Performance of PSA and of PSA density in the diagnosis of prostate carcinoma

Martins, Antônio Carlos Pereira; Bovo, Tiago J. Borelli; Reis, Rodolfo Borges dos; Paschoalin, Edson Luiz; Cologna, Adauto José; Suaid, Haylton Jorge

doi:10.1590/s0102-86502002000900002

Cited by 4 publications

(5 citation statements)

References 11 publications

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“…The PSAD parameter was developed to undermine the influence of the prostate volume on the serum level of PSA [ 6 ]. Meanwhile, PSAD greater than 0.15 is associated with 25% incidence of cancer, and a PSAD less than 0.10 with 5% incidence of cancer [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…One of these parameters is PSAD with cutoff level of 0.15, for patients with PSA between 4–10 ng/mL, would discriminate most of the cases of carcinoma from BPH. But, other studies show that PSAD has no value for such discrimination [ 6 ]. The specific cutoff for PSA and PSAD to delineate patients at high risk who should undergo biopsy has been controversial, especially when the PSA and PSAD values are influenced by race and environment [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Prostate-specific antigen and prostate-specific antigen density cutoff points among Indonesian population suspected for prostate cancer

Shahab

Soebadi

Djatisoesanto

et al. 2013

Prostate International

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Purpose:Racial differences exist in the incidence of prostate cancer (PCa). Although many studies have looked at the performance of prostate-specific antigen (PSA) and PSA density (PSAD) in the detection of PCa, only a few have looked at it in relation to Indonesian men. The objective of this study is to find out better PSA and PSAD cutoff point in the detection of PCa in Indonesian men.Methods:A total of 404 consecutive Indonesian men underwent prostate biopsy for suspicion of PCa from 2008 to 2011. The biopsy criteria include one or more of the following: serum PSA more than 10 ng/mL, PSAD more than 0.15 if PSA 4–10 ng/mL, hypoechoic lesion during transrectal sonography and/or abnormal digital rectal examination.Results:Forty five out of 404 (11.1%) had positive biopsies. The mean age, prostate volume, PSA and PSAD were respectively 64.06 years, 43.03 mL, 45.59 ng/mL and 1.15. Of the 404, 131 cases (32.4%) were confirmed to be urinary retention. Positive urine culture found in 182 cases (45%). The cutoff point to detect PCa as estimated by the receiver operating characteristics was 6.95 ng/mL for PSA (sensitivity 97.8%, specificity 19.6%) and 0.7072 for PSAD (sensitivity 62.2%, specificity 78.7%). Positive predictive value for this PSA and PSAD cutoff point were 11.6% and 27.5% respectively (P=0.004 and P=0.000). There was a significant correlation between hypoechoic lesion and positive biopsy results (P =0.000). Urinary retention elevates PSA cutoff point to 14.55 (sensitivity 90.9%, specificity 50%), while positive urine culture alters almost no PSA cutoff elevation.Conclusions:PSA and PSAD cutoff point for Indonesian men in this series is relatively different from international consensus. Furthermore, these data show that PSA and PSAD cutoff point must be adjusted to racial variation to discriminate between malignant and benign disease. Urinary retention is a significant factor for PSA cutoff increase.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prostate-specific antigen and prostate-specific antigen density cutoff points among Indonesian population suspected for prostate cancer

Shahab

Soebadi

Djatisoesanto

et al. 2013

Prostate International

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“…As reported previously 6,7,12 a tPSA cut-off of 2.5ng/ml for all patients exhibits a low specificity which means a low yield prostatic biopsies. It is also interesting to notice in Table 1 that prostate volume affect the test performance in both cut-off levels as described by others 12,13 . A possible reason to explain such influence is the lack of a regular pattern of tissue composition seen in BPH which is responsible for the increase of prostate volume.…”

Section: Patientsmentioning

confidence: 60%

“…However, it is important to stress that at this cut-off point a large proportion of tumors is missed inasmuch as if one associates the f/tPSA ratio under 19% to make a decision to indicate or not the biopsy. usually higher in benign prostates >40ml which affects tPSA density as well as the ratio of freeto-total PSA 9,12,13 .…”

Section: Discussionmentioning

confidence: 99%

Free PSA and prostate volume on the diagnosis of prostate carcinoma

Martins¹,

Rodrigues²,

Reis³

et al. 2003

Acta Cir. Bras.

