Routine Estimation of Prostate Specific Antigen Prior to Clinic Attendance in Patients with Symptoms of Bladder Outlet Obstruction

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Abstract
Summary— We report the use of serum prostate specific antigen (PSA) estimations prior to clinic attendance in 234 patients referred with symptoms of bladder outlet obstruction to a general urology clinic. Ninety‐three patients with PSA levels > 10 ng/ml were seen earlier than planned and offered transurethral resection or transrectal biopsy of the prostate gland. Forty‐six patients (49%) proved to have carcinoma of the prostate, compared with 10 of 141 (7%) patients who had PSA values < 10 ng/ml. With a decision value of 10 ng/ml, the sensitivity for detecting carcinoma was 82% and specificity 73.5%. Using a decision value of 7 ng/ml improved the sensitivity to 95% without significantly affecting the specificity (70%). Twenty‐four patients with prostatic cancer had bone metastases; the sensitivity of PSA for predicting a positive bone scan using a decision value of 25 ng/ml was 92%, but the specificity was only 31%.