PSA density as a parameter in prostate biopsy decision of patients with prostate sized 80 mL or larger (original) (raw)
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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...
2019
PURPOSE To evaluate the potential of prostate cancer detection on the basis of prostate-specific antigen (PSA)-level and percent free PSA (% fPSA) according to the outcome of prostate needle biopsy. METHODS This was a retrospective study of 1040 patients that underwent a prostate biopsy in the Urologic Clinic of the University Hospital of Ioannina, Greece. The patients underwent needle biopsy after abnormal finding in digital rectal examination (DRE). Tissue samples were extracted using a 12-core TRUS-GB. The patients were divided into four groups according to the biopsy outcome. Total serum and free PSA were measured. RESULTS The mean PSA concentration of cancer versus noncancer groups was significantly higher (p<0.05). The positive predictive value (PPV) of PSA for serum concentration >10 ng/ml was 47% while the negative predictive value (NPV) in patients with PSA levels <4 ng/ml was 81%. The diagnostic accuracy of % fPSA for patients with PSA level between 4-10 ng/ml was...
Türk Üroloji Dergisi/Turkish Journal of Urology, 2019
Objective: We aimed to determine whether the effect of prostate volume on cancer detection rates is influenced by serum prostate-specific antigen (PSA). Material and methods: A total of 2465 men who underwent transrectal ultrasound-guided biopsy were retrospectively evaluated. Standard 10-core prostate biopsy was performed in all cases. Patients were divided into three groups according to the serum PSA levels: ≤10 ng/mL (Group 1), 10-20 ng/mL (Group 2) and >20 ng/mL (Group 3). In each group age, serum PSA levels and prostate volumes were compared in patients with and without prostate cancer. Results: A total of 2079 patients were included in the study group. Cancer detection rates were 16%, 25%, 53% in Groups 1, 2 and 3, respectively (p= 0.001). In Group 1, there was a significant difference in mean prostate volume of patients with and without prostate cancer (p= 0.01). However, this difference was not seen in Group 2 or 3 (p=0.06 and p=0.08, respectively). The mean age and PSA level which are the other determinants of prostate cancer diagnosis were similar between patients with and without cancer in the Group 1, thus prostate volume was the only determinant of the diagnosis. Conclusion: According to our findings, prostate volume is an important factor for prostate cancer diagnosed with prostate biopsy only in patients with a PSA level of ≤10 ng/mL.
The Prostate, 2000
Background: Prostate cancer is one of the most common and leading cause of death among different genitourinary causes. However, screening of prostate cancer is limited to Digital Rectal Examination (DRE) and Prostate Specific Antigen (PSA) in Nepal. The aim of this study is to find out which modality is more helpful for the diagnosis of Prostate Cancer. Methods: A retrospective cross-sectional study was conducted in the department of Urology, College of Medical Sciences, Chitwan, Nepal. All patients included in this study were who presented to the OPD with Lower Urinary Tract Symptoms (LUTS). The patients were above the age of 40 with clinical suspicion prostate cancer based on either DRE or PSA. Results: A total of 150 patients were enrolled from April 2019 to April 2020. Their mean± SD age was of 65.18±9.38 years. The accuracy of the diagnostic test for DRE and PSA were cut off at 4, PSA cut off range of 4 to 10, PSA cut off range of 10 to 30 and PSA cut off at 30 showed that all the screening indices were better for DRE (Sensitivity=100%, Specificity=59.2%, Diagnostic Accuracy=62.2%) than for PSA cut off at 4 (Sensitivity=100%, Specificity=27.6%, Diagnostic Accuracy=32.9%). Among various cut off score or ranges for PSA, cut off score at 30 provided the best screening indices with Sensitivity of 66.7%, Specificity of 97.4% and Diagnostic Accuracy of 95.1%. Conclusions: PSA has higher diagnostic accuracy then DRE.
Medical Archives, 2012
A im: Establish the main differences in the prostate volume, prostate specific antigen density (PSAD), number of biopsy samples in patients with primarily or rebiopsy detected prostate cancer. Materials and methods: In the 2007-2009 period, at the KCUS Urology Clinic, there were 379 TRUS guided prostate biopsies in 323 patients with known prostate volume. The total of 56 patients (17.3%) underwent the first rebiopsy, primarily due to precancerous lesions. The mean prostate volume, ranges of prostate size, PSAT, PSAD and the number of biopsy samples were analysed retrospectively, and the main characteristics in patients with primarily and rebiopsy diagnosed Pca were evaluated as well. Results: The first biopsy cancer detection rate was 29.6% (112/379). The rebiopsy detection rate was 30.3%. There was no statistically significant difference in the prostate volume and the number of biopsy samples among the total number of patients with prostate cancer against the group with benign (suspected) findings. There was a higher Pca detection rate in patients with the prostate volume <40 cm3 and 40-60 cm3, against the group with the prostate volume >60 cm3. PSAD was significantly higher in patients with PCa (0.24 vs. 0.18; p=0.013). The total of 27.2% of the patients with negative biopsy findings and 48% of the patients with diagnosed Pca had PSAD >0.15. PSAD showed sensitivity and specificity in prostate cancer detection of 50% and 75%, with PPV of 48%. Furthermore, the patients with PSAD >0.15 had a higher Gleason score versus the patients with PSAD <0.15 (6.7 ± 2.4 vs. 5.9 ± 1.7; p <0.003). A comparison of the main characteristics in patients with primarily and rebiopsy detected prostate cancer gave a statistically significant difference only in the number of biopsy samples (10.9 vs. 14.1, p <.0000). Conclusion: Patients with a smaller prostate volume, lower PSAD and a higher number of biopsy samples in rebiopsy have a higher chance of prostate cancer detection. PSAD carries a higher specificity in rebiopsy decision, and a higher PSAD is related to a higher Gleason score.
