Editorial comment

Abstract

At present, the optimal use of PSA-based parameters remains unclear. There is a basis for supposing that variables such as prostate volume and patient age could have an impact on the predictive power of these PSA-based parameters. 1 Djavan B. Zlotta A.R. Remzi M. et al. Total and transition zone prostate volume and age how do they affect the utility of PSA based diagnostic parameters for early prostate cancer detection?. Urology. 1999; 54: 846-852 Abstract Full Text Full Text PDF Scopus (62) Google Scholar , 2 Vashi A.R. Wojno K.J. Henricks W. et al. Determination of the “reflex range” and appropriate cutpoints for percent free prostate-specific antigen in 413 men referred for prostatic evaluation using the AxSYM system. Urology. 1997; 49: 19-27 Abstract Full Text PDF Scopus (116) Google Scholar , 3 Djavan B. Zlotta A.R. Byttebier G. et al. Prostate specific antigen density of the transition zone for early detection of prostate cancer. J Urol. 1998; 160: 411-419 Abstract Full Text Full Text PDF Scopus (133) Google Scholar , 4 Stephan C. Lein M. Jung K. et al. The influence of prostate volume on the ratio of free to total prostate specific antigen in serum of patients with prostate carcinoma and benign prostate hyperplasia. Cancer. 1997; 79: 104-109 Crossref Scopus (80) Google Scholar In a community-based population of 2119 healthy men, total PSA was shown to correlate with both prostate volume and age, 5 Oesterling J.E. Jacobsen S.J. Chute C.G. et al. Serum prostate-specific antigen in a community-based population of healthy men. Establishment of age-specific reference ranges. JAMA. 1993; 270: 860-864 Crossref Scopus (1183) Google Scholar and the possibility cannot be dismissed that volume-related and age-related variability would also apply to additional PSA-based parameters. The present study applies newly calculated and validated cutoffs for PSAD and PSA-TZ. In a referral population with a total PSA level of 4 to 10 ng/mL, we investigated the variability of these parameters in patients with and without prostate cancer when stratified by total prostate volume, TZ volume, and age. 1 Djavan B. Zlotta A.R. Remzi M. et al. Total and transition zone prostate volume and age how do they affect the utility of PSA based diagnostic parameters for early prostate cancer detection?. Urology. 1999; 54: 846-852 Abstract Full Text Full Text PDF Scopus (62) Google Scholar The need for volume-specific and/or age-specific reference ranges for free/total PSA, PSA-TZ, PSAD, and PSA velocity (PSAV) were investigated prospectively. Significant differences between those with prostate cancer and those without in the evaluated PSA-based parameters were generally evident in cases of small or large prostate glands, as well as small or large TZ volumes.