Clinical significance of transrectal ultrasound measurement of prostate volume in predicting prostate cancer by free prostate specific antigen density / 现代泌尿外科杂志

【Objective】 To explore the application value of free prostate specific antigen density(fPSAD) based on rectal ultrasound in the prediction of prostate biopsy results. 【Methods】 Data of 578 patients undergoing transrectal ultrasound guided prostate biopsy during Jan.2014 and Jul.2021 were retrospectively analyzed, including prostate specific antigen(PSA) level, free prostate specific antigen(fPSA) level, fPSA/total prostate specific antigen(tPSA), prostate specific antigen density(PSAD), combined prostate specific antigen density(cPSAD), fPSAD, prostate volume and other clinical parameters. 【Results】 There were 253 cases of prostate cancer and 325 cases of prostatic hyperplasia. The positive puncture rate was 43.8%. The critical value of fPSAD was 0.05, the corresponding area under receiver operating characteristic (ROC) curve was 0.830, and the Yoeden index was 0.539. The sensitivity, specificity, diagnosis accordance rate and Kappa value of fPSAD to predict prostate cancer were 0.76, 0.77, 76.7% and 0.529, respectively. Compared with PSA, fPSA/tPSA and PSAD, PSA had the highest sensitivity (92.5%), fPSAD had the highest specificity (77.2%), and fPSAD had the highest diagnostic accordance rate (76.7%). 【Conclusion】 When transrectal prostate volume measurement is used to predict prostate cancer, fPSAD has relatively high specificity and diagnosis accordance rate, which is obviously better than using PSA, fPSA/tPSA ratio and PSAD alone in the differential diagnosis and prediction of prostate cancer and prostatic hyperplasia.

New model of PIRADS and adjusted prostatespecific antigen density of peripheral zone improves the detection rate of initial prostate biopsy: a diagnostic study / 亚洲男科学杂志(英文版)

This study explored a new model of Prostate Imaging Reporting and Data System (PIRADS) and adjusted prostate-specific antigen density of peripheral zone (aPSADPZ) for predicting the occurrence of prostate cancer (PCa) and clinically significant prostate cancer (csPCa). The demographic and clinical characteristics of 853 patients were recorded. Prostate-specific antigen (PSA), PSA density (PSAD), PSAD of peripheral zone (PSADPZ), aPSADPZ, and peripheral zone volume ratio (PZ-ratio) were calculated and subjected to receiver operating characteristic (ROC) curve analysis. The calibration and discrimination abilities of new nomograms were verified with the calibration curve and area under the ROC curve (AUC). The clinical benefits of these models were evaluated by decision curve analysis and clinical impact curves. The AUCs of PSA, PSAD, PSADPZ, aPSADPZ, and PZ-ratio were 0.669, 0.762, 0.659, 0.812, and 0.748 for PCa diagnosis, while 0.713, 0.788, 0.694, 0.828, and 0.735 for csPCa diagnosis, respectively. All nomograms displayed higher net benefit and better overall calibration than the scenarios for predicting the occurrence of PCa or csPCa. The new model significantly improved the diagnostic accuracy of PCa (0.945 vs 0.830, P < 0.01) and csPCa (0.937 vs 0.845, P < 0.01) compared with the base model. In addition, the number of patients with PCa and csPCa predicted by the new model was in good agreement with the actual number of patients with PCa and csPCa in high-risk threshold. This study demonstrates that aPSADPZ has a higher predictive accuracy for PCa diagnosis than the conventional indicators. Combining aPSADPZ with PIRADS can improve PCa diagnosis and avoid unnecessary biopsies.

