血清PSA、PSAD和PSAT在前列腺穿刺活检中的意义

目的探讨血清前列腺特异性抗原(PSA)、前列腺特异性抗原密度(PSAD)和前列腺移行带特异性抗原密度(PSAT)在前列腺穿刺活检中的意义。方法对192例患者行前列腺穿刺活检,其中PSA≥4ng/ml者184例,PSA<4ng/ml且直肠指诊及经直肠B超有阳性发现者8例。对PSA、PSAD和PSAT与前列腺穿刺活检的关系进行分析。结果192例患者中经前列腺穿刺诊断为前列腺癌(PCa)100例,活检阳性率52.1%,其中8例PSA<4ng/ml者中,活检结果为前列腺横纹肌肉瘤1例,良性前列腺增生7例;93例PSA>20ng/ml者中80例为PCa,活检阳性率86.0%;91例PSA4~20ng/ml者中19例为PCa,活检阳性率20.9%。血清PSA4~20ng/ml患者,PSAD>0.10或PSAT>0.10时,敏感性均为100%,特异性为11.1%或4.2%,阳性预测值为22.9%或21.6%,可避免8.8%(8/91)或3.3%(3/91)阴性穿刺结果。血清PSA4~20ng/ml时,前列腺穿刺阳性组和阴性组PSA分别为(13.2±4.7)和(11.4±4.6)ng/ml(P>0.05);PSAD分别为0.36±0.18和0.19±0.09(P=0.001);PSAT分别为0.67±0.36和0.32±0.18(P=0.000)。血清PSA、PSAD和PSAT的ROC曲线下面积分别为0.613、0.810和0.833,PSAD和PSAT的ROC曲线下面积与PSA比较,差异均有统计学意义(P<0.05)。结论PSA>20ng/ml时应做前列腺穿刺活检;PSA4~20ng/ml时,PSAD和PSAT对预测患者是否行前列腺穿刺活检有较大帮助。     

PSA、PSAD和PSAT在前列腺穿刺活检中的价值

目的 研究血清前列腺特异性抗原(PSA)及其密度(PSAD)和移行带密度(PSAT)在前列腺穿刺活检中的价值.方法 选取本院2014年5月至2015年5月收治的150例患者进行前列腺穿刺活检,分析并比较PSA、PSAD、PSAT在前列腺穿刺活检中的差异及其在确诊疾病方面的价值.结果 在前列腺穿刺活检的150例中发现PSA＜4 ng/mL有8例,4 ng/mL≤PSA≤20 ng/mL有66例,PSA ＞20 ng/mL有76例.其中在PSA＜4 ng/mL的8例中,活检结果良性前列腺增生6例,前列腺小细胞癌1例,前列腺横纹肌肉瘤1例.在4 ng/mL≤PSA≤20 ng/mL的66例中,活检结果诊断为前列腺癌增生患者54例,活检阳性率为81.8％,PSA平均值为(13.98±1.51) ng/mL,PSAD平均值为(0.32±0.18);PSAT平均值为(0.35±0.18);活检前列腺癌12例,活检阳性率为19.2％,PSA平均值为(14.29±1.48) ng/mL,PSAD平均值为(0.42±0.15),PSAT平均值为(0.82±0.15);将其分为良性前列腺增生组和前列腺癌组,两组差异具有统计学意义(P＜0.05).当PSAD ＞0.13或PSAT＞ 0.15时,前列腺癌的敏感性分别为92.86％和96.94％.在PSA＞ 20 ng/mL的76例中,前列腺癌有68例,活检阳性率89.47％.结论 在4 ng/mL≤PSA≤20 ng/mL时,PSAD和PSAT对前列腺增生和前列腺癌的鉴别诊断具有重要意义,其中又以PSAT更为准确;PSA＞ 20ng/mL时,应高度怀疑前列腺癌,及时确诊治疗.     

