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Evaluation of a stage II screening protocol for prostate cancer

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dc.contributor.author deRuiter, Wayne K. en_US
dc.date.accessioned 2009-07-09T17:35:18Z
dc.date.available 2009-07-09T17:35:18Z
dc.date.issued 2003-07-09T17:35:18Z
dc.identifier.uri http://hdl.handle.net/10464/1860
dc.description.abstract In 2003, prostate cancer (PCa) is estimated to be the most commonly diagnosed cancer and third leading cause of cancer death in Canada. During PCa population screening, approximately 25% of patients with a normal digital rectal examination (DRE) and intermediate serum prostate specific antigen (PSA) level have PCa. Since all patients typically undergo biopsy, it is expected that approximately 75% of these procedures are unnecessary. The purpose of this study was to compare the degree of efficacy of clinical tests and algorithms in stage II screening for PCa while preventing unnecessary biopsies from occurring. The sample consisted of 201 consecutive men who were suspected of PCa based on the results of a DRE and serum PSA. These men were referred for venipuncture and transrectal ultrasound (TRUS). Clinical tests included TRUS, agespecific reference range PSA (Age-PSA), prostate specific antigen density (PSAD), and free-to-total prostate specific antigen ratio (%fPSA). Clinical results were evaluated individually and within algorithms. Cutoffs of 0.12 and 0.15 ng/ml/cc were employed for PSAD. Cutoffs that would provide a minimum sensitivity of 0.90 and 0.95, respectively were utilized for %fPSA. Statistical analysis included ROC curve analysis, calculated sensitivity (Sens), specificity (Spec), and positive likelihood ratio (LR), with corresponding confidence intervals (Cl). The %fPSA, at a 23% cutoff ({ Sens=0.92; CI, 0.06}, {Spec=0.4l; CI, 0.09}, {LR=1.56; CI, O.ll}), proved to be the most efficacious independent clinical test. The combination of PSAD (cutoff 0.15 ng/ml/cc) and %fPSA (cutoff 23%) ({Sens=0.93; CI, 0.06}, {Spec=0.38; CI, 0.08}, {LR=1.50; CI, 0.10}) was the most efficacious clinical algorithm. This study advocates the use of %fPSA at a cutoff of 23% when screening patients with an intermediate serum PSA and benign DRE. en_US
dc.language.iso eng en_US
dc.publisher Brock University en_US
dc.subject Prostate--Cancer--Diagnosis. en_US
dc.subject Medical screening. en_US
dc.title Evaluation of a stage II screening protocol for prostate cancer en_US
dc.type Electronic Thesis or Dissertation en_US
dc.degree.name M.Sc. Applied Health Sciences en_US
dc.degree.level Masters en_US
dc.contributor.department Applied Health Sciences Program en_US
dc.degree.discipline Faculty of Applied Health Sciences en_US


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