الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
Prostate cancer is one of the most important cancers in men worldwide. Its incidence can be influenced by several risk factors including genetic susceptibility, environmental exposure, dietary factors and differences in health care and cancer registration (or a combination of these).
The marked increase in detection of prostate cancer occurred due to the development of tumor markers of prostate mainly prostate–specific antigen (PSA).
In spite of the low incidence of prostate cancer in Egypt the increase of the aging population, ushers that prostate cancer will become a more enormous challenge. This study was conducted to verify the output of prostate cancer as detected by the conducted screening program in Urology department, Alexandria Faculty of medicine and to reveal some associated predisposing factors for prostate cancer.
The study included 1207 male patients aging >55 years; including data for 1107 patients obtained from records and 100 interviewed men. Patients with Diabetes Mellitus, infertile or those with lower urinary tract symptoms were excluded from the study.
All patients were submitted to thorough history taking; complete physical examination including digital rectal examination (DRE). Measurements of serum total PSA and serum total testosterone. Patients with high serum PSA (> 4 ng/ ml) and/ or suspicious DRE underwent transrectal ultrasound guided (TRUS) extended prostatic biopsy.
Interview questionnaire collected data about patients’ age, social, medical characteristics and dietary pattern.
The following results were obtained
The median age of the studied patients was 64 years. that the majority (87%) of screened patients had a PSA level less than 4 ng/ ml, while 4.4%, 3.5% and 5.1% had PSA levels 4.1- 10, 10.1- 20 and >20 ng/ ml respectively. The median PSA of the studied patients was 0.8 ng/ ml. Moreover; results of DRE carried out to screened patients revealed that the percentage of patients with suspicious findings was directly related to the level of serum PSA; as it was 0.1%, 24%, 83% and 97% for patients with PSA less than 4, 4.1- 10, 10.1- 20 and more than 20 ng/ ml respectively. The prostate cancer detection rate was 8.5% (1/ 12 screened men).
Applying PSA for screening was associated with a sensitivity of 99%, 92% and 59% using PSA cut-off values of < 4, > 10 and > 20 ng/ ml respectively and a specificity of 0%, 85%, and 100% at the PSA cut-off points of >4, >10, >20 ng/ml respectively
In the present study we could derive a cut-off of 10.05 ng/ml with the sensitivity of 92 per and 92.6 per cent of specificity as shown in the ROC curve. The area under the ROC curve (AUC) for PSA to discriminate any prostate cancer vs no cancer was 0.973 (95% confidence interval [CI],( 0.950-0.997), (P value <.000).
Low level of serum testosterone did not reach a significantly statistical association with diagnosis of prostate cancer (p = 0.8).
High BMI and high intake of dairy food and meat were significantly associated with the diagnosis of prostate cancer. High vegetables and Fruits intake were associated with lower percentage of prostate cancer.
The present study recommended that awareness programs should be provided to the public regarding the risk of obesity and the way to prepare and eat healthy food that add no extra risk for cancer, training of family physicians across Egypt to provide screening advice and encourage the shared decision making approach between patients and physicians regarding screening for prostate cancer and the necessity of TRUS biopsy for some screened patients.