Abstract
Background: Prostate cancer is a leading cause of morbidity and mortality in our male population, thus screening initiatives will help to improve outcomes. The current screening marker, total prostate-specific antigen (PSA), is not prostate cancer specific. The development of percentage free PSA (%FPSA) has largely improved the detection of prostate cancer. Objectives: To assess the performance of %FPSA ratio at the 25% cut-off and its ability to distinguish between prostate cancer and benign prostatic lesions. Methods: This was a retrospective study conducted on male patients with total prostate-specific antigen values < 10 ng/ml and with prostate histology results. Male patients with total prostate-specific antigen between 4 and 10 ng/ml had their free prostate-specific antigen determined together with the calculation of the free prostate-specific antigen ratio. The ratio was then correlated with prostate histology results to determine the presence of prostate cancer at the cut-off ratio of 25%. Results: Prostate cancer was detected in 28 (21.37%) patients out of the total population of 131. Ninety-two patients had a FPSA ratio of < 25%, 22 (22.8%) of whom were found to have prostate cancer. Notably the sensitivity and specificity were found to be 86% and 27% respectively, with a positive predictive of value of 21% at this cut-off. Conclusions: The study demonstrates a %FPSA ratio of 25% not to be a good discriminator between prostatic cancerous and benign lesions. It is thus recommended that a prostate biopsy should be done based on clinical examination findings rather than the level of total prostate specific antigen from 0–10 ng/ml or %FPSA ratio. Keywords: diagnostic accuracy, non-communicable diseases, prostatic neoplasm, screening
Highlights
Prostate cancer is a leading cause of morbidity and mortality in our male population, screening initiatives will help to improve outcomes
Patients who had total PSA (TPSA) values < 10 ng/ml, free PSA (FPSA) values, FPSA ratios and prostate histology results were included in the study; patients who did not have FPSA and/or histology were excluded from the study
The remaining 122 patients had TPSA 4–10 ng/ml with 23 having Prostate cancer (PCA) and 99 having benign lesions. Of these 122 patients, using the %FPSA ratio and theTPSA:FPSA ratio quartiles.We established that more patients are classified as prostatic benign lesions as compared with PCA (Figure 1 and 2)
Summary
Prostate cancer is a leading cause of morbidity and mortality in our male population, screening initiatives will help to improve outcomes. The current screening marker, total prostate-specific antigen (PSA), is not prostate cancer specific. Methods: This was a retrospective study conducted on male patients with total prostate-specific antigen values < 10 ng/ml and with prostate histology results. Results: Prostate cancer was detected in 28 (21.37%) patients out of the total population of 131. It is recommended that a prostate biopsy should be done based on clinical examination findings rather than the level of total prostate specific antigen from 0–10 ng/ml or %FPSA ratio. Prostate cancer (PCA) is a common male cancer globally and in South Africa (SA) the incidence has been reported to be 40.5 per 100 000 per year.[1] The global incidence has been reported to vary substantially due to differences in the screening of cancer through prostate-specific antigen (PSA) testing. Due to efficient blood supply, small amounts (or concentrations) of PSA constantly pass to the bloodstream.[5]
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