Abstract
The objective of this paper is to validate prostate specific antigen (PSA) density (PSAD) routine use to enhance PSA specificity in men with normal digital rectal examination and intermediate PSA values. It is a retrospective study of 235 men from a prostate cancer (PCa) screening program. All of them presented PSA values between 4 and 10 ng/ml, normal digital rectal examination, and a transrectal ultrasound (TRUS) guided biopsy available (PSA≥4 ng/ml as the sole criterion for biopsy). Multivariate analysis failed to demonstrate higher PSAD values in men with PCa. PSAD cutoff points higher than 0.07 ng/ml per cc were considered as unacceptable, with less than 95% sensitivity. When a cutoff point of 0.15 was considered, as many as 30.6% of the cancers were missed. In conclusion we cannot recommend the use of this parameter for the above mentioned purpose.
.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 4 print issues and online access
$259.00 per year
only $64.75 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Carter HB et al Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease. JAMA 1992 267 2215–2220
Oesterling JE et al Serum prostate-specific antigen in a community-based population of healthy men: establishment of age-specific reference ranges. JAMA 1993 270 860–864
Stenman UH et al A complex between prostate-specific antigen and alpha-1-antichymotrypsin is the major form of prostate-specific antigen in serum of patients with prostatic cancer: assay of the complex improves clinical sensitivity for cancer. Cancer Res 1991 51 222–226
Benson MC et al Prostate specific antigen density: a means of distinguishing benign prostatic hyperplasia and prostate cancer. J Urol 1992 147 815–816
Benson MC et al The use of prostate specific antigen density to enhance the predictive value of intermediate levels of serum prostate specific antigen. J Urol 1992 147 817–821
Seaman E et al PSA density (PSAD). Role in patient evaluation and management. Urol Clin North Am 1993 20 653–663
Bazinet M et al Prospective evaluation of prostate-specific antigen density and systematic biopsies for early detection of prostatic carcinoma. Urology 1994 43 44–51
Nishiya M, Miller GJ, Lookner DH, Crawford ED Prostate specific antigen density in patients with histologically proven prostate carcinoma. Cancer 1994 74 3002–3009
Ramon J et al Prostate-specific antigen density: a means to enhance detection of prostate cancer. Eur Urol 1994 25 288–94
Arai Y et al Prospective evaluation of prostate specific antigen density and systematic biopsy for detecting prostate cancer in Japanese patients with normal rectal examinations and intermediate prostate specific antigen levels. J Urol 1997 158 861–864
Catalona WJ et al Comparison of prostate specific antigen concentration versus prostate specific antigen density in the early detection of prostate cancer: receiver operating characteristic curves. J Urol 1994 152 2031–2036
Catalona WJ et al Comparison of percent free PSA, PSA density, and age-specific PSA cutoffs for prostate cancer detection and staging. Urology 2000 56 255–260
Klingler HC et al The value of prostate specific antigen (PSA) density and free: total PSA ratio in selecting patients with a normal digital rectal examination and intermediate total PSA levels for further investigation. Br J Urol 1998 82 393–397
Cookson MS et al The lack of predictive value of prostate specific antigen density in the detection of prostate cancer in patients with normal rectal examinations and intermediate prostate specific antigen levels. J Urol 1995 154 1070–1073
Brawer MK et al The inability of prostate specific antigen index to enhance the predictive the value of prostate specific antigen in the diagnosis of prostatic carcinoma. J Urol 1993 150 369–373
Littrup PJ, Williams CR, Egglin TK, Kane RA Determination of prostate volume with transrectal US for cancer screening. Part II. Accuracy of in vitro and in vivo techniques. Radiology 1991 179 49–53
Carter HB et al Prostate-specific antigen variability in men without prostate cancer: effect of sampling interval on prostate-specific antigen velocity. Urology 1995 45 591–596
Lujan M et al Prostate specific antigen variation in patients without clinically evident prostate cancer. J Urol 1999 162 1311–1313
Kikuchi E et al Prostate specific antigen adjusted for transition zone volume: the most powerful method for detecting prostate carcinoma. Cancer 2000 89 842–849
Acknowledgements
This paper has been supported in part by grants of Spanish ‘Fondo de Investigaciones Sanitarias’ (96/0248, 96/1800, 99/0245). Our institution is a member of the European Randomised Study of screening for prostate cancer (ERSPC). Special thanks to Javier Martín, Eduardo Martín MD, Ernesto Sánchez MD, Juan C Ruiz MD, and Alberto Herrero MD for their important contribution to this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lujan, M., Paez, A., Llanes, L. et al. Prostate specific antigen density. Is there a role for this parameter when screening for prostate cancer?. Prostate Cancer Prostatic Dis 4, 146–149 (2001). https://doi.org/10.1038/sj.pcan.4500509
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.pcan.4500509
Keywords
This article is cited by
-
Compatibility of the radical prostatectomy specimen findings with digital rectal examination
Journal of Cancer Research and Clinical Oncology (2023)
-
Prostate-specific antigen (PSA) density in the diagnostic algorithm of prostate cancer
Prostate Cancer and Prostatic Diseases (2018)
-
Prostate-specific antigen density values among patients with symptomatic prostatic enlargement in Nigeria
World Journal of Surgical Oncology (2016)