Utilidad del porcentaje de antígeno prostático específico libre en comparación al antígeno prostático específico total para detención de cáncer prostático
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Date
2024
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Universidad Nacional de Trujillo
Abstract
Introducción. El cáncer prostático es el segundo más frecuente en varones a nivel mundial y ocupa
el quinto lugar en mortalidad. En el Perú, representa el cáncer más frecuente y la tercera causa de
mortalidad por cáncer independientemente del sexo. El test de antígeno prostático específico se
emplea para el tamizaje de cáncer prostático sin embargo su uso sistemático se encuentra limitado
por su falta de especificidad y alta proporción de biopsias y tratamientos innecesarios con riesgo de
complicaciones y efectos adversos. El porcentaje de antígeno prostático específico libre se considera
como un indicador de cáncer de próstata más específico, sin embargo, la certeza general de la
evidencia es baja y la selección de los puntos de corte adecuados en la práctica clínica es complicada
y variable por su dependencia parcial de la edad del paciente, tamaño de la próstata y nivel de
antígeno prostático específico.
Objetivo. Comparar el rendimiento diagnóstico del porcentaje de antígeno prostático específico libre
y el antígeno prostático específico total para la detección del cáncer de próstata en varones sometidos
a tamizaje.
Material y métodos. Se realizó un estudio retrospectivo de validez de pruebas diagnósticas con una
muestra consecutiva de 56 casos de adenocarcinoma prostático y 161 controles con hiperplasia
prostática benigna seleccionados desde noviembre 2015 hasta febrero 2020 de las historias clínicas
del servicio de urología del Hospital III EsSalud Chimbote que cumplieron criterios de selección.
Resultados. Se encontró para el porcentaje de antígeno prostático específico libre un AUC de 0,82
(IC 95%: 0,75 – 0,89), un punto de corte óptimo de 20,0%, sensibilidad del 95,0%, especificidad del
35%, exactitud diagnóstica de 50,2%, odds ratio diagnóstico de 9,42 y una reducción del 10,8% de
falsos positivos para biopsias innecesarias en comparación al antígeno prostático específico total que
obtuvo un AUC de 0,76 (IC 95%: 0,69- 0,83), sensibilidad del 96,4%, especificidad del 24,2 %,
exactitud diagnóstica de 42,86% y odds ratio diagnóstico de 7,41.
Conclusiones. El porcentaje de antígeno prostático específico libre presentó un mayor rendimiento
diagnóstico que el antígeno prostático específico total y puede reducir en un 10.8% adicional la
proporción de biopsias prostáticas innecesarias, con un punto de corte óptimo del 20,0%.
Introduction. Prostate cancer is the second most common cancer in men worldwide and ranks fifth in mortality. In Peru, it represents the most frequent cancer and the third cause of cancer mortality regardless of sex. The prostate-specific antigen test is used to screen for prostate cancer, however its systematic use is limited by its lack of specificity and the high proportion of biopsies and unnecessary treatments with the risk of complications and adverse effects. The percentage of free prostate-specific antigen is considered a more specific indicator of prostate cancer, however, the general certainty of the evidence is low and the selection of the appropriate cut-off points in clinical practice is complicated and variable due to its dependence based on the patient's age, prostate size, and PSA level. Objective. To compare the diagnostic performance of the percentage of free prostate-specific antigen and the total prostate-specific antigen for the detection of prostate cancer in men undergoing screening. Material and methods. A retrospective study of the validity of diagnostic tests was carried out with a consecutive sample of 56 cases of prostatic adenocarcinoma and 161 controls with benign prostatic hyperplasia selected from November 2015 to February 2020 from the medical records of the urology service of Hospital III EsSalud. Chimbote that met the selection criteria. Results. An AUC of 0.82 (95% CI: 0.75 - 0.89) was found for the percentage of free prostate-specific antigen, with an optimal cut-off of 20.0%, sensitivity 95.0%, specificity 35.0%, accuracy diagnostic rate 50.2%, diagnostic odds ratio 9.42, and 10.8% reduction in false positives for unnecessary biopsies compared to total prostate-specific antigen, which had an AUC of 0.76 (95% CI: 0.69- 0.83), sensitivity 96.4%, specificity 24.2%, diagnostic accuracy 42.86% and diagnostic odds ratio 7.41. Conclusions. The percentage of free prostate-specific antigen presented a higher diagnostic performance than total prostate-specific antigen and can reduce the proportion of prostate biopsies unnecessarily by an additional 10.8% with an optimal cut-off point of 20.0%.
Introduction. Prostate cancer is the second most common cancer in men worldwide and ranks fifth in mortality. In Peru, it represents the most frequent cancer and the third cause of cancer mortality regardless of sex. The prostate-specific antigen test is used to screen for prostate cancer, however its systematic use is limited by its lack of specificity and the high proportion of biopsies and unnecessary treatments with the risk of complications and adverse effects. The percentage of free prostate-specific antigen is considered a more specific indicator of prostate cancer, however, the general certainty of the evidence is low and the selection of the appropriate cut-off points in clinical practice is complicated and variable due to its dependence based on the patient's age, prostate size, and PSA level. Objective. To compare the diagnostic performance of the percentage of free prostate-specific antigen and the total prostate-specific antigen for the detection of prostate cancer in men undergoing screening. Material and methods. A retrospective study of the validity of diagnostic tests was carried out with a consecutive sample of 56 cases of prostatic adenocarcinoma and 161 controls with benign prostatic hyperplasia selected from November 2015 to February 2020 from the medical records of the urology service of Hospital III EsSalud. Chimbote that met the selection criteria. Results. An AUC of 0.82 (95% CI: 0.75 - 0.89) was found for the percentage of free prostate-specific antigen, with an optimal cut-off of 20.0%, sensitivity 95.0%, specificity 35.0%, accuracy diagnostic rate 50.2%, diagnostic odds ratio 9.42, and 10.8% reduction in false positives for unnecessary biopsies compared to total prostate-specific antigen, which had an AUC of 0.76 (95% CI: 0.69- 0.83), sensitivity 96.4%, specificity 24.2%, diagnostic accuracy 42.86% and diagnostic odds ratio 7.41. Conclusions. The percentage of free prostate-specific antigen presented a higher diagnostic performance than total prostate-specific antigen and can reduce the proportion of prostate biopsies unnecessarily by an additional 10.8% with an optimal cut-off point of 20.0%.
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