Abstract
ObjectivesDue to the growing controversy of the operating characteristics of PSA, the value of screening for prostate cancer and the potential of overtreatment, this study was conducted to compare the operating characteristics of the absolute value of PSA and of PSA kinetics for the diagnosis of prostate adenocarcinoma. In addition, the aim was also to determine the operating characteristics of PSA kinetics for predicting tumor grade differentiation. MethodsA descriptive, cross-sectional study was conducted to compare the diagnostic tests, between the absolute value of PSA and the PSA kinetics, using the pathology report of a prostate biopsy as reference. Records were collected between January 1st 2008 and December 31st 2011, including men older than 40years who entered the opportunistic screening program for prostate cancer of the Organización Sanitas Internacional (OSI), with at least three PSA samples and a period greater than 12months between them. All PSA samples and prostate biopsies were processed in the central laboratory of the OSI. Patients who received 5-alpha-reductase inhibitors were excluded. ResultsA prevalence of 29% for prostate cancer was observed. The sensitivity and specificity for a PSA cutoff of 4ng/ml for the diagnosis of prostate cancer was 95% and 6%, respectively. Through a comparative analysis of the AUC between the absolute value of PSA and 9 different measurementsof the PSA kinetics, no additional benefit was found for diagnosing prostate cancer. According to the AUC analysis, there was a slight, non-significant advantage of PSA kinetics over PSA absolute value for the diagnosis of low grade prostate cancer. In a multivariate analysis of the PSA kinetics, a model for predicting the probability of low differentiation can be described. ConclusionsPSA for screening is still useful in our population. PSA kinetics has no advantage for the initial diagnosis of prostate cancer. The multivariate model of the PSA kinetics improves the ability to predict tumor differentiation.© 2014 Sociedad Colombiana de Urología. Published by Elsevier España, S.L. All rights reserved.
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