The Clinical Usefulness of the Prostate-specific Antigen, Prostate- specific Antigen Density, Digital Rectal Examination, and Transrectal Ultrasonography in the Screening Test of Prostate Cancer in Koreans / 대한비뇨기과학회지

ABSTRACT

PURPOSE: The efficacy of the prostate-specific antigen (PSA), prostate-specific antigen density (PSAD), digital rectal examination (DRE) and transrectal ultrasonography (TRUS) for diagnosing prostate cancer in Koreans was investigated. MATERIALS AND METHODS: The medical records from a selected population of 346 patients (30 to 93 years old, mean age 66.0) who had visited the department of Urology in Seoul National University Hospital from January 1994 to December 2000 were reviewed retrospectively. All patients a transrectal ultrasonography-guided biopsy. The student's t test was used for statistical analysis. RESULTS: Prostate cancer was detected in 119 (34.4%) out of 346 patients. PSA, PSAD, TRUS, and DRE showed a sensitivity of 95.8%, 88.2%, 66.4% and 61.3%, a specificity of 26%, 49.3%, 66.5% and 55.9%, and a positive predictive value of 40.4%, 47.7%, 51% and 42.2%, respectively. The positive predictive value from the combination of PSAD and TRUS was 67%, which was the highest when two among the four methods were selected and combined. The detection rate for prostate cancer was 23% (31 out of 135 patients) when the PSA level was between 4 and 10ng/ml, and was 20.9% (18 out of 86 patients) when PSA level was between 4 and 10ng/ml and the DRE findings were negative. CONCLUSIONS: In detecting prostate cancer, PSA showed the highest sensitivity and TRUS showed the highest specificity and positive predictive value. PSAD might be a useful method for diagnosing prostate cancer when combined with TRUS. A TRUS-guided biopsy should be done in patients when the PSA level is between 4 and 10ng/ml in Korea.