985 FREE/TOTAL PROSTATIC SPECIFIC ANTIGEN RATIO IMPROVES PROSTATE CANCER DETECTION IN SCREENED MEN WITH PSA BETWEEN 2.51–3.9 NG/DL AND NORMAL DIGITAL RECTAL EXAMINATION

You have accessJournal of UrologyProstate Cancer: Detection and Screening1 Apr 2011985 FREE/TOTAL PROSTATIC SPECIFIC ANTIGEN RATIO IMPROVES PROSTATE CANCER DETECTION IN SCREENED MEN WITH PSA BETWEEN 2.51–3.9 NG/DL AND NORMAL DIGITAL RECTAL EXAMINATION Lucas Nogueira, Eliney Ferreira Faria, Leonardo Oliveira Reis, Rodolfo Borges dos Reis, Roberto Dias Machado, Celso Freitas, Wesley Magnabosco, Gustavo Franco Carvalhal, and Marcos Tobias-Machado Lucas NogueiraLucas Nogueira Belo Horizonte, Brazil More articles by this author , Eliney Ferreira FariaEliney Ferreira Faria Barretos, Brazil More articles by this author , Leonardo Oliveira ReisLeonardo Oliveira Reis Campinas, Brazil More articles by this author , Rodolfo Borges dos ReisRodolfo Borges dos Reis Ribeirao Preto, Brazil More articles by this author , Roberto Dias MachadoRoberto Dias Machado Barretos, Brazil More articles by this author , Celso FreitasCelso Freitas Barretos, Brazil More articles by this author , Wesley MagnaboscoWesley Magnabosco Barretos, Brazil More articles by this author , Gustavo Franco CarvalhalGustavo Franco Carvalhal Porto Alegre, Brazil More articles by this author , and Marcos Tobias-MachadoMarcos Tobias-Machado Sao Paulo, Brazil More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1017AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The proposed prostate specific antigen (PSA) serum level cut-off of 4.0 ng/dL as indication of prostate biopsy in a setting of normal digital rectal examination (DRE) has been widely criticized. Different PSA cutoffs fail in identifying patients with prostate cancer (PCa) while excluding the ones without cancer. The free/total PSA ratio (f/tPSA%) has been used routinely to increase specificity and reduce unnecessary biopsies, albeit rarely used as screening tool. This study aims to demonstrate the role of f/tPSA% in improving PCa detection in a screened population. METHODS We analyzed a cohort of 17,571 screened men over 45 years who accepted at least one offer of screening from January 2004 to December 2007. This group encompasses men from 231 Brazilian cities, reached by a mobile unit. All men underwent DRE and total and free (PSA) serum measurements. Full urological evaluation in a specialized Cancer Center was recommended to all men with suspicious DRE, PSA > 4.0 ng/dL, or PSA 2.5–3.9 ng/dL and free/total ftPSA% < 15%. Transrectal ultrasound guided prostate biopsy (14 cores) was performed upon confirmation of these findings after patient's consent. All patients were followed and further biopsies were performed if indicated. RESULTS The mean age was 61.2 (range, 45–98) years, with 84.8% of men aged 50–74 years. Overall, 74% and 70.9% of the cohort had never undergone a DRE or PSA measurement, respectively. Abnormal PSA measurements, suspicious DRE or both were present in 73.2%, 19.7%, and 7.1% of those who underwent biopsy, respectively. PCa was diagnosed in 652 (3.7%) men. The overall positivity of all biopsies was 39.6%. Positive predictive values (PPV) for each criterion are shown in table 1. Biopsy findings in the group of men with normal DRE and PSA 2.5–3.9 ng/dL and ftPSA% < 15% showed Gleason scores >= 7 in 23.4% of the patients, denoting non-indolent disease. Table 1. Relation of biopsy positivity rates and indication criteria. Abnormal Parameters⁎ Biopsied Men (%) Positive Cases (%) DRE,PSA,ftPSA 45 37(82.2) DRE,PSA 72 46(63.9) PSA,ftPSA 357 188(52.7) PSA 547 211(38.6) DRE,ftPSA 23 8(34.9) FtPSA 302 94(31.1) DRE 301 68(22.6) ⁎ PSA = serum PSA > 4.0 ng/dL; DRE = suspicious digital rectal examination; ftPSA = ftPSA ration < 15%. CONCLUSIONS Clinically significant prostate cancer is prevalent in men with PSA levels in the range of 2.5 to 3.9 ng/mL. Adding free PSA and free/total PSA ratio cutoffs as an additional tool for indicating biopsy in a screened population increases cancer detection, while avoiding unnecessary biopsies. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e397 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lucas Nogueira Belo Horizonte, Brazil More articles by this author Eliney Ferreira Faria Barretos, Brazil More articles by this author Leonardo Oliveira Reis Campinas, Brazil More articles by this author Rodolfo Borges dos Reis Ribeirao Preto, Brazil More articles by this author Roberto Dias Machado Barretos, Brazil More articles by this author Celso Freitas Barretos, Brazil More articles by this author Wesley Magnabosco Barretos, Brazil More articles by this author Gustavo Franco Carvalhal Porto Alegre, Brazil More articles by this author Marcos Tobias-Machado Sao Paulo, Brazil More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...