前列腺移行带特异抗原密度检测前列腺癌的临床观察

目的　评价前列腺移行带特异抗原密度 (PSAT)检测前列腺癌 (PCa)的临床价值。　方法　用酶免法测定 30例PCa及 88例良性前列腺增生症 (BPH)患者血清PSA水平 ,用经直肠前列腺B超测定患者总前列腺体积及移行带体积 ,并计算PSA密度 (PSAD)及PSAT值。　结果　PSA在 4～ 10ng/ml时 ,PCa和BPH患者PSAD值分别为 0 .2 6± 0 .11、0 .13± 0 .0 6 ,两组间相比差别具有显著性意义 (P <0 .0 1) ;PSAT值则分别为 1.0 4± 0 .70、0 .2 1± 0 .13 ,两组间相比差别具有显著性意义 (P <0 .0 1)。若选择PSAD =0 .15作为判断患者是否需穿刺活检的标准 ,将有 2 7%的PCa漏诊 ,而若选择PSAT =0 .35作为判断患者是否需穿刺活检的标准 ,只有 9%的PCa漏诊 (P <0 .0 1)。　结论　PSAT是一种新的有效的检测PCa的方法 ,PSA在 4～ 10ng/ml范围时 ,用PSAT检测PCa较用PSAD更精确。     

前列腺特异性抗原相关指标在前列腺良恶性疾病诊断中的运用比较

目的比较前列腺特异性抗原密度(PSAD)、前列腺移行带抗原密度(PSAD-TZ)、前列腺特异性抗原(PSA)及游离前列腺特异性抗原和总前列腺特异性抗原比值(FPSA/TPSA)、在良性前列腺增生(BPH)和前列腺癌(PCa)鉴别诊断中的作用。方法55例BPH和23例PCa病人,PSA为4～20ng/ml,比较PSA、PSAD、FPSA/TPSA、PSAD-TZ指标,并进行统计学分析比较。结果BPH和PCa两组PSA平均值分别为(9.41±3.25)ng/ml和(11.29±2.50)ng/ml,两组比较P>0.05。两组PSAD平均值分别为(0.14±0.09)和(0.23±0.11),两组比较P<0.05。两组FPSA/TPSA平均值分别为(0.61±0.23)和(0.25±0.14),两组比较P<0.05。两组PSAD-TZ平均值分别为(0.25±0.19)和(0.52±0.25),两组比较P<0.01。结论PSAD、FPSA/TPSA、PSAD-TZ对PSA<20ng/ml的前列腺良、恶性病变具有鉴别作用,其中尤以PSAD-TZ更为准确。     

PSAD与PSAD-TZ在前列腺良、性疾病诊断中的应用价值

目的 :比较前列腺特异性抗原密度 (PSAD)、前列腺移行带抗原密度 (PSAD TZ)、前列腺特异性抗原 (PSA)及游离前列腺特异性抗原和总前列腺特异性抗原比值 (FPSA/TPSA)在良性前列腺增生 (BPH)和前列腺癌 (PCa)鉴别诊断中的作用。　方法 :4 3例BPH和 2 0例PCa病人 ,PSA均 <2 0 μg/L ,比较PSA、PSAD、FPSA/TPSA、PSAD TZ指标 ,并进行统计学分析。　结果 :BPH和PCa两组PSA平均值分别为 (10 .4 7± 6 .2 5 )、(13.92± 3.2 0 ) μg/L ,差异无显著性 (P >0 .0 5 )。两组PSAD平均值分别为 (0 .15± 0 .12 )和 (0 .2 4± 0 .13) ,差异有显著性 (P <0 .0 5 )。两组FPSA/TPSA平均值分别为 (0 .5 8± 0 .4 2 )和 (0 .2 6± 0 .17) ,差异有显著性 (P <0 .0 5 )。两组PSAD TZ平均值分别为 (0 .2 6± 0 .2 2 )和 (0 .5 1± 0 .2 8) ,差异具有非常显著性。 (P <0 .0 1)。　结论 :PSAD、FPSA/TPSA、PSAD TZ对PSA <2 0 μg/L的前列腺良恶性增生病人具有鉴别作用 ,其中尤以PSAD TZ更为准确     

