Detection Of Prostate Cancer In Patients Research Articles

Advanced strain elastography is a reliable approach for prostate cancer detection in patients with elevated PSA levels

This study aimed to examine the validity and reproducibility of strain elastography (SE) for detecting prostate cancer (PCa) in patients with elevated prostate-specific antigen (PSA) levels. The study included 107 patients with elevated PSA levels. All eligible patients underwent transrectal ultrasound (TRUS) with real-time elastography (RTE) to detect suspicious lesions. Two readers independently evaluated the lesions and assigned a strain ratio and elastography score to each lesion. Histopathology was used as a reference standard to estimate the validity of RTE in predicting malignant lesions. An intraclass correlation (ICC) was performed to detect reliability of the strain ratios and elastography scores. TRUS-guided biopsy detected malignancies in 64 (59.8%) patients. TRUS with RTE revealed 122 lesions. The strain ratio index (SRI) cut-off values to diagnose malignancy were 4.05 and 4.35, with sensitivity, specificity, and accuracy of 94.7%, 91.3%, and 93.4%, respectively. An elastography score > 3 was the best cut-off value for detecting malignancy. According to readers, the sensitivity, specificity, and accuracy were 91.3–94.7%, 89.5–93.4%, and 91.3–90.9%, respectively. Excellent inter-reader agreement was recorded for SRI and elastography scores, with ICC of 0.937 and 0.800, respectively. SE proves to be an efficient tool for detecting PCa with high accuracy in patients with elevated PSA levels.

Detection Rate of Prostate Cancer in Repeat Biopsy after an Initial Negative Magnetic Resonance Imaging/Ultrasound-Guided Biopsy.

A negative multiparametric magnetic resonance imaging (mpMRI)-guided prostate biopsy in patients with suspected prostate cancer (PC) results in clinical uncertainty, as the biopsy can be false negative. The clinical challenge is to determine the optimal follow-up and to select patients who will benefit from repeat biopsy. In this study, we evaluated the rate of significant PC (sPC, Gleason score ≥7) and PC detection in patients who received a follow-up mpMRI/ultrasound-guided biopsy for persistent PC suspicion after a negative mpMRI/ultrasound-guided biopsy. We identified 58 patients at our institution that underwent repeat targeted biopsy in case of PI-RADS lesions and systematic saturation biopsy between 2014 and 2022. At the initial biopsy, the median age was 59 years, and the median prostate specific antigen level was 6.7 ng/mL. Repeat biopsy after a median of 18 months detected sPC in 3/58 (5%) patients and Gleason score 6 PC in 11/58 (19%). Among 19 patients with a downgraded PI-RADS score at the follow-up mpMRI, none had sPC. In conclusion, men with an initial negative mpMRI/ultrasound-guided biopsy had a high likelihood of not harboring sPC at repeat biopsy (95%). Due to the small size of the study, further research is recommended.

Metabolic syndrome evaluation improves prostate cancer detection in patients undergoing a repeat biopsy

Metabolic syndrome evaluation improves prostate cancer detection in patients undergoing a repeat biopsy

Predictive Effect of EPS Results on Prostate Cancer Detection in Patients with High PSA Values

Predictive Effect of EPS Results on Prostate Cancer Detection in Patients with High PSA Values

The Role and Significance of Bioumoral Markers in Prostate Cancer.

Simple SummaryProstate cancer (PCa) represents a very important health problem worldwide. Used as the main screening method for almost four decades, PSA (Prostate Specific Antigen) has proven its limitations. In this review, the authors try to make an evaluation of the biomarkers commercially available and used to improve the PCa detection in patients with elevated PSA. The authors also present the current PCa screening and diagnosis protocols in Romania.The prostate is one of the most clinically accessible internal organs of the genitourinary tract in men. For decades, the only method of screening for prostate cancer (PCa) has been digital rectal examination of 1990s significantly increased the incidence and prevalence of PCa and consequently the morbidity and mortality associated with this disease. In addition, the different types of oncology treatment methods have been linked to specific complications and side effects, which would affect the patient’s quality of life. In the first two decades of the 21st century, over-detection and over-treatment of PCa patients has generated enormous costs for health systems, especially in Europe and the United States. The Prostate Specific Antigen (PSA) is still the most common and accessible screening blood test for PCa, but with low sensibility and specificity at lower values (<10 ng/mL). Therefore, in order to avoid unnecessary biopsies, several screening tests (blood, urine, or genetic) have been developed. This review analyzes the most used bioumoral markers for PCa screening and also those that could predict the evolution of metastases of patients diagnosed with PCa.

