Determination of a Cut-off Point for Prostatic Specific Antigen to Avoid Unjustified Biopsy Among Asymptomatic Elderly Men

Abstract

Background: To our knowledge, there is no national screening program for prostate cancer in Egypt. The Uro-surgery department in Alexandria University established a screening program for prostate cancer among men aged 55 years or more in January 2012. Objective: To determine a valid Prostatic Specific Antigen (PSA) cutoff point for performing Transrectal Ultrasonography (TRUS) guided biopsy among asymptomatic elderly men. Methods: A screening cross sectional study was conducted on a convenient sample of 1207 men aged ≥55 years who were attending urology department, Alexandria University for non-prostatic symptoms during years 2013 and 2014. Digital Rectal Examination (DRE) and PSA level measurement were performed for all included subjects. TRUS guided biopsy was done for those who found to have PSA ˃ 4ng/ ml and or suspicious DRE. Results: Among subjects who had PSA level of 4.1-10, the Positive Predictive Value (PPV) for cancer prostate was 54% among those with suspicious DRE findings as compared to 0 among those with nonsuspicious DRE. For PSA level of 10.1-20 and >20 with suspicious DRE, PPV was (77% and100% respectively). The mean serum total PSA was 77 and 0.6 ng/ ml for patients with and without prostatic cancer respectively (p= 0.0001). The yield of cancer prostate among all screened men was 103/1207= 8% and 103/157= 66% among those with PSA˃ 4 ng/ ml and or having suspicious DRE and were biopsied. Considering all men who had biopsy, ROC curve could derive a cutoff value of 10.05 ng/ml with a sensitivity of 92% and a specificity of 92.6%. Inability to perform biopsy for men with PSA ≤4 ng/ml was the main limitation. Conclusion: In a country of relatively low prevalence of prostate cancer like Egypt, a cutoff point of PSA in combination with DRE for doing TRUS biopsy could be 10.05 ng/ ml among asymptomatic men ≥55 years of age with a likelihood ratio of 12.43.

Efficacy of early screening for prostate cancer in an elderly patient with absence of urinary symptoms but a manifestation of a rare symptom: a case report

“…This gap in knowledge may be a significant factor in the initial diagnosis in later stage prostate cancer and diagnosis after metastasis. 17,18 Further this misconception may impact a patient's decision to undergo further prostate screening. 19 The national health service in the UK website lists seven symptoms of prostate cancer, all of which are in reference to urinary tract symptoms.…”