Peripheral zone PSA density: a predominant variable to improve prostate cancer detection efficiency in men with PSA higher than 4 ng ml / 亚洲男科学杂志(英文版)

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

PSA density in the diagnosis of prostate cancer in the Chinese population: results from the Chinese Prostate Cancer Consortium / 亚洲男科学杂志(英文版)

We performed this study to investigate the diagnostic performance of prostate-specific antigen density (PSAD) in a multicenter cohort of the Chinese Prostate Cancer Consortium. Outpatients with prostate-specific antigen (PSA) levels ≥4.0 ng ml

Risk factors for prostate cancer in male patients with MRI-negative and PSA-abnormal findings / 中华男科学杂志

Objective@#To investigate the risk factors for clinically significant PCa diagnosed by transrectal ultrasound-guided systematic prostate biopsy in patients with MRI-negative and PSA-abnormal findings.@*METHODS@#From January 2014 to December 2017, 335 male patients with MRI-negative (PI-RADS 2.0 score ≤ 2) and PSA-abnormal (4－30 ng/ml ) findings underwent systematic prostate biopsy guided by transrectal ultrasound under local anesthesia in our department. We collected and analyzed the demographic data, clinical symptoms, complications, past history and PSA density (PSAD) of the patients.@*RESULTS@#Clinically significant PCa was diagnosed in 21 (6.3%) of the 335 patients. Multivariate logistic regression analysis showed that the independent risk factors were higher age (AUC: 0.704, P 71 years old or with PSAD >0.18 ng/ml/ml so as to avoid missed diagnosis and unnecessary invasive biopsy as well. /.

The value of prostate specific antigen density in the detection of prostate cancer by the multi-parametric MRI / 中华泌尿外科杂志

Objective To evaluate whether prostate specific antigen density(PSAD) could improve the multi-parametric MRI detection of prostate cancer.Methods A total of 110 men from Beijing United Family Hospital and clinics undergoing systematic biopsy + MRI-targeted biopsy from April 2013 to March 2019 were included in the study.The median age was 63.5 years (43.0-84.0 years),median prostate specific antigen (PSA)was 7.0 ng/ml (0.7-43.4 ng/ml),median PSAD was 0.16ng/ml2 (0.03-1.15 ng/ml2),median PI-RADS was 3.5 (2.0-5.0).Results A total of 45 cases of prostate cancer were detected,including 32 cases of clinically significant prostate cancer.Systematic biopsy detected 36 cases of prostate cancer,including 23 cases of clinically significant prostate cancer;MRI-targeted biopsy detected 38 cases of prostate cancer,including 27 cases of clinically significant prostate cancer.For MRI-targeted biopsy,the area under curve (AUC) of PSAD,PI-RADS and PSAD + PI-RADS were 0.807,0.757,0.841 for prostate cancer and were 0.806,0.78,0.862 for clinically significant prostate cancer.PSAD + PI-RADS achieved significantly superior AUC compared with PI-RADS alone for both prostate cancer detection (P =0.0034) and clinically significant prostate cancer detection (P =0.0128).For systematic biopsy + MRI-targeted biopsy,the AUC of PSAD,PI-RADS and PSAD + PI-RADS were 0.765,0.791,0.857 for prostate cancer and were 0.790,0.785,0.853 for clinically significant prostate cancer.PSAD + PI-RADS showed significantly higher AUC compared with P[-RADS for prostate cancer detection (P =0.0042) and clinically significant prostate cancer detection(P =0.0170).Conclusions For prostate biopsy na(i)ve men,PSAD + PI-RADS showed significantly higher predictive value than PI-RADS alone for prostate cancer and clinically significant prostate cancer detection either by MRI-targeted biopsy or by systematic biopsy + MRI-targeted biopsy.

Using the prostate imaging reporting and data system version 2 (PI-RIDS v2) to detect prostate cancer can prevent unnecessary biopsies and invasive treatment / 亚洲男科学杂志(英文版)

