Long-Term Prediction of Prostate Cancer Up to 25 Years Before Diagnosis of Prostate Cancer Using Prostate Kallikreins Measured at Age 44 to 50 Years

2007 ◽  
Vol 25 (4) ◽  
pp. 431-436 ◽  
Author(s):  
Hans Lilja ◽  
David Ulmert ◽  
Thomas Björk ◽  
Charlotte Becker ◽  
Angel M. Serio ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Predictive Value ◽  
Prostate Cancer Screening ◽  
Conditional Logistic Regression ◽  
Specific Antigen ◽  
Screening Programs ◽  
Free Psa ◽  
Swedish Cancer Registry ◽  
Total Psa

PurposeWe examined whether prostate-specific antigen (PSA) forms and human kallikrein 2 (hK2) measured at age 44 to 50 years predict long-term risk of incident prostate cancer.MethodsFrom 1974 to 1986, 21,277 men age ≤ 50 years in Malmö, Sweden, enrolled onto a cardiovascular study (74% participation). The rate of PSA screening in this population is low. According to the Swedish Cancer Registry, 498 were later diagnosed with prostate cancer. We measured hK2, free PSA, and total PSA (tPSA) in archived blood plasma from 462 participants later diagnosed with prostate cancer and from 1,222 matched controls. Conditional logistic regression was used to test for association of prostate cancer with hK2 and PSA forms measured at baseline.ResultsMedian delay between venipuncture and prostate cancer diagnosis was 18 years. hK2 and all PSA forms were strongly associated with prostate cancer (all P < .0005). None of the 90 anthropometric, lifestyle, biochemical, and medical history variables measured at baseline was importantly predictive. A tPSA increase of 1 ng/mL was associated with an increase in odds of cancer of 3.69 (95% CI, 2.99 to 4.56); addition of other PSA forms or hK2 did not add to the predictive value of tPSA. tPSA remained predictive for men diagnosed ≥ 20 years after venipuncture, and the predictive value remained unchanged in an analysis restricted to palpable disease.ConclusionA single PSA test at age 44 to 50 years predicts subsequent clinically diagnosed prostate cancer. This raises the possibility of risk stratification for prostate cancer screening programs.

scholarly journals The predictive value of PSA in diagnosis of prostate cancer in non screened population

2005 ◽  
Vol 52 (4) ◽  
pp. 81-87 ◽  
Author(s):  
V. Vukotic ◽  
S. Cerovic ◽  
M. Kozomara ◽  
M. Lazic
Keyword(s):  
Prostate Cancer ◽  
Predictive Value ◽  
Prostate Cancer Screening ◽  
Predictive Values ◽  
Psa Density ◽  
Free Psa ◽  
Wide Range ◽  
Valuable Marker ◽  
Total Psa ◽  
Sensitivity Specificity

INTRODUCION : PSA is the most important tumor marker in all solid tumor, indispensable in the management of prostate cancer. Screening for prostate cancer is still not recommended, although performed in many countries, which introduced questions about the usefulness of PSA in detection of prostate cancer. The PSA threshold has also been changed, the value of PSA derivatives revised. Whether such changes are applicable in non screened population is questionable. Aim of this study was to evaluate the predictive value of PSA, free/ total PSA and PSA density in our non screened population. Patients and methods: TRUS guided prostate biopsy was performed in 579 patients. The number of cores was 6-12. Mean age of the patients was 67.5 years (30-90). PSA was ranging from 0.41 to 2250 ( mean 38.6ng/ml, median: 11.95, SD 140,45). Digitorectal examination was considered positive in 351 patients. Free PSA was measured in 352 patients with the index ranging from 0.02 to 0.88 ( mean free/total PSA: 0.14, median:0.13, ). The volume of the prostate was measured in all patients according the prostate ellipsoid model, and PSA density calculated according to the formula PSA/PV. Patients were stratified in 6 groups according to PSA value ( I: PSA ng/ml, II: PSA 2.5-4, III: PSA 4-10, IV: PSA 10-20, V: PSA:20 to 50, Group 6: PSA 50 ). RESULTS: Non homogenicity of the patients can be seen through the wide range of PSA which was from 0.4 to 2025). Prostate cancer was diagnosed in 233 pts (40.2%). As expected, the probability of detecting cancer was raised with PSA (p), and was extremely rare in pts with PSA below 4 ng/ml. PSA, free/total PSA, volume of the prostate and PSA density were significantly different according to the presence of cancer. Most of our patients had PSA between 4 and 20 ng/ml. Predictive value of PSA was 20.6% for pts with PSA from 4 to 10 and 32.7% for those with PSA from 10 to 20 ng/ml. Sensitivity, specificity, positive and negative predictive values for different cut off?s of PSA (4, 10 and 20) was performed. The best results were obtained for PSA cut off of 10 ng/ml. In the group of patient with PSA, PSA density more reliable than free/total PSA index. CONCLUSION: PSA is still valuable marker for detection of prostate cancer in our non screened population. According to our results PSA threshold should not be lowered below 4 ng/ml. PSA density is a reliable PSA derivative, free/total PSA index having less importance in pts with PSA below 20 ng/ml.

