Re-examining Prostate-specific Antigen (PSA) Density: Defining the Optimal PSA Range and Patients for Using PSA Density to Predict Prostate Cancer Using Extended Template Biopsy

To compare the predictive accuracy of prostate-specific antigen (PSA) density vs PSA across different PSA ranges and by prior biopsy status in a prospective cohort undergoing prostate biopsy. Men from a prospective trial underwent an extended template biopsy to evaluate for prostate cancer at 26 sit...

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Bibliographic Details
Published in:Urology (Ridgewood, N.J.) N.J.), 2017-07, Vol.105, p.123-128
Main Authors: Jue, Joshua S., Barboza, Marcelo Panizzutti, Prakash, Nachiketh S., Venkatramani, Vivek, Sinha, Varsha R., Pavan, Nicola, Nahar, Bruno, Kanabur, Pratik, Ahdoot, Michael, Dong, Yan, Satyanarayana, Ramgopal, Parekh, Dipen J., Punnen, Sanoj
Format: Article
Language:English
Subjects:
Aged
Biopsy
Humans
Male
Middle Aged
Neoplasm Grading
Predictive Value of Tests
Prospective Studies
Prostate-Specific Antigen - blood
Prostatic Neoplasms - blood
Prostatic Neoplasms - diagnosis
ROC Curve
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Summary:To compare the predictive accuracy of prostate-specific antigen (PSA) density vs PSA across different PSA ranges and by prior biopsy status in a prospective cohort undergoing prostate biopsy. Men from a prospective trial underwent an extended template biopsy to evaluate for prostate cancer at 26 sites throughout the United States. The area under the receiver operating curve assessed the predictive accuracy of PSA density vs PSA across 3 PSA ranges (10 ng/mL). We also investigated the effect of varying the PSA density cutoffs on the detection of cancer and assessed the performance of PSA density vs PSA in men with or without a prior negative biopsy. Among 1290 patients, 585 (45%) and 284 (22%) men had prostate cancer and significant prostate cancer, respectively. PSA density performed better than PSA in detecting any prostate cancer within a PSA of 4-10 ng/mL (area under the receiver operating characteristic curve [AUC]: 0.70 vs 0.53, P 10 mg/mL (AUC: 0.84 vs 0.65, P 
ISSN:0090-4295
1527-9995
DOI:10.1016/j.urology.2017.04.015