title: The role of an abnormal prostate-specific antigen level and an abnormal digital rectal examination in the diagnosis of prostate cancer: A cross-sectional study in Qatar.
abstract: OBJECTIVE
  To investigate the role of an abnormal prostate-specific antigen (PSA) level and abnormal findings on a digital rectal examination (DRE) in the detection of prostate cancer in men in Qatar.
  
  
  METHODS
  Between June 2008 and September 2012, 651 patients had a transrectal ultrasonography-guided biopsy of the prostate (TRUSBP) at our centre. The indications for a biopsy were a high PSA level (>4 ng/mL), or an abnormal DRE result. Patients were assessed by a thorough history, clinical examination and routine laboratory investigations. Data, including age, DRE findings, TRUS findings, total PSA level, prostate volume and the pathology results, were evaluated.
  
  
  RESULTS
  The mean (SD) age of the 651 patients was 64.1 (7.4) years. Prostate cancer was detected in 181 men (27.8%), benign prostatic hyperplasia in 275 (42.2%) and prostatitis in 236 (36.4%). The sensitivity and specificity for detecting prostate cancer were 93.9% and 8.5% for an abnormal PSA level (>4 ng/mL), 46.1% and 84.7% for abnormal DRE findings, and 95% and 30.2% for the two combined. Using a receiver operating characteristics curve, a PSA threshold of 7.9 ng/mL had a sensitivity of 56.6% and specificity of 52.8%. When a PSA threshold of 7.9 ng/mL was used in combination with abnormal DRE findings, the overall accuracy was 76.9%.
  
  
  CONCLUSIONS
  The PSA threshold level of 7.9 ng/mL, determined by this analysis, has a higher likelihood of detecting prostate cancer in men in Qatar. However, it failed to detect cancer in substantially many men with statistically significant disease.
authors.affiliation: Department of Urology, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Khalid
authors.initials: K
authors.lastname: Al Rumaihi
authors.affiliation: Department of Urology, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Khalid
authors.initials: K
authors.lastname: Al Jalham
authors.affiliation: Department of Urology, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Nagy
authors.initials: N
authors.lastname: Younes
authors.affiliation: Department of Urology, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Ahmad A
authors.initials: AA
authors.lastname: Majzoub
authors.affiliation: Urology and Nephrology Center, Mansoura, Egypt.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Shokeir
keywords: Biopsy; NPV, negative predictive value; PPV, positive predictive value; PSA; Prostate cancer; ROC, receiver operating characteristics (curve); TRUSBP, TRUS-guided prostate biopsy; Transrectal ultrasonography