血清PSA含量及前列腺PSA密度与经直肠超声引导下前列腺穿刺活检诊断前列腺癌的关系

目的探讨经直肠超声引导下前列腺穿刺活检术前列腺癌检出率与血清前列腺特异性抗原(PSA)及血清前列腺特异性抗原密度(PSAD)的关系。方法对134例患者行经直肠超声引导下前列腺5区13针系统穿刺活检。根据PSA水平分为PSA≤4ng/ml组(7例)、4ng/mlPSA15ng/ml组(48例)及PSA≥15ng/ml组(79例)。测量并计算前列腺体积(PV)及PSAD,分析前列腺癌检出率及不同PSA、PSAD水平下对前列腺癌的诊断效能。比较前列腺癌与非前列腺癌患者PSA、PV及PSAD的差异。结果前列腺癌总检出率为50.75%(68/134),前列腺患者共68例(前列腺癌组),非前列腺癌患者共66例(非前列腺啊组)。PSA≤4ng/ml、4ng/mlPSA≤15ng/ml及PSA15ng/ml组前列腺癌检出率分别为14.29%(1/7)、20.83%(10/48)及72.15%(57/79),差异有统计学意义(P0.05)。PSA≥4ng/ml时前列腺癌检出率随着PSA值的增高而上升。134例患者PSAD值为(1.09±1.72)ng/(ml·cm3),以PSAD≥0.19ng/(ml·cm3)为截点诊断前列腺癌的敏感度为95.59%(65/68),特异度为51.52%(34/66),阳性预测值67.01%(65/97),阴性预测值为32.99%(32/97)。4ng/mlPSA≤15ng/ml组中,以PSAD≥0.19ng/(ml.cm3)为截点诊断前列腺癌的敏感度为80.00%(8/10),特异度为71.05%(27/38),阳性预测值为42.11%(8/19),阴性预测值为57.89%(11/19)。前列腺癌组PSA及PSAD值均高于非前列腺癌组(P均0.05),PV小于非前列腺癌组(P0.05)。4ng/mlPSA≤15ng/ml组中,前列腺癌与非前列腺癌患者PSA及PV差异均无统计学意义(P均0.05),前列腺癌患者PSAD高于非前列腺癌患者(P0.05)。结论血清PSA及PSAD均与前列腺穿刺活检前列腺癌检出率有关,PSA15ng/ml应行穿刺活检,PSAD对4ng/mlPSA≤15ng/ml的患者是否应行穿刺活检具有指导意义。     

特异性抗原密度联合前列腺穿刺活检诊断前列腺癌的价值

目的 :评价前列腺移行带特异性抗原密度 (PSAT)与前列腺穿刺活检联合检测在前列腺癌 (PCa)诊断中的价值。方法 :对 4 9例血清PSA >10 μg/L患者行前列腺穿刺活检后 ,部分给予重复穿刺及手术治疗 ,综合比较PSAT。结果 :4 9例中 ,前列腺活检病理检查诊断为PCa 2 4例 (4 8.98% ) ,良性前列腺增生 (BPH) 2 5例 (5 1.0 2 % ) ,其PSAT平均值分别为 (0 .6 1± 0 .11)、(0 .38± 0 .13) μg/L ,两者相比差别有统计学意义 (P <0 .0 1) ;后者行手术治疗后病理检查诊断为PCa 6例 (2 4 % ) ,BPH 19例 (76 % ) ,其PSAT平均值分别为 (0 .4 0± 0 .11)、(0 .32± 0 .0 7) μg/L ,两者相比差别有统计学意义 (P <0 .0 5 )。结论 :PSAT对PCa ,特别是早中期PCa的诊断 ,比前列腺穿刺活检更为敏感 ,二者联合检测对临床诊治有重要的价值和意义。     

