Prostate Specific Antigen Density: A Means of Distinguishing Benign Prostatic Hypertrophy and Prostate Cancer

The object of the study was to examine the usefulness of volume-adjusted prostate-specific antigen (PSA) parameters for prediction of prostate cancer in the patients with intermediate PSA levels. The subjects were 235 patients with intermediate PSA levels (range: 4.1-10.0 ng/ml) whose prostate volume (PV) and prostate transition zone volume (TZV) were evaluated between August 1996 and April 2004. PSA, PV, TZV, PSA density (PSAD) (PSA/PV) and PSA transition zone density (PSATZD) (PSA/TZV) were assessed with the receiver operating characteristic (ROC) curve and the area under the curve (AUC). Simple and multivariate logistic regression analyses were used to analyze the odds ratios of age, PSA, PSAD, PSATZD, PV, TZV, digital rectal examination (DRE) and transrectal ultrasonography (TRUS) findings. Fifty-five patients (23.4%) of 235 patients had biopsyproven prostate cancer. The univariate analysis revealed significant differences in the mean values of age, PSAD, PSATZD, PV, TZV and DRE between the patients with cancer and the non-cancer patients. The ROC curve analysis revealed that PV, TZV, PSAD and PSATZD had significant predictive values as compared with that of PSA. However, there was no difference in AUC between them. The stepwise logistic regression analysis showed that the age, PV, PSATZD and DRE had significant predictive values, and that PSATZD had the most predictive power. In conclusion, both PSAD and PSATZD had significant predictive values in discriminating prostate cancer. Furthermore, the stepwise logistic regression analysis showed that PSATZD had the strongest predictive value.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Tanaka

Fujimoto

Chihara

et al. 2007

“…16 PSAD was defined as serum total PSA value divided by total prostate volume. 4,5 PSAV was also calculated when more than one PSA measurement was available [(last PSAÀprevious PSA)/ time elapsed (years)]. 1 When three PSA measurements were available, the average PSAV was calculated.…”

Section: Methodsmentioning

confidence: 99%

“…3 The concept of PSA density (PSAD) was first described by Benson et al, 4,5 and is defined as the quotient of serum PSA level divided by the prostate volume estimated by means of transrectal ultrasound (TRUS). Several studies have recommended the use of this parameter to enhance PSA specificity when intermediate levels of this marker are present.…”

Section: Introductionmentioning

confidence: 99%

Prostate specific antigen density. Is there a role for this parameter when screening for prostate cancer?

Luján

Páez

González

et al. 2001

The objective of this paper is to validate prostate specific antigen (PSA) density (PSAD) routine use to enhance PSA specificity in men with normal digital rectal examination and intermediate PSA values. It is a retrospective study of 235 men from a prostate cancer (PCa) screening program. All of them presented PSA values between 4 and 10 ng/ml, normal digital rectal examination, and a transrectal ultrasound (TRUS) guided biopsy available (PSA ! 4 ng/ml as the sole criterion for biopsy). Multivariate analysis failed to demonstrate higher PSAD values in men with PCa. PSAD cutoff points higher than 0.07 ng/ml per cc were considered as unacceptable, with less than 95% sensitivity. When a cutoff point of 0.15 was considered, as many as 30.6% of the cancers were missed. In conclusion we cannot recommend the use of this parameter for the above mentioned purpose.

“…PSAD, a parameter introduced by Benson et al to enhance early detection of prostate cancer, is de®ned as the serum PSA value divided by the volume of the entire gland. 28 The PSAD was calculated during ultrasound. Transrectal ultrasound-guided biopsies were performed in the sagittal plane with a 7.5 MHz sector scanner ®tted with a biopsy guide using an 18 gauge needle driven by a spring-loaded biopsy gun.…”

Section: Methodsmentioning

confidence: 99%

Ultrasound-guided seminal vesicle biopsies in prostate cancer

Wymenga

Duisterwinkel

Groenier

et al. 2000

Invasion of prostatic adenocarcinoma into the seminal vesicles (SV) is generally accepted as an index of poor prognosis. The pre-operative identi®cation of SV invasion is an important element in staging since it may alter subsequent treatment decisions. We studied the possibility of diagnosing SV invasion with two biopsies from the junction between the prostate and seminal vesicles. Also we studied the correlation of several prognostic factors with the risk of clinical stage T 1,2,3 prostate cancer patients of having cancer growth into the seminal vesicles.Consecutive patients referred for transrectal ultrasound (TRUS) and biopsy because of clinical suspicion of prostate cancer were examined. This staging procedure was evaluated in patients who underwent a pelvic lymphadenectomy and radical retropubic prostatectomy (RRP).In 83 out of 138 patients prostate cancer was detected whereas 55 patients had benign disease. In 44% of prostate cancer patients a positive SV biopsy was found. The accuracy of the biopsies adjacent to the junction of the SV and the prostate was 91%. The best predictors for SV invasion were tumor grade of the biopsy sample (P`0.001), serum prostate-speci®c antigen (PSA) (P`0.0005), PSA density (P`0.0005) and clinical stage (P`0.0005). No signi®cance was found in the relation to seminal vesicle involvement with free/total (f/t) PSA ratio (P 0.588) for the prostate cancer group (SV and SV 7 ).In a receiver operating characteristic curves analysis, PSA density was signi®cantly more accurate for prediction of SV invasion than PSA or f/t PSA ratio. In ®ve prostatectomized patients (and negative SV biopsy) no SV invasion was found in the ®nal pathologic examination either.SV biopsy at the junction of the SV and prostate is accurate for staging with high ef®cacy and low morbidity. To predict SV invasion in prostate cancer patients, PSA density was more accurate than PSA or f/t PSA ratio. The determination of the f/t PSA ratio in patients with low and intermediate PSA levels (eg`15 mg/L) is not useful to estimation of the risk of seminal vesicle involvement. The combination of serum PSA concentration, PSA density, tumor grade from the biopsy specimens ad clinical stage provides the best prediction of SV invasion. These parameters are identical to the conventional predictors of pathology after RRP. SV biopsies may provide additional information; if one or both basal biopsies are positive, a clinical T 1,2 disease is altered to T 3 . Hence SV biopsy is useful for selection of patients who might obtain good results from RRP for prostate cancer. Prostate Cancer and Prostatic Diseases (2000) 3, 100±106.