Is PSA density of the peripheral zone as a useful predictor for prostate cancer in patients with gray zone PSA levels?

Lee, Jaegeun; Yang, Seung Woo; Jin, Long; Lee, Chung Lyul; Lee, Ji Yong; Shin, Ju Hyun; Lim, Jae Sung; Song, Ki Hak

doi:10.1186/s12885-021-08216-6

Cited by 8 publications

(7 citation statements)

References 25 publications

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“…Many studies have shown that PSAD is more effective than PSA in predicting PCa (15,34,35). Although they only mentioned the gray zone (PSA level upper normal limit 10 ng/mL), our results suggest that a PSA level up to 20 ng/mL could also help predict cancer based on PSAD.…”

Section: Discussionmentioning

confidence: 52%

“…Many studies related to PSAD in men with PSA levels in the gray zone (11,15,16) as well as in PSA <20 ng/mL (9,10,13,17,18) have been conducted, we investigate PSAD as a risk factor for PCa in patients with low-to-intermediate risk (PSA levels 2.5-20.0 ng/mL), and found that the risk of PCa increased in this patient cohort when PSAD was 0.218 or higher. In patients with high PSA levels, PCa should be excluded based on TRUS-Bx findings.…”

Section: Discussionmentioning

confidence: 94%

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Prostate-specific antigen density as the best predictor of low- to intermediate-risk prostate cancer: a cohort study

Park¹,

Yu²

2023

Transl Cancer Res

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Background: Evaluation of prostate cancer (PCa) when serum prostate-specific antigen (PSA) level is vaguely elevated is complicated. This is because serum PSA levels only reflect the number of prostate epithelial cells. We aimed to compare PSA and various prostate volume-related factors to determine which one can best predict PCa in patients with a PSA level of 2.5-20 ng/mL. Methods: Patients who underwent transrectal ultrasound (TRUS)-guided prostate biopsy at the Inje University Sanggye Paik Hospital between January 2018 and July 2021 and who had a PSA level of 2.5-20 ng/mL were retrospectively identified (n=275). Among them, based on biopsy results, patients were divided into cancer group and non-cancer groups, and age, PSA, total prostate volume (TPV), peripheral zone volume (PZV), peripheral zone PSA density (PZ-PSAD), transitional zone-PSAD (TZ-PSAD), and PSAD were compared and analyzed using receiver operating characteristic (ROC) and univariate analyses.Results: The areas under ROC curves (AUCs) for age, total PSA, TPV, PZV, PZ-PSAD, TZ-PSAD, and PSAD for predicting PCa in patients with a PSA level of 2.5-20.0 ng/mL were 0.678, 0.680, 0.671, 0.639, 0.731, 0.736, and 0.764, respectively. In univariate and multivariate analysis, all categorical variables were divided based on the cut-off value and used to predict PCa. Those with a PSAD of ≥0.218 ng/mL 2 were found to be at an increased risk of PCa than those with a PSAD of <0.218 ng/mL 2 [odds ratio (OR) =3.51; 95% confidence interval (CI): 1.306-9.415], which was the best result, followed by TZ-PSAD with a cut-off value of 0.353. At a PSAD level of 0.218 ng/mL 2 , 85.0% of the PCa group could avoid unnecessary biopsy and 61.4% of the non-PCa group could reduce missed diagnosis when the TRUS findings were inaccurate.Conclusions: PSAD may inform biopsy decisions as the best predictor of PCa when TRUS findings are ambiguous in patients with a PSA level of 2.5-20.0 ng/mL.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 94%

Prostate-specific antigen density as the best predictor of low- to intermediate-risk prostate cancer: a cohort study

Park¹,

Yu²

2023

Transl Cancer Res

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“… 18 and Lee et al . 19 indicated that PZPSAD was better than PSA for the detection of PCa. In this study, we found that PZ-ratio had an advantage over PSA in the diagnosis of PCa, while PSADPZ had no advantage over PSA.…”

Section: Discussionmentioning

confidence: 99%

New model of PIRADS and adjusted prostate-specific antigen density of peripheral zone improves the detection rate of initial prostate biopsy: a diagnostic study