PSA密度在PSA 2.5～10.0 ng/mL和10.1～20.0 ng/mL患者前列腺癌诊断价值的多中心研究

目的探讨前列腺特异性抗原密度(PSAD)在前列腺特异性抗原(PSA)值位于2.5~10 ng/m L和10.1~20.0 ng/m L患者前列腺癌诊断的效能。方法回顾性分析广州地区两家医院中PSA在2.5~20.0 ng/m L之间,行经直肠前列腺体积测量并行前列腺穿刺的461名患者临床资料,入选者分为PSA 2.5~10.0 ng/m L和PSA10.1~20.0 ng/m L两组,通过受试者工作特征曲线(ROC)分析法评价PSAD与PSA在预测前列腺癌的诊断效力。结果 PSA 2.5~10.0 ng/m L和PSA 10.1~20.0 ng/ml两组的曲线下面积比较,PSAD均高于PSA。在PSA 2.5~10.0 ng/m L组,PSAD预测前列腺癌的最佳临界点为0.15 ng·m L~(-1)·m L~(-1),敏感性和特异性分别为64.4%和64.6%;在PSA10.1~20.0 ng/m L组,PSAD预测前列腺癌的最佳临界点为0.33 ng·m L~(-1)·m L~(-1),敏感性和特异性分别为60.3%和82.7%。结论对于PSA2.5~10.0 ng/m L和10.1~20.0 ng/m L的中国男性,PSAD是一种更优的前列腺癌预测指标。     

（F/T）/PSAD在血清PSA〈4ng/mL前列腺癌诊断中的应用

目的探讨游离前列腺特异性抗原百分比/前列腺特异性抗原密度[（F/T）/PSAD]在前列腺特异性抗原（PSA）小于4 ng/mL的前列腺癌诊断中的意义。方法回顾分析血清PSA〈4 ng/mL的17例前列腺癌患者及同期血清PSA〈4 ng/mL的前列腺增生患者31例的临床资料,分析FPSA/TPSA、PSAD、（F/T）/PSAD值对PSA正常范围前列腺癌的诊断效率。结果前列腺癌组与前列腺增生组比较,FPSA/TPSA、PSAD、（F/T）/PSAD值差异有统计学意义（P〈0.05）,在敏感性为90%的前提下,（F/T）/PSAD特异性最高。结论在保持较高敏感性的前提下,应用（F/T）/PSAD可提高血清PSA正常范围内前列腺癌诊断特异性,提高早期前列腺癌的诊断率。     

良性前列腺增生TURP术后病理诊断前列腺癌27例分析

目的探讨前列腺增生症病人经尿道前列腺电切（TURP）术后病理检出前列腺癌的临床特点及治疗措施。方法对三家医院于2003年1月～2006年12月经尿道前列腺电切术（TURP）327例进行回顾性分析,对比术后病理诊断为前列腺癌的患者与前列腺增生的患者的前列腺抗原及前列腺特异性抗原密度（PSAD）。结果327例患者中PSA在4～10ng/ml间者共112例,PSA在10～20ng/ml之间者共15例。术后病理诊断为前列腺癌的27例,其中有21例患者的PSAD值高于0.15。结论经尿道前列腺电切术（TURP）是早期发现前列腺癌的重要手段;前列腺特异性抗原密度（PSAD）有助于更好地鉴别前列腺增生症和前列腺癌。     

