Pattern of use of prostate-specific antigen (PSA) among different clinical specialties: retrospective study in a tertiary hospital

Abstract

OBJECTIVE: The Urology Clinic at our unit receives many referrals for raised PSA. The study focused on why PSA was checked initially, whether it was clinically indicated or affected patient management. PATIENTS AND METHODS: This was a single center cross-sectional study on all whose PSA were checked from January 2014 to March 2014. Patient demographics, requesting specialty, indications of checking PSA were extracted from clinical records. PSA results and patients’ clinical outcomes were followed up. RESULTS: 2104 PSA requests of whose mean age 69.6 years old were reviewed. Mean PSA was 36.37 ng/mL (median 2.7 ng/mL). 429(20.4%, 2014) had elevated PSA (>4 ng/mL). 386(90%, 429) were subsequently managed at the Urology Clinic. 128 patients (29.8%, 429) underwent trans-rectal ultrasound guided prostate biopsy. 49 patients (38%, 128) were diagnosed with prostate cancer, of which 23 (46.9%, 49) opted for radical treatment – 10(43.5%, 23) underwent radical prostatectomy, 13(56.5%, 23) had radiotherapy. Logistic analysis showed that age and stage of disease were significantly higher in whom underwent radiotherapy. Age was the only statistically significant predictor for prostate cancer (p = 0.001). Others factors, like PSA level, requesting specialty and clinical indications were not predictors for prostate cancer detection. CONCLUSION: Inappropriate PSA testing is widespread at our institute. Patient counselling is important prior to its checking as to understand the implications of raised PSA levels.