The value of magnetic resonance imaging and ultrasonography (MRI/US)-fusion biopsy in clinically significant prostate cancer detection in patients with biopsy-naïve men according to PSA levels: Apropensity score matching analysis.

ObjectivesTo evaluate the detection rate of clinically significant prostate cancer (csPCa) in Magnetic resonance imaging and ultrasonography (MRI/US) fusion biopsy in patients with biopsy-naïve men for varying prostate-specific antigen (PSA) levels. Since MRI can efficiently detect csPCa compared to standard transrectal ultrasound (TRUS) guided biopsy; however, the optimal PSA threshold for its use is unclear.Materials and methodsWe retrospectively reviewed those who underwent MRI/US-fusion and standard biopsy from January 2016 to June 2018. Patients were divided into three groups: PSA <4, 4–10, >10 ng/mL. Propensity scoring was performed to balance the characteristics of the different biopsy groups, and the detection rate of csPCa was compared.ResultsData from a total of 670 males were included in the analysis (standard TRUS, n = 333; MRI/US fusion, n = 337). Prior to matching, patients who received MRI/US-fusion biopsy had lower prostate volume. Propensity score matching balanced this characteristic and generated a cohort comprising 195 patients from each group. In the matched cohort, patients with PSA 4–10 ng/mL had a significantly increased risk of csPCa by MRI/US-fusion vs. standard biopsy (35.0% vs. 26.6%, P = 0.033). However, patients with PSA <4 ng/mL had csPCa found by MRI/US-fusion versus standard biopsy (12.0% vs. 16.0%, P = 0.342), whereas, patients with PSA >10 ng/mL had csPCa found by MRI/US-fusion versus standard biopsy (78.0% vs. 80.0%, P = 0.596). In multivariate logistic analysis among patients with PSA 4-10 ng/mL, MRI/US-fusion biopsy (odds ratio: 2.46, 95% confidence interval = 1.31–4.60, P = 0.005) were significantly associated with a detection of csPCa.ConclusionsDetection of csPCa by MRI/US-fusion biopsy is more efficient in patients with biopsy-naïve men with PSA 4–10 ng/mL. However, standard TRUS biopsy may identify csPCa in patients with PSA <4 ng/mL and ≥10 ng/mL, emphasizing the importance of performing a standard biopsy in conjunction with MRI/US-fusion biopsy in such populations.

The Utility of Combined Target and Systematic Prostate Biopsies in the Diagnosis of Clinically Significant Prostate Cancer Using Prostate Imaging Reporting and Data System Version 2 Based on Biparametric Magnetic Resonance Imaging.

This study aimed to determine the predictive value of the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) based on biparametric magnetic resonance imaging (bpMRI) with combined target biopsy (TBx) and systematic biopsy (SBx) in patients with suspicion of having clinically significant prostate cancer (csPCa). In this retrospective study, we reviewed the clinical and pathological records of 184 consecutive patients who underwent bpMRI before prostate biopsy. We focused on patients with PI-RADS v2 scores ≥ 3. MRI was performed using a 3-Tesla clinical scanner with a 32-channel phased-array receiver coil. PI-RADS v2 was used to describe bpMRI findings based on T2-weighted imaging and diffusion-weighted imaging scores. The primary endpoint was the diagnostic accuracy rate of PI-RADS v2 based on bpMRI for patients with prostate cancer (PCa) who underwent combined TBx and SBx. A total of 104 patients were enrolled in this study. Combined TBx and SBx was significantly superior to either method alone for PCa detection in patients with suspicious lesions according to PI-RADS v2. TBx and SBx detected concordant csPCa in only 24.1% of the patients. In addition, the rate of increase in the Gleason score was similar between SBx (41.5%) and TBx (34.1%). The diagnostic accuracy of bpMRI is comparable to that of standard multiparametric MRI for the detection of csPCa. Moreover, combined TBx and SBx may be optimal for the accurate determination of csPCa diagnosis, the International Society of Urological Pathology grade, and risk classification.

Diagnostic Accuracy of 68Ga-PSMA PET/CT for Initial Detection in Patients With Suspected Prostate Cancer: A Systematic Review and Meta-Analysis.