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...
Japanese Journal of Clinical Oncology, 2000
To evaluate whether serum total prostate-specific antigen (PSA), PSA density (serum total PSA level divided by prostate volume), γ-seminoprotein and γ-seminoprotein/total PSA ratio could predict prostate cancer (PCa) prior to biopsy. Methods: A total of 316 consecutive patients who had undergone transrectal prostate biopsy and/or transurethral resection were examined. The prostate volume was determined by transrectal ultrasonography (TRUS) and the ability of the above-mentioned four variables to distinguish PCa from benign prostatic hyperplasia (BPH) was evaluated. Results: PCa was detected in 61 cases. Receiver-operating characteristic (ROC) analysis revealed that both the PSA density and serum total PSA were the most useful predictors of PCa among the four variables. For the patients with a serum total PSA level of 4.1-10.0 ng/ml, PSA density was significantly more accurate than total PSA (p < 0.005). An optimum PSA density value of 0.18 was chosen as a cutoff because it showed the highest sum of sensitivity and specificity, 92 and 54%, respectively. Using this PSA density cutoff, the number of biopsies could have been reduced to 57 from 63% when compared with a PSA density of 0.15. Conclusions: PSA density was significantly more accurate than other variables in predicting PCa. To avoid unnecessary biopsies, the PSA density cutoff value of 0.18 would be recommendable for determining a prostate biopsy for Japanese males with a serum total PSA level of 4.1-10.0 ng/ml.
Journal of Laboratory Physicians
Background Determination of isolated prostate-specific antigen (PSA) in asymptomatic individuals has not demonstrated sufficient sensitivity and specificity to be useful in the routine evaluation of prostate disease. To enhance the accuracy of serum PSA we have used a proportion of serum PSA and prostate volume, which we refer to as prostate-specific antigen density (PSAD). Prostate volume in this study was calculated using transrectal ultrasonography (TRUS).Materials and Methods A total of 106 patients with prostatic disease clinically confined to the prostate glands were evaluated.Results and Observation The mean PSAD for prostate cancer was 0.15 ± 0.01 while that for benign hypertrophy of the prostate (BPH) was 0.11 ± 0.02 (p < 0.05). Significant difference (p < 0.05) was noted in the prostate volume in these two groups with the mean prostate volume measured by TRUS in the BPH to be 53.85 ± 9.71 mL compared with 58.14 ± 7.48 mL in the carcinoma. PSA density of 0.13 ng/mL ca...
Urology, 2007
Data have suggested benign prostatic hyperplasia, and not cancer, as the major reason for elevated prostate-specific antigen (PSA) values between 2.0 and 9.0 ng/mL. If this hypothesis were correct, within these ranges, a smaller prostate volume would be a stronger predictor of cancer than the PSA level itself (the relative contribution from cancer is greater in smaller glands). METHODS We examined our institutional data set of transrectal ultrasound-guided procedures from 2000 to 2003. We studied patients who presented for their first prostate biopsy with a PSA level of 2.0 to 9.0 ng/mL. The indications for biopsy were elevated age-specific PSA level or abnormal digital rectal examination findings. Other covariates included patient age, abnormal transrectal ultrasound findings, transrectal ultrasound volume, and biopsy sampling scheme. Univariate analyses were used to assess the association between each variable and cancer diagnosis. Multivariate logistic regression modeling was then used to determine the adjusted risk factors for cancer at biopsy. RESULTS On univariate analyses, all measured covariates were predictive of cancer. On multivariate modeling, the significant risk factors (in order of strength) for positive biopsy findings were smaller prostate volume (odds ratio [OR] 0.26, P Ͻ0.001), increasing age (OR 1.72, P Ͻ0.001), increasing PSA (OR 1.64, P Ͻ0.001), and the presence of hypoechoic lesions (OR 2.42, P Ͻ0.001). CONCLUSIONS When the PSA level is in the 2.0 to 9.0 ng/mL range, a smaller prostate volume is the strongest predictor of cancer detection. These data support previous studies suggesting the amount of benign prostatic hyperplasia, and not cancer, as the major factor responsible for elevated PSA. UROLOGY 69: 103-107, 2007.