Combined use of prostate-specific antigen derivatives decreases the number of unnecessary biopsies to detect prostate cancer

• Published in: American journal of clinical oncology Vol. 24; no. 6; pp. 610 - 613
• Main Authors: ÖZEN, Haluk, AYGÜN, Cem, ERGEN, Ali, SÖZEN, Sinan, AKI, Fazil Tuncay, UYGUR, Mehmet Cemil
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-12-2001
• Subjects: Adenocarcinoma - blood; Adenocarcinoma - diagnosis; Adenocarcinoma - pathology; Adult; Aged; Biological and medical sciences; Biopsy, Needle; Humans; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Prospective Studies; Prostate-Specific Antigen - blood; Prostatic Neoplasms - blood; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - pathology; Reference Values; ROC Curve; Sensitivity and Specificity; Tumors of the urinary system; Urinary tract. Prostate gland; Surgical biopsy; Human; Urinary system disease; Prostate disease; Malignant tumor; Prostate specific antigen; Sensitivity; Specificity; Serum; Diagnosis; Detection; Male genital diseases; Prostate
• ISSN: 0277-3732; 1537-453X
• DOI: 10.1097/00000421-200112000-00017

The authors evaluated the prostate cancer detection rate in Turkish patients with prostate-specific antigen (PSA) levels of 4 ng/ml to 10 ng/ml and who had normal digital rectal examination (DRE) findings. They also aimed to evaluate the value of PSA density and percent free PSA in minimizing unnecessary prostate biopsies for these PSA ranges. This prospective study included 134 consecutive men referred for early prostate cancer detection or lower urinary tract symptoms. All men underwent transrectal ultrasound with systematic sextant needle biopsies. The ability of PSA density and percent free PSA to improve the power of PSA in the detection of prostate cancer was evaluated with statistical analyses as well as receiver operating characteristics curves. Among the 134 men, 124 (92.5%) had a benign histology and 10 (7.5%) had cancer diagnosed on the initial biopsies. Despite the disappointing results in regard to the sensitivity and specificity of PSA derivatives alone, the combination of PSA density and percent free PSA significantly increased the area under the curve compared with the use of each test alone. To increase the specificity of PSA in this patient population, the authors recommend combining two PSA derivatives in deciding whether to perform a biopsy. In a PSA range of 4 ng/ml to 10 ng/ml and with normal DRE, a percent free PSA < 21% and a PSA density > 0.18 yields highest specificity with 90% sensitivity.