Diagnosis of prostate cancer in Serbia

A rising incidence of prostate cancer is noticed in USA and Europe, which might be due to better diagnostic procedures and screening programs started in some countries. We still lack epidemiological studies confirming the same trend in our country, but the rising number of patients in whom radical prostatectomy is performed is an indirect proof of bigger recruitment of patients with prostate cancer. The purpose of this study was to establish the most appropriate diagnostic protocol for detection of prostate cancer in our unscreened population.

Transrectal ultrasound (TRUS) -guided biopsies of the prostate were performed in 229 patients. Biplanar transrectal probe with needle channel was used. Six to 10 tissue cores were obtained from each patient.

The mean patients' age was 67.12 years (range 42-88). All patients had serum prostatic specific antigen (PSA) estimation before biopsy, which ranged from 0.41 to 1550 ng/ml (mean 50.83), with 146 (63.8%) patients having PSA level greater than 10 ng/ml. Free (F) PSA was performed in 120 (52.4%) patients; the range of F to total (T) PSA ratio was 0.02 to 0.74 (mean > 0.13). Digital rectal examination (DRE) was positive in 65% of the patients. The mean prostate volume was 40.5 ml (range 11-140). Cancer was diagnosed in 99 (43.2%) patients, prostate cancer in situ (PIN) alone was diagnosed in 37 (16.2%), chronic prostatitis in 73 (31.9%), while benign prostatic hyperplasia (BPH) was found in 20 (8.7%) patients.

The cancer detection rate in our patients was high. In a lot of patients the biopsy was needed only for histological proof, not as a staging tool, the intention of which is the selection of patients with localized prostate cancer amenable to curative treatment. There is still reluctance to use PSA as a sole indication for biopsy, positive DRE still being mandatory. With such a policy we are missing a lot of curable prostate cancer cases, thus increasing the cost of treatment. A national policy including screening should be considered.