f/t PSA比值、PSA密度、PSA移行带密度在tPSA灰区前列腺偶发癌诊断中的意义

【摘要】 目的： 探讨血清f/t PSA比值、PSA密度、PSA移行带密度在tPSA位于灰区时前列腺癌诊断中的意义。方法： tPSA位于4～10ng/ml的前列腺增生患者112例,术前经前列腺穿刺活检均证实为前列腺增生,行TURP术后病理证实21例为前列腺偶发癌患者。回顾性分析该21例前列腺偶发癌患者和其余前列腺增生患者间的血清f/t PSA比值、PSA密度、PSA移行带密度,并进行统计学分析,以了解其在tPSA灰区前列腺偶发癌诊断中的意义。结果：前列腺偶发癌组和BPH组血清f/t PSA比值分别为0.13±0.03、0.21±0.04;PSAD分别为0.20±0.05 ng/ml2 、0.12±0.04 ng/ml2;PSATZ分别为0.38±0.06 ng/ml2 、 0.21±0.05 ng/ml2;两组在以上三个检测指标上差异具有显著性(P<0.05)。以0.15 ng/ml2为截断点则PSAD 灵敏性为76.115%,特异性为69.146%;以0.35 ng/ml2为截断点则PSATZ 灵敏性为60.642%,特异性为93.943%。结论：f/t PSA比值、PSAD、PSATZ对前列腺偶发癌的诊断具有重要价值,其中尤以PSATZ更具预测价值。     

前列腺特异性抗原密度的测定在诊断前列腺癌中的价值

对１０例非转移性前列腺癌和２０例前列腺增生的前列腺特异性抗原密度（ＰＳＡＤ）进行研究。前列腺癌平均ＰＳＡＤ值为０．７１１，而前列腺增生为０．０７５；两者有极显著性差异（Ｐ＜０．００１）。９例ＰＳＡＤ＞０．２者，８例为前列腺癌。１６例ＰＳＡＤ＜０．１者，无１例前列腺癌。８例前列腺癌患者中有３例前列腺特异性抗原（ＰＳＡ）＜１０ｎｇ／ｍｌ，１例＜２．８ｎｇ／ｍｌ。１６例前列腺增生患者中７例ＰＳＡ＞２．８ｎｇ／ｍｌ，３例＞１０ｎｇ／ｍｌ。表明血清ＰＳＡ轻中度增高或正常时，ＰＳＡＤ可作为前列腺癌早期筛选诊断的有效指标之一。     

Utility of Volume Adjusted Prostate Specific Antigen Density in the Diagnosis of Prostate Cancer in Arab Men

Background: This study was undertaken to assess the utility of prostate specific antigen (PSA) and PSA density (PSAD) in discriminating between benign and malignant prostate disease in the Kuwaiti Arab population.Methods: A total of 100 consecutive patients suspected of having prostate cancer because of serum PSA > 4 ng/ml, or detection of a prostatic nodule on rectal examination were further investigated by determination of PSAD, TRUS of prostate, sexant prostatic biopsy and histological analysis to establish the correct diagnosis. Other diagnostic measures included the determination of the area under the receiver operating characteristic (ROC) curve, sensitivity and specificity. Results: Of the 100 prostate biopsies that were performed, 33 cases were confirmed to be prostate cancer and 67 were described as benign lesions comprising benign prostatic hyperplasia (BPH) with or without prostatitis. The age range for patients with prostate cancer was 42–90 years, and 52–90 years for those without prostate cancer. The mean prostate volume was 58.82 cc (range 9–177 cc) and 62.60 cc (range 15–140 cc), the mean PSA value was 36.65 ng/ml (range 5.8–200 ng/ml) and 16.49 ng/ml (range 1.4–46.0 ng/ml), while the mean PSAD was 0.92 (range 0.046–5.714) and 0.452 (range 0.034–2.294) for patients with prostate cancer and patients without prostate cancer respectively. Patients with PSA less than 4 ng/ml (3 cases) all had benign prostate lesions, and 7 cases with PSA more than 50 ng/ml all had prostate cancer and were excluded because values above 50 ng/ml have close to 100% specificity for prostate cancer. Further analysis was done on the remaining 90 cases which were patients with a PSA between 4 and 50 ng/ml. The discriminating power of serum PSA for detecting prostate cancer as estimated by the area under ROC was 0.686 while that for PSAD was 0.732. The maximum likelihood for a positive PSA was at a PSAD cut-off point of 0.32. For the PSA cut-off point of l0 ng/ml, the sensitivity was 80%, and specificity was 42.2%. For the PSAD cut-off point of 0.32, the sensitivity was 58% and the specificity 76.6%. Conclusions: Determination of PSAD is not a useful adjunct to serum PSA values in the range of 10–50 ng/ ml in our population. PSAD value less than 0.32 with PSA less than l0 ng/ml strongly suggests benign disease.     