scholarly journals Usefulness of the prostate health index in predicting the presence and aggressiveness of prostate cancer among Korean men: a prospective observational study

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jae Yoon Kim ◽  
Ji Hyeong Yu ◽  
Luck Hee Sung ◽  
Dae Yeon Cho ◽  
Hyun-Jung Kim ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Specific Antigen ◽  
Significant Proportion ◽  
Health Index ◽  
Free Psa ◽  
Prostate Health Index ◽  
Total Psa ◽  
Prostate Health

Abstract Background We aimed to evaluate the usefulness of the Beckman Coulter prostate health index (PHI) and to compare it with total prostate-specific antigen (PSA) levels and related derivatives in predicting the presence and aggressiveness of prostate cancer (PCa) in the Korean population. Methods A total of 140 men who underwent their first prostate biopsy for suspected PCa were included in this prospective observational study. The diagnostic performance of total PSA, free PSA, %free PSA, [–2] proPSA (p2PSA), %p2PSA, and PHI in detecting and predicting the aggressiveness of PCa was estimated using the receiver operating characteristic curve (ROC) and logistic multivariate regression analyses. Results Of 140 patients, PCa was detected in 63 (45%) of participants, and 48 (76.2%) of them had significant cancer with a Gleason score (GS) ≥ 7. In the whole group, the area under the curve (AUC) for ROC analysis of tPSA, free PSA, %fPSA, p2PSA, %p2PSA, and PHI were 0.63, 0.57, 0.69, 0.69, 0.72, and 0.76, respectively, and the AUC was significantly greater in the PHI group than in the tPSA group (p = 0.005). For PCa with GS ≥ 7, the AUCs for tPSA, free PSA, %fPSA, p2PSA, %p2PSA, and PHI were 0.62, 0.58, 0.41, 0.79, 0.86, and 0.87, respectively, and the AUC was significantly greater in the PHI group than in the tPSA group (p < 0.001). In the subgroup with tPSA 4–10 ng/mL, both %p2PSA and PHI were strong independent predictors for PCa (p = 0.007, p = 0.006) and significantly improved the predictive accuracy of a base multivariable model, including age, tPSA, fPSA and %fPSA, using multivariate logistic regression analysis. (p = 0.054, p = 0.048). Additionally, at a cutoff PHI value > 33.4, 22.9% (32/140) of biopsies could be avoided without missing any cases of aggressive cancer. Conclusions This study shows that %p2PSA and PHI are superior to total PSA and %fPSA in predicting the presence and aggressiveness (GS ≥ 7) of PCa among Korean men. Using PHI, a significant proportion of unnecessary biopsies can be avoided.

scholarly journals The Combination of Human Glandular Kallikrein and Free Prostate-specific Antigen (PSA) Enhances Discrimination Between Prostate Cancer and Benign Prostatic Hyperplasia in Patients with Moderately Increased Total PSA

1999 ◽  
Vol 45 (11) ◽  
pp. 1960-1966 ◽  
Author(s):  
Angeliki Magklara ◽  
Andreas Scorilas ◽  
William J Catalona ◽  
Eleftherios P Diamandis
Keyword(s):  
Prostate Cancer ◽  
Benign Prostatic Hyperplasia ◽  
Prostate Specific Antigen ◽  
Prostatic Carcinoma ◽  
Specific Antigen ◽  
Area Under The Curve ◽  
Prostatic Hyperplasia ◽  
Free Psa ◽  
Glandular Kallikrein ◽  
Total Psa