Huang

Cai

Qiu

et al. 2022

Asian Journal of Andrology

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This study explored a new model of Prostate Imaging Reporting and Data System (PIRADS) and adjusted prostate-specific antigen density of peripheral zone (aPSADPZ) for predicting the occurrence of prostate cancer (PCa) and clinically significant prostate cancer (csPCa). The demographic and clinical characteristics of 853 patients were recorded. Prostate-specific antigen (PSA), PSA density (PSAD), PSAD of peripheral zone (PSADPZ), aPSADPZ, and peripheral zone volume ratio (PZ-ratio) were calculated and subjected to receiver operating characteristic (ROC) curve analysis. The calibration and discrimination abilities of new nomograms were verified with the calibration curve and area under the ROC curve (AUC). The clinical benefits of these models were evaluated by decision curve analysis and clinical impact curves. The AUCs of PSA, PSAD, PSADPZ, aPSADPZ, and PZ-ratio were 0.669, 0.762, 0.659, 0.812, and 0.748 for PCa diagnosis, while 0.713, 0.788, 0.694, 0.828, and 0.735 for csPCa diagnosis, respectively. All nomograms displayed higher net benefit and better overall calibration than the scenarios for predicting the occurrence of PCa or csPCa. The new model significantly improved the diagnostic accuracy of PCa (0.945 vs 0.830, P < 0.01) and csPCa (0.937 vs 0.845, P < 0.01) compared with the base model. In addition, the number of patients with PCa and csPCa predicted by the new model was in good agreement with the actual number of patients with PCa and csPCa in high-risk threshold. This study demonstrates that aPSADPZ has a higher predictive accuracy for PCa diagnosis than the conventional indicators. Combining aPSADPZ with PIRADS can improve PCa diagnosis and avoid unnecessary biopsies.

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“…Despite high sensitivity rates of PSA levels in the diagnosis of PC, the low specificity rates yield to unnecessary biopsy procedures. 6 - 8 The PSA cutoff value of 4 ng/ml is considered as a common threshold for the biopsy decision. 2 In the current study, the cutoff value of 4 ng/mL demonstrated high sensitivity and low specificity in the diagnosis of CSPC.…”

Section: Discussionmentioning

confidence: 99%

“…4 , 5 Recent studies underlined that PSAD was a more accurate predictor of PC, having similar or better sensitivity but greater specificity compared to PSA levels. 6 - 8 …”

Section: Introductionmentioning

confidence: 99%

The Impact of Prostate Imaging Reporting and Data System Version 2.1 and Prostate-Specific Antigen Density in the Prediction of Clinically Significant Prostate Cancer

Tezcan¹,

Ozturk²,

Bekar³

et al. 2023

Urol Res Pract

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Objective: The aim of this study was to evaluate the diagnostic performance of multiparametric magnetic resonance imaging for clinically significant prostate cancer and to determine whether applying Prostate Imaging Reporting and Data Systems version 2.1 score could improve the diagnostic pathway besides the biochemical characteristics. Materials and methods: In this study, 199 patients with clinically suspected prostate cancer who underwent multiparametric magnetic resonance imaging were included. Logistic regression analyses and receiver operating characteristic curve were performed to determine independent predictors and to compare diagnostic performance of indicators for clinically significant prostate cancer. Two models were established. In model 1, the diagnostic performance of prostate-specific antigen- and prostate-specific antigen density-derived parameters were evaluated. In model 2, the prediction potential of model 1 plus Prostate Imaging Reporting and Data Systems version 2.1 score was analyzed. Results: Sixty-four patients were positive for clinically significant prostate cancer by histopathological analysis (32.1%). In model 1, a prostate-specific antigen density >0.15 was labeled as the strongest predictor of malignancy. In model 2, a prostate-specific antigen density >0.15, a Prostate Imaging Reporting and Data Systems score ≥3, and a Prostate Imaging Reporting and Data Systems score ≥4 demonstrated the strongest association with malignancy. Among these parameters, a Prostate Imaging Reporting and Data Systems score ≥4 ( P = .003) was found to be the most robust predictor for malignancy, followed by a Prostate Imaging Reporting and Data Systems score ≥3 ( P = .012). The multivariate analysis revealed higher accuracy in model 2 (76.9%) than in model 1 (67.8%). The area under curve values with respect to prostate-specific antigen, prostate-specific antigen density, model 1, and model 2 were 0.632, 0.741, 0.656, and 0.798, respectively. Conclusion: These results indicated that Prostate Imaging Reporting and Data Systems version 2.1 score and prostate-specific antigen density are independent predictors for the presence of clinically significant prostate cancer. Both prostate-specific antigen density and Prostate Imaging Reporting and Data Systems version 2.1 score should be risen to prominence in the decision of biopsy instead of PSA.

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Is PSA density of the peripheral zone as a useful predictor for prostate cancer in patients with gray zone PSA levels?

Cited by 8 publications

References 25 publications

Prostate-specific antigen density as the best predictor of low- to intermediate-risk prostate cancer: a cohort study

Prostate-specific antigen density as the best predictor of low- to intermediate-risk prostate cancer: a cohort study

New model of PIRADS and adjusted prostate-specific antigen density of peripheral zone improves the detection rate of initial prostate biopsy: a diagnostic study

The Impact of Prostate Imaging Reporting and Data System Version 2.1 and Prostate-Specific Antigen Density in the Prediction of Clinically Significant Prostate Cancer

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