Factors Associated With PSA False Negative and False Positive Results and the Impact on Patient's Health.

Study Overview
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Brief Summary
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Objectives: The primary aim of this study is to evaluate the outcomes of the determination of PSA for the early detection of prostate cancer or in the presence of symptoms, in general practice in two health departments of the Valencian Community (Spain). Specific objectives: To analyse the clinical and analytical factors associated with the presence of false positive and false negative results in PSA determinations in patients within the setting of opportunistic screening and in those with symptoms. To evaluate the patient's clinical outcome, diagnostic and/or clinical and/or therapeutic interventions implemented in each patient according to the PSA value and the patient's clinical variables during the two years of follow-up. Furthermore, the investigadors will study whether this management is appropriate to the recommendations of the European Society of Urology.

Detailed Description
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Sample size and recruitment procedure: The investigators will select a cohort of patients with positive PSA results and a cohort of patients with negative results in each centre, to be followed for two years. According to a review by the American Cancer Society, a value of PSA of 4 ng/ml had an estimated sensitivity of 21% to detect any type of prostate cancer and a specificity of 91%. The investigators estimate a prevalence of prostate cancer in this population not lower than 5% (given that the investigators include asymptomatic and symptomatic patients), with a 95% margin of error and 2% precision, the investigators will need to include 457 patients with a negative PSA result and 865 PSA-positive patients. Taking into account a 20% possible loss during follow-up, the investigators will increase to 572 patients with a negative PSA result (286 per centre) and 1,081 patients with a positive PSA result (541 per centre) who will be selected consecutively from among those included in the cross-sectional study until the investigators reach the proposed sample size. The investigators will use the initial randomized list (which included determinations during the first 6 months of 2018) to select patients who meet both negative and positive PSA criteria and if it is necessary, the investigators will continue to review analyses until the sample size is achieved. Data collection procedure: The investigators will follow both cohorts (positive and negative PSA results) for two years by reviewing their medical records (every 3 months for patients with a positive PSA result and annually for patients with a negative result). The following variables will be recorded: sociodemographic and clinical characteristics (patient who has the PSA determination as part of opportunistic screening or due to the presence of symptoms suggestive of disease), other comorbidities, toxic habits, previous history of cancer, family history, present pharmacological treatment and setting. The investigators will evaluate the presence of false positive and negative results according to the latest recommendations of the European Association of Urology (specific objective 1). The interventions performed after PSA determination and until the follow-up deadline, and their adaptation to the latest available recommendations (specific objective 2) will be evaluated separately by at least two investigators. Data analysis plan The analysis will be performed using the Stata IC 15 program. Specific objective 1. The investigators will calculate the proportion of false positive and false negative results for the diagnosis of PCa and the associated variables. In the case of false positive tests, the investigators will also describe the time from a positive PSA result until PCa is ruled out using mean, standard deviation or median and interquartile ranges for the total population and relevant subgroups. Specific objective 2. The investigators will assess the probability of having a diagnostic, surgical or therapeutic intervention according to variables using risk ratio (statistical precision as for specific objective 1). If necessary, the investigators will use log-binomial regression estimating prevalence ratios. the investigators will also evaluate the agreement between the interventions performed and the available guidelines.

Official Title
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Study of the Adequacy of the Requests of Prostate-Specific Antigen (PSA), Factors Associated With the False Negative and Positive Results and the Impact on Patient's Health

Conditions
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Prostate-Specific Antigen /Blood

Intervention / Treatment
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* Diagnostic Test: Positive Prostate-Specific Antigen test result


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with a PSA determination result in a routine health examination from the Health Department 17 and 19, in the Valencian Community (Spain) Exclusion Criteria: Patients who have been previously diagnosed with prostate cancer. Patients who are being followed for previous high PSA values.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 99 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Positive PSA result<br>Men with a positive PSA test defined as: Serum total PSA concentration is over 10 ng/ml. Serum total PSA between 4 and 10 ng/ml if the value of the free PSA/total PSA fraction is under 25%, in at least in two determinations. | Diagnostic Test: Positive Prostate-Specific Antigen test result<br>* Positive PSA test result as part of opportunistic screening or due to the presence of symptoms suggestive of disease.<br>|
| Negative PSA result<br>Men with a negative PSA test defined as: Serum total PSA concentration is under 10 ng/ml. Serum total PSA between 4 and 10 ng/ml if the value of the free PSA/total PSA fraction is over 25%. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of patients with a false-positive result in the determination of serum PSA levels. | False positive result of the PSA determination defined as follows: If the PSA test is positive (meaning, serum total PSA level is over 10 ng/ml or serum total PSA level between 4 and 10 ng/ml if the value of the free PSA/total PSA fraction is under 25%, in at least in two determinations) and the result of digital rectal examination and/or subsequent biopsy is negative. | 2 years since PSA determination | 
| Proportion of patients with a false-negative result in the determination of serum PSA levels | False negative result of the PSA determination defined as follows: If the serum PSA value is negative (meaning, serum total PSA level is under 10 ng/ml or serum total PSA between 4 and 10 ng/ml if the value of the free PSA/total PSA fraction is over 25%) and the patient is diagnosed with prostate cancer in the subsequent follow-up. | 2 years since PSA determination | 
| Frequency of patients with appropriate diagnostic interventions performed in those with a positive serum PSA value according to EAU - ESTRO - ESUR - SIOG Guidelines on Prostate Cancer. | Appropriateness of diagnostic interventions is defined as strategies that satisfies or not satisfies EAU recommendations with regard to the following issues: Recommendations for clinical diagnosis of prostate cancer. Recommendations for repeat-biopsy imaging. | 2 years since PSA determination | 
| Frequency of prostate cancer patients with an appropriate treatment protocol according to EAU - ESTRO - ESUR - SIOG Guidelines on Prostate Cancer. | Appropriate treatment protocol is defined according to the EAU recommendations with regard to the number and type of therapeutic interventions carried out after prostate cancer diagnosis. The following information will be considered: Surgical treatments. Radiotherapeutic treatments. Active therapeutic options outside surgery and radiotherapy. Each patient will be classified as Appropriate according to guideline, more intensive than guideline or less intensive than guideline. | 2 years since PSA determination | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Prostatic Neoplasms, False Positive Reactions, False Negative Reactions, Disease Management