Prostate Specific Antigen Density of the Transition Zone: A New Effective Parameter for Prostate Cancer Prediction (original) (raw)
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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...
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...
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.
Prospective evaluation of prostate cancer detection by prostate-specific antigen-related parameters
International Journal of Urology, 1999
Background: The diagnostic value of prostate-specific antigen (PSA) for differentiating prostate cancer from benign prostatic conditions is limited by its lack of specificity. Several PSA-related parameters have been suggested as enhancing the discriminatory power of total PSA values, but their clinical utility should be considered preliminary until established in a prospectively evaluated cohort. Methods: In a prospective cohort study, results of ultrasound-guided biopsy and/or transurethral resection of the prostate gland were assessed in 706 consecutive Japanese men. The clinical usefulness of total PSA, free PSA, percentage of free PSA, PSA density (PSAD), PSA density for transition zone (PSADT) and gland volume for predicting prostate cancer was investigated using receiver operating characteristic (ROC) curve analysis in 16 different patient subgroups. Results: Overall, 150 of the 706 patients (21.2%) had prostate carcinoma. The ROC curve analysis showed that PSAD and PSADT were more powerful predictors of prostate cancer than total PSA in most of the 16 patient subgroups tested. The improvement in performance was modest, however. No substantial difference was noted between PSAD and PSADT. Total gland volume did not significantly affect the performance of these parameters. The use of a PSAD threshold value of 0.11-0.15 ng/mL per cm 3 (or a PSADT value of 0.23-0.27 ng/mL per cm 3 ) would have avoided 24-48% (or, for PSADT, 34-40%) of unnecessary biopsies at the cost of missing 5-10% of detectable cancers in a patient subgroup with intermediate total PSA levels. The performance of free PSA and percentage of free PSA was worse than that of any other test in this study. This may be due to inappropriate handling of sera prior to measurement. Conclusions: The discriminatory potential of total PSA for predicting prostate cancer was modestly improved by the use of PSAD and PSADT. No substantial advantage of PSADT over PSAD could be demonstrated. Stringent and standardized storage conditions should always be maintained when applying free PSA-related parameters.
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.
Urology, 1999
Objectives. To define the role of total prostate (TP) volume, transition zone (TZ) volume, and age as determinants of the utility of prostate-specific antigen (PSA)-based diagnostic parameters for early detection of prostate cancer (PCa) in a prospective multicenter study. Methods. The study participants were 974 consecutive men with serum total PSA (tPSA) levels of 4 to 10 ng/mL who were referred for early PCa detection or lower urinary tract symptoms. All patients underwent prostate ultrasound examination and sextant biopsy with two additional TZ biopsies. In patients with negative initial biopsies, repeated biopsies were performed at 6 weeks. tPSA, the free/total PSA ratio (f/t PSA), PSA density of the TZ (PSA-TZ), PSA density (PSAD), and PSA velocity (PSAV) were determined and compared across TP volume strata of 30 cm 3 or less and greater than 30 cm 3 , TZ volume strata of 20 cm 3 or less and greater than 20 cm 3 , and various age groups to evaluate the need for volume and/or age-specific reference ranges. Results. PCa was found in 345 (35.4%) of 974 patients and benign prostatic tissue was found in 629 (64.6%) of 947 patients. Across TP volume strata, significantly higher values of tPSA (P Ͻ0.01), PSA-TZ, PSAD (P Ͻ0.001), and PSAV (P Ͻ0.05) and lower values of f/t PSA (P Ͻ0.001) were observed in patients with PCa than in those without PCa. Similar results were obtained with respect to TZ volume strata, except in the case of PSAV (P Ͻ0.05). tPSA, PSA-TZ, and PSAD were significantly higher (P Ͻ0.05) in patients with PCa than in those without PCa for all corresponding age ranges. In patients with PCa, f/t PSA was significantly lower (P Ͻ0.001) within the same age ranges. Within each group (PCa or benign), f/t PSA, PSAD, PSA-TZ, and PSAV values were unaffected by age strata. However, PSA parameters dependent on prostate volume (PSAD, PSA-TZ) were statistically lower (P Ͻ0.001) in prostates with a higher TP volume (greater than 30 cm 3 ) and TZ volume (greater than 20 cm 3 ); f/t PSA values were unaffected by TP and TZ volumes. Conclusions. f/t PSA and PSA-TZ were the most powerful parameters to differentiate between benign prostatic tissue and PCa. f/t PSA was the sole parameter unaffected by age and prostate volume. We believe new volume-specific cutpoints, as presented in the current study, should be employed when using PSAD and PSA-TZ for the early detection of PCa. UROLOGY 54: 846-852, 1999. © 1999,
International Braz J Urol, 2007
Objective: Compare the capacity of the PSA density (PSAD), Free PSA percentage (%FPSA) and PSA transition zone density (PSATZ) in improving the sensitivity and specificity of the PSA to detect prostate cancer (PCa) in men with a PSA between 4 and 10 ng/mL. Materials and Methods: One hundred and forty five men with PSA between 4 and 10 ng/mL were prospectively studied. Blood collection for the total PSA and free PSA was performed as well as transrectal ultra-sound with prostate biopsy and measurement of the total prostate volume (TPV) and transition zone volume (TZV). Patients with initial negative biopsy were followed and the prostate biopsy was repeated in those that presented PSA increase. The capacity of the PSAD, %FPSA and PSADTZ in improving the sensitivity and specificity pf the PSA test to the detection of the PCa was assessed by univariate and multivariate analyses and through the ROC curve. Results: Of the 145 patients, 38 (26.2%) had PCa and in 107 (73.8%) a benign prostate disease was diagnosed. No difference among the PSAD, %FPSA and PSADTZ was found. The multivariate analysis showed that the PSADTZ, %FPSA, TZV and age were those more powerful and highly significant PCa predictors. Conclusion: The determination of %FPSA and PSAD can allow a better discrimination between PCa and benign disease that the isolated use of PSA. The combination of PSADTZ, %FPSA, TZV and age promote a high accuracy for PCa detection.
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.
The Utility of PSA and PSA Density in Assessing the Risk of Prostate Cancer
Introduction: The specific threshold of Prostate specific antigen(PSA) to diagnose prostate cancer has been controversial hence Prostate specific antigen density (PSAD) was introduced as better diagnostic tool. Our aim was to identify the sensitivity and specificity of PSA at different cut off values, to assess and compare the utility of PSA and PSAD for diagnosing prostate cancer. Methods : A Crossectional study was done on 156 prostatic specimens. Clinical and USG findings and histopathological diagnosis were noted. The PSA and PSAD levels were estimated. Sensitivity, specificity, PPV, NPV and diagnostic accuracy of PSA value at cut off 4ng/ml, and PSAD was compared. Sensitivity and specificity of PSA at 10ng/ml, 20 ng/ml and 50 mg/ml was also compared to predict malignancy. Results: Sensitivity, specificity, PPV, NPV and diagnostic accuracy of PSA at cut off 4ng/ml, and PSAD was 93.55%, 52%, 32.58%, 97.01%, 60.26% and 80.65%, 74.40%, 43.86%, 93.240%, 75.64% respectively. Sensitivity of PSA ranged from 93.55% to 45.16% and specificity of 52% to 99.2% with increasing PSA cut off value of 4 ng/ml to 50 ng/ml. Conclusion: PSA value at >10ng/ml is better predictor of malignancy as compared at Cut off 4 ng/ml. PSAD is more reliable marker with better diagnostic accuracy in comparison to PSA at 4ng/ml. Histopathology remains the gold standard for diagnosing malignancy.
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...