Abstract
Objetivo
Determinar la posible correlación entre los valores del antígeno específico de la próstata (PSA) y los hallazgos del tacto rectal en pacientes con cáncer prostático y enfermedad prostática benigna.
Diseño
Estudio de evaluación de pruebas diagnósticas de tipo retrospectivo, longitudinal, con carácter observacional.
Emplazamiento
Hospital Gregorio Marañón, Madrid.
Participantes
Se incluyó a 706 pacientes con PSA en el rango de 4,1-20 ng/ml estudiados por sospecha de cáncer prostático localizado mediante tacto rectal y ecografía transrectal, en los que se realizaron biopsies prostáticas aleatorizadas.
Mediciones principales
Se estudiaron como variables predictoras el PSA total, el cociente PSA libre/total y el tacto rectal categorizado como normal o sospechoso de cáncer. La variable desenlace fue el diagnóstico de cáncer prostático obtenido mediante biopsia.
Resultados
Con una detección de cáncer del 28,2%, no se encontraron diferencias estadísticamente significativas en los valores medios de PSA o PSA libre/total entre los pacientes sin/con tacto rectal sospechoso. El análisis mediante curvas ROC (con un intervalo de confianza del 95%) entre ambos grupos de pacientes encontró para el PSA en el valor de 4,8 ng/ml una misma sensibilidad del 95%, con una especificidad similar, del 6 y el 10%, respectivamente.
Conclusiones
En el rango de PSA 4,1-20 ng/ml, los hallazgos del tacto rectal aparecieron como una variable sin relación con la elevación del PSA ni con el cociente PSA libre/total y, por tanto, no son indicativos de un menor o mayor volumen tumoral productor de PSA. La realización de esta exploración podría ser considerada como opcional.
Palabras clave: Cáncer, Próstata, Pruebas diagnósticas
Abstract
Objective
To determine the presence of a possible correlation between prostate specific antigen (PSA) and the findings from digital rectal examination (DRE) in patients with prostate cancer or benign prostatic hyperplasia.
Design
Retrospective, longitudinal, and observational study of diagnostic tests.
Setting
Gregorio Marañón Hospital, Madrid, Spain.
Participants
It included 706 patients with a PSA in the range 4.1-20 ng/mL, studied owing to suspected prostate cancer localized using DRE and transrectal ultrasound, in whom randomised prostate biopsies were performed.
Main measurements
Total PSA and free/total PSA ratio and DRE normal or suspicious were studied as main variables. The outcome variable was the diagnosis of prostatic ancer by biopsy.
Results
With a detection of cancer of 28.2%, there were no statistically significant differences in the PSA or free/total PSA ratio mean values between patients with or without suspicious DRE. The analysis using ROC curves (with a 95% confidence interval) between both groups of patients found the same sensitivity of 95% with a similar specificity of 6% and 10%, respectively, for a PSA of 4.8 ng/mL.
Conclusions
In the PSA range of 4.1-20 ng/mL, the findings of DRE appeared as a variable unrelated to the increase in PSA or the free/total PSA ratio and, therefore are not indicative of a lesser or greater volume of a tumour producing PSA. The performing of this examination could be considered as optional.
Key words: Cancer, Prostate, Diagnosis tests
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