title: Outcomes of men who present with elevated serum PSA (>20 ng/mL) to an inner-city hospital.
abstract: BACKGROUND
  We report the incidence, clinicopathologic features, and outcomes of men who presented to an inner-city hospital with serum PSA >20 ng/ml.
  
  
  METHODS
  Five-hundred-sixty men underwent a transrectal ultrasound needle-guided biopsy of the prostate for elevated PSA >4 ng/ml with or without an abnormal digital rectal examination.
  
  
  RESULTS
  Of the 560 men, 65 (12%) were found to have a serum PSA >20 ng/ml, and 57 (10%) were diagnosed with prostate cancer. In the group of 57 men with cancer, the positive predictive value of PSA alone was 72% for PSA levels of 20-29.99 ng/ml and 100% for PSA >30 ng/ml. Of the 57 men, 18 underwent definitive therapy, 24 underwent androgen deprivation, 8 refused treatment or were lost to follow-up, and 7 were treated on protocol. An additional seven men with cancer refused therapy or were lost to follow-up, thus giving a total of 15 (26%) men who were noncompliant to medical advice.
  
  
  CONCLUSIONS
  Serum PSA >30 ng/ml is an almost certain predictor of the presence of prostate cancer. Aggressive prostate cancer education and screening programs are needed in our inner cities in order to detect prostate cancer at an earlier, treatable stage.
authors.affiliation: Division of Urology, The University of Florida, Jacksonville, FL 32610, USA.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Anai
authors.forename: C Shawn
authors.initials: CS
authors.lastname: West
authors.forename: Myron
authors.initials: M
authors.lastname: Chang
authors.forename: Kogenta
authors.initials: K
authors.lastname: Nakamura
authors.forename: John
authors.initials: J
authors.lastname: Pendleton
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Rosser
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D015331:Cohort Studies; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen