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Utility of Digital Rectal Examination, Serum Prostate Specific Antigen, and Transrectal Ultrasound in the Detection of Prostate Cancer: A Developing Country Perspective

  • Kash, Deep Par (Department of Urology, Sindh Institute of Urology and Transplantation (SIUT)) ;
  • Lal, Murli (Department of Urology, Sindh Institute of Urology and Transplantation (SIUT)) ;
  • Hashmi, Altaf Hussain (Department of Urology, Sindh Institute of Urology and Transplantation (SIUT)) ;
  • Mubarak, Muhammed (Department of Histopathology, Sindh Institute of Urology and Transplantation (SIUT))
  • Published : 2014.04.01

Abstract

Purpose: To determine the utility of digital rectal examination (DRE), serum total prostate specific antigen (tPSA) estimation, and transrectal ultrasound (TRUS) for the detection of prostate cancer (PCa) in men with lower urinary tract symptoms (LUTS). Materials and Methods: All patients with abnormal DRE, TRUS, or serum tPSA >4ng/ml, in any combination, underwent TRUS-guided needle biopsy. Eight cores of prostatic tissue were obtained from different areas of the peripheral prostate and examined histopathologically for the nature of the pathology. Results: PCa was detected in 151 (50.3%) patients, remaining 149 (49.7%) showed benign changes with or without active prostatitis. PCa was detected in 13 (56.5%), 9 (19.1%), 26 (28.3%), and 103 (74.6%) of patients with tPSA <4 ng/ml, 4-10 ng/ml, 10-20 ng/ml and >20 ng/ml respectively. Only 13 patients with PCa had abnormal DRE and TRUS with serum PSA <4 ng/ml. The detection rate was highest in patients with tPSA >20 ng/ml. The association between tPSA level and cancer detection was statistically significant (p<0.01). Among 209 patients with abnormal DRE and raised serum PSA, PCa was detected in 128 (61.2%). Conclusions: The incidence of PCa increases with increasing serum level of tPSA. The overall screening and detection rate can be further improved by using DRE, TRUS and TRUS-guided prostate needle biopsies.

Keywords

Biopsy;digital rectal examination;prostate cancer;transrectal ultrasound;Pakistan

