The Clinical Utility of Measuring Total PSA, PSA Density, gamma-Seminoprotein and gamma-Seminoprotein/Total PSA in Prostate Cancer Prediction (original) (raw)
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International braz j urol : official journal of the Brazilian Society of Urology, 2018
To assess the accuracy of prostate-specific antigen (PSA) adjusted for the transition zone volume (PSATZ) in predicting prostate cancer by comparing the ability of several PSA parameters in predicting prostate cancer in men with intermediate PSA levels of 2.6 - 10.0 ng/mL and its ability to reduce unnecessary biopsies. This study included 656 patients referred for prostate biopsy who had a serum PSA of 2.6 - 10.0 ng/mL. Total prostate and transition zone volumes were measured by transrectal ultrasound using the prolate ellipsoid method. The clinical values of PSA, free-to-total (F/T) ratio, PSA density (PSAD) and PSATZ for the detection of prostate cancer were calculated and statistical comparisons between biopsy-positive (cancer) and biopsy-negative (benign) were conducted. Cancer was detected in 172 patients (26.2%). Mean PSA, PSATZ, PSAD and F/T ratio were 7.5 ng/mL, 0.68 ng/mL/cc. 0.25 ng/mL/cc and 0.14 in patients with prostate cancer and 6.29 ng/mL, 0.30 ng/mL/cc, 0.16 ng/mL/c...
International Journal of Research in Medical Sciences
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 a...
PSA density and prostate cancer detection
Journal of the Medical Association of Thailand Chotmaihet Thangphaet, 2012
Objective: To evaluate the diagnostic value of prostate-specific antigen density (PSAD) and the appropriate cutoff for the detection of prostate cancer. Material and method: Between January 2008 and March 2011, 292 men with PSA levels between 4 and 10 ng/mL underwent transrectal ultrasonography (TRUS) with prostate biopsy. The diagnostic value of PSA levels and PSAD were compared using receiver operating characteristic curves. Results: Prostate cancer was diagnosed in 64 (22%) of the 292 men who had PSA levels 4 to 10 ng/mL. The mean PSA level was 6.96 ng/mL. The mean age was 66 years. The area under the curve (AUC) of PSA and PSAD were 0.475 and 0.665, respectively. The sensitivity and specificity of PSAD at cutoff of 0.15 was 78% and 43%, respectively Conclusion: PSAD was a better discriminator of prostate cancer than PSA for PSA levels less than 10 ng/ml. Our data suggested that a different PSAD cutoff than previously recommended need to be defined for Thai people.
Performance of PSA and of PSA density in the diagnosis of prostate carcinoma
Acta Cirurgica Brasileira, 2002
Objective-The aim of the study was to investigate the influence of the prostate volume and PSA density on the performance of total PSA to diagnosis of prostate carcinoma. Methods-We analyzed 217 patients (PSA 0-10ng/ml) submitted to transrectal sextant prostate biopsy. Criteria for biopsy indication was PSA >2ng/ml and/or digital rectal exam suspicious of prostate cancer. Results-Fifty five patients had prostate neoplasia (25.3%) and in 8/55 (25.3%) the serum PSA was under 4ng/ml. The sensitivity and specificity of the test were respectively 98.2% / 16.6% at a cutoff point of 2.5ng/ml and 85.4% / 38.8% at cutoff of 4ng/ml. The corresponding values for prostates >40ml or <40ml were: 96.2% / 8.1% and 100% / 27.2% at the cutoff point of 2.5ng/ml, and 92.5% / 20% and 78.5% / 62.3% at a cutoff level of 4ng/ml. For prostates <40ml a PSA cutoff point of 4ng/ml leads to a misdiagnosis in 21.4% of the malignant tumors. The median PSAD of benign prostates are different according to prostate volume (.40ml or <40ml). PSAD at cutoff of 0.08 increases the PSA specificity at both PSA cutoff points. Conclusions-Prostate volume affects the sensitivity and specificity of PSA and the median values of PSAD. PSAD of 0.08 increases the PSA specificity specially at a cutoff point of 2.5ng/ml in prostates smaller than 40ml.