Diagnostic value of prostate-specific antigen-related parameters in discriminating prostate cancer.

BACKGROUND: Using the percentage (of total) of free prostate-specific antigen (PSA) in discriminating prostate cancer (CaP) from benign prostate hyperplasia (BPH) has not been fully delineated in Japanese men. To clarify the clinical significance of percent free PSA, various parameters, including total prostate volume, percent free PSA, PSA density (PSAD) and PSA density of transition zone volume (PSAT), were compared. METHODS: Ninety-seven patients who had visited one of three community-based hospitals, and whose total PSA value ranged from 4 to 20 ng/mL were prospectively enrolled in this study. Fresh sera were applied to measure the percent free PSA. RESULTS: Of the 97 patients, CaP and BPH were diagnosed in 24 (25%) and 73 patients, respectively. In discriminating CaP patients, the cutoff values of 17% for percent free PSA, 0.3 ng/mL per cm3 for PSAT, and 0.19 ng/mL per cm3 for PSAD yielded specificity levels of 56, 40 and 58% at sensitivity levels of 92, 92 and 79%, respectively. As for the 65 patients with intermediate PSA, range 410 ng/mL, and normal digital rectal examination, the percent free PSA and total prostate volume statistically discriminated CaP patients from BPH patients. A multiple logistic regression model proved percent free PSA to be the only significant discriminating factor (P=0.045; odds ratio, 9.06). CONCLUSIONS: This prospective study revealed percent free PSA to be a significant useful predictor in discriminating CaP from BPH in Japanese men.     

PSA相关标志物在前列腺癌诊断中的价值

目的 探讨在前列腺特异抗原(prostate specific antigen,PSA)灰区(PSA 4～10ng/mL)患者中,血清总PSA及游离PSA比值(f/tPSA)、前列腺特异性抗原密度(PSAD)和(f/t) PSA/PSAD值对穿刺病理结果的诊断价值.方法 回顾2008年1月至2016年3月本院接受经直肠超声(transrectal ultrasound,TRUS)引导下前列腺穿刺的患者929例,对其中249例PSA 4～ 10 ng/mL患者的临床资料进行了整理分析.根据病理结果,分为前列腺癌组(PCa组)38例(15.26％),前列腺增生组(BPH组)211例(84.74％).对患者年龄、tPSA、f/tPSA、体积、PSAD、(f/t) PSA/PSAD值进行统计学分析.结果 两组患者的年龄水平比较差异无统计学意义(P＞0.05);在f/tPSA、体积、(f/t) PSA/PSAD水平,BPH组大于PCa组;在tPSA、PSAD水平,PCa组大于BPH组,差异均有统计学意义(P＜0.05).PCa组患者中f/tPSA或PSAD异常者32例,占84.21％:BPH组中f/tPSA或PSAD异常者110例,占52.13％,差异有统计学意义(X2=13.52,P ＜0.005).结论 f/tPSA和PSAD异常对PSA灰区的患者是否行前列腺穿刺具有指导意义.如果f/tPSA和PSAD结果相矛盾,f/tPSA联合PSAD、PSAD联合(f/t) PSA/PSAD的诊断价值相对较高.     

