Prospective evaluation of prostate cancer detection by prostate‐specific antigen‐related parameters

Abstract

Background: The diagnostic value of prostate-specific antigen (PSA) for differentiating prostate cancer from benign prostatic conditions is limited by its lack of specificity. Several PSA-related parameters have been suggested as enhancing the discriminatory power of total PSA values, but their clinical utility should be considered preliminary until established in a prospectively evaluated cohort. Methods:In a prospective cohort study, results of ultrasound-guided biopsy and/or transurethral resection of the prostate gland were assessed in 706 consecutive Japanese men. The clinical usefulness of total PSA, free PSA, percentage of free PSA, PSA density (PSAD), PSA density for transition zone (PSADT) and gland volume for predicting prostate cancer was investigated using receiver operating characteristic (ROC) curve analysis in 16 different patient subgroups. Results: Overall, 150 of the 706 patients (21.2%) had prostate carcinoma. The ROC curve analysis showed that PSAD and PSADT were more powerful predictors of prostate cancer than total PSA in most of the 16 patient subgroups tested. The improvement in performance was modest, however. No substantial difference was noted between PSAD and PSADT. Total gland volume did not significantly affect the performance of these parameters. The use of a PSAD threshold value of 0.11-0.15 ng/mL per cm 3 (or a PSADT value of 0.23-0.27 ng/mL per cm 3 ) would have avoided 24-48% (or, for PSADT, 34-40%) of unnecessary biopsies at the cost of missing 5-10% of detectable cancers in a patient subgroup with intermediate total PSA levels. The performance of free PSA and percentage of free PSA was worse than that of any other test in this study. This may be due to inappropriate handling of sera prior to measurement. Conclusions:The discriminatory potential of total PSA for predicting prostate cancer was modestly improved by the use of PSAD and PSADT. No substantial advantage of PSADT over PSAD could be demonstrated. Stringent and standardized storage conditions should always be maintained when applying free PSA-related parameters.

Prostatic volume and volume-adjusted prostate-specific antigen as predictive parameters for prostate cancer patients with intermediate PSA levels

“…Our results support those of Egawa et al 5 emphasizing that the usefulness of both PSAD and PSATZD was similar in cancer detection for the patients with intermediate PSA levels. Furthermore, our results suggest that both PV and TZV also have significant predictive values as well as both PSAD and PSATZD in the ROC curve analysis.…”

“…[1][2][3][4][5][6][7][8][9][10][11] Regarding the volume- Volume-adjusted PSA N Tanaka et al adjusted parameters, PSAD and PSATZD were considered as significant predictive factors. Kikuchi et al 7 reported that PSATZD has the most useful validity among PSA, free PSA to total PSA ratio, alpha-1-antichymotripsin-PSA complex, PSAD and PSATZD.…”

“…Djavan et al 6 also reported that the free PSA was more effective in prostates less than 30 cm 3 in volume. Egawa et al 5 reported that the usefulness of both PSAD and PSATZD was similar in cancer detection for the patients with intermediate PSA levels.…”

“…[1][2][3][4][5][6][7][8][9][10][11] Regarding the reports on prostate cancer detection in the Japanese population, one study 7 revealed the advantage of PSATZD, whereas others demonstrated the usefulness of the free PSA 9 and cPSAD. 10 Nevertheless, there is no absolute discriminating method for prediction of prostate cancer in the patients with intermediate PSA levels.…”

The ratio of prostate‐specific antigen (PSA) to prostate volume (PSA density) as a parameter to improve the detection of prostate carcinoma in PSA values in the range of < 4 ng/mL

“…16,17,[22][23][24][25][26][27][28][29][30][31][32] Although most studies showed an advantage of using PSAD compared with PSA alone, only a few studies could demonstrate further a better performance of PSAD compared with %fPSA. [32][33][34] Two of those studies included relatively small numbers of patients (n ϭ 43 patients and n ϭ 105 patients). 33,34 The other, very recent study by Sakai et al 32 in 400 Japanese men demonstrated a better performance of PSAD and, surprisingly, tPSA compared with %fPSA.…”