BACKGROUND. Early diagnosis is important in the overall management of prostate cancer (PCa). Gallium-68-labeled prostate-specific membrane antigen (PSMA) PET/CT has an established role in the detection of recurrent disease and staging of patients with intermediate- to high-risk PCa. However, only a small number of studies have evaluated its role in the initial diagnosis of PCa. OBJECTIVE. This systematic review was conducted to evaluate the diagnostic performance of 68Ga-PSMA PET/CT in the initial detection of PCa in patients with clinical or biochemical findings suspicious for PCa. EVIDENCE ACQUISITION. This systematic review followed PRISMA guidelines. Searches in PubMed, Scopus, and Embase were conducted using relevant keywords, and articles published through April 30, 2020, were included. Using histopathology results as the reference standard, the numbers of true- and false-positives and true- and false-negatives were extracted. Pooled estimates of diagnostic test accuracy-including sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and summary ROC (SROC) curve-were generated using bivariate random-effects meta-analysis. EVIDENCE SYNTHESIS. Seven studies comprising 389 patients were included in the systematic review and meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for the initial diagnosis of PCa using 68Ga-PSMA PET/CT were 0.97 (95% CI, 0.90-0.99), 0.66 (95% CI, 0.52-0.78), 2.86 (95% CI, 1.95-4.20), and 0.05 (95% CI, 0.01-0.15), respectively. The test had high accuracy; the area under the SROC curve was 0.91 (95% CI, 0.88-0.93). CONCLUSION. Gallium-68-labeled PSMA PET/CT had excellent sensitivity and negative likelihood ratio in the initial diagnosis of PCa in patients with clinical or biochemical findings suspicious for PCa. CLINICAL IMPACT. Gallium-68-labeled PSMA PET/CT had high diagnostic accuracy for the initial detection of PCa in patients with clinical or biochemical findings suspicious for PCa and has potential utility as a rule-out test for these patients.

SC31 - Metabolic syndRoma evaluation improves prostate cancer detection in patients undergoing a repeat biopsy

SC31 - Metabolic syndRoma evaluation improves prostate cancer detection in patients undergoing a repeat biopsy

Comparison of 68Ga-PSMA-617 PET/CT with mpMRI for the detection of PCa in patients with a PSA level of 4\u201320\xa0ng/ml before the initial biopsy

The study was aimed at assessing the diagnostic performance of 68Ga-PSMA-617 PET/CT in the detection of prostate cancer (PCa) in patients with a prostate-specific antigen (PSA) level of 4–20 ng/ml and to compare its efficacy with that of multiparametric MRI (mpMRI). We analyzed the data of 67 consecutive patients with PSA levels of 4–20 ng/ml who almost simultaneously underwent 68Ga-PSMA-617 PET/CT and mpMRI. 68Ga-PSMA-617 PET/CT and mpMRI diagnostic performances were compared via receiver operating characteristic (ROC) curve analysis. Of the 67 suspected PCa cases, 33 had pathologically confirmed PCa. 68Ga-PSMA-617 PET/CT showed a patient-based sensitivity, specificity, and positive and negative predictive values (PPVs and NPVs) of 87.88%, 88.24%, 87.88%, and 88.24%, respectively. The corresponding values for mpMRI were 84.85%, 52.94%, 63.64%, and 78.26%. The area under the curve values for 68Ga-PSMA-617 PET/CT and mpMRI were 0.881 and 0.689, respectively. 68Ga-PSMA-617 PET/CT showed a better diagnostic performance than mpMRI in the detection of PCa in patients with PSA levels of 4–20 ng/ml.

Epidemiological study on more accurate diagnosis of prostate cancer.

The study aimed at assessing the potential benefit of prostate health index (PHI) for early detection of prostate cancer (PCa) and the use of PHI as a marker predicting the presence of PCa before performing prostate biopsy. The study comprised 55 males who underwent prostate biopsy. Before the procedure, blood samples were collected to test prostate specific antigen (PSA) and free/total PSA ratio (%fPSA) and PHI was calculated. Receiver operating characteristic (ROC) analysis was used to assess the benefit of these values for predicting the presence of PCa. Based on histological examination 31 males were diagnosed with PCa, the remaining 24 were negative. Among the PCa patients, 39% had a Gleason score of 6, 26% had a score of 7 and 35% had a score of 8-10. There were statistically significant differences in PHI and PSA between males with and without PCa. The areas under the ROC curve for %fPSA, total PSA and PHI were 0.712, 0.746 and 0.789, respectively. PHI showed the best predictive ability to estimate biopsy results. If the cut-off criterion PHI > 36.4 (77.42% sensitivity, 66.67% specificity) had been used, 41.7% of males would have avoided unnecessary biopsy. The use of PHI may considerably improve the accuracy of PCa detection in patients with elevated PSA and thus reduce the number of unnecessary biopsies.

