PSA density as a parameter in prostate biopsy decision of patients with prostate sized 80 mL or larger

Background: Patients with high prostate volume (>80 ml) and high PSA levels make it difficult to decide on prostate biopsy. In this study, author aimed to detect of predictive factors to distinguish malignant or benign prostatic lesions in patients with prostate size over 80 ml.Methods: A total of 299 patients underwent TRUSBP at the clinics between 2012-2017. Cases with prostate volume over 80 ml were divided into groups according to the pathology by benign (group 1) or malign (group 2). Author evaluated the predictive factors in two groups. Patient’s age, grading and findings of digital rectal examination, prostate volume, number of received cores, total (tPSA) and free PSA (fPSA) before biopsy, rate of percentage of free to total prostate specific antigen (f/tPSA) and PSA density was compared in both groups.Results: Benign prostate hyperplasia was detected in 217 patients (72.58%) and prostate adenocarcinoma was detected in 82 patients (27.42%). The patient’s age, tPSA, fPSA and PSA density were 63.81 years, 9.71 ng/ml, 1.78 ng/ml and 0.10 g/ml2 in group 1 and 69.10 years, 38.32 ng/ml, 5.86 ng/ml and 0.42 ng/ml2 respectively. Patient’s age, tPSA, fPSA and PSA density was statistically significant between in two groups (p<0,05). Number of received cores and rate of f/tPSA were 14.02-13.84% and 19.06-17.62% in group 1 and 2, respectively and was not statistically significant. In group 2, prostate adenocarcinoma was most common detected with Gleason score 4+3 in 21 of 82 patients (25.6%).Conclusions: High prostate volume (>80 ml) has a significant influence in PSA values and results of the biopsy, PSA density is extremely important in performing prostate biopsy decisions.

What should be the PSA threshold value? 2.5 or 4 ng/mL?

Background: In this study, author aimed to detect of threshold value of prostate-specific antigen (PSA) to distinguish malignant or benign prostatic lesions in PSA evaluation.Methods: A total of 61 patients underwent TRUSBP due to high PSA values (2.5-4 ng/mL) at the clinic between 2012-2017. Digital rectal examinations of all patients were normal. Cases with PSA elevation were divided into groups according to the pathology by benign (group 1) or malign (group 2). Author evaluated the predictive factors with the exception of digital rectal examination findings in two groups.Results: Benign prostate hyperplasia was detected in 35 patients (57.4%) and prostate adenocarcinoma was detected in 26 patients (42.6%). The patient’s age, tPSA, fPSA and PSA density were 62.07 years, 3.55 ng/mL, 0.65 ng/mL and 0.09 ng/ml2 in group 1 and 58.54 years, 3.55 ng/mL, 0.74 ng/mL and 0.10 ng/ml2 in group 2, respectively. Patient’s age was statistically significant between in two groups (p<0.05). Number of received cores and rate of f/tPSA were 12.24-12 and 20.51-18.45% in group 1 and 2, respectively. tPSA, fPSA and PSA density, number of received cores and rate of f/tPSA were similar in both groups. In group 2, prostate adenocarcinoma was most common detected with Gleason score 3+3 in 19 of 26 patients (73.1%).Conclusions: There is a need different assessment to distinguish of malignant lesions from benign lesions. Nowadays, it was impossible to make this difference in patients without digital rectal examination findings, so accepted threshold of PSA should be 2.5 ng/mL.