Akduman, Bulent | Crawford, E. David

Article | 2006 | EUROPEAN UROLOGY SUPPLEMENTS5 ( 9 ) , pp.634 - 639

The Prostate Cancer Prevention Trial (PCPT) demonstrated that finasteride therapy significantly reduced the risk of prostate cancer by 24.8% (p < 0.001) compared with placebo. Controversially, there was an increased incidence of high-grade (Gleason score >= 7) tumours in the finasteride arm compared with placebo. The increase in incidence of high-grade disease observed in finasteride-treated subjects does not appear to be a histopathologic effect. A number of potential biases have been identified, including increased detection rate due to prostate volume reduction and improved prostate-specific antigen specificity and sensitivity fo . . .r detecting prostate cancer. This would suggest that there was an improved detection of overall prostate cancer as well as high-grade prostate cancer in men treated with finasteride, rather than an increase in risk compared with placebo. Further analyses of the data from the PCPT together with other clinical findings strongly suggest that the increase in high-grade tumours in the finasteride arm is an artefact. (c) 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved Daha fazlası Daha az

Mungan, A. Gorkem | Erol, Bulent | Akduman, Bulent | Bozdogan, Gurdal | Kiran, Sibel | Yesilli, Cetin | Mungan, N. Aydin

Article | 2007 | CLINICAL CHEMISTRY AND LABORATORY MEDICINE45 ( 7 ) , pp.912 - 916

Background: The aim of this study was to evaluate age-related changes in free/total prostate-specific antigen (f/t PSA) ratio, focusing on the avoidance of unnecessary prostate biopsies. Methods: A total of 898 men aged 30-88 years without a history of prostate surgery and disease were enrolled into the study. Serum tPSA, fPSA and f/t PSA ratios were determined for the study population and for different age categories. All males who had suspicious digital rectal examination and tPSA > 4 ng/mL underwent transrectal ultrasonography-guided prostate biopsy. Receiver operating characteristic (ROC) curves for each group were generated by . . .plotting the sensitivity vs. 1-specificity for the f/t PSA ratio. The sensitivity and specificity were obtained using different f/t PSA ratio cutoffs for different age groups. Results: Prostate cancer was detected in 63 patients (7%). Age-specific cutoffs were determined according to likelihood ratios at the levels of 10%, 15% and 15% f/t PSA ratio for ages 50-59, 60-69 and >= 70 years, respectively. However, a single cutoff of 10% is recommended across all age ranges (positive likelihood ratio 2.36). ROC curves demonstrated that the area under the curve (AUC) was significant for all patients with initial PSA of 4-10 ng/mL (AUC 0.703-0.796), except for the >= 70-year age group (AUC 0.549). Conclusions: The current study showed that the use of f/t PSA ratio in patients with PSA levels of 4-10 ng/mL should enhance the specificity of PSA screening and decrease the number of unnecessary biopsies. f/t PSA levels may show dissimilarities according to age and ethnicity, so further studies are warranted to identify this relationship Daha fazlası Daha az