Impact of PSA density of transition zone as a potential parameter in reducing the number of unnecessary prostate biopsies in patients with psa levels between 2.6 and 10.0 ng/mL

Vol. 44 (4): 709-716, July – August, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0506


Hugo A. Socrates Castro 1, Wagner Iared 2, José Eduardo Mourão Santos 1, Raphael Sandes Solha 2, David Carlos Shigueoka 1, Sergio Aron Ajzen 2
1 Departamento de Diagnóstico por Imagem, 2 Departamento de Radiologia, Universidade Federal de São Paulo, Unifesp, São Paulo, SP, Brasil


Purpose: To assess the accuracy of prostate-specific antigen (PSA) adjusted for the transition zone volume (PSATZ) in predicting prostate cancer by comparing the ability of several PSA parameters in predicting prostate cancer in men with intermediate PSA levels of 2.6 – 10.0 ng/mL and its ability to reduce unnecessary biopsies.

Materials and Methods: This study included 656 patients referred for prostate biopsy who had a serum PSA of 2.6 – 10.0 ng/mL. Total prostate and transition zone volumes were measured by transrectal ultrasound using the prolate ellipsoid method. The clinical values of PSA, free-to-total (F/T) ratio, PSA density (PSAD) and PSATZ for the detection of prostate cancer were calculated and statistical comparisons between biopsy-positive (cancer) and biopsy-negative (benign) were conducted.

Results: Cancer was detected in 172 patients (26.2%). Mean PSA, PSATZ, PSAD and F/T ratio were 7.5 ng/mL, 0.68 ng/mL/cc. 0.25 ng/mL/cc and 0.14 in patients with prostate cancer and 6.29 ng/mL, 0.30 ng/mL/cc, 0.16 ng/mL/cc and 0.22 in patients with benign biopsies, respectively. ROC curves analysis demonstrated that PSATZ had a higher area under curve (0.838) than F/T ratio (0.806) (P<0.001) and PSAD (0.806) (P<0.001).

With a cut-off value of 0.22 ng/mL/cc, PSATZ had 100% of sensitivity and could have prevented 24% of unnecessary biopsies.

Conclusions: PSATZ may be useful in enhancing the specificity of serum PSA. Compared to other PSA related parameters, it was better in differentiating between prostate cancer and benign prostatic enlargement. Also, PSATZ could reduce a significant number of unnecessary biopsies.

Keywords: Prostate; Biopsy; Diagnosis

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