Peripheral zone PSA density

Abstract

To improve the diagnostic efficiency of prostate cancer (PCa) and reduce unnecessary biopsies, we defined and analyzed the diagnostic efficiency of peripheral zone prostate-specific antigen (PSA) density (PZ-PSAD). Patients who underwent systematic 12-core prostate biopsies in Shanghai General Hospital (Shanghai, China) between January 2012 and January 2018 were retrospectively identified ( n = 529). Another group of patients with benign prostatic hyperplasia ( n = 100) were randomly preselected to obtain the PSA density of the non-PCa cohort (N-PSAD). Prostate volumes and transition zone volumes were measured using multiparameter magnetic resonance imaging (mpMRI) and were combined with PSA and N-PSAD to obtain the PZ-PSAD from a specific algorithm. Receiver operating characteristic (ROC) curve analysis was used to assess the PCa detection efficiency in patients stratified by PSA level, and the area under the ROC curve (AUC) of PZ-PSAD was higher than that of PSA, PSA density (PSAD), and transition zone PSA density (TZ-PSAD). PZ-PSAD could amend the diagnosis for more than half of the patients with inaccurate transrectal ultrasonography (TRUS) and mpMRI results. When TRUS and mpMRI findings were ambiguous to predict PCa (PIRADS score ≤3), PZ-PSAD could increase the positive rate of biopsy from 21.7% to 54.7%, and help 63.8% (150/235) of patients avoid unnecessary prostate biopsy. In patients whose PSA was 4.0–10.0 ng ml −1 , 10.1–20.0 ng ml −1 , and >20.0 ng ml −1 , the ideal PZ-PSAD cut-off value for predicting clinically significant PCa was 0.019 ng ml −2 , 0.297 ng ml −2 , and 1.180 ng ml −2 , respectively (sensitivity >90%). Compared with PSA, PSAD, and TZ-PSAD, the efficiency of PZ-PSAD for predicting PCa is the highest, leading to fewer missed diagnoses and unnecessary biopsies.

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

“…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.…”

“…Kalish et al, assuming that BPH is mainly induced in TZ and that PSA change due to BPH is caused by an enlarged gland in TZ, showed that TZ-PSAD calculated by adjusting PSA with TZV is the most important predictor in predicting PCa (19). However, on the contrary, Wang et al reported that PZ-PSAD was the most important in predicting PCa by increasing the positivity rate of biopsy from 21.7% to 54.7% when TRUS and mpMRI were ambiguous (17). There are also several studies that state that TZ-PSAD is not superior to PSAD in PCa prediction (16,35).…”