Performance of Combined Magnetic Resonance Imaging/Ultrasound Fusion-guided and Systematic Biopsy of the Prostate in Biopsy-naïve Patients and Patients with Prior Biopsies

BackgroundAs recent prospective studies showed targeted biopsies (TBs) to be superior to systematic biopsies (SBs), magnetic resonance imaging (MRI) is gaining wider acceptance in the diagnostic setup of prostate cancer (PCa). ObjectiveTo examine the performance of MRI/ultrasound fusion-guided TB in combination with SB in the detection of PCa in patients with and without prior biopsy. Design, setting, and participantsA total of 219 men undergoing combined transrectal TB and 12-core SB from February 2014 to November 2018 were analysed. For all patients showing a suspicion of PCa in multiparametric MRI, TB was performed using fusion imaging with real-time virtual sonography. Outcome measurements and statistical analysisCancer detection rates (CDRs) and significant CDRs for TB, SB, and TB+SB were analysed. Further stratification was performed for a number of previous biopsy sessions and Prostate Imaging Reporting and Data System (PI-RADS) score. Significant PCa was defined as any PCa with Gleason score ≥3+4. Results and limitationsOf all, 141 patients were biopsy naïve, while 78 patients had at least one prior biopsy. Median prostate-specific antigen (PSA) level prior to biopsy was 8.4ng/ml (interquartile range 5.5–11.8ng/ml). The overall CDR was 63.5% (139/219), while the PI-RADS–dependent CDRs for the combination of TB+SB were 29.1%, 67.7%, and 86.2% for patients with PI-RADS 3, 4, and 5, respectively. Looking at TB or SB alone, CDRs were 55.7% and 57.5%. The overall CDR for significant PCa was 51.6%. (18.2%, 50.5%, and 81.5% for PI-RADS 3, 4, and 5, respectively). CDRs were significantly higher for biopsy-naïve patients (65.2% vs 67.4% vs 71.6% for TB vs SB vs TB+SB) than for patients with one previous negative biopsy (38.2% vs 43.6% vs 50.9% for TB vs SB vs TB+SB; all p<0.01). ConclusionsMultiparametric MRI can raise the CDR in patients with and without biopsies performed earlier. With higher PI-RADS lesions, the risk of harbouring PCa increases. Combining TB with SB further improved the diagnostic accuracy in biopsy-naïve patients and after one previous negative biopsy. Patient summaryMultiparametric magnetic resonance imaging before prostate biopsy increases cancer detection rates in biopsy-naïve patients and patients with a previous negative biopsy. The combination of targeted biopsy with systematic biopsy improved the diagnostic accuracy in biopsy-naïve patients and after one previous negative biopsy.

Is prostate volume better than PSA density and free/total PSA ratio in predicting prostate cancer in patients with PSA 2.5–10 ng/mL and 10.1–30 ng/mL?

Objective: Benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are the most common benign and malignant diseases of the prostate gland. The clinical distinction between BPH and PCa should be determined to guide patients to appropriate treatment. We aimed to evaluate the value of PSA, prostate volume (PV) and associated parameters for the detection of PCa in patients with PSA levels of 2.5–30.0 ng/mL.Materials and methods: A total of 211 men with a biopsy (≥10 cores) and a PSA of 2.5–30.0 ng/ml were included in the study. To evaluate the performance of PV in diagnosing PCa, subjects were divided into PSA 2.5–10.0 ng/ml and PSA 10.1–30.0 ng/ml groups. Age, BMI, PSA, PV, f/t PSA, PSAD, and biopsy Gleason score were included in the analysis.Results: PCa was diagnosed in 74 (35.1%) of the 211 patients. The differences in f/t PSA, PV, and PSAD for patients with and without PCa were statistically significant. (p < .001). PV was a significantly better indicator of PCa than PSAD and f/t PSA ratio in both groups.Conclusions: PV plays an active role in predicting PCa in patients with PSA in gray-zone as well as in patients with PSA 10.1–30 ng/mL.

