PROSTATE SPECIFIC ANTIGEN DENSITY OF THE TRANSITION ZONE ENHANCES SPECIFICITY OF PROSTATE SPECIFIC ANTIGEN IN THE DETECTION OF PROSTATE CANCER IN PATIENTS WITH INTERMEDIATE PSA LEVELS

PROSTATE SPECIFIC ANTIGEN DENSITY OF THE TRANSITION ZONE ENHANCES SPECIFICITY OF PROSTATE SPECIFIC ANTIGEN IN THE DETECTION OF PROSTATE CANCER IN PATIENTS WITH INTERMEDIATE PSA LEVELS
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Title:PROSTATE SPECIFIC ANTIGEN DENSITY OF THE TRANSITION ZONE ENHANCES SPECIFICITY OF PROSTATE SPECIFIC ANTIGEN IN THE DETECTION OF PROSTATE CANCER IN PATIENTS WITH INTERMEDIATE PSA LEVELS
Author/Abstract:

Virgilio G. Petero, MD and Jason L. Letran, MD

Section of Urology, Department of Surgery, University of Santo Tomas Hospital and Cardinal Santos Medical Center.

Objectives: This study was done to evaluate the importance of prostate specific antigen density of the transition zone (PSADtz) in prostate cancer detection by comparing it with PSA and PSAD in patients with PSA level in the diagnostic gray zone of 4-20 ng/ml. Another aim was to determine the optimum PSADtz cut-off value that would detect significant number of prostate cancers while at the same time, minimize unnecessary biopsies in patients with benign prostate. Materials and Methods: One hundred eight men with a suspicion of prostate malignancy, due to an elevated serum PSA (>4.0-20.0), participated in this prospective cohort study. The specificities at selected sensitivities of PSA, PSAD and PSADtz cut-off levels were computed. Receiver operating characteristic (ROC) curves were constructed to compare the 3 indices. Results: Twenty five patients were diagnosed to have prostate cancer for a detection rate of 22.9% (25/108). ROC curve showed PSADtz is superior to PSAD and PSA in predicting prostate cancer. At the PSADtz level of 0.47 ng/ml/cc, a sensitivity of 92%, specificity of 46.3% and a positive predictive value of 39.66% noted. Conclusion: PSADtz enhances the specificity of serum PSA and is superior to serum PSA and PSAD in predicting prostate cancer. At the PSADtz level of 0.47 ng/ml/c, more than 90% of cancers will be detected while 46.3% unnecessary biopsies are avoided.

Key words: Prostate specific antigen density, prostate specific antigen.

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