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OBJECTIVE: To analyse the influence of prostate volume on the performance of total prostate specific antigen (tPSA) and free PSA (fPSA) on the diagnosis of prostate adenocarcinoma. METHODS: A total of 188 patients underwent transrectal ultrasound guided biopsies (10-12 cores) due to prostate nodes detected by digital rectal examination and/or tPSA range of 2.5-10ng/ml. Mean age was 65.7±8.7 years. 19/100 (19%)(GI) patients with prostate volume >40ml had prostate cancer while the corresponding figure for patients with prostate <40ml was 26/88 (29.5%)(GII). We analyzed the sensitivity and specificity of tPSA at cut-off points of 2.5 and 4ng/ml as well as the influence of the ratio f/tPSA in both groups of patients. RESULTS: In the group GI tPSA sensitivity and specificity were 94.4% and 19.5% at the cut-off level of 4ng/ml and 100% and 6% at 2.5ng/ml. The corresponding values for GII were 76.5% and 62.9%, and 100% and 19.3%. In group GI a cut-off of 19% for the ratio f/tPSA kept tPSA sensitivity over 90% while the specificity increased to 46.2% at cut-off level of 4ng/ml and to 32.9% at 2.5ng/ml. In the group GII the ratio f/tPSA was not able to increase the specificity of tPSA at a cut-off level of 4ng/ml without an expressive reduction of sensitivity. On the other side, for this group a cut-off of 16% for the f/tPSA ratio rose the specificity to 46.7% for a sensitivity over 90%. CONCLUSION: We recommend stratification of patients according to prostate volume to define tPSA cut-off point. The cut-off level of 2.5ng/ml for tPSA combined with f/tPSA ratio of 19% in prostates >40ml and 16% in prostates <40ml was a better option for prostate biopsy indication than tPSA at a cut-off of 4ng/ml associated or not with f/tPSA ratio.

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“…Interestingly, using urinary Fibronectin mRNA down-regulation to predict PCa resulted in a more specific, albeit less sensitive test than traditional PSA testing which has a sensitivity and specificity of 86% and 33% at the FDA recommended threshold of ≥4ng/mL of blood 65. The improvement in specificity rises dramatically when compared to PSA at a cutoff of ≥2.5ng/mL (98.2% sensitivity and 16.6% specificity) 66. As for TP53INP2 on the other hand, its down-regulation was moderately sensitive (75%), identifying many patients with PCa, but was entirely non-specific (7%), designating many of the benign samples as malignant and being unable to accurately identify more than one negative.…”

Section: Discussionmentioning

confidence: 99%

Potential Urinary Protein Biomarker Candidates for the Accurate Detection of Prostate Cancer among Benign Prostatic Hyperplasia Patients

Haj-Ahmad¹,

Abdalla²,

Haj-Ahmad³

2014

J. Cancer

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Globally, Prostate cancer (PCa) is the most frequently occurring non-cutaneous cancer, and is the second highest cause of cancer mortality in men. Serum prostate specific antigen (PSA) has been the standard in PCa screening since its approval by the American Food & Drug Administration (FDA) in 1994. Currently, PSA is used as an indicator for PCa - patients with a serum PSA level above 4ng/mL will often undergo prostate biopsy to confirm cancer. Unfortunately fewer than ~30% of these men will biopsy positive for cancer, meaning that the majority of men undergo invasive biopsy with little benefit. Despite PSA's notoriously poor specificity (33%), there is still a significant lack of credible alternatives. Therefore an ideal biomarker that can specifically detect PCa at an early stage is urgently required. The aim of this study was to investigate the potential of using deregulation of urinary proteins in order to detect Prostate Cancer (PCa) among Benign Prostatic Hyperplasia (BPH). To identify the protein signatures specific for PCa, protein expression profiling of 8 PCa patients, 12 BPH patients and 10 healthy males was carried out using LC-MS/MS. This was followed by validating relative expression levels of proteins present in urine among all the patients using quantitative real time-PCR. This was followed by validating relative expression levels of proteins present in urine among all the patients using quantitative real time-PCR. This approach revealed that significant the down-regulation of Fibronectin and TP53INP2 was a characteristic event among PCa patients. Fibronectin mRNA down-regulation, was identified as offering improved specificity (50%) over PSA, albeit with a slightly lower although still acceptable sensitivity (75%) for detecting PCa. As for TP53INP2 on the other hand, its down-regulation was moderately sensitive (75%), identifying many patients with PCa, but was entirely non-specific (7%), designating many of the benign samples as malignant and being unable to accurately identify more than one negative.

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Performance of PSA and of PSA density in the diagnosis of prostate carcinoma

Cited by 4 publications

References 11 publications

Prostate-specific antigen and prostate-specific antigen density cutoff points among Indonesian population suspected for prostate cancer

Prostate-specific antigen and prostate-specific antigen density cutoff points among Indonesian population suspected for prostate cancer

Free PSA and prostate volume on the diagnosis of prostate carcinoma

Potential Urinary Protein Biomarker Candidates for the Accurate Detection of Prostate Cancer among Benign Prostatic Hyperplasia Patients

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