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Int J Clin Pract. 2013 Jun;67(6):552-7. doi: 10.1111/j.1742-1241.2012.03014.x.

Differences in prostate cancer detection rates according to the level of glomerular filtration rate in patients with prostate specific antigen levels of 4.0-10.0 ng/ml.

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Department of Urology, Seoul National University Boramae Hospital, Seoul, Korea.



To investigate differences in prostate cancer detection rates according to the level of glomerular filtration rates (GFR).


Patients with prostate-specific antigen (PSA) levels of 4.0-10.0 ng/ml were analysed. Age, serum creatinine, estimated GFR, body mass index, total PSA (tPSA), free PSA (fPSA), per cent free PSA (%fPSA), comorbidities, biopsy Gleason sum and per cent positive core were retrospectively reviewed. All parameters were compared to show whether patients with GFR <60 ml/min/1.73 m(2) (group A) have higher risk of prostate cancer than patients with GFR ≥ 60 (group B). The primary endpoint was cancer detection rate and the secondary endpoints were differences in mean tPSA, fPSA, %fPSA and pathologic outcomes.


  A total of 1092 men (243 cancer patients) were included. Mean age was 65.8 ± 7.7 years. No differences in mean age and tPSA were found between groups A and B. Mean fPSA, %fPSA and cancer detection rate were significantly higher in group A than group B. The incidence of %fPSA <25% was significantly lower in group A than in group B. GFR <60 ml/min/1.73 m(2) , fPSA and %fPSA <25% were significant predictors for the presence of prostate cancer in patients with tPSA between 4 and 10 ng/ml. However, %fPSA <25% was not a significant predictor for group A.


  Because of the increased cancer detection rates in patients with CKD of stage ≥ 3 whose tPSA levels are 4.0-10.0 ng/ml, performing prostate biopsy should be actively considered in patients with CKD.

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