AB129. Role of routine examination in diagnose of prostate cancer

Purpose: There is still no consensus exist about the importance of routine diagnostic procedures in diagnosing of the prostate cancer (PCa). In the purpose of defining the roles in diagnosing of the PCa, commonly used procedures such as ordinary digital rectal examination (DRE), transrectal ultrasonography of the prostate (TRUS), elevated levels of prostate-specific antigen (PSA) and PSA density (PSA D) were investigated in the frames of single clinic.

Study materials, procedures and methods: We retrospectively analyzed medical records of 231 patients who underwent transrectal prostate biopsy (TRPB) in the Republican specialized center of urology (Tashkent, Uzbekistan) within year 2013. Indications for performing TRBP were suspicions of the presence of the PCa at any level of investigation, during DRE, elevated PSA/PSA D or TRUS. In the cases of positive TRPB result, Gleason score was calculated for defining the stage of PCa. We calculated sensitivity and specificity of each procedure using area under curve (ROC-curve analysis) and crosstabs and we also used Spearman’s rho coefficient of bivariate correlations for evaluating the strength of associations between diagnostic procedures and positive TRPB result.

Findings: The age of patients varied from 47 to 85 (Mean ± SD =69.2±7.1) years. Among 97 of patients with suspected PCa during DRE 76 (78.4%) resulted in positive TRPB. Average Gleason score among these positive results was 7.6. Of 29 patients with TRUS signs of PCa suspicion, results of the TRBP were positive in 26 (89.7%) with mean Gleason score of 5.9. TRPB positive for PCa resulted in 100 (52.6%) of 190 patients with elevated PSA. Average Gleason score in this group of patients was 3.3. Sensitivity and specificity of the DRE for diagnosing PCa were most optimal among all procedures resulting in 74.5% and 76.9% respectively. Sensitivity of elevated PSA was highest among all diagnostic procedures—98.0%, but specificity was the lowest—1.1%. Lower values of the sensitivity were observed for TRUS (25.5%), but specificity of this procedure was very high (96.7%). Sensitivity for evaluated PSA D was as high as 91.2%, but specificity was too low as 7.7%. Highest levels of correlation were found between positive TRPB and DRE (rho =0.51; P=0.0). Positive TRPB also associated with serum PSA level with strength of 0.43 and with suspicion of PCa by TRUS with rho =0.39. Gleason score correlated with DRE (rho =0.54), with TRUS (rho =0.39), PSA (rho =0.46) and PSA D (rho =0.49).

Conclusions: Unfortunately, even nowadays there no effective noninvasive procedures with confirmed efficacy and available for common use exist for diagnosing of PCa possessing high levels of validity. Transrectal prostate biopsy remains the most valuable diagnostic procedure for PCa. In other hand, such easy-to-do screening procedure as digital rectal examination has not lost its relevance. But at the same time, according to the results of our study, patients with DRE signs of the PCa, has an average Gleason score over 7 thus having potentially aggressive advanced cancer with poor prognosis.

Keywords: Prostate cancer (PCa); routine examination; transrectal prostate biopsy (TRPB)