Mahmoud MUSTAFA, Bedeir Ali-ELDEİN, Tarek MOHSEN, EL-Housseiny I. IBRAHİEM

Prostat spesifik antijen ve türevleri prostat kanserini saptamadaki diagnostik önemi; etnik ve coğrafik varyasyon

Amaç: Prostat spesifik antijen (PSA) ve türevleri prostat kanserini saptamada diagnostik değerinin araştırılması. Gereç ve yöntem: Temmuz 2004 ve mart 2005 yılları arasında, transrektal ultrason eşliğinde (TRUSG) altı kor biyopsi yapılan 105 hasta çalışmaya dahil edildi. Tüm hastalarda PSA değeri 4-20 ng/ ml ± anormal parmakla rektal muayene (PRM) bulgusu mevcuttu. Tüm hastalar için PSA dansitesi (PSAD) ve transizyonel zon PSA dansitesi (TZPSAD) hesaplanmıştır. Prostat kanseri olan ve benign prostat hiperplazisi (BPH) olan hastalarda klinik değişkenler karşılaştırıldı; prostat hacmi, PSAD, TZPSAD, TRUSG bulguları ve PRM bulguları. Ayrıca TRUSG ve PRM’nin diagnostik değeri araştırıldı. Bulgular: Yüzbeş hastadan 11 hastada prostat kanseri saptandı (% 10.47). Benign prostat hiperplazisi olan hastalarda ve prostat kanseri olan hastalarda prostat hacmi, TPSA değeri, TRUSG ve PRM bulgularında anlamlı fark izlenmezken TPSAD ve TZPSAD de anlamlı fark saptanmıştır. (p=0.001, p=0.009 sırasıyla). TRUSG ve PRM’nin doğrulama (accuracy) oranı %59.04 ve % 50.47 idi, sırasıyla ve her ikisi prostat kanserini öngörmede yetersiz bulumuştur (p=0.25). Sonuç: Total PSA değeri 4- 20 ng/dl olan hastalarda prostat kanserini saptamada TPSA’nın istatistiksel diagnostik önemi yoktur. Ancak bu hastalarda TPSAD ve TZPSAD’nin prostat kanserini saptamada doğru (accurate) parametreler olarak karşımıza çıkmaktadır. Transrektal ultrasonoğrafi ve PRM prostat kanserini öngörmede yetersiz kalmıştır.

The ethnic and geographic variation in the diagnostic values of prostate specific antigen and its derivatives in detecting prostate cancer

Objective: To evaluate the diagnostic value of prostate specific antigen (PSA) and its derivatives in detecting prostate cancer at biopsies. Materials and methods: Between July 2004 and March 2005, 105 patients who underwent transrectal ultrasound-guided (TRUSG) systemic sextant core biopsies were included. All patients had PSA values 4–20 ng/ml ± abnormal digital rectal examinations (DRE) findings. PSA density (PSAD) and PSA density of the transition zone (TZPSAD) were calculated for each patient. Comparison between the clinical variables of patients with prostate cancer and benign prostatic hyperplasia (BPH) in terms of TPSA, total volume, TPSAD, TZPSAD, TRUS findings and DRE findings, was done. The diagnostic value of TRUS and DRE were also evaluated. Results: Out of 105 patients 11 had prostatic cancer (10.47%). There was no significant difference between subjects with BPH and subjects with prostate cancer in terms of total prostate volume, TPSA values, TRUS findings and DRE findings. However the values of TPSAD and TZPSAD for patients with BPH differs significantly from that of patients with prostate cancer (P = 0.0001, P = 0.009 respectively). The accuracy of DRE and TRUSG were 59.04% and 50.47% respectively, both of them are poor predictors with insignificant difference (P= 0.25). Conclusion: Total PSA is of no diagnostic value in detecting prostate cancer in Egyptian patients with PSA < 20 ng/ml. However TPSAD and TZPSAD could be considered as accurate parameters with clinical significant for prostate cancer prediction in patients with PSA below 20 ng/ml. TRUS and DRE are poor predictor of prostate cancer with no significant difference.

