Specificity and accuracy of TRUS-measured PSA-density and transition zone-PSA in the diagnosis of prostate cancer |
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Institution: | 1. Department of Radiology, Brigham and Women''s Hospital, Boston, Massachusetts;2. Department of Radiology, Dana-Farber Cancer Institute, DL-198, 450 Brookline Ave, Boston 02215 Massachusetts;3. Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts;4. Department of Radiology, Boston Children''s Hospital, Boston, Massachusetts;5. Department of Pathology, Harborview Medical Center and University of Washington Medical Center, Seattle, Washington;6. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts |
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Abstract: | Between 4 and 15 ng/ml serum prostate-specific antigen (PSA) has a low specificity for prostate cancer (PCa). One accepted method to enhance this specificity is transrectal ultrasonography (TRUS)-measured PSA-density (PSA-D). We compared this method with a new alternative, transition zone PSA (PSA-TZ). We measured total and transition zone prostatic volumes by TRUS and calculated PSA-D and PSA-TZ in 59 patients with suspicion of PCa and PSA between 4 and 15 ng/ml. All patients then had sextant biopsies of the prostate, 30 were positive for PCa and 29 showed benign tissue. With a cut-off value of 0.35, PSA-TZ had a positive predicted value of 77% for PCa, whereas PSA-D, with a cut-off value of 0.12, had a positive predicted value of 55%. Our data suggest PSA-TZ to be more reliable for avoiding unnecessary biopsies in patients with PCa suspicion and serum PSA below 15 ng/ml. PSA-TZ, calculated by TRUS, enhances the specificity of PSA for needle biopsy diagnosis of PCa. |
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