Acta Cirurgica Brasileira, 2002
Objective -The aim of the study was to investigate the influence of the prostate volume and PSA density on the performance of total PSA to diagnosis of prostate carcinoma. Methods -We analyzed 217 patients (PSA 0-10ng/ml) submitted to transrectal sextant prostate biopsy. Criteria for biopsy indication was PSA >2ng/ml and/or digital rectal exam suspicious of prostate cancer. Results -Fifty five patients had prostate neoplasia (25.3%) and in 8/55 (25.3%) the serum PSA was under 4ng/ml. The sensitivity and specificity of the test were respectively 98.2% / 16.6% at a cut-off point of 2.5ng/ml and 85.4% / 38.8% at cut-off of 4ng/ml. The corresponding values for prostates >40ml or <40ml were: 96.2% / 8.1% and 100% / 27.2% at the cut-off point of 2.5ng/ml, and 92.5% / 20% and 78.5% / 62.3% at a cut-off level of 4ng/ml. For prostates <40ml a PSA cut-off point of 4ng/ml leads to a misdiagnosis in 21.4% of the malignant tumors. The median PSAD of benign prostates are different according to prostate volume (.40ml or <40ml). PSAD at cut-off of 0.08 increases the PSA specificity at both PSA cut-off points. Conclusions -Prostate volume affects the sensitivity and specificity of PSA and the median values of PSAD. PSAD of 0.08 increases the PSA specificity specially at a cut-off point of 2.5ng/ml in prostates smaller than 40ml. Available from URL: http://www.scielo.br/acb
Urology, 1999
Objectives. To enhance the specificity of prostate cancer (PCa) detection and reduce unnecessary biopsies in men with prostate-specific antigen (PSA) levels of 2.5 to 4.0 ng/mL, we prospectively evaluated various PSA-based diagnostic parameters. Methods. This study included 273 consecutive men with serum PSA of 2.5 to 4.0 ng/mL referred for early PCa detection or lower urinary tract symptoms. All men underwent prostate ultrasound and sextant biopsy with two additional transition zone (TZ) biopsies. If the first biopsies were negative, repeated biopsies were performed at 6 weeks. Total PSA, PSA density (PSAD), PSA density of the transition zone (PSA-TZ), free/total PSA ratio (f/t PSA), and PSA velocity (PSAV) were determined, and the sensitivity, specificity, and predictive values of these various parameters were calculated. Results. Of 273 patients, 207 had histologically confirmed benign prostatic hyperplasia (BPH) and 66 had PCa. f/t PSA and PSA-TZ were the most powerful predictors of PCa, followed by PSA, PSAD, and PSAV. Areas under the receiver operating characteristic curves for f/t PSA and PSA-TZ were 74.9% and 70.1%, respectively. With a 95% sensitivity for PCa detection, an f/t PSA cutoff of 41% and a PSA-TZ cutoff of 0.095 would result in the lowest number of unnecessary biopsies (29.3% and 17.2% specificity for f/t PSA and PSA-TZ, respectively) compared with all other PSA-related parameters evaluated. Conclusions. Compared with standard total PSA assays, f/t PSA and PSA-TZ significantly enhance the sensitivity and specificity of PCa detection in a referral patient population with a total PSA of 2.5 to 4.0 ng/mL. UROLOGY 54: 517-522, 1999.
PSA density as a better predictor of prostate cancer than percent-free PSA in a repeat biopsy
Journal of the Chinese Medical Association, 2011
Background: The aim of our study was to identify the optimal predictor of prostate cancer among several prostate-specific antigen (PSA) derivatives in repeat prostate biopsy. Methods: We retrospectively assessed the repeat prostate biopsy specimens, obtained between 1999 and 2008, of 212 patients with a total PSA (tPSA) of 4e10 ng/ml and normal digital rectal examination. Using a receiver operating characteristic (ROC) analysis, we assessed the predictive power of tPSA, percent free PSA (f/t PSA), PSA density (PSAD), and PSA velocity (PSAV) for the detection of prostate cancer. Results: Repeat prostate biopsy specimens were positive for prostate cancer in the case of 26 patients and negative in the case of 186 patients. The areas under the receiver operating characteristic (ROC) curves for tPSA, f/tPSA, PSAD, and PSAV were 72.7%, 57.9%, 74.4%, and 64.8%, respectively. The ROC curve analysis revealed that PSAD was a better predictor of prostate cancer than f/t PSA. Moreover, when PSAD at an optimal cutoff of 0.18 ng/ml/cc was considered as the predictor, the detection of prostate cancer was found to have a high sensitivity and specificity (77% and 69%, respectively). Conclusion: In a repeat prostate biopsy, PSAD is superior to f/t PSA as a predictor of prostate cancer. And, by assessing this predictor, an unnecessary repeat biopsy of patients with tPSA of 4e10 ng/ml can be avoided.