Prostate cancer (PCa) is one of the most common cancers among men globally. The authors aimed to evaluate the ability of the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) to classify men with PCa, clinically significant PCa (CSPCa), or no PCa, especially among those with serum total prostate-specific antigen (tPSA) levels in the "gray zone" (4-10 ng ml-1). A total of 308 patients (355 lesions) were enrolled in this study. Diagnostic efficiency was determined. Univariate and multivariate analyses, receiver operating characteristic curve analysis, and decision curve analysis were performed to determine and compare the predictors of PCa and CSPCa. The results suggested that PI-RADS v2, tPSA, and prostate-specific antigen density (PSAD) were independent predictors of PCa and CSPCa. A PI-RADS v2 score ≥4 provided high negative predictive values (91.39% for PCa and 95.69% for CSPCa). A model of PI-RADS combined with PSA and PSAD helped to define a high-risk group (PI-RADS score = 5 and PSAD ≥0.15 ng ml-1 cm-3, with tPSA in the gray zone, or PI-RADS score ≥4 with high tPSA level) with a detection rate of 96.1% for PCa and 93.0% for CSPCa while a low-risk group with a detection rate of 6.1% for PCa and 2.2% for CSPCa. It was concluded that the PI-RADS v2 could be used as a reliable and independent predictor of PCa and CSPCa. The combination of PI-RADS v2 score with PSA and PSAD could be helpful in the prediction and diagnosis of PCa and CSPCa and, thus, may help in preventing unnecessary invasive procedures.

The Within-Group Discrimination Ability of the Cancer of the Prostate Risk Assessment Score for Men with Intermediate-Risk Prostate Cancer

BACKGROUND: Significant clinical heterogeneity within contemporary risk group is well known, particularly for those with intermediate-risk prostate cancer (IRPCa). Our study aimed to analyze the ability of the Cancer of the Prostate Risk Assessment (CAPRA) score to discern between favorable and non-favorable risk in patients with IRPCa. METHODS: We retrospectively reviewed the data of 203 IRPCa patients who underwent extraperitoneal robot-assisted radical prostatectomy (RARP) performed by a single surgeon. Pathologic favorable IRPCa was defined as a Gleason score ≤ 6 and organ-confined stage at surgical pathology. The CAPRA score was compared with two established criteria for the within-group discrimination ability. RESULTS: Overall, 38 patients (18.7% of the IRPCa cohort) had favorable pathologic features after RARP. The CAPRA score significantly correlated with established criteria I and II and was inversely associated with favorable pathology (all P < 0.001). The area under the receiver operating characteristic curve for the discriminative ability between favorable and non-favorable pathology was 0.679 for the CAPRA score and 0.610 and 0.661 for established criteria I and II, respectively. During a median 37.8 (interquartile range, 24.6–60.2) months of follow-up, 66 patients (32.5%) experienced biochemical recurrence (BCR). Cox regression analysis revealed that the CAPRA score, as a continuous sum score model or 3-group risk model, was an independent predictor of BCR after RARP. CONCLUSION: The within-group discrimination ability of preoperative CAPRA score might help in patient counseling and selecting optimal treatments for those with IRPCa.

Using the prostate imaging reporting and data system version 2 (PI-RIDS v2) to detect prostate cancer can prevent unnecessary biopsies and invasive treatment / 亚洲男科学杂志(英文版)

Prostate cancer (PCa) is one of the most common cancers among men globally. The authors aimed to evaluate the ability of the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) to classify men with PCa, clinically significant PCa (CSPCa), or no PCa, especially among those with serum total prostate-specific antigen (tPSA) levels in the 'gray zone' (4-10 ng ml-1). A total of 308 patients (355 lesions) were enrolled in this study. Diagnostic efficiency was determined. Univariate and multivariate analyses, receiver operating characteristic curve analysis, and decision curve analysis were performed to determine and compare the predictors of PCa and CSPCa. The results suggested that PI-RADS v2, tPSA, and prostate-specific antigen density (PSAD) were independent predictors of PCa and CSPCa. A PI-RADS v2 score ≥4 provided high negative predictive values (91.39% for PCa and 95.69% for CSPCa). A model of PI-RADS combined with PSA and PSAD helped to define a high-risk group (PI-RADS score = 5 and PSAD ≥0.15 ng ml-1 cm-3, with tPSA in the gray zone, or PI-RADS score ≥4 with high tPSA level) with a detection rate of 96.1% for PCa and 93.0% for CSPCa while a low-risk group with a detection rate of 6.1% for PCa and 2.2% for CSPCa. It was concluded that the PI-RADS v2 could be used as a reliable and independent predictor of PCa and CSPCa. The combination of PI-RADS v2 score with PSA and PSAD could be helpful in the prediction and diagnosis of PCa and CSPCa and, thus, may help in preventing unnecessary invasive procedures.

