Impact of PSA and DRE on Histologic Findings at Prostate Biopsy in Turkish Men Over 75 Years of Age

Abstract

Prostate specidic antigen (PSA) and digital rectal examination (DRE) are the known predictive factors for positive prostate biopsies differing according to the age, region and race. There have been only very limited studies about the impact of PSA on histological findings at prostate biopsy in Turkey. The aim of this study was to evaluate the impact of PSA and clinical stage on histologic findings of prostate biopsy in men older than 75 years of age as a first study in the Turkish population. A total of 1,645 consecutive prostate biopsies were included, with 194 men aged 75 or older. Cancer was identified in 104 patients (53.6%). Of the 104 positive biopsies, Gleason scores were less than 7 in 53 (49%) patients, 7 or greater in 51 (51%) patients. Positive prostate biopsies were significantly correlated with advanced age (p=0.0001), abnormal DRE (p=0.0001) and raised PSA (p=0.0001). The prostate volume was significantly correlated with advanced age especially in prostate cancer patients over 75 years, compared with those under 75 (p=0.0001). These results are useful for counseling men older than 75 years for prostate cancer detection. However, PCa screening decisions are currently based on urologist judgment and detection of latent asymptomatic disease is an important concern regarding costs, overdiagnosis, overtreatment and quality of life (QOL) for men aged 75 years and older. Healthy old patients with a long life expectancy need to be carefully evaluated for eligibility for PCa screening.

Epidemiology, Etiology, Diagnosis and Treatment of Prostate Cancer

“…A 50 years old American man has a lifetime risk of 40% for latent cancer, 16% for developing clinically apparent cancer and a 2.9% risk of death due to prostate cancer. Other factors including widespread use of prostate specific antigen (PSA) screening also appear to have contributed to the increase in annual prostate cancer incidence (Verim et al, 2013). PSA is a glycoprotein produced by cell, either benign or malignant of the prostate gland.…”

Cumulative Probability of Prostate Cancer Detection Using the International Prostate Symptom Score in a Prostate-specific Antigen-based Population Screening Program in Japan

“…In the present study, the proportion of men with severe LUTS was significantly lower in men detected with prostate cancer during screening than in those without cancer, suggesting the possible existence of men with LUTS who underwent PSA testing outside the population screening program. Previous studies revealed that benign prostatic hyperplasia (BPH) affected serum PSA levels, and elevated serum PSA levels could be a proxy parameter of prostate volume in patients with BPH (Hochberg et al, 2000;Mochtar et al, 2003;Verim L et al, 2013). Considering this consensus, serum PSA levels may be higher in men with LUTS than in those without LUTS in the entire population, a possibility addressed in several studies (Matsubara et al, 2006;Franlund et al, 2012).…”

Comparative Histopathological Characterization of Prostate Cancer in Saudi Patients by Conventional and 2005 ISUP Modified Gleason Systems

“…PSA screening is controversial, and PSA levels may also be high due to presence of BPH, infection or by manipulation of the prostate gland by surgery or catheterization (Svetec and Thompson, 1998). Using histopathological procedure for prostate cancer diagnosis, pathologists obtain tissue samples from prostate biopsies and examine it after staining protocols to identify the tissue structures (Orozco et al, 1998;Verim et al, 2013). This traditional histopathological-based diagnosis has remained the standard diagnostic method for many years but with the introduction of advanced techniques like microarrays, mass spectrometry and DNA sequencing, new avenues have opened in cancer diagnosis and therapeutics.…”