Abstract
Background and objective: This study combined two clinical indicators (age and prostate volume (PV)) to generate age to PV (AVR) ratio, whose diagnostic value for prostate cancer (PCa) was examined based on prostate specific antigen (PSA) in the range of 4--20.0 ng/mL. Methods: The medical records of patients who underwent transrectal ultrasound-guided biopsy of the prostate in our hospital from June 2015 to June 2019 were examined retrospectively. According to the pathological results of the biopsy, the patients were divided into the PCa and benign prostatic hyperplasia (BPH) groups. Receiver operating characteristic (ROC) curves for TPSA, PSAD, PV, (F/T)PSA, AVR, and PSA-AV were plotted with SPSS 26.0 and GraphPad Prism 5.0, and areas under the ROC curves (AUROCs) were determined and compared by Delong test. A log-linear model was used to compare AVR and other parameters with similar high sensitivities, for specificity. Results: The AUROC for AVR was significantly different from those of TPSA (p < 0.001), PV (p = 0.004),(F/T)PSA (p < 0.001), and PSA-AV (p = 0.006), and similar to that of PSAD (p = 0.064). With the same high sensitivity (90.0%), log-linear model analysis showed that the specificity of AVR was significantly higher than those of TPSA and (F/T)PSA (p < 0.01), while there were no significant differences among AVR and PSAD, PV and PSA-AV. Conclusion: With PSA in the range of 4--20.0 ng/mL, AVR may be useful in sparing an invasive intervention for a number of patients.
Highlights
Benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are the most common benign and malignant prostate diseases in middle-aged and elderly men, respectively [1]
In order to further improve the diagnosis of PCa in the “diagnostic gray area”, a number of scholars have proposed prostate volume (PV), prostate specific antigen density (PSAD: Total prostate specific antigen (TPSA)/PV), free/total PSA ((F/T)PSA: Free prostate specific antigen (FPSA)/TPSA), and other related indicators
The Chinese Urological Association (CUA) guidelines recommended the following items for puncture indications: (1) prostatic nodules found by DRE; (2) abnormal images of the prostate detected by Bscan ultrasonography, computed tomography (CT) or Magnetic Resonance Imaging (MRI); (3) PSA >10 ng/mL; (4) PSA = 4–10 ng/mL, abnormal (F/T)PSA or abnormal PSAD value
Summary
Benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are the most common benign and malignant prostate diseases in middle-aged and elderly men, respectively [1]. Wang et al [5] found that PSA levels are significantly higher in patients with PCa compared with healthy men, suggesting that PSA can be used as a diagnostic indicator of PCa. because PSA is organ-specific rather than tumor-specific, and several factors may lead to its level increase [6,7], this biomarker has a number of limitations in distinguishing prostate hyperplasia from PCa, especially with PSA levels in the range of 4–10 ng/mL. Because PSA is organ-specific rather than tumor-specific, and several factors may lead to its level increase [6,7], this biomarker has a number of limitations in distinguishing prostate hyperplasia from PCa, especially with PSA levels in the range of 4–10 ng/mL This interval is known as the “diagnostic gray area” in PCa [8]. Conclusion: With PSA in the range of 4–20.0 ng/mL, AVR may be useful in sparing an invasive intervention for a number of patients
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