AN AUDIT OF PROSTATE-SPECIFIC ANTIGEN AND CLINICAL SYMPTOMS IN GENERAL-PRACTICE

The objective was to devise local guidelines for the referral of patie nts with suspected prostatic carcinoma following evaluation by a retro spective audit of the value of the prostate-specific antigen concentra tion, together with age, urological symptoms, and digital rectal exami nation in the diagnosis of carcinoma of the prostate. Relevant details were collected from the notes of 582 patients from general practice a nd hospital. The significant diagnostic factors were ascertained by st epwise logistic regression. Prostate-specific antigen concentration, d igital rectal examination and significant terminal dribbling were the most powerful factors in the diagnosis of carcinoma of the prostate. W hen prostate-specific antigen concentration was considered in isolatio n, a value of 6.5 ng/ml appeared appropriate for referral. Age was not significant, perhaps due to the narrow patient age range. The signifi cant diagnostic factors were built into an algorithm calculating the p robability of carcinoma of the prostate. This algorithm, together with prostate-specific antigen concentration results and digital rectal ex amination findings, forms the basis of the referral guidelines and a s ubsequent prospective study.