Applied research of prostate specific antigen combined with prostate cancer gene 3 in diagnosis of prostate disease / 中华内分泌外科杂志

Objective To detect the expression of peripheral blood free prostate specific antigen (fSPA),total prostate specific antigen (tSPA),prostate specific antigen density (PSAD) and prostate cancer gene 3 (PCA3) in prostate disease,and the significance of combined detection of fSPA,tSPA and PCA3.Methods 67 patients with prostate cancer,75 patients with prostatic hyperplasia and 70 healthy male were selected as the research objects from Dec.2014 to Jul.2016.The serum level of fSPA and tSPA was detected by chemiluminescence immune staining method.The prostate volume was tested by ultrasonic sound and PSAD value was calculated.The total RNA was extracted by Trizol,and the serum PCA3 mRNA expression was detected by RT-PCR.The specificity and sensitivity of combined detection of fSPA,tSPA and PCA3 were analyzed.Results The serum levels of fSPA,tSPA,PSAD and PCA3 in prostate cancer were significantly higher than those in patients with prostatic hyperplasia and healthy male,and they were higher in patients with hyperplasia of prostate than in healthy male,and the differences had statistical significance (P＜0.01).The serum levels of fSPA,tSPA,PSAD and PCA3 were higher in patients with Gleason score ≥7 points and in T3-T4 stage than in patients with Gleason score ＜7 and in T1-T2 stage,and the difference had statistical significance (P＜0.01).The serum levels of fSPA,tSPA,PSAD and PCA3 were positively correlated with Gleason score and TMN pathological stage,and the difference had statistical significance (P＜0.01).The AUC value of fSPA,tSPA,PSAD and PCA3 in diagnosis of prostate cancer was 0.53,0.57,0.63 and 0.75,and the AUC value of combined detection was 0.92.The combined detection efficiency was higher than the single index.The specificity of fSPA,tSPA,PSAD and PCA3 was 67.16％,68.66％,73.13％ and 85.07％,and the sensitivity was 71.64％,70.15％,74.63％ and 82.09％ respectively.The specificity of combined detection was 97.01％,the sensitivity was 92.54％,and the difference had statistical significance (P＜0.01).Conclusion The serum level of fSPA,tSPA,PSAD and PCA3 is increased in prostate disease,and is negatively correlated with Gleason score and TMN pathological stage.The combined detection of fSPA,tSPA,PSAD and PCA3 can improve the sensitivity and specificity of prostate disease diagnosis,and is of high clinical value.

The performance characteristics of prostate-specific antigen and prostate-specific antigen density in Chinese men / 亚洲男科学杂志(英文版)

We investigated the performance characteristics of prostate-specific antigen (PSA) and PSA density (PSAD) in Chinese men. All Chinese men who underwent transrectal ultrasound-guided prostate biopsy (TRUS-PB) from year 2000 to 2013 were included. The receiver operating characteristic (ROC) curves for both PSA and PSAD were analyzed. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) at different cut-off levels were calculated. A total of 2606 Chinese men were included. For the ROC, the area under curve was 0.770 for PSA (P < 0.001) and 0.823 for PSAD (P < 0.001). PSA of 4.5 ng ml-1 had sensitivity of 94.4%, specificity of 14.1%, PPV of 29.5%, and NPV of 86.9%; PSAD of 0.12 ng ml-1 cc-1 had sensitivity of 94.5%, specificity of 26.6%, PPV of 32.8%, and NPV of 92.7%. On multivariate logistic regression analyses, PSA cut-off at 4.5 ng ml-1 (OR 1.61, 95% CI 1.05-2.45, P= 0.029) and PSAD cut-off at 0.12 ng ml-1 cc-1 (OR 6.22, 95% CI 4.20-9.22, P< 0.001) were significant predictors for prostate cancer detection on TRUS-PB. In conclusion, the performances of PSA and PSAD at different cut-off levels in Chinese men were very different from those in Caucasians. PSA of 4.5 ng ml-1 and PSAD of 0.12 ng ml-1 cc-1 had near 95% sensitivity and were significant predictors of prostate cancer detection in Chinese men.

