Screening for Prostate Cancer: Role of Free Psa, Psad with Prostate Biopsy Findings and Digital Rectal Examination

Background and Aim The incidence of various cancers including the prostate, is on the rise globally. Prostate cancer is one of the most frequently reported cancer in men worldwide. This study was done to study the correlation of free PSA, percentage free PSA, and PSAD, with prostate biopsy findings, and the role of DRE in screening for carcinoma prostate. Methods The cross-sectional, correlational study was conducted at a tertiary care hospital in Coastal Kerala, over a period of 18 months in a sample size of 100 patients. The following was the study outline followed; Results The prevalence of prostate cancer was found to be 41%, maximum number of patients were in the age group of 50 -70 years of age. Percentage free PSA (%fPSA) and prostate volume were found to vary significantly between patients with Benign Prostate Hyperplasia and prostate cancer. At a cut off of 0.15, PSA density was seen to significantly vary between patients with BPH and prostate cancer. At a cut off of 15% (chosen based on prior studies), %fPSA was seen to significantly vary between patients with BPH and prostate cancer. The sensitivity and specificity of %fPSA were 73.17% and 93.22% respectively. Digital rectal examination varied significantly between patients with benign enlargement and those with malignancy. However, false positive rate with DRE alone was 44.06%. Conclusion DRE continues to be a useful screening technique as a part of clinical examination to identify patients who should undergo further screening for prostate cancer such as PSA estimation, free PSA estimation, and if required, a prostate biopsy, but DRE alone cannot be used to make accurate clinical decision owing to the false positives. Percentage fPSA could be a useful tool that can be used to avoid unnecessary biopsies in patients with a PSA range between 4.0 – 10.0 ng/ml.