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Prostate specific antigen--a screening test for prostatic cancer?

C S Powell¹, A M Fielding, K Rosser

¹Department of Urology, Morriston Hospital, Swansea.

British Journal of Urology

|November 1, 1989

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Serum prostate specific antigen (PSA) shows promise for screening prostate cancer in symptomatic men. However, its low positive predictive value means it

Area of Science:

Urology
Oncology
Biochemistry

Background:

Bladder outflow obstruction symptoms prompt prostate cancer screening.
Prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) are biomarkers for prostate cancer.
Distinguishing between benign prostatic conditions and prostate cancer is clinically significant.

Purpose of the Study:

To evaluate the efficacy of serum PSA and PAP as screening markers for prostate cancer (CaP) in patients with bladder outflow obstruction.
To compare the diagnostic accuracy of PSA and PAP in this patient cohort.

Main Methods:

Blood samples were collected from 211 patients with symptoms of bladder outflow obstruction.
Serum levels of PSA and PAP were analyzed.
Patients with elevated markers underwent further investigations, including biopsy.

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Main Results:

PSA levels >10 µg/L were found in 36 patients; PAP levels >5 IU/L were found in 7 patients.
All patients with elevated PAP also had elevated PSA.
PSA demonstrated 90% specificity and 89.5% sensitivity for CaP detection, while PAP showed 100% specificity and 36.8% sensitivity.
17 patients were diagnosed with CaP, 9 with distant metastases.

Conclusions:

Routine use of PAP for prostate cancer detection is not recommended.
PSA is a justified screening test for patients with prostatism symptoms, but its positive predictive value (47%) limits its use in mass screening programs.
Further research may refine PSA's role in targeted prostate cancer screening.