CODE: 7.2 - Role of digital rectal examination, transrectal ultrasound and PSA level in the diagnosis of prostate cancer
Article published in Urologia Polska 2006/59/Suplement 1.

authors

Stanisław Szempliński, Jakub Dobruch, Elza Modzelewska, Artur A. Antoniewicz, Przemysław Szostek, Andrzej Borówka

Klinika Urologii CMKP, I Zespół Dydaktyki Urologicznej - Oddział Urologii Międzyleskiego Szpitala Specjalistycznego w Warszawie

summary

Introduction. Prostate cancer is diagnosed using TRUS guided tru-cut biopsy. Elevated se-rum prostate specyfic antigen (PSA) level, abnormal (suspected of PCA) digital rectal examination of prostate, hypoechogenic lesion in transrectal ultrasound are indications to biopsy.

The aim of the study. The purpose of the study is to evaluate the role of digital rectal ex-amination (DRE), transrectal ultrasound (TRUS) in addition to PSA level, in the diagnosis of prostate cancer.

Material and method. 854 men with elevated PSA level (>4 ng/ml) and/or suspected DRE and/or suspected TRUS were included in the study. The biopsy was performed between January 2000 and March 2005. All men had TRUS guided tru-cut biopsy. Those patients who were included in the study only due to elevated level of PSA, hed multicore mapping biopsy (6-22x). If DRE or TRUS were abnormal we made biopsy of the suspected focci and in potential candidates for radical treatment additional mapping biopsy were taken.

Results. Prostate cancer was diagnosed in 497 (58%) men. Prostate biopsies were positive in 95 (19.2%), 8 (1.6%), 6 (0.7%) men due to soley increased PSA (>4 ng/ml) or abnormal DRE or abnormal TRUS respectively. PCA was found in 21 (4.5%) men with elevated PSA and abnormal DRE, in 291 (63%) men with elevated PSA and abnormal DRE and abnormal TRUS. Based on these data there was calculated positive predictive value (PPV) for prostate carcinoma. PPV of elevated PSA, abnormal DRE were respectivelly 28.6% and 21.6%. PPV of elevated PSA and abnormal DRE, abnormal DRE and TRUS, elevated PSA and abnormal TRUS, elevated PSA and abnormal DRE and abnormal TRUS were respectivelly 47.7%, 64%, 78.6%, 89.3%.

Conclusion. Those patients who were qualified to TRUScoreBX due to suspected DRE had the lowest propability of PCA. The highest propability of PCA diagnosis concerned those who were included in the study because of elevated PSA and abnormal TRUS and DRE. The propability of PCA diagnosis in case of increased PSA level is almost 30%.