Prostate-specific antigen density predicts favorable pathology and biochemical recurrence in patients with intermediate-risk prostate cancer / 亚洲男科学杂志(英文版)

This study was designed to identify clinical predictors of favorable pathology and biochemical recurrence (BCR) in patients with intermediate-risk prostate cancer (IRPCa). Between 2006 and 2012, clinicopathological and oncological data from 203 consecutive men undergoing robot-assisted radical prostatectomy (RARP) for IRPCa were reviewed in a single-institutional retrospective study. Favorable pathology was defined as Gleason score ≤6 and organ-confined cancer as detected by surgical pathology. Logistic regression analysis was used to determine predictive variables of favorable pathology, and the Kaplan-Meier and multivariate Cox regression model were used to estimate BCR-free survival after RARP. Overall, 38 patients (18.7%) had favorable pathology after RARP. Lower quartile prostate-specific antigen density (PSAD) was associated with favorable pathology compared to the highest quartile PSAD after adjusting for preoperative PSA, clinical stage and biopsy Gleason score (odds ratio, 5.42; 95% confidence interval, 1.01-28.97; P = 0.048). During a median 37.8 (interquartile range, 24.6-60.2) months of follow-up, 66 patients experienced BCR. There were significant differences with regard to BCR free survival by PSAD quartiles (log rank, P = 0.003). Using a multivariable Cox proportion hazard model, PSAD was found to be an independent predictor of BCR in patients with IRPCa after RARP (hazard ratio, 4.641; 95% confidence interval, 1.109-19.417; P = 0.036). The incorporation of the PSAD into risk assessments might provide additional prognostic information and identify some patients in whom active surveillance would be appropriate in patients with IRPCa.

The value of prostate-specific antigen density in the prediction of extraprostatic extension in patients with clinically organ-confined prostate cancer / 中华泌尿外科杂志

Objective To evaluate the role of PSA density with prostate volume determined by MR images in the prediction of extraprostatic extension in patients with clinically organ-confined prostate cancer.Method A total of 71 patients with clinically organ-confined prostate cancer who underwent radical prostatectomy from January 2009 to December 2013 were included in the study.MRI PSAD,preoperative total serum PSA (tPSA),free PSA/total PSA (fPSA/tPSA),biopsy Gleason score,prostate volume,age,body mass index in patients with extraprostatic extension were compared with those in patients with organ-confined disease.The receiver operating characteristic (ROC) curve was used to analyze the performance of each of the above parameters to predict the extraprostatic extension.Multivariate logistic regression analysis was used to select the independent influencing factors for extraprostatic extension.Results Pathologic examination revealed 32 patients were positive for extraprostatic extension and 39 paticnts had organ-confined disease.MRI PSAD(P ＜ 0.001),tPSA (P ＜ 0.00l) and biopsy Gleason score levels (P =0.006) were higher in patients with extraprostatic extension than that in patients with organ-confined disease,and prostate volume was lower(P =0.009).MRI PSAD showed the largest area under ROC curve (AUC) among those parameter(AUC =0.852,P ＜ 0.001),and tPSA was the second (AUC =0.764).Multivariate logistic regression analyses showed that MRI PSAD was an independent predictor of extraprostatic extension.Conclusions MRI PSAD was better than tPSA in predicting pathological stage of extraprostatic extension.The value of PSAD should not be ignored in the prediction of pathological stage.