References

  1. Verim L, Yildirim A, Basok EK, et al (2013). Impact of PSA and DRE on histologic findings at prostate biopsy in Turkish men over 75 years of age. Asian Pac J Cancer Prev, 14, 6085-8. https://doi.org/10.7314/APJCP.2013.14.10.6085
  2. Stock C, Hruza M, Cresswell J, Rassweiler JJ (2008). Transrectal ultrasound guided biopsy of the prostate: Development of the procedure, current clinical practice, and introduction of self-embedding as a new way of processing biopsy cores. J Endurol, 22, 1321-29. https://doi.org/10.1089/end.2008.0068
  3. Strohmaier WL, Keller T, Bichler KH (1999). Follow-up in prostate cancer patients: which parameters are necessary? Eur Urol, 35, 21-5. https://doi.org/10.1159/000019814
  4. Torp-Pedersen S, Juul N, Jakobsen H (1988). Transrectal prostatic ultrasonography. Equipment, normal findings, benign hyperplasia and cancer. Scand J Urol Nephrol Suppl, 107, 19-25.
  5. Woolf SH (1995). Screening for prostate cancer with prostate-specific antigen-an examination of the evidence. N Engl J Med, 333, 1401-05. https://doi.org/10.1056/NEJM199511233332107
  6. Yamamoto T, Ito K, Ohi M, et al (2001). Diagnostic significance of digital rectal examination and transrectal ultrasonography in men with prostate specific antigen levels of 4 ng/mL or less. Urol, 58, 994-98. https://doi.org/10.1016/S0090-4295(01)01409-1
  7. Zappa M (1998). Over-diagnosis of prostate carcinoma by screening: An estimate based on the results of the Florence Screening Pilot Study. Ann Oncol, 9, 1297-300. https://doi.org/10.1023/A:1008492013196
  8. Zheng X-Y, Zhang P, Xie L-P, et al (2012). Prostate specific antigen velocity (PSAV) and PSAV per initial volume (PSAVD) for early detection of prostate cancer in Chinese men. Asian Pac J Cancer Prev, 13, 5529-33. https://doi.org/10.7314/APJCP.2012.13.11.5529
  9. Nath A, Singh JK, Vendan SE, Priyanka, Sinha S (2012). Elevated level of prostate specific antigen among prostate cancer patients and high prevalence in the Gangetic zone of Bihar, India. Asian Pac J Cancer Prev, 13, 221-3. https://doi.org/10.7314/APJCP.2012.13.1.221
  10. Martin RM, Vatten L, Gunnell D, Romundstad P, Nilsen TIL (2008). Lower urinary tract symptoms and risk of prostate cancer: The HUNT 2 Cohort, Norway. Int J Cancer, 123, 1924-28. https://doi.org/10.1002/ijc.23713
  11. McNeal JE, Redwine EA, Freiha FS, Stamey TA (1988). Zonal distribution of prostatic adenocarcinoma: correlation with histologic pattern and direction of spread. Am J Surg Pathol, 12, 897-906. https://doi.org/10.1097/00000478-198812000-00001
  12. Mettlin C (1997). The American Cancer Society National Prostate Cancer Detection Project and National Patterns of Prostate Cancer Detection and Treatment. CA Cancer J Clin, 47, 265-72. https://doi.org/10.3322/canjclin.47.5.265
  13. Pinnock C, O'Brien B, Marshall VR (1998). Older men's concerns about their urological health: a qualitative study. Australian and New Zealand J Pub Health, 22, 368-73. https://doi.org/10.1111/j.1467-842X.1998.tb01393.x
  14. Poudel B, Mittal A, Shrestha R, Nepal AK, Shukla PS (2012). Prostate biomarkers with reference to body mass index adn duration of prostate cancer. Asian Pac J Cancer Prev, 13, 2149-52. https://doi.org/10.7314/APJCP.2012.13.5.2149
  15. Rashid R, Mubarak M, Kazi J (2013). Frequency of adenocarcinoma in transrectal ultrasound-guided prostate needle biopsies in men with clinical suspicion of prostate cancer and raised serum prostate specific antigen. Middle East J Cancer, 4, 73-8.
  16. Shapiro A, Lebensart PD, Pode D, Bloom RA (1994). The clinical utility of transrectal ultrasound and digital rectal examination in the diagnosis of prostate cancer. Br J Radiol, 67, 668-71. https://doi.org/10.1259/0007-1285-67-799-668
  17. Shiraishi T, Getzenberg RH, Kulkarni P (2012). Cancer/testis antigens: novel tools for discerning aggressive and non-aggressive prostate cancer. Asian J Androl, 14, 400-4. https://doi.org/10.1038/aja.2011.144
  18. Hua L, Xu B, Cheng G, et al (2011). Prostate cancer detected after introduction of PSA screening. Surg Practice, 15, 2-6. https://doi.org/10.1111/j.1744-1633.2010.00527.x
  19. Gohji K, Okamoto M, Morisue K, Fujii A (1995). Usefulness of digital rectal examination, serum prostate-specific antigen, transrectal ultras onography and systematic prostate biopsy for the detection of organ-confined prostate cancer. Int J Urol, 2, 116-20. https://doi.org/10.1111/j.1442-2042.1995.tb00436.x
  20. Hodge KK, McNeal JE, Terris MK, Stamey TA (1989). Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol, 142, 71-5. https://doi.org/10.1016/S0022-5347(17)38664-0
  21. Hoffman R (2011). Screening for prostate cancer. N Engl J Med, 365, 2013-19. https://doi.org/10.1056/NEJMcp1103642
  22. Jabaly SS, Mohammad MA (2008). Prostate-specific antigen versus digital rectal examination in the diagnosis of prostate cancer. Dohuk Med J, 2, 80-90.
  23. Kavasmaa OT, Tyomkin DB, Mehik A, et al (2013). Changing trends in symptomatology, diagnostics, stage and survival of prostate cancer in Northern Finland during a period of 20 years. World J Surg Oncol, 11, 258. https://doi.org/10.1186/1477-7819-11-258
  24. Khan IA, Nasir M, Akbar M, et al (2008). Carcinoma of Prostate in clinically benign enlarged gland. J Ayub Med Coll Abottabad, 20, 90-2.
  25. Kuriyama M, Wang MC, Papsidero LD, et al (1980). Quantitation of prostate - specific antigen in serum by a sensitive enzyme immunoassay. Cancer Res, 40, 4658-62.
  26. Lalitha K, Suman G, Pruthvish S, Mathew A, Murthy NS (2012). Estimation of time trends of incidence of prostate cancer-an Indian scenario. Asian Pac J Cancer Prev, 13, 6245-50. https://doi.org/10.7314/APJCP.2012.13.12.6245
  27. Lee F, Torp-Pedersen S, Littrup PJ, et al (1989). Hypoechoic lesions of the prostate: clinical relevance of tumor size, digital rectal examination, and prostate-specific antigen. Radiol, 170, 29-32. https://doi.org/10.1148/radiology.170.1.2462262
  28. Baruteuoglu B, Bozdemir AE, Ertan Y, et al (2009). Performance of total prostate specific antigen and free prostate specific antigen ratio for screening prostate cancer in Turkish population. Turkish J Cancer, 39, 18-24.
  29. Ahmed Z, Azad NS, Yaqoob N, et al (2007). Frequency of primary solid malignant neoplasms in both sexes as seen in our practice. J Ayub Med Coll Abbottabad, 19, 53-5.
  30. Applewhite JC, Matlaga BR, McCullough DL, Hall MC (2001). Transrectal ultrasound and biopsy in the early diagnosis of prostate cancer. Cancer Control J, 8, 141-50. https://doi.org/10.1177/107327480100800204
  31. Barakzi MA, Mubarak M, Kazi JI (2011). Histopathological lesions in transrectal ultrasound guided biopsies of prostate with raised serum prostate specific antigen. Nephro Urol, 3, 186-90.
  32. Belbase NP, Agrawal CS, Pokharel PK, et al (2013). Prostate cancer screening in a healthy population cohort in Eastern Nepal: an explanatory trial study. Asian Pac J Cancer Prev, 14, 2835-8. https://doi.org/10.7314/APJCP.2013.14.5.2835
  33. Cooner WH, Mosley BR, Rutherford Jr CL, et al (1990). Prostate cancer detection in a clinical urological practice by ultrasonography, digital rectal examination and prostate specific antigen. J Urol, 143, 1146-54. https://doi.org/10.1016/S0022-5347(17)40211-4
  34. Djavan BA, Zlotta C, Kratzik M, et al (1999). PSA, PSA density, PSA density of transition zone, free/total PSA ratio, and PSA velocity for early detection of prostate cancer in men with serum PSA 2.5 to 4. Urol, 54, 517-23. https://doi.org/10.1016/S0090-4295(99)00153-3

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