The Assessment of Pathological PSA Values by the General Practitioner - Observation or Intervention?

AIM: The aim of the present study was to evaluate the initiated consecutive diagnostic course after measurement of an elevated PSA value by the general practitioner. PATIENTS AND METHODS: 406 patients who underwent ultrasound-guided transrectal biopsy of the prostate were assessed retrospectively. Using a standardised questionnaire, we evaluated the examination findings detected by the general practitioners responsible for the patients' medical care. RESULTS: 88 patients revealed an elevated PSA-value of > or = 4 ng / mL. 60 of these patients showed an elevated PSA already in the first measurement. 36 patients underwent repeated measurement of PSA performed by the general practitioner. In 4 of these 36 patients an elevated PSA level had al-ready been measured in a previous analysis, and, therefore, repeated measurement was performed in the follow-up. The median time interval between assessment of the pathological PSA value and prostate biopsy amounted to at least 20 weeks in the case of a pathological PSA value in the first measurement and up to a maximum of 43 weeks in the case of a further control of an already increased PSA value. Altogether 47 cases of prostate cancer were detected. In 40 of these patients with histologically proven prostate cancer, the pathological PSA value had previously been assessed by the general practitioner. CONCLUSION: In the majority of cases, an elevated PSA value resulted in a contemporary diagnostic course using transrectal biopsy of the prostate. In particular cases a further control measurement of PSA was accomplished, which resulted in an unacceptable delay regarding the histological confirmation of the diagnosis.