The predictive value of PSA in diagnosis of prostate cancer in non screened population
Acta chirurgica iugoslavica, 2005
INTRODUCION : PSA is the most important tumor marker in all solid tumor, indispensable in the management of prostate cancer. Screening for prostate cancer is still not recommended, although performed in many countries, which introduced questions about the usefulness of PSA in detection of prostate cancer. The PSA threshold has also been changed, the value of PSA derivatives revised. Whether such changes are applicable in non screened population is questionable. Aim of this study was to evaluate the predictive value of PSA, free/ total PSA and PSA density in our non screened population. Patients and methods: TRUS guided prostate biopsy was performed in 579 patients. The number of cores was 6-12. Mean age of the patients was 67.5 years (30-90). PSA was ranging from 0.41 to 2250 ( mean 38.6ng/ml, median: 11.95, SD 140,45). Digitorectal examination was considered positive in 351 patients. Free PSA was measured in 352 patients with the index ranging from 0.02 to 0.88 ( mean free/total PS...
Annals of clinical and laboratory science, 2003
This study assessed the efficacy of prostate specific antigen density (PSAD) and PSA transition zone density (PSATZ) in predicting prostate cancer in men with PSA levels of 4.0-10.0 ng/ml. Between July 1996 and July 2000, PSAD and PSATZ were determined in 202 patients who underwent ultrasonography-guided systemic sextant biopsies plus 2 transitional zone biopsies. Of the 202 patients, 27 (13.4%) had prostate cancer and 175 (86.6%) had benign prostatic hyperplasia (BPH) on pathologic examination. Although there was no significant difference in mean PSA level between the prostate cancer and BPH patients (p = 0.28), the mean PSAD (p = 0.011) and PSATZ (p = 0.036) were significantly higher in prostate cancer than in BPH patients. In discriminating prostate cancer patients, the cut-off values of 0.35 ng/ml/cc for PSATZ, and 0.15 ng/ml/cc for PSAD yielded specificity levels of 69 and 56, and sensitivity levels of 63 and 81%, respectively. In conclusion, no substantial advantage of PSATZ o...
2016
Introduction: Prostate cancer is the fourth most common cancer in the men older than 50 years. It is in second place after lung cancer. Although the cause of prostate carcinoma has remained unknown, but clinical and experimental observations suggested the effective role of hormonal, genetic and environmental factors. Objectives: This study aimed to determine the relationship between total serum prostate-specific antigen (PSA) levels and free PSA to total PSA ratio with prostate cancer malignancy grade in biopsy specimens, and was performed according to Gleeson criteria. Materials and Methods: This study is a descriptive-analytical study. In patients with prostatic carcinoma the serum level of total PSA and free PSA were measured and according to the Gleason scoring system degree of malignancy was investigated. All data were analyzed by SPSS software. Results: A significant and direct relationship between free PSA/total PSA and Gleason score was found. Also, a significant correlation was observed between serum PSA level and the grade of the disease. Conclusion: Considering that prostatic carcinoma is one of cancers usually diagnosed late and since biopsy is hardly accepted by patients, with regard to the relationship between serum levels of free PSA and free PSA/total PSA ratio we can use serum level of free PSA and total PSA for diagnosis. Consequently, not only rapid and timely diagnosis of all types of cancer can have a positive impact on the healing process but also have particular effect in the treatment and reducing mortality established by this disease.