Abstract Background: Prostate-specific antigen (PSA) is the most reliable tumor marker available and is widely used for the diagnosis and management of prostate cancer. Unfortunately, PSA cannot distinguish efficiently between benign and malignant disease of the prostate, especially within the range of 4–10 μg/L. Among the refinements developed to enhance PSA specificity is the free/total PSA ratio, which is useful in discriminating between the two diseases within the diagnostic “gray zone”. Recent data indicate that human glandular kallikrein (hK2), a protein with high homology to PSA, may be an additional serum marker for the diagnosis and monitoring of prostate cancer. Methods: We analyzed 206 serum samples (all before treatment was initiated) from men with histologically confirmed benign prostatic hyperplasia (n = 100) or prostatic carcinoma (n = 106) with total PSA in the range of 2.5–10 μg/L. Total and free PSA and hK2 were measured with noncompetitive immunological procedures. Statistical analysis was performed to investigate the potential utility of the various markers or their combinations in discriminating between benign prostatic hyperplasia and prostatic carcinoma. Results: hK2 concentrations were not statistically different between the two groups of patients. There was a strong positive correlation between hK2 and free PSA in the whole patient population. hK2/free PSA ratio (area under the curve = 0.69) was stronger predictor of prostate cancer than the free/total PSA ratio (area under the curve = 0.64). At 95% specificity, the hK2/free PSA ratio identified 30% of patients with total PSA between 2.5–10 μg/L who had cancer. At 95% specificity, the hK2/free PSA ratio identified 25% of patients with total PSA between 2.5 and 4.5 μg/L who had cancer. Conclusions: Our data suggest that hK2 in combination with free and total PSA can enhance the biochemical detection of prostate cancer in patients with moderately increased total PSA concentrations. More specifically, the hK2/free PSA ratio appears to be valuable in identifying a subset of patients with total PSA between 2.5 and 4.5 μg/L who have high probability of cancer and who should be considered for biopsy.

scholarly journals Prostate Cancer Screening in the Workplace

AAOHN Journal ◽  
1998 ◽  
Vol 46 (8) ◽  
pp. 379-384 ◽  
Author(s):  
Claire Snyder ◽  
Peggy N. Schrammel ◽  
Claudia B. Griffiths ◽  
Robert I. Griffiths
Keyword(s):  
Prostate Cancer ◽  
Cancer Screening ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Screening Tests ◽  
Test Results ◽  
Total Cost ◽  
Screening Programs ◽  
Psa Testing ◽  
The Cost

Recognition of the mortality and morbidity associated with prostate cancer has resulted in employer based screening programs. This retrospective cohort study identified the employer costs of prostate cancer screening and referrals due to abnormal test results. The subjects were 385 men enrolled in a workplace screening program at a single employer between 1993 and 1995. Screening consisted of digital rectal examination (DRE) annually for enrolled employees aged 40 years and older, plus annual prostate specific antigen (PSA) testing for those 50 and older, and those 40 and older and considered at high risk. Data related to the health care and lost productivity costs of screening and referrals for abnormal test results were collected and analyzed. The total cost of screening was $44,355, or approximately $56 per screening encounter (788 DREs; 437 PSAs). Abnormal screening tests resulted in 52 referrals. Upon further evaluation, 42% were found to have an enlargement, 29% a node, and 12% benign prostatic hyperplasia. Only one malignancy was found. The total cost of additional referrals was $31,815, or 42% of the cost of screening plus referrals. As the cost per screening encounter was low, prostate cancer screening in the workplace is an efficient alternative.

Discordant prostate specific antigen test results despite WHO assay standardization

2018 ◽  
Vol 33 (3) ◽  
pp. 275-282 ◽  
Author(s):  
Martin Boegemann ◽  
Christian Arsov ◽  
Boris Hadaschik ◽  
Kathleen Herkommer ◽  
Florian Imkamp ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Early Detection ◽  
Specific Antigen ◽  
Test Results ◽  
Serum Samples ◽  
Prostate Specific Antigen Test ◽  
Free Psa ◽  
Prostate Biopsies ◽  
Cancer Early Detection ◽  
Total Psa

