Diagnostic value of the density of prostatspecific antigen in the detection of the prostate gland

Abstract

The problem of diseases of the prostate gland (PG) today is extremely urgent. This is due to an increase in the number of cases of diseases, including malignant neoplasms, the spread of pathology among young men, difficulties in diagnosing, especially in the early stages, late detection, and an increase in mortality. Therefore, the issue of early detection of this nosology is very important. Purpose. Conduct a comprehensive analysis, which consists in comparing the specificity and ratio of indicators such as total PSA, free PSA, PSA-index, the presence or absence of acute urinary retention, and especially the PSA-density indicator with histopathological examination after transrectal biopsy of the prostate gland for early verification clinical diagnosis of prostate cancer. Material and methods. The study involved 112 patients who received treatment in the urology department of the City Clinical Hospital for Emergency and Emergency Medical Aid in Zaporozhye for the period October 2017 – October 2018 about the symptoms of the lower urinary tract and elevated levels of total PSA. All patients underwent general clinical and X-ray examination, laboratory tests, ultrasound of the urinary system, determination of the level of total and free prostate-specific antigen (PSA), digital rectal examination and transrectal biopsy of the prostate gland. All patients had a total PSA above 4 ng/ml. In this regard, a transrectal biopsy of the prostate gland was performed under the control of a transrectal ultrasound transducer. As a result, PHE patients were divided into three groups. The first group consisted of 50 patients who, as a result of PHE, received a conclusion about the presence of benign prostatic hyperplasia in them in the absence of signs of cancer. The second group consisted of 56 patients who, according to the results of PHE, had moderately differentiated (G2) adenocarcinoma of the prostate. Group 3 consisted of 6 patients who were diagnosed with poorly differentiated (G3) adenocarcinoma of the prostate in histopathology report. Results. As a result of this clinical study, it was found that patients with low-grade (G3) adenocarcinoma of the prostate gland had chronic urinary retention more often and had occurred in 83% of patients, in patients with moderately differentiated (G2) adenocarcinoma, and in patients with BPH, this figure was correspondingly 70% and 56%. Chronic urinary retention in patients with adenocarcinoma of the prostate gland was detected more frequently, and in patients with BPH, acute urinary retention was more frequent. (44% in the first group versus 30% and 17% in patients with adenocarcinoma G2 and G3, respectively). The average total PSA in patients of group 1 was 20.09 ng/ml, and in patients with moderately differentiated (G2) adenocarcinoma, it was more than 2 times and amounted to 42.45 ng/ml. It is worth noting that in patients with a diagnosis of low-grade (G3) adenocarcinoma of the prostate gland, this indicator was almost 10 times higher than in patients of group 1 and 5 times compared with patients of group 2 and was respectively 192.46 ng/ml. The maximum indicator of total PSA was also higher in patients of group 3 and amounted to 1046.0 ng/ml, and in patients with BPH and moderately differentiated (G2) adenocarcinoma, this indicator was 71.9 ng/ml and 764.0 ng/ml, respectively. The average PSA index was higher in patients with BPH (26.78%), and in patients with adenocarcinoma of G2 and G3, this figure was 22.14% and 20.5%, respectively. Special attention needs to be stopped as such an indicator as PSA density. In patients with low-grade (G3) prostate adenocarcinoma, this indicator was only in one case in the normal range and its average in group 3 was almost 3 times higher than in patients with moderately differentiated (G2) prostate adenocarcinoma and 12 times higher than in patients with group 1 and amounted to 2.8 ng/ml/cm3. The PSA density levels in patients of groups 1 and 2 were 0.23 ng/ml/cm3 and 1.1 ng/ml/cm3, respectively. The maximum PSA density values †were also significantly higher in patients with G2 and G3 adenocarcinoma and amounted to 15.3 ng/ml/cm3 and 9.5 ng/ml/cm3, respectively, against the results of group 1, where this indicator was 0.65 ng/ml/cm3. Findings. A clinical study allows us to see that the indicators existing in the routine practice of a urologist cannot with great certainty compared with a transrectal prostate biopsy indicate a prostate cancer. Prostate biopsy in the diagnosis of prostate cancer is the gold standard present in identifying this disease.