The value of serum PSA subgroups and biopsy Gleason score in the prediction of pathologic stage of prostate cancer / 肿瘤

Objective: To evaluate the role of serum prostate specific antigen (PSA) subgroups and biopsy Gleason score in the prediction of pathologic stage of prostate cancer. Methods: Ninety two patients with prostate adenocarcinoma pathologically confirmed were retrospectively analyzed in the study. All the patients underwent radical prostatectomy and had preoperative tPSA, free PSA,free PSA/total PSA (fPSA/tPSA), PSA density (PSAD) and biopsy Gleason score. Each of the above parameters in patients with organ-confined disease were compared with that in patients with extraprostatic extension. The receiver operating characteristics (ROC) curve was used to analyze the performance of each of the above parameters to predict the pathologic stage;multivariate logistic regression analysis was used to select the main influencing factors of organ-confined disease. Results: PSAD, tPSA, fPSA/tPSA and biopsy Gleason score levels were higher in patients with extraprostatic extension than that in patients with organ-confined disease (P 0.7, P < 0.05]. Multivariate analysis revealed that only PSAD and biopsy Gleason score were the main influencing factors of organ-confined disease (P < 0.05), and multivariate model of AUC reached 0.80 (P = 0.000). Conclusion: PSAD was better than PSA in predicting pathological stage of organ-confined disease. Predictive models could consider using PSAD instead of tPSA. PSAD in combination with other factors was able to improve the predictive accuracy.

The Clinical Significance of Transrectal Ultrasonography, Prostate-specific Antigen and Prostate-specific Antigen Density for the Reduction of Unnecessary Biopsies / 대한남성과학회지

PURPOSE: To establish criteria for the safe reduction of unnecessary biopsies, we compared transrectal ultrasonography (TRUS) findings, serum prostate-specific antigen (PSA), and PSA density (PSAD) in the decision criteria for the TRUS guided prostate biopsy (TRUS-Bx). MATERIALS & METHODS: A total of 914 patients underwent TRUS-Bx due to elevated PSA and/or focal nodules on the TRUS. The patients were divided into the prostate cancer (n=286, 31.3%) and the non-prostate cancer groups (n=628, 68.7%). The sensitivity, specificity, and accuracy of TRUS, PSA, and PSAD were retrospectively evaluated, and the single criterion or the combinations of the criteria which can safely reduce the unnecessary biopsies without missing prostate cancer were investigated. RESULTS: The sensitivity, specificity and accuracy of TRUS, PSA (cut-off value, 4ng/ml) and PSAD (cut-off level, 0.20ng/ml/cc) were 75.9%/78.3%/53.8%, 33.0%/52.5%/73.7%, and 34.0%/42.9%/48.3%, respectively. At the cut-off level of PSAD (0.20 ng/ml/cc), 65.1% of unnecessary biopsies were spared but 132 cases (22.2%) of prostate cancer were detected. However a focal nodule was detected on TRUS in 120 cases (90.9%) and the remaining 12 cases (9.1%) had PSA above 10ng/ml. By the combinations of criteria (PSAD, TRUS and PSA), 27.7% of unnecessary biopsies were spared without missing cancer. CONCLUSIONS: A short-interval follow-up seems to substitute for the prostate biopsy if PSAD is below 0.20ng/ml/cc without nodular lesions on TRUS and PSA value is below 10ng/ml.

The Clinical Significance of Transrectal Ultrasonography, Prostate-specific Antigen and Prostate-specific Antigen Density for the Reduction of Unnecessary Biopsies / 대한남성과학회지