Introduction: Total PSA (tPSA) and free PSA (fPSA) are the most commonly used biomarkers for early detection of prostate cancer. Despite standardization efforts, many available PSA assays may still produce discordant results. In the present study, we compared four PSA assays calibrated to the WHO standards 96/670 and 96/668 for tPSA and fPSA, respectively. Methods: Within the scope of the Prostate Cancer Early Detection Study Based on a ‘‘Baseline’’ PSA Value in Young Men (PROBASE), we tested tPSA and fPSA in serum samples from 50 patients in the four different PROBASE sites using four WHO-calibrated assays from Roche (Elecsys, Cobas), Beckman-Coulter (Access-II) and Siemens (ADVIA Centaur). The comparison was performed using the Passing–Bablok regression method. Results: Compared to Access, the median tPSA levels for Centaur, Elecsys, and Cobas were +3%, +11%–20%, and +17%–23%, respectively, while for median fPSA levels the differences for Centaur, Elecsys, and Cobas were +49%, +29%–31%, and +22%, respectively. Discussion: Despite all investigated assays being WHO-calibrated, the Elecsys and Cobas tPSA assays produced considerably higher results than the Access and Centaur assays. Differences in fPSA-recovery between all investigated assays were even more pronounced. When applying the tPSA cutoff of 3.1 μg/L recommended for WHO-calibrated assays, the use of higher calibrated assays may lead to unnecessary prostate biopsies. Conversely, if the historical threshold of 4 μg/L is applied when using WHO-calibrated assays, it could lead to falsely omitted prostate biopsies.

Evaluation of prostate cancer risk in men with PSA < 1.5.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 64-64
Author(s):  
Whitney N. Stanton ◽  
E. David Crawford ◽  
Paul Arangua ◽  
John Hoenemeyer ◽  
Francisco G. La Rosa ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Specific Antigen ◽  
Prostate Cancer Risk ◽  
Clinical Information ◽  
Mrna Levels ◽  
Protein Biomarkers ◽  
Cancer Awareness ◽  
Free Psa ◽  
Increased Risk ◽  
Total Psa

64 Background: Prostate Specific Antigen (PSA) screening remains controversial primarily because of over detection and treatment. There is an unmet clinical need to identify patients at increased risk for high-grade (HG – Gleason Score ≥7) prostate cancer (PCa) since PSA has low sensitivity. Combining PSA with well-validated prostate cancer biomarkers (PCM) can improve risk assessment. We investigated the performance of three PCMs (phi – prostate health index, 4KScore, and SelectMDx) on patients with PSA levels < 1.5 ng/mL that represent a “safe zone” where risk of any PCa is rare Methods: 652 men were screened for PCa during the annual Prostate Cancer Awareness Week at the University of Colorado Hospital. This study was supported by Prostate Condition Education Council and the Schramm Foundation. phi is evaluated using p2PSA, total PSA, and free PSA in serum. Phi < 52.7 suggests absence of HG PCa. 4KScore incorporates four kallikrein protein biomarkers: total PSA, free PSA, intact PSA, human kallikrein protein, and clinical information. A 4KScore < 20% suggests absence of HG PCa. The SelectMDx post-DRE urine test measures mRNA levels of the homeobox C6 and distal-less homeobox 1 biomarkers. SelectMDx score of 0% indicates absence of HG PCa. Results: No patients with a PSA < 1.5 had SelectMDx > 0% and/or phi > 52.7. One patient had a 4KScore of 27%, indicating a risk for HG PCa. For patients with PSA between 1.5-3.99, 2.9% (4/135), 7.4% (4/54), and 2.3% (2/85) had positive phi, 4KScore, and SelectMDx results, respectively. Conclusions: Men with PSA <1.5 ng/mL are at very low risk for HG PCa. Men with PSA between 1.5-3.99 with positive PCM results may be referred for further evaluation. [Table: see text]

Novel Artificial Neural Network for Early Detection of Prostate Cancer

2002 ◽  
Vol 20 (4) ◽  
pp. 921-929 ◽  
Author(s):  
Bob Djavan ◽  
Mesut Remzi ◽  
Alexandre Zlotta ◽  
Christian Seitz ◽  
Peter Snow ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Early Detection ◽  
Roc Curve ◽  
Predictive Accuracy ◽  
Specific Antigen ◽  
Psa Density ◽  
Free Psa ◽  
Ann Models ◽  
Artificial Neural ◽  
Total Psa

