The value of prostate specific antigen (PSA) density and free: total PSA ratio in selecting patients with a normal digital rectal examination and intermediate total PSA levels for further investigation

Klingler, H. Christoph; Woo, Henry H.; Rosario, Derek J.; Cutinha, Patrick; Anderson, John B.; Ward, A. Milford; Chapple, Christopher R.

doi:10.1046/j.1464-410x.1998.00761.x

Cited by 11 publications

(7 citation statements)

References 34 publications

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“…Our results were slightly higher, therefore, for the detection of PCa using PSA [15]. For patients with total PSA 4-10 ng/ml, there are authors [17,18] who, using PSAD in order to diagnose PCa, obtained a significant increase in specificity with a minimum reduction in sensitivity. In our series, by just applying a PSAD threshold of 0.20, we managed to increase the specificity for total PSA, but with an unacceptable reduction in sensitivity (44%) and leaving undiagnosed 60.5% of Pca.…”

Section: Discussioncontrasting

confidence: 48%

Diagnostic Methods in the Detection of Prostate Cancer: Prospective Observational Study

López-Sáez¹,

Otero²,

Dominguez‐Villar³

et al. 2007

CMIR

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Objective: The last decade has seen numerous modifications in the way the prostate cancer is diagnosed. Current diagnostic methods in prostate cancer lacking the ability to predict individual patient outcome, which highlights the need for more sensitive approaches. We investigated the value of digital rectal examination (DRE), transrectal ultrasonography (TRUS) and prostatic specific antigen (PSA) analysis as aids in general clinical practice and in the early detection of prostate cancer. The purpose of this paper is to evaluate the efficiency and effectiveness of analytical and imaging methods for diagnosing prostate cancer in the north-west Spain.Material and Methods: We investigated prospectively two groups of patients (in all 760) with pathological DRE or PSA. Sensitivity (Se), specificity (Sp), Positive predictive Value (PPV), Negative Predictive Value (NPV), Receiver Operating Characteristics (ROC) curves and other analyses were performed to determine the relative contributions of PSA, DRE, TRUS, Colour Doppler Ultrasound (CDUS), symptoms and patient age to cancer prediction.Results: The presence of prostatic disease symptoms did not distinguish between subjects with and without cancer (p=0.8450). The most sensitive (98%) was total PSA (>4 ng/ml) and the most specific were DRE (78%) and TRUS (65%). The contribution of PSA, DRE and TRUS to the diagnosis of prostate cancer was significant (p<0.05). In patients with a PSA of 4-10 ng/ml, using a threshold PSA specificity increased, using a free/total PSA ratio of 15%. Both echographic methods were effective (p<0.05), with greater specificity for CDUS.Conclusion: The PSA continues to be the most sensitive method for prostate cancer diagnosis. DRE tends to be more negative at early stages of cancer detection. Comparing the conventional TRUS echography with the CDUS, the latter is a better detector in the diagnosis of cancer.

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Section: Discussioncontrasting

confidence: 48%

Diagnostic Methods in the Detection of Prostate Cancer: Prospective Observational Study

López-Sáez¹,

Otero²,

Dominguez‐Villar³

et al. 2007

CMIR

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“…determined that ratio of free to total PSA in patients with carcinoma prostate is significantly lower than in men with BPH. Klinger et al 1 . showed that free: total PSA ratio was better diagnostic marker than total PSA.…”

Section: Sensitivitymentioning

confidence: 99%

“…Cancer of prostate is the second commonest malignancy in men 1 . Benign prostatic hyperplasia (BPH) is the most common benign neoplasm in men and its incidence is age related.…”

Section: Introductionmentioning

confidence: 99%

Role of Serum Total PSA (Prostate Specific Antigen) and Free to Total PSA Ratio in the Diagnosis of Carcinoma Prostate