PURPOSE: To establish criteria for the safe reduction of unnecessary biopsies, we compared transrectal ultrasonography (TRUS) findings, serum prostate-specific antigen (PSA), and PSA density (PSAD) in the decision criteria for the TRUS guided prostate biopsy (TRUS-Bx). MATERIALS & METHODS: A total of 914 patients underwent TRUS-Bx due to elevated PSA and/or focal nodules on the TRUS. The patients were divided into the prostate cancer (n=286, 31.3%) and the non-prostate cancer groups (n=628, 68.7%). The sensitivity, specificity, and accuracy of TRUS, PSA, and PSAD were retrospectively evaluated, and the single criterion or the combinations of the criteria which can safely reduce the unnecessary biopsies without missing prostate cancer were investigated. RESULTS: The sensitivity, specificity and accuracy of TRUS, PSA (cut-off value, 4ng/ml) and PSAD (cut-off level, 0.20ng/ml/cc) were 75.9%/78.3%/53.8%, 33.0%/52.5%/73.7%, and 34.0%/42.9%/48.3%, respectively. At the cut-off level of PSAD (0.20 ng/ml/cc), 65.1% of unnecessary biopsies were spared but 132 cases (22.2%) of prostate cancer were detected. However a focal nodule was detected on TRUS in 120 cases (90.9%) and the remaining 12 cases (9.1%) had PSA above 10ng/ml. By the combinations of criteria (PSAD, TRUS and PSA), 27.7% of unnecessary biopsies were spared without missing cancer. CONCLUSIONS: A short-interval follow-up seems to substitute for the prostate biopsy if PSAD is below 0.20ng/ml/cc without nodular lesions on TRUS and PSA value is below 10ng/ml.

The Clinical Usefulness of the Prostate-specific Antigen, Prostate- specific Antigen Density, Digital Rectal Examination, and Transrectal Ultrasonography in the Screening Test of Prostate Cancer in Koreans / 대한비뇨기과학회지

PURPOSE: The efficacy of the prostate-specific antigen (PSA), prostate-specific antigen density (PSAD), digital rectal examination (DRE) and transrectal ultrasonography (TRUS) for diagnosing prostate cancer in Koreans was investigated. MATERIALS AND METHODS: The medical records from a selected population of 346 patients (30 to 93 years old, mean age 66.0) who had visited the department of Urology in Seoul National University Hospital from January 1994 to December 2000 were reviewed retrospectively. All patients a transrectal ultrasonography-guided biopsy. The student's t test was used for statistical analysis. RESULTS: Prostate cancer was detected in 119 (34.4%) out of 346 patients. PSA, PSAD, TRUS, and DRE showed a sensitivity of 95.8%, 88.2%, 66.4% and 61.3%, a specificity of 26%, 49.3%, 66.5% and 55.9%, and a positive predictive value of 40.4%, 47.7%, 51% and 42.2%, respectively. The positive predictive value from the combination of PSAD and TRUS was 67%, which was the highest when two among the four methods were selected and combined. The detection rate for prostate cancer was 23% (31 out of 135 patients) when the PSA level was between 4 and 10ng/ml, and was 20.9% (18 out of 86 patients) when PSA level was between 4 and 10ng/ml and the DRE findings were negative. CONCLUSIONS: In detecting prostate cancer, PSA showed the highest sensitivity and TRUS showed the highest specificity and positive predictive value. PSAD might be a useful method for diagnosing prostate cancer when combined with TRUS. A TRUS-guided biopsy should be done in patients when the PSA level is between 4 and 10ng/ml in Korea.

The Value of Prostate Specific Antigen Density in the Diagnosis of Prostate Adenocarcinoma / 대한비뇨기과학회지

