Impact of PSA density of transition zone as a potential parameter in reducing the number of unnecessary prostate biopsies in patients with PSA levels between 2.6 and 10.0 ng/mL

Castro, Hugo Alexandre Sócrates de; Iared, Wagner; Santos, José Eduardo Mourão; Solha, Raphael Sandes; Shigueoka, David Carlos; Ajzen, Sérgio Aron

doi:10.1590/s1677-5538.ibju.2017.0506

Cited by 10 publications

(13 citation statements)

References 24 publications

(48 reference statements)

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“…PCa usually arises from the PZ, and most BPH originates in the TZ. [10, 12] Our result are consistent with this opinion. Compared with patients without PCa, lower TZV (12.35 vs 32.14 ml, P <0.001) and higher PZV (32.9 vs 27.79 ml, P <0.001) was found in patients with PCa, which indicates the diagnostic potential of TZV and PZV for diagnosing PCa.…”

Section: Discussionsupporting

confidence: 92%

“…PSA mainly leaks from the TZ. [10, 12] Therefore, we hypothesized that prostate-zone adjusted PSA serves as a more effective parameter than PSAD and PSA for the diagnosis of PCa, which is consistent with published studies. For example, a study of 1712 patients who underwent TRUS-guided prostate biopsies found that the AUC of PSADTZ is 0.766 and those of PSAD and PSA are 0.749 and 0.585, respectively, for diagnosing PCa.…”

Section: Discussionsupporting

confidence: 81%

“…[7] A study of 172 patients found that the AUC of PSA significantly increases from 0.683 to 0.806 using PSAD. [12] However, a study of 109 patients with clinically localized prostate cancer found that PSAD fails to outperform PSA for preoperative prediction of prostate cancer. [20]…”

Section: Discussionmentioning

confidence: 99%

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The roles of MRI-based prostate volume and associated zone-adjusted prostate-specific antigen concentrations in predicting prostate cancer and high-risk prostate cancer

et al. 2019

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Prostate biopsies are frequently performed to screen for prostate cancer (PCa) with complications such as infections and bleeding. To reduce unnecessary biopsies, here we designed an improved predictive model of MRI-based prostate volume and associated zone-adjusted prostate-specific antigen (PSA) concentrations for diagnosing PCa and risk stratification. Multiparametric MRI administered to 422 consecutive patients before initial transrectal ultrasonography-guided 13-core prostate biopsies from January 2012 to March 2018 at Fujian Medical University Union Hospital. Univariate and multivariate logistic regression analyses and determination of the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was performed to evaluate and integrate the predictors of PCa and high-risk prostate cancer (HR-PCa). The detection rates of PCa was 43.84% (185/422). And the detection rates of HR-PCa was 71.35% (132/185) in PCa patients. Multivariate analysis revealed that prostate volume(PV), PSA density(PSAD), transitional zone volume(TZV), PSA density of the transitional zone(PSADTZ), and MR were independent predictors of PCa and HR-PCa. PSA, peripheral zone volume(PZV) and PSA density of the peripheral zone(PSADPZ) were independent predictors of PCa but not HR-PCa. The AUC of our best predictive model including PSA + PV + PSAD + MR + TZV or PSA + PV + PSAD + MR + PZV was 0.906 for PCa. The AUC of the best predictive model of PV + PSAD + MR + TZV was 0.893 for HR-PCa. In conclusion, our results will likely improve the detection rate of prostate cancer, avoiding unnecessary prostate biopsies, and for evaluating risk stratification.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 81%

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The roles of MRI-based prostate volume and associated zone-adjusted prostate-specific antigen concentrations in predicting prostate cancer and high-risk prostate cancer

et al. 2019

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“…1 ). At the conclusion of screening, 11 studies (one in Korean) were included in this systematic review [ 13 14 15 16 17 18 19 20 21 22 23 ].…”

