Pathologic Characteristics of Prostate Cancers Missed by Application of the Age-specific Prostate-specific Antigen Reference in Men over Sixties

Abstract

To examine the pathologic characteristics of prostate cancers missed by application of the age-specific prostate-specific antigen(PSA) reference in Korean men over sixties in clinical practice based on PSA cutoff 3.0ng/ml. Materials and Methods: We made retrospective analysis of 1,063 patients aged between 60-79 who had had transrectal ultrasonography(TRUS)- guided biopsy due to the rise of PSA over 3.0ng/ml or abnormal findings in digital rectal examination(DRE) or TRUS. Age-specific PSA reference was set at 3.9ng/ml for 60s and 5.4ng/ml for 70s. Results: Prostate cancer was detected in 34.3%(365/1,063) as a whole, and 31.5% in 60s, and 39.5% in 70s according to the age. When age-specific reference 3.9ng/ml was applied to 60s, 20(9.6%) cancers were missed compared with clinical cutoff value(3.0ng/ml). When age-specific reference 5.4ng/ml was applied to 70s, 23(16.0%) cancers were missed. On the average, 43(12.2%) of cancers were missed in 60s and 70s. Of 43 missed cancers, 39(90.7%) were with normal DRE and TRUS. Of these cancers, 16(41.0%) were clinically insignificant on biopsy, but only 7(22.6%) were insignificant in the pathologic examination of 31 radical prostatectomy specimens. Conclusions: In our clinical practice based on PSA cutoff 3.0ng/ml, most cancers missed by application of age-specific reference are clinically significant. But, considering the positive effect of age-specific reference on avoidance of unnecessary biopsies, large prospective study is needed to evaluate the efficacy of age-specific reference in Korean men over sixties.