PT160 - Multivariable retrospective lesion based analyses of number of MRI ultrasound fusion targeted biopsy cores needed for prostate cancer detection in patients treated with radical prostatectomy

PT160 - Multivariable retrospective lesion based analyses of number of MRI ultrasound fusion targeted biopsy cores needed for prostate cancer detection in patients treated with radical prostatectomy

Effectiveness of Bi-Parametric MR/US Fusion Biopsy for Detecting Clinically Significant Prostate Cancer in Prostate Biopsy Naïve Men.

PurposeTo explore the effect of bi-parametric MRI-ultrasound (MR/US) fusion prostate biopsy on the detection of overall cancer and significant prostate cancer (sPCa).Materials and MethodsWe examined 140 patients with suspected prostate cancer lesions on MRI from August 2016 to March 2018. All patients had undergone 3T pre-biopsy bi-parametric (T2 weighted and diffusion-weighted) prostate MRI (bpMRI), and their MRI images were evaluated with Prostate Imaging Reporting and Data System (PI-RADS) version 2.0. MR/US fusion targeted prostate biopsy was performed for lesions with a PI-RADS score ≥3 before systemic biopsy. The results of targeted and systemic biopsy were evaluated in regards to detection rate according to PI-RADS score.ResultsOf the patients (mean age=67.2 years, mean prostate-specific antigen level=8.1 ng/mL), 66 (47.1%) and 37 (26.4%) patients were diagnosed with cancer and significant prostate cancer, respectively. The rate of positive targeted biopsy increased with higher PI-RADS score (3: 40.4%, 4: 56.7%, 5: 90.0%). The proportion of significant prostate cancer among positive target lesions was 65.3% (32/49).ConclusionbpMRI is a feasible tool with which to identify sPCa. MR/US fusion biopsy, rather than systemic biopsy, can help identify sPCa. We recommend using supplemental tools to increase prostate cancer detection in patients with PI-RADS 3 lesions.

Value of free/total prostate-specific antigen (f/t PSA) ratios for prostate cancer detection in patients with total serum prostate-specific antigen between 4 and 10 ng/mL: A meta-analysis.

Background:Prostate carcinoma is a common disease that occurs in men over 50 years old. Many studies have explored the effect of free/total prostate-specific antigen (f/t PSA) ratio in monitoring prostate cancer. We conducted a meta-analysis to identify the accuracy of the f/t PSA ratio in the diagnosis of prostate cancer in patients who have PSA levels of 4 to 10 ng/mL.Methods:Databases searched included PubMed and OVID databases, from inception to March 2017, after a systematical review, sensitivity, specificity, and other measures of accuracy of the f/t PSA ratio in the diagnosis of prostate cancer were pooled. We used summary receiver operating characteristic curves to summarize overall test performance.Results:Fifteen case–control studies from 14 articles were identified. The results indicated that the sensitivity of the f/t PSA ratio in the diagnosis of prostate cancer ranged from 0.5 to 0.94 (pooled sensitivity 0.70, 95% CI: 0.67–0.72), whereas its specificity ranged from 0.31 to 0.93 (pooled specificity 0.55, 95% CI: 0.57–0.60). The positive likelihood ratio was 1.85 (95% CI: 1.56–2.20), negative likelihood ratio was 0.42 (95% CI: 0.34–0.53), and diagnostic odds ratio was 4.81 (9.53% CI: 3.33–6.94).Conclusions:The f/t PSA ratio determination has a low sensitivity and specificity for the diagnosis of prostate cancer; it would not be useful for the diagnosis of prostate cancer by itself. The results of f/t PSA ratio measurements should refer to the clinical manifestations and the results of conventional tests such as biopsies.

