Diagnostic value of free-to-total PSA proportion and PSA density in prostate cancer detection for prostate volumes ??? 100 cc


Murat Zor, Engin Kaya

Introduction: Free to total PSA proportion (f/t FPSA) and PSA density (PSAD) are mostly used PSA derivatives for better cancer detection. In this study, we aimed to evaluate whether or not f/t PSA and PSAD had any diagnostic contribution to prostate cancer (pCa) detection in patients that had prostate volumes ≥ 100 cc.Material and Methods: The medical records of transrectal ultrasound guided prostate biopsy performed patients were ret-rospectively evaluated and divided into two categories according to their prostate volumes (<100 cc and ≥100 cc). The di-agnostic value of total PSA, PSAD and f/t PSA in prostate cancer detection for prostate volumes ≥ 100 cc were statistically evaluated.Results: Among 311 patients 51 and 260 had prostate volumes ≥100 cc and <100 cc, respectively. pCa detected patients with greater prostate volumes had slightly increased serum PSA levels, but the difference was not statistically significant. f/t PSA was higher, and PSAD was lower in greater prostate volumes when compared prostate volumes <100 cc and the differ-ences was significant. Moreover, the AUC for PSAD and f/t PSA for prostate volumes ≥100 cc were 0.51 and 0.58, respective-ly. All was suggestive for the insufficient diagnostic contribution of both PSA derivatives in greater prostate volumes ≥100 cc. Conclusions: The most significant value of our study was demonstrating the inability of pCa detection of PSAD and f/t PSA in prostate volumes ≥100 cc. Although larger and prospective studies are warranted to make better inferences, up to that time our results may guide clinicians in their daily practice.