BPH患者组织学前列腺炎与PSA、前列腺体积、PSAD、IPSS、Qmax及PVR的相关性研究

目的:探讨BPH患者组织学前列腺炎与PSA、前列腺体积、PSA密度(PSAD)、IPSS、最大尿流率(Qmax)及残余尿量(PVR)的相关性。方法:手术切除或经尿道前列腺电切术(TURP)治疗的BPH患者673例。按照是否伴有组织学前列腺炎将患者分为两组:A组:BPH伴组织学前列腺炎;B组:BPH不伴有组织学前列腺炎。比较两组患者PSA、前列腺体积、PSAD、IPSS、Qmax及PVR。结果:A组PSA水平为(5.64±2.48)μg/L,前列腺体积(43.66±13.11)ml,PSAD 0.129±0.048,IPSS(24.72±5.39)分,Qmax(6.94±3.23)ml/s,PVR(124.90±49.80)ml;B组PSA水平为(4.97±1.99)μg/L,前列腺体积(40.41±11.44)ml,PSAD 0.123±0.034,IPSS(23.40±6.21)分,Qmax(7.75±3.52)ml/s,PVR(112.73±50.03)ml。A组PSA水平、前列腺体积、IPSS和PVR均明显高于B组(P<0.05);A组Qmax明显低于B组(P<0.05);PSAD两组间差异无统计学意义(P>0.05)。结论:组织学前列腺炎能明显增加患者的PSA水平、前列腺体积、IPSS和PVR,降低患者Qmax。但是组织学前列腺炎与PSAD无关;组织学前列腺炎是影响BPH临床进展的重要因素。     

游离前列腺特异抗原百分率检测前列腺癌的临床观察

目的 评价游离前列腺特异抗原（ＰＳＡ）百分率（Ｆ／Ｔ百分率）检测前列腺癌的临床价值。方法 用免疫放射法测定１１７例血清游离ＰＳＡ（Ｆ－ＰＳＡ）、总ＰＳＡ（Ｔ－ＰＳＡ）值,并计算游离ＰＳＡ所占百分率（Ｆ／Ｔ百分率）值;其中前列腺癌３１例,前列腺肥大８６例。结果 Ｆ／Ｔ百分率值在前列腺癌组明显低于前列腺肥大组（Ｐ〈０．０１）;若总ＰＳＡ限定于４￣１０ｎｇ／ｍｌ范围内,应用Ｆ／Ｔ百分率值可区别前列腺癌与     

Prostate specific antigen density for discriminating prostate cancer from benign prostatic hyperplasia in the gray zone of prostate-specific antigen.

Serum prostate specific antigen (PSA) is currently the best blood marker for prostate cancer. However, low specificity for detection of prostate cancer, especially in the gray zone of PSA, is a problem. We evaluated the clinical significance of PSA density (PSAD) in gray zone PSA cases with conversion of serum PSA to a Stanford reference value. In a series of histologically confirmed 63 benign prostatic hyperplasia (BPH) patients and 234 prostate cancer patients, 36 BPH patients and 25 prostate cancer patients had gray zone PSA levels. Serum PSA was measured with the Markit-F or Markit-M PA assay. All data were converted to Stanford reference values. We used transabdominal ultrasound to determine prostate volume. PSAD was determined as the serum PSA/prostate volume ratio. The mean PSA values for BPH and prostate cancer were 6.42 +/- 1.80 and 7.80 +/- 2.15 ng/ml (p = 0.0116), respectively, and prostate volume was 33.4 +/- 14.1 ml and 17.1 +/- 8.2 ml, respectively (p < 0.0001). The mean PSAD for prostate cancer was 0.572 +/- 0.363 while that for BPH was 0.218 +/- 0.085 (p = 0.0001). Cut-off values with sensitivity > 90% were 0.218 for PSAD and 30 ml for prostate volume. At these cut-off values, specificity reached 56% for each marker. In discriminating prostate cancer from BPH in the gray zone of PSA, PSAD demonstrated better performance than PSA.