Outcomes of men who present with elevated serum PSA (greater than 20 ng/mL)to an inner-city hospital

A80

Introduction: We report the incidence, clinicopathologic features, and outcomes of men who presented to an inner-city hospital with serum PSA greater than 20 ng/ml.
 Materials and Methods: Five hundred and sixty men underwent a transrectal ultrasound needle-guided biopsy of the prostate for elevated PSA greater than 4 ng/ml with or without an abnormal digital rectal examination.
 Results: Of the 560 men 65 (12%) were found to have a serum PSA greater than 20 ng/ml, with 57 having prostate cancer on needle biopsy. In the group of 57 men with cancer, the positive predictive value of PSA alone was 72% for PSA levels of 20-29.99 ng/ml, 100% for PSA greater than 30 ng/ml. Eighteen of the 57 men underwent definitive therapy, 24 underwent androgen deprivation, 8 men refused treatment or were lost to follow-up and 7 were treated on protocol. Overall, 15 of 57 (26%) patients diagnosed with cancer refused therapy or were lost to follow-up. Another 17 men (30%) died during this study, 12 of their disease.
 Conclusions: Serum PSA above 30 ng/ml is an almost certain predictor of the presence of prostate cancer. Aggressive prostate cancer education and screening programs are needed in our inner cities in order to detect prostate cancer at an earlier, treatable stage.