Ojewola R W, Tijani K H, Jeje E A, Ogunjimi M A, Anunobi C C, Adesanya A O
Division of Urology, Department of Surgery, Lagos University Teaching Hospital, P.M.B 12003, Lagos.
West Afr J Med. 2013 Jan-Mar;32(1):8-13.
To evaluate the usefulness of prostate specific antigen (PSA) and digital rectal examination (DRE) in the diagnosis of cancer of the prostate (CaP) amongst unscreened patients.
PATIENTS, MATERIALS AND METHODS: A prospective study 168 unscreened men who were referred for evaluation for CaP. They all had a 10-core extended transrectal prostatic needle biopsy using size 16 Tru Cut needle for either an elevated serum total PSA of > 4 ng/ml or abnormal DRE findings or both. Overall cancer detection rate was determined and detection rates were determined separately for patients with elevated PSA with normal DRE, abnormal DRE with normal PSA and those with both indications. The performances of each indication were determined separately and in combination in terms of their sensitivity, specificity, predictive values and accuracy. The results were compared amongst patients with different indications for biopsy.
The overall cancer detection rate was 44.0%. Detection rates in patients with elevated PSA with normal DRE and abnormal DRE with normal PSA were 30.0% and 17.4% respectively. There was statistically significant increased detection of 61.2% amongst patients with both indications. The overall sensitivities of PSA, DRE and combination of both were 94.6%, 75.7% and 70.3% respectively while the specificities were 20.2%, 44.7% and 64.9% respectively. The accuracies of PSA, DRE and combination of both indications were 53%, 58% and 67.3% respectively while the PPVs were 48.3%, 51.9% and 61.2% respectively. Mean Gleason score was 6.82 while the overall complication rate was 23.2%
Neither PSA nor DRE is sensitive, specific, predictive or accurate enough on its own to be an ideal screening or diagnostic test for CaP. Therefore, optimal evaluation of patients with suspected CaP is best achieved with both even in unscreened populations.
评估前列腺特异性抗原（PSA）和直肠指检（DRE）在未接受筛查的患者中诊断前列腺癌（CaP）的效用。
患者、材料与方法：一项前瞻性研究，纳入168例因CaP评估而转诊的未接受筛查的男性。他们均因血清总PSA升高>4 ng/ml或DRE检查结果异常或两者兼具，使用16号Tru Cut穿刺针进行10针扩展经直肠前列腺穿刺活检。确定总体癌症检出率，并分别确定PSA升高但DRE正常、DRE异常但PSA正常以及两种指征均有的患者的检出率。分别并联合确定每种指征在敏感性、特异性、预测值和准确性方面的表现。比较不同活检指征患者的结果。
总体癌症检出率为44.0%。PSA升高但DRE正常的患者检出率为30.0%，DRE异常但PSA正常的患者检出率为17.4%。两种指征均有的患者检出率在统计学上显著提高，为61.2%。PSA、DRE及两者联合的总体敏感性分别为94.6%、75.7%和70.3%，而特异性分别为20.2%、44.7%和64.9%。PSA、DRE及两种指征联合的准确性分别为53%、58%和67.3%，阳性预测值分别为48.3%、51.9%和61.2%。平均Gleason评分为6.82，总体并发症发生率为23.2%。
单独的PSA或DRE在敏感性、特异性、预测性或准确性方面均不足以成为CaP的理想筛查或诊断试验。因此，即使在未接受筛查的人群中，对疑似CaP患者进行最佳评估也最好同时使用这两种方法。
