Predictive value of PSA and PSA density in the diagnosis of prostate cancer in patients with acute urinary retention

Abstract

Objective To analyze the clinicopathological characteristics of patients transurethrally cathetered due to acute urinary retention (AUR) and with high prostate specific antigen (PSA),and to evaluate the value of PSA and prostate specific antigen density (PSAD) in the diagnosis of prostate cancer (PCa) in these patients.Methods Data from 95 patients who had been transurethrally cathetered due to AUR and underwent transrectally ultrasound-guided prostate biopsy were retrospectively analyzed.The indications for biopsy in this study were abnormally elevated serum levels of PSA,positive transrectal prostate ultrasound and/or magnatic resonance imaging findings,and abnormal digital rectal examination.The incidence of PCa was recorded according to total PSA levels,while receiver operating characteristic curve (ROC curve) was plotted for appraisement on the predictive value of PSAD.Results The positive biopsy rate was 17.9％ (17/95).The positive rate was 0 (0/21),6.1％ (2/33),13.0％ (3/23) and 66.7％ (12/18) for patients with PSA 4.1-10.0,10.1-20.0,20.1-50.0 and ≥50.1 μg/L,respectively.In patients with PSA≥ 10.1 μg/L,the area under ROC curve of PSAD was 0.935,and the optimal cutoff was ＞ 0.54 mg/L2,while corresponding sensitivity,specificity,positive predictive value,negative predictive value was 94.1％,84.2％,61.5％ and 97.9％,respectively.Conclusions Prostate biopsy should not be performed on all AUR patients with transurethral catheters and elevated PSA levels.Patients with PSA ≥10.1 μg/L and PSAD ＞ 0.54 mg/L2 are at higher risk of PCa diagnosis. Key words: Prostatic neoplasms ; Urinary retention ; Biopsy ; Urinary catheterization ; Prostate-specific antigen