PURPOSE: Most studies have shown considerable overlap between benign prostatic hyperplasia(BPH) and cancer, using a prostate specific antigen(PSA) cut-off point of 4.0ng/ml. Because of lack of sensitivity and specificity, the value of PSA measurement in the diagnosis of prostate cancer has been questioned. The concept of PSA density(PSAD) was introduced to enhance the specificity of serum PSA. To determine the value of PSAD in the diagnosis of prostate cancer, we investigated whether PSAD-based clinical guidelines could help in the diagnosis of prostate cancer and assist in avoiding a significant number of biopsies. MATERIALS AND METHODS: Retrospective data were analysed from a selected population of 130 patients(mean age 66 years, range 42-86), 54 with histopathologically diagnosed prostate cancer and 76 with BPH. DRE(digital rectal examination) and TRUS(transrectal ultrasonography) were performed and PSA and PSAD were determined for each patient. RESULTS: The median PSA level was 7.0ng/ml(range 0.6-87ng/m1) in the patients with a benign diagnosis and 25.5ng/ml(range 2.2-736ng/m1) in those with malignancies. Also, the median PSAD was 0.18ng/m1/cm3(range 0.02-2.56ng/ml/cm3) in the benign group and 0.75ng/m1/cm3(range 0.06-22.3ng/m1/cm3) in the malignant group. Both PSA and PSAD discriminated BPH from cancer in a whole range of PSA level and were statistically significant. Of the 130 patients, 49(377 %) had a PSA level in the intermediate range(4.0-10.0ng/ml). In these patients, the median PSA was 6.5ng/ml(range 4.2-10ng/m1) In the benign group and 5.2ng/ml(range 4.1-9.8ng/ml) in the malignant group. Also, the median PSAD was 0.16ng/m1/cm3(range 0.07-0.39ng/m1/cm3) in the benign group and 0.17ng/m1/cm3 (range 0.08-0.27ng/m1/cm3) in the malignant group Both PSA and PSAD had no discriminating ability between BPH arid cancer in the Intermediate PSA range(4.0-10.0ng/ml). CONCLUSIONS: PSAD was of no additional value over serum PSA measurement in discriminating BPH from cancer for the population with intermediate PSA levels.

Relationship of Prostate Specific Antigen & Prostate Specific Antigen Density and Prostatic Intraepithelial Neoplasia in Patient with Benign Prostatic Hyperplasia and Prostatic Cancer / 대한비뇨기과학회지

Prostate intraepithelial neoplasia (PIN) is a putative premalignant change in the human prostate, which is an intraluminal proliferation of the secretory cells of the prostatic duct-acinar system that is enveloped by a basal cell layer and displays a spectrum of dysplastic cytologic features ranging from minimal atypia (low grade PIN) to those which are ultimately indistinguishable from carcinoma cells (high grade PIN). To evaluate the clinical significance of the PIN in prostatic tumor and BPH, we reviewed the serum prostate specific antigen (PSA), prostate specific antigen density (PSAD), and pathologic findings in the specimen of 21 BPH and 11 Prostate cancers, which were pathologically confirmed. The distributions of PIN are 7/21 (33%) in BPH and 8/ 11 (73%) in prostatic ca (P0.05). There was no significant difference in the distribution of PIN according to histologic types of BPH. And high grade PIN was observed only in prostatic cancer. Therefore, if high grade PIN is observed in pathologic specimens, undetected prostatic cancer should be found.

Prostate Specific Antigen Density (PSAD) in the Detection of the Prostate Cancer / 대한비뇨기과학회지

Prostate specific antigen(PSA) is an extremely valuable tumor marker. However, its use in detection of prostate cancer is limited by low sensitivity and specificity. To enhance the accuracy of serum PSA we used the quotient of serum PSA and prostate volume, which is referred to as prostate specific antigen density(PSAD). Prostate volume in this study was calculated from transrectal ultrasonographic determinations using the formula, length x width x depth x 0.52 = volume. The serum PSA was analyzed using the Hybritech assay. Prostate biopsy was performed transperineally from at least six sites. The cancer detection rate was 3.3%(three out of 91 patients) in the group with PSA value of less than 4.0ng/ml and 11.3%(eight out of 71 patients) in the group with PSA value of 4.1 to 10. 0ng/ml. In the latter group, mean PSA value for the positive(n=8) and negative(n=63) biopsy group was 7.10+/-1.22 and 6.61+/-1.79ng/ml each(p=0.4630), but mean PSAD value was 0.275+/-0.089 and 0.187+/-0.078 each(p=0.0045). In the group of 38 patients with PSA value of 10.1 to 20.0ng/m1, the cancer detection rate was 15.8%(six patients) and the mean PSA value for the positive(n=6) and negative(n=32) biopsy group was 15.5+/-3.09 and 13.4+/-2.78ng/ml each(p=0. 1038), but the mean PSAD value was 0.535+/-0.082 and 0.334+/-0.182 each(p=0.0128). These results suggest that PSAD be useful in distinguishing BPH and prostate cancer in the patients with intermediate PSA values(4.1ng/ml to 20.0ng/ml).