title: [Advantages and risks of the use of prostate-specific antigen (PSA) in the health-care area No. 4 of Gijon (Asturias)].
abstract: OBJECTIVE
  The diagnosis of prostate cancer has changed significantly with the introduction of PSA in the clinical practice. Despite screening is under controversy the use of PSA has become widespread. The objective of this paper is to know the use of PSA in our health-care area and to analyze perceived risks and benefits.
  
  
  METHODS
  From the informatic archives we analyze PSA determinations performed in our health-care area (290.956 citizens) over 2000 and 2001. We also analyzed prostate biopsies generated and number of cancers detected.
  
  
  RESULTS
  25.519 PSA determinations were performed. 59% came from general practitioners (GP), 34% from urologists and 7% from the rest of specialists. 39% are performed to men older than 70 years. PSA was normal in 78.7% of the patients and higher than 4 ng/ml in 21.2%. 488 prostatic biopsies were performed diagnosing 178 cancers (diagnostic yield 36.5%). Depending on the first PSA, diagnosis was started by a GP in 44% of the cases, a urologist in 46%, and the remaining 10% by other specialists. Mean time from first PSA to diagnosis was 5 months, without significant differences between GPs and specialities . The use of PSA by GPs is variable (between 8.1 and 45.8 determinations per 100 men over 50 years), without significant differences in prostate cancer detection by number of PSAs or differences in age. In comparison with the period 1982-1993 the incidence of prostate cancer goes from 30.76 to 52.8 new cases/100.000 inhabitants/year. There is a greater incidence and increase of cancer in the rural area (from 33.52 to 221.1 new cases/ 100.000 inhabitants/year).
  
  
  CONCLUSIONS
  We confirm the general use of this test and the trend to screening in the primary health-care level, which participates in an important manner in the diagnosis. PSA brings forward the diagnosis of prostate cancer 5 years in our area, and shoots its incidence rates. The high use of such marker in our population of advanced age may be considered inadequate.
authors.affiliation: Servicio de Análisis Clínicos, Hospital de Cabueñes, Gijón, Asturias, España. J_cepeda_p@hotmail.com
authors.forename: Javier
authors.initials: J
authors.lastname: Cepeda Piorno
authors.forename: Manuel
authors.initials: M
authors.lastname: Rivas del Fresno
authors.forename: Eduardo
authors.initials: E
authors.lastname: Fuente Martín
authors.forename: Esther
authors.initials: E
authors.lastname: González García
authors.forename: Valentín
authors.initials: V
authors.lastname: Muruamendiaraz Fernández
authors.forename: Eloy
authors.initials: E
authors.lastname: Fernández Rodríguez
mesh_terms: D000230:Adenocarcinoma / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D001706:Biopsy; D042241:Early Diagnosis; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000097:blood*; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000706:statistics & numerical data; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012306:Risk; D012680:Sensitivity and Specificity; D013030:Spain / Q000453:epidemiology; D014572:Urology / Q000706:statistics & numerical data
chemical_list: D014408:Biomarkers, Tumor; D009363:Neoplasm Proteins; D017430:Prostate-Specific Antigen