Source: Arab Journal of Urology; Nov 2018; vol. 16
Publication Date: Nov 2018
Publication Type(s): Conference Abstract
Available at Arab Journal of Urology - from Europe PubMed Central - Open Access
Abstract:Objective: To review the usefulness of prostate-specific antigen (PSA) testing in men presenting to an urgent clinic with haematuria in our practice in a District hospital in the UK.
Methods: We reviewed the retrospective data of 200 patients who presented with visible haematuria (VH) and non-visible haematuria (NVH), aged between 50 and 79 years, between January 2016 and June 2017. All patients underwent digital rectal examination (DRE) and PSA testing as part of our standard investigation for haematuria.
Results: In all, 200 cases were included. A total of 155 cases had VH, 134 of them had a benign DRE and normal PSA level. One of the other 21 cases had an abnormal DRE and elevated PSA level and was diagnosed with Gleason 8 prostate cancer. Three of 21 cases had abnormal DREs and normal PSA levels, two of these patients underwent transrectal ultrasonography (TRUS)-guided prostate biopsy, which revealed Gleason 6 prostate cancer in one of them but showed no evidence of malignancy in the other patient. Whilst, 17 of the 21 cases had normal DREs and elevated PSA levels, 11 of the 17 cases had a repeat PSA test which came back normal, while the other six cases were further investigated with magnetic resonance imaging of the prostate and/or TRUS biopsies, but no malignancy was found. A total of 45 cases presented with NVH, all of them had benign DREs. Only four cases with elevated PSA levels with no malignancy were detected in further investigations. Overall, the number of patients who underwent further investigations was 14/200 (7%). Overall, the rate of prostate cancer diagnosis was 1%; the rate of diagnosis with VH was 1.29% and 0% with NVH.
Conclusion: Despite using PSA as a standard investigation for patients who presented to the urgent clinic with haematuria, the rate of cancer diagnosis was very low (1%) and detected in patients with abnormal DRE rather than elevated PSA levels. Our cancer detection rate of 1% is less than those from the European Randomized Study of Screening for Prostate Cancer (ERSPC; 8.2%), Prostate Testing for Cancer and Treatment (ProtecT; 2.2%) and the Prostate, Lung, Colorectal, and Ovarian cancer screening trial (PLCO; 1.4%). PSA level measurement should not be considered as a useful test in standard investigations of haematuria, unless an abnormal DRE is found during examination.Copyright © 2018