Prostate - Specific Antigen, an Effective Screening Tool for Prostate Cancer - An Analysis of 932 TRUS Core Needle Biopsies

Prostate cancer is the second most frequent cancer and the fifth leading cause of cancer death among men in 2020. Since it is a slow growing tumour, an early detection leads to better chance of successful treatment. Prostate-Specific Antigen (PSA) is a protein found exclusively in prostatic tissue. It is elevated in different prostatic pathologies apart from carcinoma.A cohort of 932 prostatic core needle biopsies was selected after necessary exclusions. The routine haematoxylin & eosin and immunohistochemistry slides were retrieved along with the histopathologic diagnosis rendered. The diagnosis was then correlated with PSA.The mean age for diagnosis of prostatic disease and carcinoma was 68.39 years and 70.21 years respectively. 50.50% cases were premalignant or malignant whereas the remaining 49.50% cases were benign. A cut-off of 4 ng/ml had a sensitivity of 99.78% and a specificity of 7.33%. Gleason score 8 and 9 were most common, accounting for 56.39% of the malignant cases.The present study showed a statistical correlation of age and PSA with prostatic carcinoma. PSA is a valid and sensitive marker and may be continued as an early marker for the screening of prostate cancer. The risk of cancer is minimal with a PSA less than 4 ng/ml whereas an elevated PSA is associated with pathology and hence even a borderline elevation should not be ignored. Due to a low specificity, PSA needs to be corroborated with DRE and transrectal ultrasonography followed by biopsy in cases with PSA > 4ng/ml.Key words: Prostate, Prostate - Specific Antigen, Prostatic Adenocarcinoma, Benign Prostatic Hyperplasia.