Prostate-Specific Antigen Density as a Powerful Predictor of Extracapsular Extension and Positive Surgical Margin in Radical Prostatectomy Patients with Prostate-Specific Antigen Levels of Less than 10 ng/ml

PURPOSE: To assess the ability of preoperative variables to predict extracapsular extension (ECE) and positive surgical margin (PSM) in radical prostatectomy patients with prostate-specific antigen (PSA) levels of less than 10 ng/ml. MATERIALS AND METHODS: From January 2008 to December 2009, 121 patients with prostate cancer with PSA levels lower than 10 ng/ml who underwent radical prostatectomy were enrolled in the study. The differences in clinical factors (age, PSA, PSA density [PSAD], digital rectal examination [DRE] positivity, positive magnetic resonance imaging [MRI], Gleason sum, positive core number, and positive biopsy core percentage) with ECE and the presence of positive margins were determined and their independent predictive significances were analyzed. RESULTS: The ECE-positive patients had higher PSA, PSAD, and MRI-positive percentages, and PSM patients had higher PSA, PSAD, MRI-positive percentages, Gleason sum, and positive biopsy core percentages for prostate cancer. In the multivariate analysis, PSAD and MRI positivity were the best independent predictors for ECE, and PSA and PSAD were the best independent predictors of PSM. By receiver operating characteristic curve analysis, PSAD had better discriminative area under the curve value than did PSA for ECE (0.765 vs 0.661) and PSM (0.780 vs 0.624). The best predictive PSAD value was 0.29 ng/ml/cc for ECE and 0.27 ng/ml/cc for PSM. CONCLUSIONS: PSAD has relevance to ECE (plus MRI findings) and PSM (plus PSA). PSAD might be a powerful predictor of ECE and PSM preoperatively in patients undergoing a radical prostatectomy with PSA levels of less than 10 ng/ml.

Significance of Serum Concentration of Free and Total Prostate Specific Antigen in Benign Prostatic Hyperplasia and Prostate Cancer / 대한비뇨기과학회지

PURPOSE: This study was performed to investigate whether the free to total PSA ratio(F/T PSA ratio) offers a better discriminant for the detection of patient with prostatic cancer(CaP) and those with benign prostatic hyperplasia(BPH) than serum total PSA alone. MATERIALS AND METHODS: From September 1996 to February 1999, free and total PSA levels were measured on frozen sera samples of 154 men with BPH and 46 with CaP using immunoradiometric assay. RESULTS: In all subjects, the mean total PSA was significantly higher in CaP group(72.59+/-66.58ng/ml) than BPH group(3.12+/-4.10ng/ml). The mean PSAD was significantly higher in CaP group(1.64+/-1.86) than BPH group(0.08+/-0.01). The mean F/T PSA ratio was significantly lower in CaP group(0.19+/-0.07) than BPH group(0.30+/-0.13). Among 41 subjects whose total PSA were between 4-20ng/ml, the mean PSAD was significantly higher in CaP group(0.37+/-0.16) than BPH group(0.17+/-0.07), but the mean F/T PSA ratio was not significantly different between CaP(0.19+/-0.10) and BPH group(0.25+/-0.13). By comparing the sensitivity and specificity of total PSA alone, PSAD and F/T PSA ratio on receiver operating characteristic(ROC) curve in all subjects and subjects with total PSA between 4-20ng/ml, F/T PSA ratio had no superiority than total PSA alone and PSAD for. discrimination between CaP and BPH. CONCLUSIONS: We suggest that the F/T PSA ratio is not superior to total PSA alone and PSAD in the detection of prostatic cancer, and further evaluation of the usefulness of F/T PSA ratio should be required.

Serum PSA concentration, Prostate Specific Antigen Density with Aging / 대한비뇨기과학회지

By definition, PSAD is the serum PSA concentration divided volume of the gland, as determined from transrectal ultrasonography. If prostatic volume were the sole determinant of the serum PSA concentration, there would be no correlation between PSAD and age. We examined the relationships between serum PSA concentration, rostatic volume and age. Entry included 318 men over 40 years who have no clinical evidence of prostate cancer. The mean age of this study population was 65.2(range 40-89). The mean PSA was 3.94ng/ml and the mean prostate volume 36.4cc(range 11-120). 85 men(26.7 %) had volumes >20cc and levels >4ng/ml. When all entry included, the serum PSA concentration correlates directly with age (r=0.2, p0.15 in levels 4-10ng/ml. In conclusion, the application of PSAD in clinical field should be taken into consideration seriously and interpretation of PSA should be include the corresponding variables such as age and prostate volume. The PSA velocity or age specific reference range for PSA can aid in the application of PSA.

The Clinical Usefulness of Serum PSA and PSAD in BPH / 대한비뇨기과학회지

We have reviewed the records of 126 patients with BPH under the assumption that the increase in serum PSA varies depending on the volume, the acute inflammation and the different histologic types. The results are as follows; 1.The PSA and PSAD excluding the 8 patients with acute inflammation were 3.55+/-2.569 and 0.084+/-0.73 in the mixed type, 2.644+/-2.573 and 0.11+/-0.16 in the stromal predominant type, and 2.847+/-0.73 and 0.71+/-0.34 in the glandular predominant type. (P=0.033, 0.054, respectively) 2.The PSA and PSAD were 21.481+/-9.582, 0.312+/-0.143 in the 8 patients with acute inflammation and 3.19+/-2.539 , 0.117+/-0.158 in the 118 patients without inflammation(P=0.000, 0.000, respectively). 3.Of the 35 patients with PSA> 4.0ng/ml, the PSAD of 27 patients, excluding the eight with acute inflammation, and the PSAD of 91 patients who were 4ng/ml and below were 0.11+/-0.058 and 0.059+/-0.045 respectively (P=0.000). Additionally the PSAD of the 25 patients with 4.0ng/ ml=PSA10.0ng/dl and of the 91 patients with 4.0ng/ml and below were 0.11+/-0.041 and 0. 059+/-0.045, respectively ( P=0.000). In view of the results, it cannot be determined that PSAD is more effective in foreseeing the histologic types of BPH than PSA and we cannot recommend the use of PSAD as a substitute for biopsy in the case of increased PSA in predicting and differentiating prostatic cancer.