Actitud del médico de atención primaria en la detección precoz del cáncer de próstata mediante el antígeno prostático específico

Objetivo

Estudiar la actitud del medico de atencion primaria cuando obtiene un antigeno prostatico especifico (PSA) elevado (≥ 4 ng/ml) y las variables asociadas a la practica de biopsia de prostata y al diagnostico de carcinoma de prostata (CP).

Diseno

Estudio observacional descriptivo.

Emplazamiento

ABS urbana.

Pacientes

Noventa y cuatro varones no diagnosticados previamente de CP que durante el ano 1998 tuvieron un valor de PSA ≥ 4 ng/ml. El listado se obtuvo del laboratorio de referencia.

Mediciones

Por revision de las historias clinicas se recogieron las variables: antecedentes familiares de CP, edad, valor del PSA, motivo de peticion del PSA (si no constaba se consideraba cribado), derivacion al urologo, practica de tacto rectal, ecografia transrectal, biopsia de prostata y diagnostico final.

Resultados

La edad media era de 70 anos (DE, 9,31). El motivo de peticion del PSA fue: sintomatologia urinaria en 25 (26,6%), otros signos o sintomas en 25 (26,6%), peticion del paciente en 2 (2,1%) y cribado en 42 (44,7%). Se realizo tacto rectal en 16 casos. Veintinueve sujetos se derivaron al urologo para estudio. Constaba ecografia y biopsia en 36 pacientes. Las variables asociadas a la realizacion de biopsia de prostata en el modelo logistico fueron: valor superior del PSA (OR, 1,1; IC del 95%, 1,03–1,18), mayor edad (OR, 0,92; IC del 95%, 0,87–0,98) y practicado tacto rectal (OR, 3,58; IC del 95%, 1,02–12,51). Se diagnosticaron 10 CP.

Conclusiones

El motivo mas frecuente de peticion del PSA fue por cribado. No se solicito biopsia de prostata en 58 varones. Seria conveniente una guia de actuacion para la atencion primaria en relacion al diagnostico de CP para valores de PSA ≥4 ng/ml.

Objectives

To study the attitude of primary care doctors when a high (≥ 4 ng/ml) prostate-specific antigen (PSA) is found and to examine the variables linked to a prostate biopsy and the diagnosis of prostate cancer (PC).

Design

Descriptive, observational study.

Setting

Urban health district.

Patients

Ninety-four men not previously diagnosed with PC who in 1998 had a PSA figure ≥ 4 ng/ml. The list was obtained from the pertinent laboratory.

Measurements

The following variables were gathered from review of clinical records: family background of PC, age, PSA figure, reason for request for PSA (if not given, it was considered a screening), referral to the urologist, rectal touch, transrectal echography, prostate biopsy and final diagnosis.

Results

Average age was 70 (SD, 9.31). The reason for requesting PSA was: urine symptoms in 25 (26.6%), other signs or symptoms in 25 (26.6%), request of patient in 2 cases (2.1%) and screening in 42 (44.7%). Rectal touch took place in 16 cases. Twenty-nine people were referred for examination to the urologist. 36 patients had an echography and biopsy. Variables linked to the prostate biopsy in the logistic model were: higher value of the PSA (OR 1.1; 95% CI, 1.03–1.18), being older (OR 0.92; CI, 0.87–0.98) and rectal touch performed (OR 3.58; CI, 1.02–12.51). Ten cases of PC were diagnosed.

Conclusions

The most common reason for a PSA request was screening. Prostate biopsy was not requested for 58 men. A primary care guide to action concerning PC diagnosis in cases of PSA ≥ 4 ng/ml would be useful.