Abstract
ABSTRACTPurpose: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.Materials and Methods: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.Results: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/cc and 0.22 in patients with benign biopsies, respectively. ROC curves analysis demonstrated that PSATZ had a higher area under curve (0,838) than F/T ratio (0.806) (P<0.001) and PSAD (0.806) (P<0.001). With a cut-off value of 0.22 ng/mL/cc, PSATZ had 100% of sensitivity and could have prevented 24% of unnecessary biopsies.Conclusions:PSATZ may be useful in enhancing the specificity of serum PSA. Compared to other PSA related parameters, it was better in differentiating between prostate cancer and benign prostatic enlargement. Also, PSATZ could reduce a significant number of unnecessary biopsies.
Highlights
According to the World Health Organization, prostate cancer (PC) is the second most common cancer and the sixth leading cause of death among males worldwide [1]
Table-1 summarizes the features of the distribution of quantitative variables: age, prostate volume; transition zone (TZ) volume; total prostate-specific antigen (PSA) levels; F/T ratio; PSA density (PSAD); and PSA density adjusted by transition zone (PSATZ) for patients with positive or negative biopsies
All patients with prostate cancer had significantly higher levels of total PSA, PSAD and PSATZ and significantly lower F/T ratios, prostate volume (PV) and transition zone volume (TZV) when compared to patients with negative biopsies
Summary
According to the World Health Organization, prostate cancer (PC) is the second most common cancer and the sixth leading cause of death among males worldwide [1]. It seems to be difficult to discriminate between prostate cancer and benign conditions especially among patients with intermediate PSA levels between 2.6 and 10 ng/mL [5] Within this range, there is a trade-off between specificity and sensitivity, a significant degree of the former being lost in the interest of achieving an acceptable degree of the latter [6]. Different PSA parameters such as PSA velocity [6], age specific reference ranges [7], PSA density (PSAD) [8], PSA density adjusted by transition zone (PSATZ) [9] and the correlations between its molecular forms, have been introduced to improve the diagnostic accuracy of serum PSA. Simpler and most available approaches to evaluate PSA parameters and PC screening are warranted
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