Dear Mohammad,
Our experience is somewhat different from yours. We do fPSA on patients
presenting for the first time with a total PSA between the upper limit of
the age-related reference range and 10 ug/L. This represents less than 3%
of our workload.
Approximately 50% of these turn out to have fPSA > 22% and GP's are advised
to remeasure tPSA in a year's time rather than refer for prostate biopsy.
When we audited the first couple of year's work none of the 39 patients in
this category who had subsequently had biopsy (presumably mostly during
TURP's) had any evidence of prostatic cancer.
The Urologists feel we have reduced their workload and not at the expense of
missing cases. They are therefore pleased and we continue to offer the
service.
A note of caution though. It may be O.K. as a rule out test (very high
negative predictive value) but our experience mirrors yours insofar as a low
% fPSA is every bit as likely to be due to BPH as cancer (low PPV).
Regards
David Hullin
Dr D A Hullin
Department of Clinical Biochemistry
Royal Glamorgan Hospital
Ynysmaerdy
Llantrisant
CF72 8XR
Tel: 01443 443358
> -----Original Message-----
> From: Mohammad Al-Jubouri [SMTP:[log in to unmask]]
> Sent: 28 April 2004 16:47
> To: [log in to unmask]
> Subject: %fPSA useless in our hands
>
> At the request of our local urologists, we ran a trial of free PSA for six
> months. At the end of the period 82 patients had both %fPSA and prostatic
> biopsies performed. Using a cutoff value of 10% for %fPSA, 73% of prostate
> cancer patients and 61% of BPH patients (all histologically proven), fell
> within this category. This makes %fPSA slightly better than tossing a coin
> in dicriminating prostatic cancer and BPH patients, even at this low
> cutoff level.
> What is the experience of others in this field please?
>
> Many thanks
>
> Mohammad
>
>
>
> Dr. M A Al-Jubouri
> Consultant Chemical Pathologist
>
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