The Accuracy of Increased Blood Concentration of Prostate-Specific Antigen to Prostate Malignancy
Background: Various controversies arose in the study of PSA examination as an alternative of biopsy to detect prostate malignancy. Prostate Specific Antigen (PSA) is a specific protein secreted by the prostate gland and is affected by various conditions. PSA levels will certainly increase at the enlargement of the prostate gland. An accurate cutoff point that can detect prostate cancer is needed.
Objective: To evaluate the PSA diagnostic test against prostate malignancy.
Methods: This study used a diagnostic test method for 91 patients undergoing either prostate gland surgery or open prostatectomy at Bethesda Hospital Yogyakarta in January 2014-January 2016 period. Data were taken from medical records with inclusion criteria as follow: over 50 years of age, preoperative PSA, and PA results. This study was a descriptive analytic study. In the diagnostic test AuROC, cutoff points were determined. Chisquare test was performed to assess sensitivity, specificity, PPV, NPV, LHR -, and LHR +.
Results: We studied 91 patients with a mean age of 70.24 ( 46-54 ) and mean PSA level of 27.2 ( 0.59-101 ). The results of PA prostate tissue examinations were adenocarcinoma in 15 patients ( 16.5 % ) and BPH in 76 patients ( 83.5 %) On all PSA levels, AuROC were 0.90. Specificity of PSA with 4 ng / mL cutoff, 10 ng / mL, 20 ng / mL, 50 ng / mL, and 100 ng / mL were 0.53, 35.53, 67.11, 96.05, 98.68. When the cutoffs were reduced to 4.01-10ng/mL, 10.01-20 ng/mL, 20.01-50ng/ mL,50.01-100 ng/mL, and > 100 ng/mL, the specifity were 76.32, 68.00, 69.74, 96.05, 100.00. Cutoff value of 50ng / mL had LHR + >10.00 ( 15:20 ).
Conclusion: There is a strong correlation between PSA and prostate malignancy. PSA value> 50 ng / mL has high accuracy to detect prostate malignancy. A biopsy is needed to determine a definitive diagnostic because no cutoff value can be used as a benchmark.
Groves H, Chang D, Palazzi K, Cohen S, Parsons J. The incidence of acute urinary retention secondary to BPH is increasing among California men. Prostate Cancer and Prostatic Diseases. 2013;6(3):260–5.
American Urological Association. Benign prostatic hyperplasia [Internet]. American Urological Association. 2016 [cited 2016 Sep 9]. Available from: https://www.auanet.org/education/guidelines/benign-prostatic-hyperplasia.cfm
Gabriel P, Haas G. The worldwide epidemiology of prostate Cancer: Perspectives from autopsy studies. The Canadian Journal of Urology. 2008;15(1):3866–71.
Anton SB. Prostate cancer in elderly men. Reviews in Urology. 2008;10(2):111–9.
Morgan TM, Palapattu GS, Partin AW, Wei JT. Prostate cancer tumor markers. In: Campbell M, Wein A, Kavoussi L, Walsh P, editors. Campbell-Walsh urology. Philadelphia: Elsevier Inc; 2016. p. 2565–77.
Presti JC. Neoplasms of the prostate cancer. In: Tanagho EA, McAninch JW, editors. Smith's general urology. 16th ed. USA: The McGraw-Hill Companies; 2010. p. 367–84.
Purnomo BB. Dasar-dasar urologi. 2nd ed. Jakarta: Sagung Seto; 2009.
Adhyam M, Gupta A. A review on the clinical utility of PSA in cancer prostate. Indian Journal of Surgical Oncology. 2012;3(2):120–9.
Mistry S, Mayer W, Khavari R, Ayala G, Miles B. Who's too old to screen? Prostate cancer in elderly men. Canadian Urological Association Journal. 2009;3(3):205–10.
Holmstrom B, Johansson M, Bergh A, Stenman U, Hallmans G, Stattin P. Prostate specific antigen for early detection of prostate cancer: Longitudinal study. British Medical Journal; 2009. Report No. b3537.
Lojanapiwat B, Anutrakulchai W, Chongruksut W, Udomphot C. Correlation and diagnostic performance of the prostate-specific antigen level with the diagnosis, aggressiveness, and bone metastasis of prostate cancer in clinical practice. Prostate International. 2014;2(3):133–9.
Kheirandish P, Chinegwundoh F. Ethnic differences in prostate cancer. British Journal of Cancer. 2011;105(4):481–5.
Division of Cancer Prevention and Control. Prostate cancer rates by race and ethnicity [Internet]. Centers for Disease Control and Prevention. 2016 [cited 2016 Sep 9]. Available from: http://www.cdc.gov/cancer/prostate/statistics/race.htm
DeChello L, Gregorio D, Samociuk H. Race-specific geography of prostate cancer incidence. International Journal of Health Geographics. 2006;5(59):1–8.
Chen R, Ren S, Yiu MK, Fai NC, Cheng WS, Chinese Prostate Cancer Consortium. Prostate cancer in Asia: A collaborative report. Asian Journal of Urology. 2014;1(1):15–29.
Baker SG. The central role of receiver operating characteristic (ROC) curves in evaluating tests for the early detection of cancer. Journal of the National Cancer Institute. 2003;95(7):511–5.
Heyns CF, Naude AM, Ahmed G, Stopforth HB, Stellmacher GA, Visser AJ. Serum prostate-specific antigen as surrogate for the histological diagnosis of prostate cancer. South African Medical Journal. 2001;91(8):685–9.
Adams W, Elliot C, Reese J. 1484 The fate of men presenting with PSA over 100 ng/mL: What happens when we do not screen for Prostate cancer? The Journal of Urology. 2013;189(4):e608–9.
Jang J, Kim Y. Is Prostate biopsy essential to diagnose prostate cancer in the older patient with extremely high prostate-specific antigen? Korean Journal of Urology. 2012;53(2):82–6.
Gerstenbluth RE, Seftel AD, Hampel N, Oefelein MG, Resnick MI. The accuracy of the increased prostate specific antigen level (greater than or equal to 20 ng./ml.) in predicting prostate cancer: Is biopsy always required? The Journal of Urology. 2002;168(5):1990–3.
DeAntoni EP. Age-specific reference ranges for PSA in the detection of prostate cancer. Oncology (Williston Park). 1997;11(4):475–82.
Luboldt HJ, Schindler JF, Rubben H. Age-specific reference ranges for prostate-specific antigen as a marker for prostate cancer. eau-ebu upd series 5. 2007; European Association of Urology and European Board of Urology Update Series 5. 2007;5:38–48.
Gomella LG, Halpern EJ, Trabulsi EJ. Prostate biopsy: Techniques and imaging. In: Campbell M, Wein A, Kavoussi L, Walsh P, editors. Campbell-Walsh urology. Philadelphia: Elsevier Inc; 2016. p. 2579–82.