PROSTATE-SPECIFIC ANTIGEN - INSUFFICIENT DISCRIMINATION BETWEEN BENIGN PROSTATIC HYPERPLASIA AND ORGAN-CONFINED PROSTATE-CANCER

Objective: Discrimination of patients with benign prostatic hyperplasi a (BPH) from those with cancer of the prostate (CaP) is crucial to the management of these diseases. At present, a number of new treatment m odalities for symptomatic BPH, which include various nonsurgical treat ment modalities, are being discussed. Prior to treatment, it is import ant to exclude those patients with CaP. In the present study we examin ed retrospectively the serum prostatic-specific-antigen (PSA) values i n both patient groups in order to determine whether serum PSA identifi es those patients harboring organ-confined CaP. Patients and Methods: Group 1 consisted of 121 patients with histologically confirmed BPH as determined from pathological analysis of the surgically removed speci mens. Group 2 included 69 patients with organ-confined CaP, confirmed pathologically from the analysis of the radical prostatectomy specimen s. PSA serum concentration was analyzed in both groups. Results: The m edian PSA level was 3.96 ng/ml (range: 0.5-31.2 ng/ml) in the BPH grou p and 7.8 ng/ml (range: 0.7-37.7 ng/ml) in the CaP group. In spite of a statistically significant difference (p = 0.0001), serum PSA values overlapped considerably in both groups. Conclusions: Serum PSA demonst rated only a limited ability to discriminate between BPH and organ-con fined CaP. Therefore some patients with symptomatic BPH undergoing non surgical treatment may harbor clinically significant CaP despite 'norm al' serum PSA values. Furthermore, PSA-based screening may overlook a significant percentage of patients in whom a rectal digital examinatio n would detect CaP.