South African Journal of Surgery
On-line version ISSN 2078-5151
Print version ISSN 0038-2361
HEYNS, C F; BASSON, J; VAN DER MERWE, A and ZARRABI, A D. Clinical (non-histological) diagnosis of advanced prostate cancer: evaluation of treatment outcome after androgen deprivation therapy. S. Afr. j. surg. [online]. 2014, vol.52, n.3, pp.82-85. ISSN 2078-5151. http://dx.doi.org/10.7196/sajs.1689.
INTRODUCTION: Transrectal biopsy in suspected adenocarcinoma of the prostate (ACP) may cause significant morbidity and even mortality. A strong association between serum prostate-specific antigen (PSA) and tumour burden exists. If biopsy can be avoided in advanced disease, much morbidity and cost may be saved. OBJECTIVE: To evaluate the reliability of using PSA and clinical features to establish a non-histological diagnosis of ACP. METHODS: Androgen deprivation therapy (ADT) was used in 825 (56.2%) of 1 467 men with ACP. The diagnosis of ACP was made histologically in 607 patients (73.6%) and clinically alone in 218 (26.4%), based on a serum PSA level of >60 ng/ml, and/or clinical evidence of a T3 - T4 tumour on digital rectal examination, and/or imaging evidence of metastases. We compared two randomly selected groups treated with bilateral orchidectomy (BO) based on a clinical-only (n=90) v. histological (n=96) diagnosis of ACP. RESULTS: There was no significant difference between the groups with regard to mean follow-up (26.1 v. 26.8 months), documented PSA relapse (70% v. 67.7%), and patients alive at last follow-up (91.1% v. 95.8%). ZAR1 068 200 (US$1 = ZAR8) was saved by treating men with advanced ACP on the basis of a clinical (non-histological) diagnosis only, and a total of ZAR24 321 000 was saved by using BO instead of luteinising hormone-releasing hormone agonists as ADT. CONCLUSION: A reliable clinical (non-histological) diagnosis of advanced ACP can be made based on serum PSA and clinical features. This avoids the discomfort and potentially serious complications of biopsy and saves cost.