Is Prostate Specific Antigen Density more Important than in the Diagnosis of Prostate Cancer in Patients with a Total Prostate Specific Antigen Value <10 ng/mL?

Objective: The purpose of this study was to determine the ability of the ratio of free to total prostate-specific antigen and prostate-specific antigen density to predict the presence of clinically significant prostate cancer on template biopsies. The value of these tests may be underestimated as they were previously validated against sextant transrectal biopsy of the prostate, which has been proved to miss a large proportion of significant prostate cancers. The ability of these tests to specifically detect clinically significant cancers has not previously been studied. Patients and methods: A retrospective analysis was performed of patients undergoing transperineal template biopsy who also had free to total prostate-specific antigen and prostate-specific antigen density. Receiver-operating characteristic analysis was performed to determine the comparative utility of each test in the detection of all cancers as well as clinically significant cancers, by means of the area under the curve. Results: Data from 293 patients were analysed. Prostate cancer was detected in 72% of patients, of which 62% of this group had clinically significant disease. Receiver-operating characteristic analysis demonstrated the superiority of prostate-specific antigen density and free to total prostate-specific antigen over standard prostate-specific antigen in the overall detection of cancer (area under the curve 0.662 and 0.674 vs 0.534, p=0.003 and 0.02 respectively). Both tests were even more effective in the detection of clinically significant cancers (area under the curve 0.755 and 0.715 vs 0.572, p<0.0001 and 0.009 respectively). Conclusion: The free to total prostate-specific antigen and prostate-specific antigen density both appear to perform well at detecting clinically significant prostate cancer in our population of men undergoing template biopsy. The potential role of these inexpensive tests should not be overlooked as they may be of value when deciding which patients require biopsy following an initial magnetic resonance imaging scan and also for those on surveillance protocols.

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Utility of Prostate Specific Antigen Density and Free to Total Prostate Specific Antigen Ratio for Detecting Prostate Cancer in Iranian Men: A Prospective Study of 187 Cases

Current Urology ◽

10.1159/000253399 ◽

2010 ◽

Vol 4 (1) ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Farid Dadkhah ◽

Mohammad R. Safarinejad ◽

Erfan Amini ◽

Ali R. Lashay ◽

Arash Baghayee

Keyword(s):

Prostate Cancer ◽

Prospective Study ◽

Prostate Specific Antigen ◽

Specific Antigen ◽

Total Prostate Specific Antigen ◽

Prostate Specific Antigen Density ◽

A Prospective Study

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Value of the Free to Total Prostate Specific Antigen Ratio and Prostate Specific Antigen Density for Detecting Prostate Cancer in Japanese Patients

International Journal of Urology ◽

10.1111/j.1442-2042.1998.tb00364.x ◽

1998 ◽

Vol 5 (4) ◽

pp. 343-348 ◽

Cited By ~ 6

Author(s):

Hiroshi Maeda ◽

Yoichi Arai ◽

Kazutoshi Okubo ◽

Yoshitaka Aoki ◽

Takashi Okada ◽

...

Keyword(s):

Prostate Cancer ◽

Prostate Specific Antigen ◽

Specific Antigen ◽

Japanese Patients ◽

Total Prostate Specific Antigen ◽

Prostate Specific Antigen Density

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CAN PROSTATE-SPECIFIC ANTIGEN DENSITY AND FREE / TOTAL PROSTATE-SPECIFIC ANTIGEN RATIO PREDICT CLINICALLY SIGNIFICANT PROSTATE CANCER (GLEASON ≥ 7) IN PATİENTS DIAGNOSED PROSTATE CANCER ON BIOPSY WITH A PROSTATE-SPECIFIC ANTIGEN LEVEL OF 2.5 -10 NG/ML?

10.22541/au.161332943.38073464/v1 ◽

2021 ◽

Author(s):

Fatih Bicaklioglu ◽

Hasan Aydin ◽

Ahmet Özgür Güçtaş ◽

Hamit Zafer Aksoy

Keyword(s):

Prostate Cancer ◽

Prostate Specific Antigen ◽

Sensitivity And Specificity ◽

Prostate Biopsy ◽

Specific Antigen ◽

Free Psa ◽

Total Prostate Specific Antigen ◽

Prostate Specific Antigen Density ◽

Clinically Significant ◽

Total Psa

Introduction Many men with non-clinically significant PCa (N-CSPCa) will not progress to become symptomatic within their lifetime. If we can predict clinically significant PCa (CSPCa), we can prevent patients from unnecessary biopsies, overdiagnoses, and overtreatment. The purpose of this study was to determine whether PSAD and f/t PSA can predict CSPCa (Gleason ≥ 7) in patients diagnosed with prostate cancer on biopsy with a PSA level of 2.5-10 ng/ml or not. Materials and Methods 78 patients who underwent TRUSG-guided prostate biopsy with PSA 2.5-10.0 in our clinic between March 2017 - August 2020 and whose pathology result was reported as prostate adenocarcinoma, were retrospectively evaluated. In addition to the demographic content of the patients, PSA, free PSA, prostate size (with TRUSG), rectal examination findings and prostate biopsy pathology results were recorded. Clinically significant prostate cancer was defined as a Gleason score 7. Results The mean age of the patients was 66.9 ± 8.4, PSA value was 6.9 ± 1.8, free / total PSA ratio was 18 ± 8.1%, and PSA density was 0.150 ± 0.078. The P values of PSA, free PSA, PSAD, f/t PSA, and prostate volume between CSPCa and N- CSPCa groups were 0.010, 0.780, 0.001, 0.084, and 0.030, respectively. The area under the ROC curve (AUC) of the PSAD for predicting CSPCa was 0.719 with a 95% Cl (0.604–0.835), and the standard errors were 0.062 and 0.059, respectively. When PSAD cutoff was 0.130 for predicting CSPCa, sensitivity and specificity were 75% and 63%, respectively. Conclusion PSAD can be used for predicting CSPCa, but f/t PSA can not. PSAD is not a strong stand-alone tool with its sensitivity and specificity, but we suggest that PSAD can be a part of future nomograms for predicting CSPCa and future protocols for active surveillance. Key words:prostate-specific antigen; clinically significant prostate cancer

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