Valoarea predictiva si validitatea PSA, FREE PSAsi a examenului clinic local în identificarea cancerului de prostata

Scientific context: Prostate cancer is the most common noncutaneous cancer and represents the second cause of mortality through neoplasia in United States and the EU. In Romania the incidence varies according to age, range from 6-151 per 100,000 people, reaching a maximum at the age group 70-74 years. PSA (prostate-specific antigen) is a glycoprotein produced by prostatic epithelial cells. Disruption prostate structure can lead to download large quantities of PSA in systemic circulation. Purpose: Analysis of the predictive value of clinical and paraclinical parameters for identification patients with prostate cancer. Objectives: 1. Evaluation of clinical and paraclinical characteristics of a group of patients hospitalized in Center of Urological Surgery and Renal Transplantation-Fundeni, globally/by disease and setting the diagnosis. 2. Generating predictive value and validity of tests considered - PSA, Free PSA and local clinical examination followed by descriptive evaluation of therapeutic decision for patients with positive diagnosis. Methodology: The study population consisted of 294 patients hospitalized in the Surgery Center of Urology and Renal Transplantation "Fundeni" during march 2010 - July 2011. The study population was submitted for inclusion and exclusion criteria and standard protocol for low urinary tract symptoms. Split of study population in disease/non disease patients was based on imaging criteria and predictive value and validity of PSA, Free PSA and local clinical examination was studied. Results: Average age of patients enrolled was 63 years, most patients were from urban areas. For PSA we obtained: sensitivity 86.87%, specificity 62.05%, 53.75% positive predictive value and negative predictive value 90.30%. For Free PSA values are: 79.38% Sensitivity, specificity 61.93%, 50.66% positive predictive value and negative predictive value 85.92%. Sensitivity calculated for local clinical examination is 64.65% and 61.03% specificity is. Positive predictive value is 45.71%, while negative predictive value is 77.27%. Conclusions: In the studied group, the sensitivity and positive predictive value for PSA, Free PSA and DRE were similar to those provided by most studies. Specificity adjustment may occur by increasing the number of cores collected by transrectal biopsy and decrease the threshold for positivity of PSA and increase for Free PSA. The detection rate in the studied group does not increase with increasing the number of cores, which suggests that the majority of study population included has positive ultrasound lesions. PSA value correlates with the aggressiveness of the disease and second with its prognosis. PSA becomes also a prognostic marker for the group studied. Key words: PSA, Free PSA, prostate cancer, validity, predictive value.

© Romanian Journal of Urology 2011. Provided by ProQuest LLC. All Rights Reserved.

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