Introduction and Objectives
Detection of prostate cancer in men with PSA 4–10 ng/ml and negative Digital Rectal Examination (DRE) and Transrectal Ultrasound (TRUS) is a real challenge. This study aims to examine the prognostic role of PSA Density (PSAD) in this group of men, setting different cut-off values and estimating sensitivity and specificity in each case.
Material and Methods
Retrospective study. From 1/2008 to 3/2009, 173 men aged 53–82 years old with PSA 4–10 ng/ml and negative both DRE and TRUS, were subject to TRUS guided needle biopsy. PSAD was measured and its sensitivity and specificity were estimated for five cut-off values, from 0.15 ng/ml/cm3 to 0.2 ng/ml/cm3. The procedure was accomplished by the same urologist and biopsy specimens were examined from the same pathologist. Biopsies obtained with 18-gauge biopsy needles.
Results
From 173 men, 65 were diagnosed with prostate cancer. In the rest 108, no malignancy was found after three biopsies with one month intervals approximately. Mean PSAD in men with prostate cancer was 0.199 while in men with BPH was 0.158. Sensitivity and specificity of PSAD in the detection of prostate cancer were 80% and 44.4% for a cut-off point of 0.15, 80% and 53.7 for 0.16, 76.9% and 60.18% for 0.17, 61.53% and 69.4% for 0.18, 52.3% and 73.14% for 0.19 and finally 44.6% and 76.8% for a cut-off point of 0.2. Positive prognostic value was estimated for each cut-off point.
Conclusions
PSAD alone is not an adequate tool in detecting prostate cancer in men with PSA 4–10 ng/ml and negative DRE and TRUS. Efforts should be undertaken in establishing a more sensitive and specific markers or combining the already existing markers.
Article info
Identification
Copyright
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
