PROSTATE-SPECIFIC ANTIGEN CANNOT DISTINGUISH STAGE T1A (A1) PROSTATE-CANCER FROM BENIGN PROSTATIC HYPERPLASIA

To determine if serum prostate specific antigen (PSA) has decreased th e prevalence of stages T1a (A1) and T1b (A2) prostate cancer, and to c ompare the PSA values for patients with stages T1a and T1b prostate ca ncer and men with symptomatic benign prostatic hyperplasia, 966 patien ts undergoing transurethral resection of the prostate were evaluated r etrospectively. Included in the study population were 499 consecutive patients who underwent transurethral resection of the prostate for obs tructive urinary symptoms in 1986 (no PSA group), and 467 consecutive patients who underwent resection in 1989 and 1990 who were evaluated w ith serum PSA preoperatively (PSA group). The mean age for the no PSA group was 71 years compared to 70 years for the PSA group (p = 0.36). The overall prevalence of stages T1a and T1b prostate cancer in the no PSA group was 8.6% compared to 10.3% in the PSA group (p = 0.37). The prevalence of stages T1a and T1b prostate cancer in the no PSA group was 3.6% and 5.0%, respectively, compared to 7.3% and 3.0%, respective ly, for the PSA group (p = 0.01). In the PSA group the median PSA valu e for patients with stages T1a and T1b prostate cancer was 3.8 ng./ml. compared to 3.4 ng./ml. for the patients without cancer (p = 0.59). T he median PSA level for the stage T1a cancer patients was 2.4 ng./ml., which was not statistically different from that in patients without c ancer (p = 0.31), and the median PSA level for the stage T1b cancer pa tients was 5.9 ng./ml., which was statistically different than that in patients without cancer (p = 0.01). These findings suggest that the r outine use of serum PSA does not decrease the prevalence of stage T1a prostate cancer and that PSA may decrease the prevalence of stage T1b tumors but a larger study would be necessary to document this finding.