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THE VALUE OF PROSTATE SPECIFIC ANTIGEN DENSITY (PSAD) IN THE DETECTION OF PROSTATE CANCER IN PATIENTS WITH NORMAL RECTAL EXAMINATIONS (T1) AND ELEVATED SERUM PSA LEVELS
Article published in Urologia Polska 1998/51/1.

authors

Andrzej Stokłosa 1, Andrzej W. Malewski 1, Elżbieta Keller 2, Maciej Czaplicki 1, Andrzej Borkowski 1
1 Katedra i Klinika Urologii AM w Warszawie
Kierownik: prof. dr hab. med. A. Borkowski
2 I Zakład Radiologii Klinicznej AM w Warszawie
Kierownik: prof. dr hab. med. B. Benendo-Kapu¶cińska

keywords

prostate cancer PSA PSAD

summary

Objective. The management of patients with a normal digital rectal
examination (DRE) and PSA > 4 ng/ml remains occasionally controversial. To
improve the cancer detection in this group, PSA density (PSAD), as an
independent predictor of prostste cancer presence, has been developed. It is
recommended to perform biopsies in men with PSAD of 0.15 or more, or PSA
> 10 ng/ml.
To assess PSAD as an independent discriminator of prostate cancer we enrolled
62 patients in this study.
Patients and methods. An evaluatin was done of 62 patients with a normal
DRE and PSA > 4 ng/ml. Of patients 47 underwent transrectal ultrasound with
sextant biopsies regardless of calculated PSAD and 13 had TUR, and 2 open
adenomectomy for urethral obstruction.
Results. Overall, 22 of 62 men (35%) had prostate cancer. There was
a significant difference in the mean PSA density between the patients with
positive and negative biopsy or pathological findings post TUR (p < 0,0001). The
PSA levels did not differed significantly between patients with and without
cancer (p > 0,15). In 86% of patients with prostatic cancer the PSA levels were
above 10 ng/ml.
Conclusion. In our study, PSA density discriminated well between patients
with and without cancer of prostate, and most cancers would have been
detected if a PSAD was 0.15 or more, and if it had been used as the indication
for biopsy. Our study confirmed as well that patients with PSA > 10 ng/ml,
even with normal DRE, had the very high possibility of prostate cancer (86%).

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