Prostate cancer diagnosis-what to expect in the thai population?

Abstract

Objective: To study the prostate cancer detection rates upon transrectal ultrasound (TRUS) guided biopsy in relation to prostate-specific antigen (PSA) and digital rectal examination (DRE) included risk factors for prostate cancer diagnosis. Materials and Methods: 1,176 patients who underwent TRUS prostate biopsy between 2002 to 2008 were enrolled to the study. The prostate cancer detection rates with reference to PSA level and DRE finding were investigated. Logistic regression analysis was performed on age at biopsy, clinical symptoms, prostate-specific antigen (PSA), and DRE findings to identify significant risk factors. The correlation of DRE findings in combination with PSA value was also analyzed. Results: Referring to patients with normal DRE, the cancer detection rates were 10.8%, 12.9%, 21.3%, 42.6% and 77.8% in patients with PSA <4, 4 to 10, 10.01 to 20, 20.01 to 50 and >50 ng/ml, respectively. According to patients with abnormal DRE, the cancer detection rates were 15.0%, 20.7%, 41.2%, 60.5% and 84.8% in patients with PSA <4, 4 to 10, 10.01 to 20, 20.01 to 50 and >50 ng/ ml, respectively. Additionally, the age at biopsy, PSA level and DRE finding were the significant risk factors for prostate cancer diagnosis while clinical symptom was not. The data revealed that normal DRE finding in combination with PSA level was statistically significant when PSA level was above 20 ng/ml. Similarly, the abnormal DRE finding in combination with PSA level was statistically significant when PSA level was above 10 ng/ml. Conclusion: Thai men appeared to have lower prostate cancer detection rate when compared to the Western population. The age at biopsy, PSA level and DRE finding were the significant risk factors for prostate cancer. Besides, the combination of DRE and PSA level increased the accuracy and were the best tool for prostate cancer screening. © JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND| 2019.