Platinum open access journal
pISSN 2466-0493 eISSN 2466-054X
Indexed in MEDLINE, SCIE, Scopus, DOAJ and more
    Korean J Urol. 2006 Nov;47(11):1161-1165. Korean.
    Published online Nov 30, 2006.
    https://doi.org/10.4111/kju.2006.47.11.1161
    Copyright © 2006 The Korean Urological Association
    Original Article

    Clinical Significance of Prostate-Specific Antigen Density in Patients with Serum Prostate Specific Antigen between 4 and 10ng/ml

    Byoung Kun Kim, Hyuk Soo Chang and Chun Il Kim
      • Department of Urology, Keimyung University School of Medicine, Daegu, Korea.
    • Corresponding author (Email: cikim@dsmc.or.kr )
    Received June 05, 2006; Accepted October 09, 2006.

    Abstract

    Purpose

    To examine the usefulness of the prostate-specific antigen (PSA) density for selection of biopsy candidates with serum PSA levels between 4-10ng/ml, and determine the optimal PSA density (PSAD) cut off value for use in clinical practice.

    Materials and Methods

    We retrospectively enrolled 705 patients with serum PSA levels between 4-10ng/ml. The patients were divided into the prostate cancer and the non-prostate cancer groups. The PSA level and PSAD in predicting prostate cancer were compared. A receiver operating characteristic (ROC) curve was generated, and utilized to evaluate the optimal PSAD cut off value.

    Results

    One hundred and nineteen and five hundred and eighty six patients had prostate and non-prostate cancers, respectively, on pathological examination. The mean PSA values were not significantly different; 6.9 and 7.0ng/ml, respectively (p>0.05). However, the mean PSAD values were 0.168 and 0.213ng/ml/cc; significantly higher in the prostate cancer group than the BPH group (p<0.05). The ROC curves for the PSA level and PSAD demonstrated superior benefit for the PSAD. The sensitivity, specificity and positive predictive values of a PSAD cut off of 0.15ng/ml/cc were 73.1, 45.9 and 21.5%, respectively. A PSAD cut off of 0.17ng/ml/cc showed the highest sensitivity and specificity, with sensitivity, specificity and positive predictive values of 63.9, 59.2 and 24.1%, respectively.

    Conclusions

    The PSAD seems to be useful in the selection of biopsy candidates with serum PSA levels between 4-10ng/ml, and a PSAD cut off of 0.17ng/ml/cc would seem to be preferable to 0.15ng/ml/cc.

    Keywords
    Prostate cancer; Prostate-specific antigen

    Figures

    Fig. 1
    Receiver operating characteristic curves of the prostate-specific antigen density (PSAD) and level of prostate-specific antigen (PSA).

    Tables

    Table 1
    Patient characteristics

    Table 2
    The detection rates of prostate cancer according to age

    Table 3
    The detection rates of prostate cancer according to the prostate volume

    Table 4
    The detection rates of prostate cancer and the percentage of avoided biopsy using the various PSAD parameters

    Table 5
    Sensitivity, specificity and positive predictive values of the various PSAD cut off values

    References

      1. Wang MC, Valenzuela LA, Murphy GP, Chu TM. Purification of a human prostate specific antigen. Invest Urol 1979;17:159–163.
      1. Stamey TA, Caldwell M, McNeal JE, Nolley R, Hemenez M, Downs J. The prostate specific antigen era in the United States is over for prostate cancer: what happened in the last 20 years? J Urol 2004;172:1297–1301.
      1. Catalona WJ, Richie JP, Ahmann FR, Hudson MA, Scardino PT, Flanigan RC, et al. Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: results of a multicenter clinical trial of 6,630 men. J Urol 1994;151:1283–1290.
      1. Oesterling JE. Prostate specific antigen: a critical assessment of the most useful tumor marker for adenocarcinoma of the prostate. J Urol 1991;145:907–923.
      1. Egawa S, Matsumoto K, Yoshida K, Iwamura M, Kuwao S, Koshiba K. Results of transrectal ultrasound-guided biopsies and clinical significance of Japanese prostate cancer. Jpn J Clin Oncol 1998;28:666–672.
      1. Kobayashi T, Nishizawa K, Ogura K, Mitsumori K, Ide Y. Detection of prostate cancer in men with prostate-specific antigen levels of 2.0 to 4.0ng/ml equivalent to that in men with 4.1 to 10.0ng/ml in a Japanese population. Urology 2004;63:727–731.
      1. Benson MC, Whang IS, Olsson CA, McMahon DJ, Cooner WH. The use of prostate specific antigen density to enhance the predictive value of intermediate levels of serum prostate specific antigen. J Urol 1992;147:817–821.
      1. Bazinet M, Meshref AW, Trudel C, Aronson S, Peloquin F, Nachabe M, et al. Prospective evaluation of prostate specific antigen density and systematic biopsies for early detection of prostate carcinoma. Urology 1994;43:44–51.
      1. Ramon J, Boccon-Gibod L, Billebaud T, Astior L, Kobelinsky M, Meulemans A, et al. Prostate-specific antigen density: a means to enhance detection of prostate cancer. Eur Urol 1994;25:288–294.
      1. Brawer MK, Aramburu EA, Chen GL, Preston SD, Ellis WJ. The inability of prostate specific antigen index to enhance the predictive the value of prostate specific antigen in the diagnosis of prostatic carcinoma. J Urol 1993;150:369–373.
      1. Akdas A, Tarcan T, Turkeri L, Cevik I, Biren T, Gurmen N. The diagnostic accuracy of digital rectal examination, transrectal ultrasonography, prostate-specific antigen (PSA) and PSA density in prostate carcinoma. Br J Urol 1995;76:54–56.
      1. Lee SE, Jung JY, Cho KS, Byeon SS, Kim KM, Paick JS. The value of prostate specific antigen density in the diagnosis of prostate carcinoma. Korean J Urol 1988;39:355–360.
      1. Lee SE, Jung BC, Kim TH, Jeong SJ, Kwak C. The clinical usefulness of the prostate-specific antigen density, digital rectal examination, and transrectal ultrasonography in the screening test of prostate cancer in Koreans. Korean J Urol 2002;43:14–18.
      1. Kim WJ, Lee SC, Lee SC. Value of PSA density, PSA velocity and percent free PSA for detection of prostate cancer in patients with serum PSA 4-10ng/ml patients. Korean J Urol 2004;45:747–752.
      1. Andriole GL, Telle WB, Coplen DE, Catalona WJ. PSA index (PSAI) as a predictor of prostate cancer (CaP) in men with persistent serum PSA elevation. J Urol 1992;147 Suppl:387.
      1. Benson MC, McMahorn DJ, Cooner WH, Olsson CA. An algorithm for prostate cancer detection in a patient population using prostate-specific antigen and prostate specific antigen density. World J Urol 1993;11:206–213.
      1. Yu HJ, Lai MK. The usefulness of prostate-specific antigen (PSA) density in patients with intermediate serum PSA level in a country with low incidence of prostate cancer. Urology 1998;51 5A Suppl:125–130.
    Cited by
    Crossref 1
    Google Scholar 
    Scopus 1
    MeSH Terms
    Biopsy
    Humans
    Prostate*
    Prostate-Specific Antigen*
    Prostatic Neoplasms
    ROC Curve
    Retrospective Studies
    Sensitivity and Specificity
    Metrics
    Share
    Figures
    slide

    1 / 1

    Tables
    slide
    slide
    slide
    slide
    slide

    1 / 5

    PERMALINK