PURPOSE: Two artificial neural networks (ANN) for the early detection of prostate cancer in men with total prostate-specific antigen (PSA) levels from 2.5 to 4 ng/mL and from 4 to 10 ng/mL were prospectively developed. The predictive accuracy of the ANN was compared with that obtained by use of conventional statistical analysis of standard PSA parameters. PATIENTS AND METHODS: Consecutive men with a serum total PSA level between 4 and 10 ng/mL (n = 974) and between 2.5 and 4 ng/mL (n = 272) were analyzed. A separate ANN model was developed for each group of patients. Analyses were performed to determine the presence of prostate cancer. RESULTS: The area under the receiver operator characteristic (ROC) curve (AUC) was 87.6% and 91.3% for the 2.5 to 4 ng/mL and 4 to 10 ng/mL ANN models, respectively. For the latter model, the AUC generated by the ANN was significantly higher than that produced by the single variables of total PSA, percentage of free PSA, PSA density of the transition zone (TZ), and TZ volume (P < .01), but not significantly higher compared with multivariate analysis. For the 2.5 to 4 ng/mL model, the AUC of the ANN ROC curve was significantly higher than the AUCs for percentage of free PSA (P = .0239), PSA-TZ (P = .0204), and PSA density and total prostate volume (P < .01 for both). CONCLUSION: The predictive accuracy of the ANN was superior to that of conventional PSA parameters. ANN models might change the way patients referred for early prostate cancer detection are counseled regarding the need for prostate biopsy.

The performance of [-2]proPSA and prostate health index tumor markers in prostate cancer diagnosis

2016 ◽  
Vol 40 (6) ◽  
Author(s):  
Joško Osredkar ◽  
Kristina Kumer ◽  
Teja Fabjan ◽  
Gregor Hlebič ◽  
Blaže Podnar ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Tumor Markers ◽  
Specific Antigen ◽  
Area Under The Curve ◽  
Health Index ◽  
Free Psa ◽  
Prostate Health Index ◽  
Prostatic Diseases ◽  
Total Psa ◽  
Prostate Health

AbstractBackground:Prostate-specific antigen (PSA) is an established tumor marker for the diagnosis of patients with prostate cancer. The aim of the study was to evaluate the performance of [-2]proenzyme PSA ([-2]proPSA) and prostate health index (PHI) tumor markers in the differential diagnosis between benign prostatic diseases and prostate cancer.Methods:Total PSA (tPSA), free PSA (fPSA) and [-2]proPSA were measured usingResults:For the prediction of a malignant histopathological result, the specificity at the 90% sensitivity level was 24.3% for [-2]proPSA, 32.4% for %[-2]proPSA, 28.4% for PHI, 18.9% for tPSA and 28.4% for the free-to-total PSA ratio. The area under the curve for [-2]proPSA, %[-2]proPSA, PHI, tPSA and the free-to-total PSA ratio was 0.663, 0.749, 0.742, 0.616 and 0.625, respectively.Conclusions:Our study found a moderate improvement over tPSA and %fPSA in detecting prostate cancer using the [-2]proPSA assay in patients with a tPSA range of 1.6–8.0 µg/L.

scholarly journals Novel immunoassay for the measurement of complexed prostate-specific antigen in serum

1998 ◽  
Vol 44 (6) ◽  
pp. 1216-1223 ◽  
Author(s):  
W Jeffrey Allard ◽  
Zeqi Zhou ◽  
Kwok K Yeung
Keyword(s):  
Prostate Cancer ◽  
Monoclonal Antibody ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Binding Properties ◽  
Prostate Disease ◽  
Free Psa ◽  
Total Psa ◽  
Benign Prostate ◽  
Artificial Mixtures

Abstract Serum prostate-specific antigen (PSA) is an effective diagnostic tool for detection of prostate cancer (CaP) at an early and potentially curable stage, but specificity is low. Studies have shown that the proportion of serum PSA complexed with α-1-antichymotrypsin (ACT) is higher in men with CaP than in men with benign prostate disease. We developed a novel immunoassay for complexed PSA based on the unique binding properties of a monoclonal antibody that fails to bind free PSA in the presence of antibodies specific for free PSA. The assay measured mixtures of free and complexed PSA accurately, and the measured values of free + complexed PSA in artificial mixtures and in patient sera were equivalent to the measured value of total PSA. Both the serum concentration and the proportion of complexed PSA was substantially higher in patients with CaP compared with patients with benign prostate disease. The cPSA assay may have utility in improving specificity in screening for prostate cancer.

scholarly journals Does the reflexive measurement of free PSA have a role in a tertiary cancer centre?

