Prostate-specific antigen (PSA) density in the diagnostic algorithm of prostate cancer

Background Screening for prostate cancer using prostate-specific antigen (PSA) alone leads to un-necessary biopsying and overdiagnosis. PSA density is easily accessible, but early evidence on its use for biopsy decisions was conflicting and use of PSA density is not commonly recommended in guideline...

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Bibliographic Details
Published in:Prostate cancer and prostatic diseases 2018-04, Vol.21 (1), p.57-63
Main Authors: Nordström, Tobias, Akre, Olof, Aly, Markus, Grönberg, Henrik, Eklund, Martin
Format: Article
Language:English
Subjects:
692/53/2421
692/699/67/589/466
Aged
Algorithms
Antigens
Biomedical and Life Sciences
Biomedicine
Biopsy
Cancer
Cancer Research
Decisions
Density
Diagnosis
Diagnostic systems
Genetics
Humans
Information technology
Magnetic resonance imaging
Male
Medicin och hälsovetenskap
Men
Middle Aged
Morbidity
Neoplasm Grading
Population studies
Prostate - metabolism
Prostate - pathology
Prostate biopsy
Prostate cancer
Prostate specific antigen
Prostate-Specific Antigen - genetics
Prostate-Specific Antigen - isolation & purification
Prostatic Neoplasms - diagnosis
Prostatic Neoplasms - genetics
Prostatic Neoplasms - pathology
Regression analysis
Regression models
Tumors
Ultrasound
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Summary:Background Screening for prostate cancer using prostate-specific antigen (PSA) alone leads to un-necessary biopsying and overdiagnosis. PSA density is easily accessible, but early evidence on its use for biopsy decisions was conflicting and use of PSA density is not commonly recommended in guidelines. Methods We analyzed biopsy outcomes in 5291 men in the population-based STHLM3 study with PSA ≥ 3 ng/ml and ultrasound-guided prostate volume measurements by using percentages and regression models. PSA density was calculated as total PSA (ng/ml) divided by prostate volume (ml). Main endpoint was clinically significant cancer (csPCa) defined as Gleason Score ≥ 7. Results The median PSA-density was 0.10 ng/ml 2 (IQR 0.075–0.14). PSA-density was associated with the risk of finding csPCa both with and without adjusting for the additional clinical information age, family history, previous biopsies, total PSA and free/total PSA (OR 1.06; 95% CI:1.05–1.07 and OR 1.07, 95% CI 1.06–1.08). Discrimination for csPCa was better when PSA density was added to a model with additional clinical information (AUC 0.75 vs. 0.73, P  
ISSN:1365-7852
1476-5608
1476-5608
DOI:10.1038/s41391-017-0024-7