PDF

___

1.Catalona WJ, Miller DR, Kavousi LR. Intermediate term survival results in clinically understaged prostate cancer patients following radical prostatectomy. J Urol, 140: 540-3, 1988.
2.Catalona WJ, Richie JP, Ahmaan FR, et al. Comparison of digital rectal examination and serum PSA level in early detection of prostate cancer: results of multi centre clinical trial 0f 6630 men. J Urol, 151: 1283-90, 1994.
3.Schroder FH, Wildhagen MF. Screening for prostate cancer evidence and perspective. BJU Int 88: 811-7, 2001.
4.Memon A, Al- Muhanna AN. Annual cancer incidence in kuaitis 1992-93. In Parkin DM, Whelan SL, SL, Ferlay J et al. eds Cancer incidence in five continents, Vol. VIII. No. 143. Lyons, France: IARC Scientific publication,: 410-7, 1997.
5.Kehinde EO. Prostate cancer in the middle east: perspective from Oman. In Belldegrun A, Kirby RS, Oliver RTD eds. New perspectives in prostate cancer. Oxford: ISIS Medical Media,: 383-90, 1998.
6.Hanash KA, Al-Othmaimen A, Kattan S et al. Prostatic carcinoma. A nutritional disease? Conflicting data from the Saudi Arabia. J Urol, 161: 71, 1999.
7.Terris M K. and Stamey T A.: Determination of prostate volume by transrectal ultrasound. J Urol, 145; 984, 1991.
8.Mc Crede M, Coates M, Grulich A.: Cancer incidence in migrant to New SouthWales (Autralia) from the middle east, 1972-91. Cancer Causes Control Sep. 5 (5): 414-21, 1994.
9.Boyle P, Maisonneuve P, Napalkov P.: Geographical and temporal pattern of incidence and mortality of prostate cancer. Urology 46: 47-55, 1995.
10.SAMASO Cancer Program Annual Report, 2001.
11.Tandon P, Pathak VP, Zaheer A, Chatterjee A, Walford N.: Cancer in Gizan province of Saudi Arabia: an eleven year study. Ann Saudi Med Jan, 15 (1): 14-20,1995.
12.Zhang W, Sesterhenn IA, Connelly RR et al: Inflammatory infiltrate (prostatitis) in whole mounted radical prostatectomy specimens from black and white patients is not an etiology for racial differences in prostate specific antigen. J Urol, 163: 131, 2000.
13.Morote J, Lopez M, Encabo G et al: Effect of inflammation and benign prostatic enlargement on total and percent free serum prostate specific antigen. Eur Urol, 37: 537, 2000.
14.Mose PL, Burnner A, Horninger W et al: Correlation between inflammatory cells (T and B lymphocytes, macrophages) in prostate biopsies and elevated PSA in a PSA screening population. Urology, 59: 68, 2002.
15.Nickel JC, Downey J, Young I et al: Asymptomatic inflammation and/or infection in benign prostatic hyperplasia. BJU Int, 84: 976, 1999.
16.Mahmoud Mustafa, Bedeir Ali-El-Dein, Tarek Mohsen EL-Housseiny I. Ibrahiem. Prostat Taşları Serum Prostat Spesific Antijen Seviyesini Artırır Mı? Yeni Üroloji Dergisi, 4 (2): 73-76, 2008.
17.Roumeguere T, Zlotta AR, Djavan BR et al: PSA level of the transitional zone: a new marker especially reliable for the detection of prostatic cancer. Acta Urol Belg. 65 (1): 5-9, 1997.
18.Ohi M, Ito K, Suzuki K, Yamamoto T et al.: Diagnostic significance of PSA density adjusted by transition zone volume in males with PSA levels between 2 and 4ng/ml. Eur Urol. 45 (1): 92-6. (18), 2004.
19.Martinez Jabaloyas JM, Garcia Morata F, Villamon Fort R et al: Value of prostate-specific antigen density and transitional-zone prostate-specific antigen density in the diagnosis of prostate cancer. Actas Urol Esp. 27 (6): 442-9,2003.
20.Aksoy Y, Oral A, Aksoy H, Demirel A, Akcay F. PSA density and PSA transition zone density in the diagnosis of prostate cancer in PSA gray zone cases. Ann Clin Lab Sci. 33 (3): 320-3, 2003.