Indications for Prostatic Biopsy – which is more useful: the Prostate Specific Antigen or the Digital Rectal Examination? – An Analysis of 431 Consecutive Prostatic Biopsies at the Lagos University Teaching Hospital

Abstract

Objective: To compare the reliability of the digital rectal examination (DRE) and the serum prostate specific antigen (PSA) as an indication for prostate biopsy at the Lagos University Teaching Hospital, (LUTH) Idi-Araba, Nigeria.
Patients and Methods: 42 patients were admitted for transperineal trucut biopsy of the prostate at the hospital between January 2000 to December 2001. The indication for biopsy was either an abnormal finding on DRE, serum PSA greater than 4ng/ml or both. The final histopathology report was used as the Gold standard in assessing accuracy of these two screening procedures.
Results: PSA>4ng/ml (irrespective of DRE findings) had a positive predictive value (PPV) of 68.6% for prostatic cancer (Ca-P). A raised PSA. alone (i.e. with normal findings on DRE.) had a PPV of 28.6%. DRE (irrespective of PSA) had a PPV of 88.9%. When both an abnormal DRE and a raised PSA were present, the PPV was 95.2%.
Conclusion: At LUTH, DRE is more reliable than the serum PSA analysis as an indication for prostate biopsy.


NQJHM Vol. 14 (3&4) 2004: pp. 248-250