Prostate cancer detection in patients with total serum prostate-specific antigen levels of 4–10 ng/mL: Diagnostic efficacy of MicroRNA-141

Objective: The purpose of this small pilot study was to evaluate the utility of microRNA-141 (miR-141) as a biomarker for detecting prostate cancer (PCa) in patients with total serum prostate-specific antigen (PSA) levels of 4–10 ng/mL, which is referred to as the “gray zone.” Materials and Methods: Eleven PCa patients, 23 benign prostatic hyperplasia (BPH) patients with PSA levels of 4–10 ng/mL, and 16 healthy controls were enrolled in this study. Total RNA was extracted from serum samples, and the level of miR-141 was analyzed by quantitative reverse transcription polymerase chain reaction. Results: The circulating miR-141 level was significantly higher in PCa patients than in BPH patients and healthy controls (fold change [mean ± standard deviation], 0.528 ± 0.083 for PCa, 0.297 ± 0.038 for BPH, and 0.262 ± 0.025 for controls; P< 0.05). Receiver operating characteristic curve revealed that the serum miR-141 yielded an area under the curve of 0.751, with 72% sensitivity and 92% specificity in discriminating patients with PCa from BPH patients with total serum PSA levels in the gray zone. Conclusion: The present results indicate that miR-141 expression is significantly increased in the peripheral blood of patients with PCa compared with BPH patients and healthy individuals. We think that miR-141 may guide clinicians during the decision phase of patients with PCa and BPH in the PSA gray zone.

Prostate chronic inflammation type IV and prostate cancer risk in patients undergoing first biopsy set: Results of a large cohort study

ObjectiveIn prostate specimens, chronic inflammatory infiltrate (CII) type IV has been detected, but its association with prostate cancer (PCa) is controversial. The aim of the present study is to investigate on associations of CII with PCa detection in patients undergoing prostate first biopsy set. MethodsUltrasound transrectal-guided biopsies by the transperineal approach were retrospectively evaluated in 441 consecutive patients. The study excluded patients who were in active surveillance, prostate specific antigen (PSA) ≥30 ng/mL, re-biopsies, incidental PCa after transurethral resection of the prostate (TURP), less than 14 cores or metastatic. Analysis of population and subpopulations (with or without PCa) was performed by statistical methods which included Mann–Whitney (U test), Kruskal–Wallis test, Chi-squared statistic, logistic regression. Multivariate logistic regression models predicting mean probability of PCa detection were established. ResultsPCa detection rate was 46.03%. Age, PSA, prostate volume (PV), prostate intraepithelial neoplasia (PIN) and CII were the significant independent predictors of PCa detection. PV (OR = 0.934) and CII (OR = 0.192) were both negative independent predictors. CII was a significant negative independent predictor in multivariate logistic regression models predicting the mean probability of PCa detection by age, PSA and PV. The inverse association of CII with PCa does not necessary mean protection because of PSA confounding. ConclusionIn a population of patients undergoing prostate first biopsy set, CII was a strong negative independent predictor of PCa detection. CII type IV should be considered as an adjunctive parameter in re-biopsy or active surveillance protocols.

B47 - The role of PSA for prostate cancer detection in patients with high grade intraepithelial neoplasia

B47 - The role of PSA for prostate cancer detection in patients with high grade intraepithelial neoplasia

The Prostate Health Index in predicting initial prostate biopsy outcomes in Asian men with prostate-specific antigen levels of 4–10 ng/mL

To investigate the role of the Prostate Health Index (phi) in prostate cancer (PCa) detection in patients with a prostate-specific antigen (PSA) level of 4-10 ng/mL receiving their first prostatic biopsy in an Asian population. This was a retrospective study of archived serum samples from patients enlisted in our tissue bank. Patients over 50 years old, with PSA level of 4-10 ng/mL, a negative digital rectal examination, and received their first prostatic biopsy between April 2008 and April 2013, were recruited. The serum sample collected before biopsy was retrieved for the measurement of various PSA derivatives and the phi value was calculated for each patient. The performance of these parameters in predicting the prostatic biopsy results was assessed. Two hundred and thirty consecutive patients, with 21 (9.13 %) diagnosed with PCa, were recruited for this study. Statistically significant differences between PCa patients and non-PCa patients were found for total PSA, PSA density, [-2]proPSA (p2PSA), free-to-total PSA ratio (%fPSA), p2PSA-to-free PSA ratio (%p2PSA), and phi. The areas under the curve of the receiver operating characteristic curve for total PSA, PSA density, %fPSA, %p2PSA, and phi were 0.547, 0.634, 0.654, 0.768, and 0.781, respectively. The phi was the best predictor of the prostatic biopsies results. At a sensitivity of 90 %, the use of the phi could have avoided unnecessary biopsies in 104 (45.2 %) patients. Use of the phi could improve the accuracy of PCa detection in patients with an elevated PSA level and thus avoid unnecessary prostatic biopsies.