Oya BAYINDIR, Erkin BZDEMİR, Güneş BAŞOL, Burcu BARUTÇUOĞLU

Is percent free prostate specific antigen test used more than recommended by international standarts for prostate cancer screening?

Amaç. Prostat kanser (PCa) taramasında, “serbest prostat spesifik antijen yüzdesi” (% sPSA) ölçümü prostat spesifik antijen (tPSA) testinin özgüllüğünü arttırmakta ve Amerikan Üroloji Derneği’nin (AÜD) ve Amerikan Kanser Cemiyeti’nin uluslararası tarama kılavuzlarına göre tPSA 2.5 ve 10 ng/mL arasındayken kullanılmaktadır. Bu çalışmada, pratikte %sPSA test isteklerinin sayısı ve PCa tarama kılavuzlarına uyumu değerlendirdik. Yöntem. 2004 ve 2007 yılları arasında, hastanemizde, farklı yaş gruplarında ve farklı tPSA düzeylerinde uygulanan %sPSA test sayıları incelendi. Bulgular. Yirmi beş bin sekiz yüz kırk beş %sPSA testi 2004 ve 2007 yılları rasında yapılmıştır. Sadece %23.7’sinin tPSA düzeyleri 2.5-10 ng/mL idi. Hastaların % 9.8’i 45 yaşın altında ve % 10.2’si 75 yaşın üzerinde idi. Sonuç. % sPSA taramaları, tarama kılavuzlarına tam olarak uyum göstermemektedir. Laboratuvarlar, klinisyenler ve pratisyen hekimler %sPSA test isteklerini Pca taramasında gözden geçirmelidirler.

Gereğinden fazla serbest prostat spesifik antijen yüzdesi test isteği yapılmakta mıdır?: Prostat kanseri taramasında uluslararası kılavuzlarla uyumsuzluk

Aim. For prostate cancer (PCa) screening “percent free prostate specific antigen” (pfPSA) testing is used for improving test specificity of prostate specific antigen (tPSA) and is used when tPSA is between 2.5 and 10 ng/mL, according to international screening guidelines of American Urological Association (AUA), and American Cancer Society (ACS). We evaluated the number of pfPSA testing requested in practice and the concordance to PCa screening guidelines. Method. The number of pfPSA testing performed at different age groups and different tPSA levels had evaluated, in our hospital between 2004 and 2007. Result. Twenty five thousand eight hundred and forty five pfPSA tests were performed between 2004 and 2007. Only 23.7 % of men were at tPSA levels 2.5-10 ng/mL. 9.8 % of patients were under age 45 years, and 10.2 % of them were over 75 years. Conclusion. There is no real pfPSA screening consistency with screening guidelines. Laboratories, clinicians and practitioners should overview their pfPSA requests for PCa screening.

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1. Smith RA, von Eschenbach AC, Wender R, Levin B, Byers T, Rothenberger D, Brooks D, Creasman W, Cohen C, Runowicz C, Saslow D, Cokkinides V, Eyre H.American Cancer Society guidelines for the early detection of cancer: update of early detection guidelines for prostate, colorectal, and endometrial cancers. Also: update 2001--testing for early lung cancer detection. Cancer J Clin 2001;51: 38-75.
2. Jackson BR, Roberts WL. Brief report: Free prostate-specific antigen test utilization. J Gen Intern Med 2005;20: 859-61.
3. Carroll P, Coley C, McLeod D, Schellhammer P, Sweat G, Wasson J, Zietman A, Thompson I. Prostate-specific antigen best practice policy--part I: early detection and diagnosis of prostate cancer. Urology 2001;57: 217-24.
4. So A, Goldenberg L, Gleave ME. Prostate specific antigen: an update review. Can J Urol 2003: 2040-50.
5. Lee R, Localio AR, Armstrong K, Malkowicz SB, Schwartz JS; Free PSA Study Group. A meta-analysis of the performance characteristics of the free prostate specific antigen test. Urology 2006;67: 762-8.
6. Postma R, Schröder FH, van Leenders GJ, Hoedemaeker RF, Vis AN, Roobol MJ, van der Kwast TH. Cancer detection and cancer characteristics in the European Randomized Study of Screening for Prostate Cancer (ERSPC)--Section Rotterdam. A comparison of two rounds of screening. Eur Urol. 2007; 52: 89-97.
7. Gann PH, Hennekens CH, Longcope C, Verhoek-Oftedahl W, Grodstein F, Stampfer MJ. A prospective study of plasma hormone levels, nonhormonal factors, and development of benign prostatic hyperplasia. Prostate 1995; 26: 40-9.
8. Hoffman RM, Clanon DL, Littenberg B, Frank JJ, Peirce JC. Using the free-to-total prostate-specific antigen ratio to detect prostate cancer in men with nonspecific elevations of prostate-specific antigen levels. J Gen Intern Med. 2000;15: 739-48.
9. Barutçuoğlu B, Bozdemir AE, Ertan Y, Kabaroğlu C, Tamsel S, Hekimgil M, Çal Ç, Özmen D, Bayindir O. Performance of total prostate specific antigen and free prostate specific antigen ratio for screening prostate cancer in a Turkish population. Turk J Cancer 2009;28: 18-25.
10. Crawford ED, Pinsky PF, Chia D, Kramer BS, Fagerstrom RM, Andriole G, Reding D, Gelmann EP, Levin DL, Gohagan JK . Prostate specific antigen changes as related to the initial prostate specific antigen: data from the prostate, lung, colorectal and ovarian cancer screening trial. J Urol 2006;175:1286-90
11. Schroder FH, Raaijmakers R, Postma R, van der Kwast TH, Roobol MJ. 4-year prostate specific antigen progression and diagnosis of prostate cancer in the European randomized study of screening for prostate cancer, section Rotterdam. J Urol 2005;174: 489-94.
12. Kundu SD, Grubb RL, Roehl KA, Antenor JA, Han M, Catalona WJ. Delays in cancer detection using 2 and 4-year screening intervals for prostate cancer screening with initial prostate specific antigen less than 2 ng/ml. J Urol 2005;173:1116-20.