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[Advantages and risks of the use of prostate-specific antigen (PSA) in the health-care area No. 4 of Gijon (Asturias)]. / Ventajas y riesgos de la utilización del antígeno prostático específico (PSA) en el area sanitaria v de Gijón (Asturias).

OBJECTIVES: The diagnosis of prostate cancer has changed significantly with the introduction of PSA in the clinical practice. Despite screening is under controversy the use of PSA has become widespread. The objective of this paper is to know the use of PSA in our health-care area and to analyze perceived risks and benefits. METHODS: From the informatic archives we analyze PSA determinations performed in our health-care area (290.956 citizens) over 2000 and 2001. We also analyzed prostate biopsies generated and number of cancers detected. RESULTS: 25.519 PSA determinations were performed. 59% came from general practitioners (GP), 34% from urologists and 7% from the rest of specialists. 39% are performed to men older than 70 years. PSA was normal in 78.7% of the patients and higher than 4 ng/ml in 21.2%. 488 prostatic biopsies were performed diagnosing 178 cancers (diagnostic yield 36.5%). Depending on the first PSA, diagnosis was started by a GP in 44% of the cases, a urologist in 46%, and the remaining 10% by other specialists. Mean time from first PSA to diagnosis was 5 months, without significant differences between GPs and specialities . The use of PSA by GPs is variable (between 8.1 and 45.8 determinations per 100 men over 50 years), without significant differences in prostate cancer detection by number of PSAs or differences in age. In comparison with the period 1982-1993 the incidence of prostate cancer goes from 30.76 to 52.8 new cases/100.000 inhabitants/year. There is a greater incidence and increase of cancer in the rural area (from 33.52 to 221.1 new cases/ 100.000 inhabitants/year). CONCLUSIONS: We confirm the general use of this test and the trend to screening in the primary health-care level, which participates in an important manner in the diagnosis. PSA brings forward the diagnosis of prostate cancer 5 years in our area, and shoots its incidence rates. The high use of such marker in our population of advanced age may be considered inadequate.

Ventajas y riesgos de la utilización del antígeno prostático específico (PSA) en el área sanitaria V de Gijón (Asturias) / Advantages and risk´s of the use of PSA in the health-care area Nº. 5 of Gijon (Asturias)

OBJETIVO: Con la introducción del PSAen la práctica clínica diaria, el diagnóstico del cáncerde próstata ha sufrido importantes cambios. Aunque elscreening es controvertido, su uso parece que se hageneralizado. Conocer la utilización que se hace delPSA en nuestro área sanitaria y analizar los beneficiosy riesgos que se perciben.MÉTODO: A través del archivo informático, analizamoslas determinaciones realizadas durante los años2000 y 2001 en nuestro área (290.956 habitantes).Se analizaron también las biopsias de próstata generadasy los cánceres detectados.RESULTADOS: Se realizaron 25.590 determinacionesde PSA. Proceden de Atención Primaria 59%, Urología34% y resto de especializada 7%. El 39% se realizana hombres mayores de 70 años. El PSA fue normal enel 78,7%, y mayor de 4 ng/mL en 21,2%. Se realizaron488 biopsias prostáticas, detectándose 178 carcinomas(36,5% rendimiento diagnóstico). Según el primerPSA el diagnóstico parte de primaria en 44%,Urología en 46% y resto de especializada 10%. Eltiempo medio desde el primer PSA hasta el diagnósticofue de 5 meses, sin diferencias significativas entrePrimaria y Especializada. El uso del PSA por Primariaes variable (entre 8,1 y 45,8 determinaciones porcada 100 hombres mayores de 50 años), sin diferenciassignificativas de detección de cáncer prostáticosegún número de PSAs ni diferencias de edad. Frenteal periodo 1982-1993 la incidencia de cáncer prostáticopasa de 30,76 a 52,8 nuevos casos/ 100.000habitantes/ año. Existe mayor incidencia e incrementodel cáncer en la zona rural (de 33,52 a 221,1 nuevoscasos/ 100.000 habitantes/ años).CONCLUSIONES: Confirmamos la utilización generalizadade esta prueba y la tendencia al cribado en primaria,que participa de manera importante en el diagnóstico.El PSA adelanta el diagnóstico del cáncer depróstata en 5 años en nuestro área, y dispara las tasasde incidencia de este cáncer. La elevada utilización deeste marcador en población de edad avanzada sepuede considerar inadecuada

OBJECTIVES: The diagnosis of prostatecancer has changed significantly with the introductionof PSA in the clinical practice. Despite screening isunder controversy the use of PSA has become widespread.The objective of this paper is to know the use of PSA inour health-care area and to analyze perceived risks andbenefits.METHODS: From the informatic archives we analyzePSA determinations performed in our health-care area(290.956 citizens) over 2000 and 2001. We alsoanalyzed prostate biopsies generated and number ofcancers detected.RESULTS: 25.519 PSA determinations were performed.59% came from general practitioners (GP), 34% fromurologists and 7% from the rest of specialists. 39% areperformed to men older than 70 years. PSA was normalin 78.7% of the patients and higher than 4 ng/ml in21.2%. 488 prostatic biopsies were performeddiagnosing 178 cancers (diagnostic yield 36.5%).Depending on the first PSA, diagnosis was started by aGP in 44% of the cases, a urologist in 46%, and theremaining 10% by other specialists. Mean time fromfirst PSA to diagnosis was 5 months, without significantdifferences between GPs and specialities . The use ofPSA by GPs is variable (between 8 .1 and 45.8determinations per 100 men over 50 years), withoutsignificant differences in prostate cancer detection bynumber of PSAs or differences in age. In comparisonwith the period 1982-1993 the incidence of prostatecancer goes from 30.76 to 52.8 new cases/100.000inhabitants/year. There is a greater incidence andincrease of cancer in the rural area (from 33.52 to221.1 new cases/100.000 inhabitants/year).CONCLUSIONS: We confirm the general use of thistest and the trend to screening in the primary health-carelevel, which participates in an important manner in thediagnosis. PSA brings forward the diagnosis of prostatecancer 5 years in our area, and shoots its incidencerates. The high use of such marker in our population ofadvanced age may be considered inadequate