Ferdousi

Алим

Ferdous³

et al. 2013

Bangladesh J Med Biochem

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The objective of the study was to evaluate and compare the role of total and free/total ratio of serum prostate specific antigen level in diagnosing carcinoma prostate. A cross sectional study was conducted at the Department of Biochemistry, Dhaka Medical College (DMC) with collaboration of the Department of Urology, Dhaka Medical College Hospital (DMCH), Dhaka from July 2008 to June 2009. This study was carried out on 60 patients above 50 years of age who attended the Department of Urology, Dhaka Medical College Hospital, complaining of irritative or obstructive lower urinary tract symptoms (LUTS) suspected as clinically benign prostatic hyperplasia (BPH) or cancer prostate. It was aimed to assess the role of total and free/total ratio of serum PSA in diagnosis of BPH and carcinoma prostate with reference to histological diagnosis. All the cases were evaluated by history, physical examination including digital rectal examination, serum prostate specific antigen level, transabdominal/ trans-rectal ultra-sonogram. From all patients, blood sample were collected before digital rectal examination or any per urethral manipulation. Final diagnosis was obtained by histo-pathological examination, specimen being obtained by perrectal biopsy with biopsy-gun. Histopathological examination detected prostate cancer in 20 out of 60 patient and 17 of these Cap 20 have a total PSA 4 ng/ml and only 3 have total PSA 4 ng/ml. 18 of these 20 have free to total ratio 0.16 and 02 have f/t ratio 0.16. Among 60 patients, 40 patients were detected BPH on histopathological diagnosis. 20 of these BPH patient have tPSA 4 ng/ml and 20 of BPH have tPSA 4 ng/ml. 38 of 40 BPH patient have f/t ratio>0.16 and 2 of 40 patient are f/t ratio 0.16. Receiver operating characteristic analysis indicated a threshold f/t ratio 0.16 was optimum discriminatory level. The sensitivity of total serum PSA (at cut off value of>4 ng/ml) in correctly differentiating prostatic carcinoma of those who have the condition is 85%, while the specificity of the test in correctly detecting those who do not have the disease is 50%. The PPV is 45.9%, NPV is 87% and accuracy is 61.7%. The sensitivity of free/total serum PSA (at cut off value of 0.16 ng/ml) in correctly differentiating prostatic carcinoma from BPH is 90%, while the specificity of the test in correctly detecting those who do not have prostatic carcinoma is 95%. The PPV of the test is 90% and the NPV of the test is 95%. The overall accuracy of the test is 93.3%. This study showed significant difference of total and free/total ratio of serum prostate specific antigen (PSA) in differentiating benign prostatic hyperplasia (BPH) from carcinoma prostate. Receiver operating characteristic curves showed advantage for the f/t PSA ratio when compared with total PSA in detecting prostate cancer. From the study it may be concluded that total and f/t ratio of prostate specific antigen (PSA) is a useful marker in diagnosis of carcinoma prostate. Free/total ratio is more accurate than total PSA.

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“…However, values 4-10 are suspicious and other subsidiary parameters such as percentage of free PSA (the ratio of free PSA to total PSA), PSA velocity, and PSA density, contribute to the diagnosis and decision making about prostate biopsy. [ 1 5 6 7 8 ]…”

Section: Introductionmentioning

confidence: 99%

Evaluation of prostatic cancer prevalence in patients with prostatic-specific antigen between 4 and 10 and normal digital rectal examination

et al. 2016

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Background:Prostate cancer is one of the most common male cancers. The prevalence of prostate cancer is different due to genetic and environmental factors. Diagnosis of prostate cancer is by biopsy due to prostate-specific antigen (PSA) and Digital Rectal Examination (DRE). Controversy about decision making for prostate biopsy in PSA between 4 and 10 and normal DRE, is one of the problems in this time. In this study we evaluated the prevalence of prostate cancer in males with PSA between 4 and 10 and normal DRE. We also evaluated the PSA density and percent of free PSA in patients with prostate cancer.Materials and Methods:A total of 121 males with PSA between 4 and 10 and normal DRE, were evaluated. Then, transrectal ultrasonography (TRUS) andprostate biopsy from 12 points of peripheral zone, was done. These data were analyzed by Chi-square, t-test and ANOVA and Roc curve.Results:In this study, the prevalence of prostate cancer in PSA between 4 and 10 and normal DRE, was evaluated, 29.8%. With use of Roc curve, PSA density cutoff point was calculated 0.12 and percent of free PSA cutoff point, was calculated, 18%.Conclusion:In males with PSA between 4 and 10 and normal DRE, PSA density smaller than 0.12-0.15, and percent of free PSA greater than 18%, the prevalence of prostate cancer is very few and we can safely ignore the TRUS and prostate biopsy in these males and eliminate its costs and side effects.

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The value of prostate specific antigen (PSA) density and free: total PSA ratio in selecting patients with a normal digital rectal examination and intermediate total PSA levels for further investigation

Cited by 11 publications

References 34 publications

Diagnostic Methods in the Detection of Prostate Cancer: Prospective Observational Study

Diagnostic Methods in the Detection of Prostate Cancer: Prospective Observational Study

Role of Serum Total PSA (Prostate Specific Antigen) and Free to Total PSA Ratio in the Diagnosis of Carcinoma Prostate

Evaluation of prostatic cancer prevalence in patients with prostatic-specific antigen between 4 and 10 and normal digital rectal examination

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