Galić Josip, Karner Ivan, Cenan Ljiljana, Tucak Antun, Hegedus Ivana, Pasini Josko, Bilandzija-Peranović Marijana, Mihaljević Slobodan
University Department of Urology, University Hospital Osijek, Osijek, Croatia.
Coll Antropol. 2003;27 Suppl 1:61-6.
This study compares the value of digital rectal examination (DRE) and prostate specific antigen (PSA) determination in the detection of prostate cancer. 1,000 men aged > or = 50 from the Osijek surroundings were examined. The subjects with prostatitis were excluded from the study. The subjects with elevated concentration of total prostate specific antigen and/or digital rectal examination suspect of carcinoma underwent prostate biopsy. The rate of prostate cancer detection showed to be 3.3% for PSA > 4 ng/ml, 2% for abnormal finding of DRE, and 3.7% for combination of the two methods. Out of 35 patients with prostate cancer detected, 19 had suspect DRE finding and 32 had PSA exceeding 4 ng/ml. Thus, PSA pointed to the diagnosis of prostate cancer in 91.4%, and abnormal finding of DRE in 54.2% of cases, the difference being statistically significant. The positive predictive value was 48.7% for abnormal finding of DRE, 47% for PSA > 4 ng/ml, and 80.0% for the combination of both. Although PSA determination detected a considerable proportion of tumors missed on DRE, the former alone was found to be insufficient as a screening method because of its inadequate sensitivity. When combined with digital rectal examination, the probability of prostate cancer detection increased considerably.
本研究比较了直肠指检（DRE）和前列腺特异性抗原（PSA）测定在前列腺癌检测中的价值。对来自奥西耶克周边地区的1000名年龄≥50岁的男性进行了检查。前列腺炎患者被排除在研究之外。总前列腺特异性抗原浓度升高和/或直肠指检怀疑为癌的受试者接受了前列腺活检。PSA>4 ng/ml时前列腺癌检测率为3.3%，直肠指检异常时为2%，两种方法联合时为3.7%。在检测出的35例前列腺癌患者中，19例直肠指检结果可疑，32例PSA超过4 ng/ml。因此，PSA在91.4%的病例中提示前列腺癌诊断，直肠指检异常在54.2%的病例中提示诊断，差异具有统计学意义。直肠指检异常的阳性预测值为48.7%，PSA>4 ng/ml为47%，两者联合为80.0%。虽然PSA测定检测出了相当一部分直肠指检漏诊的肿瘤，但由于其敏感性不足，单独使用PSA作为筛查方法是不够的。当与直肠指检联合使用时，前列腺癌的检测概率显著增加。
