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Japanese Journal of Clinical Oncology Advance Access published online on October 3, 2007
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hym093
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© 2007 Foundation for Promotion of Cancer Research

Histological Diagnosis of Prostate Cancer in Korean Men Aged 70–79 Years

Hong Bang Shim1, Sang Eun Lee2, Hyoung Keun Park3 and Ja Hyeon Ku2,

1 Department of Urology, Seoul Veterans Hospital, Seoul
2 Department of Urology, Seoul National University College of Medicine, Seoul
3 Department of Urology, DongGuk University International Hospital, Goyang, Korea

For reprints and all correspondence: Ja Hyeon Ku, Department of Urology, Seoul National University Hospital, 28, Yongon Dong, Jongno Ku, Seoul 110-744, Korea. E-mail: randyku{at}hanmail.net

Received March 29, 2007; accepted June 8, 2007

Background: The objective of this study was to evaluate the value of the prostate-specific antigen (PSA) in the diagnosis of prostate cancer in elderly Korean men, aged 70–79 years.

Methods: Patients with an abnormal digital rectal examination (DRE) and/or a serum PSA level greater than 2.0 ng/ml underwent a biopsy. A total of 344 men (median age 73 years) constituted the study cohort.

Results: Of 344 men, 163 (47.4%) were diagnosed with prostate cancer upon initial biopsy. The positive predictive value (PPV) for cancer was 48.4% for a PSA cutoff of 4 ng/ml, 65.3% for a cutoff of 10 ng/ml, and 87.0% for a cutoff of 20 ng/ml. When combined with an abnormal DRE, the predictive values for these PSA cutoffs increased to 79.3, 87.3 and 100%, respectively. When 10 ng/ml was chosen as a PSA cutoff level, about 50% of patients were found to have a Gleason score of 7 or higher. When 4 ng/ml was chosen as a PSA cutoff level, more than 50% of patients with an abnormal DRE were found to have a Gleason score of 7 or higher.

Conclusions: In elderly men, more than 50% of patients are found to have cancers with a Gleason score of 7 or higher when their PSA level is greater than 10 ng/ml. This threshold may be lowered to 4 ng/ml in the presence of an abnormal DRE. Our findings provide a rationale for recommending a prostate biopsy in elderly patients with an abnormal DRE and/or an elevated serum PSA level. However, at present, it is not clear whether elderly men have better outcomes when they undergo cancer screening.

Key Words: prostate-specific antigen • prostate neoplasm • prostate cancer • prostate biopsy • elderly


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