Section: Resultsmentioning

confidence: 99%

Diagnostic accuracy of prostate-specific antigen below 4 ng/mL as a cutoff for diagnosing prostate cancer in a hospital setting: A systematic review and meta-analysis

et al. 2022

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Purpose A prostate-specific antigen (PSA) cutoff of 4 ng/mL has been widely used for prostate cancer screening in population-based settings. However, the accuracy of PSA below 4 ng/mL as a cutoff for diagnosing prostate cancer in a hospital setting is inconclusive. We systematically reviewed the accuracy of PSA below 4 ng/mL cutoff in a hospital setting. Materials and Methods We systematically reviewed the literature by searching major databases until March 2020, and a meta-analysis and quality assessment were performed. Results A total of 11 studies were included at the completion of the screening process. The meta-analysis showed a sensitivity of 0.92 and a specificity of 0.16 for a PSA cutoff below 4 ng/mL. The area under the hierarchical summary receiver operating characteristic curve was 0.87, the positive likelihood ratio was 1.23, the negative likelihood ratio was 0.46, and the diagnostic odds ratio was 2.64. PSA sensitivities and specificities varied according to the cutoff range: 0.94 and 0.17 for 2 to 2.99 ng/mL, and 0.92 and 0.16 for 3 to 3.99 ng/mL, respectively. No significant differences in the sensitivity and specificity of PSA cutoffs in the range of 2 to 2.99 ng/mL and 3 to 3.99 ng/mL were found. Conclusions Although a PSA cutoff <3 ng/mL is relatively more sensitive and specific than PSA ≥3 ng/mL, no significant differences in sensitivity and specificity were found in the diagnosis of prostate cancer. Therefore, clinicians should choose an appropriate PSA cutoff on the basis of clinical circumstances and patients’ characteristics.

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“…The most commonly used marker in the diagnosis of prostate cancer is PSA [2]. The upper limit for gray-zone PSA has been determined as 10 ng/ml in numerous studies [6][7][8]15,[17][18]. Some other studies, though few in number, suggest that the upper limit for gray-zone PSA may show ethnic variation and propose that this limit is likely to be higher in countries where PCa is less common, particularly in Far Eastern countries [9,19].…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study: Has MRI-guided Fusion Prostate Biopsy Changed the Prostate-specific Antigen Gray-zone Range?

Sönmez¹,

Tombul²,

Demirtaş³

et al. 2019

Cureus

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The gray-zone prostate-specific antigen (PSA) range is accepted to be 4-10 ng/ml and is considered to vary according to age. We aimed to investigate whether fusion prostate biopsy (FPB), which has been reported to have relatively higher cancer detection rates, has an effect on gray-zone PSA cutoff value. Material and methods This retrospective study included patients that underwent standard prostate biopsy (SPB) or multiparametric magnetic resonance imaging (MpMRI)-guided FPB (SPB+ targeted biopsy). All the patients included in the study were detected with a Prostate Imaging Reporting and Data System (PI-RADS) ≥3 lesion on MpMRI (the FPB group only). The demographics, clinical characteristics, and histopathological diagnoses were recorded for each patient. Results A total of 1,628 patients comprising 1,208 patients in the SPB group and 420 patients in the FPB group were included in the study. The mean PSA level was 9.75±6.68 ng/ml in the FBP group and 10.46±6.46 ng/ml in the SPB group (p=0.053). Prostate cancer (PCa) detection rate was significantly higher in the FPB group as compared to the SPB group (42.4% vs. 36.4%). The PSA cutoff value for PCa was 9.75 ng/ml (sensitivity and specificity, 81%) in the SPB group and was 7.55 ng/ml (sensitivity and specificity, 81% and 84%, respectively) in the FPB group. In the FPB group, the cancer detection rate among the patients with a PSA level of 7.55-10.00 ng/ml was 56.1%. Conclusion The results indicated that the introduction of FPB into clinical practice, which has relatively higher cancer detection rates, has further lowered the upper limit for gray-zone PSA.

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Impact of PSA density of transition zone as a potential parameter in reducing the number of unnecessary prostate biopsies in patients with PSA levels between 2.6 and 10.0 ng/mL

Cited by 10 publications

References 24 publications

The roles of MRI-based prostate volume and associated zone-adjusted prostate-specific antigen concentrations in predicting prostate cancer and high-risk prostate cancer

The roles of MRI-based prostate volume and associated zone-adjusted prostate-specific antigen concentrations in predicting prostate cancer and high-risk prostate cancer

Diagnostic accuracy of prostate-specific antigen below 4 ng/mL as a cutoff for diagnosing prostate cancer in a hospital setting: A systematic review and meta-analysis

A Comparative Study: Has MRI-guided Fusion Prostate Biopsy Changed the Prostate-specific Antigen Gray-zone Range?

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