2013 ◽  
Vol 4 (5) ◽  
pp. 317
Author(s):  
Christopher Allard ◽  
Paul Yip ◽  
Ivan Blasutig ◽  
Karen Hersey ◽  
Neil Fleshner
Keyword(s):  
Prostate Cancer ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Diagnostic Précoce ◽  
Psa Test ◽  
Total Cost ◽  
Cancer Centre ◽  
Free Psa ◽  
Psa Testing ◽  
The Cost

Purpose: The percent free prostate-specific antigen (PSA) may complementtotal PSA for prostate cancer screening, but is of no benefitfor monitoring patients with previous prostate cancer diagnoses. Atthe Princess Margaret Hospital, a tertiary cancer centre in Toronto,Ontario, Canada, PSA values in the range 4 to 10 ng/mL promptreflexive measurements of free PSA. We hypothesize that reflexivefree PSA testing at tertiary cancer centres generates unnecessarycosts as the test is often conducted on patients with previous diagnosesof prostate cancer.Materials and Methods: We reviewed all reflexive free PSA measurementsconducted on a random sample of 250 men in a 10-yearperiod at our institution. We determined the clinical indicationsfor the PSA tests which triggered reflexive free PSA measurementsto estimate the proportion of free PSA tests that are not clinicallyindicated.Results: We reviewed the 1099 reflexive free PSA measurementsfor the 250 subjects. Of these tests, 562 (51%) were triggered byPSA tests ordered for screening/early detection, and 537 (49%)for monitoring.Conclusions: Of all reflexive free PSA tests, 49% were unnecessary.We conducted 3022 free PSA tests, at a cost of $5.84 pertest (Can$); the tests were performed in 2009 at this institution fora total cost of $17 648.48, about 49% of which ($8647.76) likelyrepresents unnecessary annual costs. We suggest a trial of userselectableorder sets allowing physicians to choose whether toinclude reflexive free PSA measurements on a case-by-case basis.This policy might improve the cost-effectiveness of the PSA test attertiary cancer centres.Objectif : Le pourcentage d’antigène prostatique spécifique (APS)libre peut compléter la mesure de l’APS total dans le dépistagedu cancer de la prostate, mais il n’est d’aucune utilité pour lasurveillance de patients ayant déjà reçu un diagnostic de cancerde la prostate. À l’hôpital Princess Margaret, un centre de soinsoncologiques tertiaires de Toronto, en Ontario (Canada), un tauxd’APS se situant entre 4 et 10 ng/mL entraîne systématiquementune évaluation des taux d’APS libre. Nous avançons l’hypothèseque la mesure de l’APS libre dans les centres de soins oncologiquestertiaires entraîne des dépenses inutiles car ce test est souventmené chez des patients ayant déjà reçu un diagnostic de cancerde la prostate.Matériel et méthodes : Nous avons examiné tous les cas de mesurede l’APS libre effectuée dans un échantillon aléatoire de 250 hommessur une période de 10 ans à notre établissement. Nous avonsvérifié les indications cliniques liées aux mesures de l’APS ayantentraîné une mesure de l’APS libre afin d’évaluer la proportionde ces mesures de l’APS libre qui n’étaient pas justifiées sur leplan clinique.Résultats : Chez les 250 sujets, 1099 mesures de l’APS libre ont étéeffectuées. Sur ces tests, 562 (51 %) ont fait suite à des mesuresde l’APS prescrites à des fins de dépistage/diagnostic précoce, et537 (49 %) à des fins de surveillance.Conclusions : De toutes les mesures de l’APS libre, 49 % n’étaientpas nécessaires; 3022 tests de mesure de l’APS libre, au coût de5,84 $ par test, ont été effectués en 2009 à notre établissement,pour un coût total de 17 648,48 $, dont environ 49 % – pour unmontant de 8647,76 $ – représente selon toute apparence desdépenses inutiles. Nous suggérons d’établir une règle basée sur lejugement clinique et permettant aux médecins de choisir d’inclureou non la mesure de l’APS libre au cas par cas. Une telle politiquepourrait améliorer la rentabilité des mesures de l’APS dans lescentres de soins oncologiques tertiaires.

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