ml, respectively. Conclusion: Serum PSA levels correlates with the age group, with the increase in age,there is rise in serum PSA levels. Transabdominal ultrasound, DRE, and serum PSA has high sensitivity in diagnosis,of prostatomegaly but it was found that none of the single screening tool has got much efficacy in differentiating,carcinoma prostate from benign hypertrophy, but the combination of DRE and serum total PSA or DRE, serum,total PSA and ultrasound abdomen showed higher efficacy in diagnosis of carcinoma prostate. Increase in serum,PSA is directly related to carcinoma prostate, but there,is no absolute cut-off for serum PSA for diagnosis of,carcinoma.