Diagnostic significance of total PSA in differential diagnosis between prostate cancer and benign prostate diseaseswith PSA (4-10) ng/ml and age below 75 year

Abstract

Objective: The aim of the research is Revealing the diagnostic importance of prostate-specific antigen (PSA) analysis at values ​​between (4-10) ng/ml in the differential diagnosis between prostate cancer and benign prostatic diseases at the age of less than 75 years in patients visiting Tishreen University Hospital between the years 2021-2022.

Methods: Study type: A Retrospective Observational Study
 The research sample consisted of 53 patients attending the Urology Clinic and Department at Tishreen University Hospital with lower urinary tract symptoms in the period extending between 2021 and 2021 AD. Each patient was studied by taking a clinical history, clinical, radiological and laboratory examination, recording findings such as prostate size, DRE , PSA value, and performing a prostate biopsy for patients who met the inclusion and exclusion criteria. A special form was organized that included the clinical history, clinical examination, laboratory results, and pathological autopsy report. Taking into consideration the following: Pay attention while taking the clinical history to the presence of a history of acute urinary continence, urethral catheterization, use of transurethral endoscopic instruments, or any acute lesion of the prostate before drawing a blood sample , as this may lead to a false increase in the PSA value.Draw blood samples before performing a DRE

Results: The most frequent age group was 60-69 years, with a rate of 50.9%. This can be explained by the hormonal changes observed with age and accompanying diseases, which play a role in the pathogenic mechanism of prostate diseases.Prostate cancer was diagnosed in (17%) of the research sample according to the histopathological findings, compared to (83%) benign cases, the largest percentage of which was (BPH) with 33 patients, constituting (62.3%) of the studied sample.The DRE was positive in the majority of cases of prostate cancer (88.9%) compared to 34.1% in benign cases. The negative test in some cases is due to DRE identifying disorders in the posterior and lateral aspect of the prostate only.The size of the prostate in cases of prostate cancer was statistically significantly lower compared to benign lesions of the prostate (P: 0.03), where it was 53±18.4 g) in malignant cases compared to 77.52±32.7 g) in benign ones.It was observed that there was a statistically significant increase in PSA values ​​with increasing age (P: 0.02), as it reached (4.81±0.7 ng/ml) in the age group (40-49 years) compared to 6.59±2.1 ng/ml (in ages older than 70 years). This is due to the accompanying increase in the size of the prostate gland with age, in addition to the fact that the natural barriers of the prostate that retain PSA within the prostate ducts become more permeable with age, allowing PSA to enter the circulation.No statistically significant differences were observed in PSA values ​​according to the presence of prostate cancer (P: 0.7), as it reached (6.39±1.7 ng/ml) in prostate cancer versus (6.18±1.9 ng/ml) in its absence, or in relation to the result of anal probing (P: 0.2). The slight increase in PSA values ​​in cancer cases can be explained by the fact that cancer cells allow PSA to easily pass through the cell wall into the peripheral extracellular fluid and reach the blood, as cancer cells lack the basal layer that limits the passage outside the cells. The cut-off point for PSA (cut-off value: 5.38) gave a sensitivity of (55.6%) and specificity (59.8%) in diagnosing prostate cancer. The accuracy of prostate size was higher in diagnosing prostate cancer (AUC: 0.73) compared to PSA (AUC: 0.42) in patients  with PSA within range (4-10ng/ml).

Conclusions: 1- Emphasizing the importance of conducting a biopsy and histological study in patients with a PSA within the range of 4-10 ng/ml, while linking it to the clinical findings directed at verifying prostate cancer (age - DRE- prostate size).

2- Emphasizing the importance of routinely titrating the prostate-specific antigen in all men over fifty, and then periodically titrating it according to the risk factors and family history of each patient.

3- Increasing public awareness about prostate cancer and the importance of early detection.

4- The importance of conducting new studies on the incidence of prostate cancer in patients whose antigen value is within the normal range, below 4 ng/ml.