Prostate-specific antigen: insufficient discrimination between benign prostatic hyperplasia and organ-confined prostate cancer.

OBJECTIVE

Discrimination of patients with benign prostatic hyperplasia (BPH) from those with cancer of the prostate (CaP) is crucial to the management of these diseases. At present, a number of new treatment modalities for symptomatic BPH, which include various nonsurgical treatment modalities, are being discussed. Prior to treatment, it is important to exclude those patients with CaP. In the present study we examined retrospectively the serum prostatic-specific-antigen (PSA) values in both patient groups in order to determine whether serum PSA identifies those patients harboring organ-confined CaP.

PATIENTS AND METHODS

Group 1 consisted of 121 patients with histologically confirmed BPH as determined from pathological analysis of the surgically removed specimens. Group 2 included 69 patients with organ-confined CaP, confirmed pathologically from the analysis of the radical prostatectomy specimens. PSA serum concentration was analyzed in both groups.

RESULTS

The median PSA level was 3.96 ng/ml (range: 0.5-31.2 ng/ml) in the BPH group and 7.8 ng/ml (range: 0.7-37.7 ng/ml) in the CaP group. In spite of a statistically significant difference (p = 0.0001), serum PSA values overlapped considerably in both groups.

CONCLUSIONS

Serum PSA demonstrated only a limited ability to discriminate between BPH and organ-confined CaP. Therefore some patients with symptomatic BPH undergoing nonsurgical treatment may harbor clinically significant CaP despite "normal' serum PSA values. Furthermore, PSA-based screening may overlook a significant percentage of patients in whom a rectal digital examination would detect CaP.