Effect of patient age on early detection of prostate cancer with serum prostate-specific antigen and digital rectal examination
| Autor: | Frederick R. Ahmann, William J. Catalona, Timothy L. Ratliff, Peter T. Scardino, M'Liss A. Hudson, W. Bedford Waters, Jean B. deKernion, Robert C. Flanigan, Jerome P. Richie, Paula C. Southwick, Louis R. Kavoussi, Michael T. Macfarlane, Bruce L. Dalkin |
|---|---|
| Rok vydání: | 1993 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Urology medicine.medical_treatment Rectum urologic and male genital diseases Prostate cancer Prostate Predictive Value of Tests Medicine Humans Prospective Studies Prospective cohort study Aged Neoplasm Staging Gynecology Aged 80 and over Prostatectomy Palpation medicine.diagnostic_test business.industry Age Factors Prostatic Neoplasms Rectal examination Middle Aged Prostate-Specific Antigen medicine.disease Middle age Prostate-specific antigen medicine.anatomical_structure business |
| Zdroj: | Urology. 42(4) |
| ISSN: | 0090-4295 |
| Popis: | This study was designed to determine the effects of age by decade on the efficacy of digital rectal examination (DRE) and serum prostate-specific antigen (PSA) for early detection of prostate cancer in men aged fifty and over. A prospective multicenter clinical trial was conducted at six university centers. All 6,630 male volunteers underwent a serum PSA (Hybritech, Tandem) determination and DRE. Quadrant biopsies of the prostate were performed if PSA was4 ng/mL or DRE suspicious. A total of 1,167 biopsies were performed, and 264 cancers were detected. The cancer detection rate increased from 3 percent in men aged fifty to fifty-nine to 14 percent in men eighty years or older (p0.0001). PSA detected significantly more of the total cancers than DRE at all age ranges (p0.05). The positive predictive values (PPV) for PSA were 32 percent (50-59 years), 30 percent (60-69 years), 34 percent (70-79 years), and 38 percent (80+ years). The corresponding PPVs for DRE were 17 percent, 21 percent, 25 percent, and 38 percent. Eighteen percent of the cancers were detected solely by DRE, whereas 45 percent of cancers were detected solely by PSA. Thus, the use of both tests in combination provided the highest rate of detection in all age groups. One hundred-sixty patients underwent radical prostatectomy and pathologic staging. Cancer was organ-confined in 74 percent (25/34) of men aged fifty to fifty-nine, 76 percent (65/86) of men aged sixty to sixty-nine, and 60 percent (24/40) of men aged seventy or over (chi 2,70 vs.or = 70, p0.05). Early detection programs yield a lower, yet still substantial, cancer detection rate in younger men, and there is a greater likelihood for detection of organ-confined disease in this age range. Younger men have the longest projected life expectancy and, therefore, the most to gain from early prostate cancer detection. |
| Databáze: | OpenAIRE |
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