DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20190933

What should be the PSA threshold value? 2.5 or 4 ng/mL?

Caner Ediz, Serhan Cimen, Serkan Akan, Muhammed Cihan Temel, Omer Yilmaz, Ozlem Koksal

Abstract


Background: In this study, author aimed to detect of threshold value of prostate-specific antigen (PSA) to distinguish malignant or benign prostatic lesions in PSA evaluation.

Methods: A total of 61 patients underwent TRUSBP due to high PSA values (2.5-4 ng/mL) at the clinic between 2012-2017. Digital rectal examinations of all patients were normal. Cases with PSA elevation were divided into groups according to the pathology by benign (group 1) or malign (group 2). Author evaluated the predictive factors with the exception of digital rectal examination findings in two groups.

Results: Benign prostate hyperplasia was detected in 35 patients (57.4%) and prostate adenocarcinoma was detected in 26 patients (42.6%). The patient’s age, tPSA, fPSA and PSA density were 62.07 years, 3.55 ng/mL, 0.65 ng/mL and 0.09 ng/ml2 in group 1 and 58.54 years, 3.55 ng/mL, 0.74 ng/mL and 0.10 ng/ml2 in group 2, respectively. Patient’s age was statistically significant between in two groups (p<0.05). Number of received cores and rate of f/tPSA were 12.24-12 and 20.51-18.45% in group 1 and 2, respectively. tPSA, fPSA and PSA density, number of received cores and rate of f/tPSA were similar in both groups. In group 2, prostate adenocarcinoma was most common detected with Gleason score 3+3 in 19 of 26 patients (73.1%).

Conclusions: There is a need different assessment to distinguish of malignant lesions from benign lesions. Nowadays, it was impossible to make this difference in patients without digital rectal examination findings, so accepted threshold of PSA should be 2.5 ng/mL.


Keywords


Prostate cancer, Prostate biopsy, Prostate specific antigen

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References


Wang MC, Valenzuela LA, Murphy GP, Chu TM. Purification of a human prostate specific antigen. Invest Urol. 1979;17(2):159-63.

Ng TK, Vasilareas D, Mitterdorfer AJ, Maher PO, Lalak A. Prostate cancer detection with digital rectal examination, prostate-specific antigen, transrectal ultrasonography and biopsy in clinical urological practice. BJU Int. 2005;95(4):545-8.

Hodge KK, McNeal JE, Terris MK, Stamey TA. Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol. 1989;142(1):71-4.

Epstein JI, Allsbrook WC, Jr., Amin MB, Egevad LL, Committee IG. The 2005 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol. 2005;29(9):1228-42.

Stamey TA, Yang N, Hay AR, McNeal JE, Freiha FS, Redwine E. Prostate-specific antigen as a serum marker for adenocarcinoma of the prostate. N Engl J Med. 1987;317(15):909-16.

Catalona WJ, Richie JP, Ahmann FR, M’Liss AH, Scardino PT, Flanigan RC, et al. Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: results of a multicenter clinical trial of 6,630 men. J Urol. 1994;151(5):1283-90.

Semjonow A, Brandt B, Oberpenning F, Roth S, Hertle L. Discordance of assay methods creates pitfalls for the interpretation of prostate-specific antigen values. Prostate Suppl. 1996;7:3-16.

Thompson IM, Pauler DK, Goodman PJ, Tangen CM, Lucia MS, Parnes HL, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level

DeAntoni EP. Age-specific reference ranges for PSA in the detection of prostate cancer. Oncology (Williston Park). 1997;11(4):475-82.

Catalona WJ, Smith DS, Ornstein DK. Prostate cancer detection in men with serum PSA concentrations of 2.6 to 4.0ng/mL and benign prostate examination. Enhancement of specificity with free PSA measurements. JAMA. 1997;277(18):1452-5.

Gilbert SM, Cavallo CB, Kahane H, Lowe FC. Evidence suggesting PSA cutpoint of 2.5ng/mL for prompting prostate biopsy: review of 36,316 biopsies. Urol. 2005;65(3):549-53.

Rashid MM, Alam AK, Habib AK, Rahman H, Hossain AK, Salam MA, et al. Efficacy of lower cut off value of serum prostate specific antigen in diagnosis of prostate cancer. Bangladesh Med Res Counc Bull. 2012;38(3):90-3.

Veneziano S, Pavlica P, Compagnone G, Martorana G. Usefulness of the (F/T)/PSA density ratio to detect prostate cancer. Urol Int. 2005;74(1):13-8.

Faria EF, Carvalhal GF, dos Reis RB, Tobias‐Machado M, Vieira RA, Reis LO, et al. Use of low free to total PSA ratio in prostate cancer screening: detection rates, clinical and pathological findings in Brazilian men with serum PSA levels <4.0 ng/mL. BJU Int. 2012;110(11 Pt B):E653-657.

Kitagawa Y, Ueno S, Izumi K, Kadono Y, Konaka H, Mizokami A, et al. Cumulative probability of prostate cancer detection in biopsy according to free/total PSA ratio in men with total PSA levels of 2.1-10.0 ng/ml at population screening. J Cancer Res Clin Oncol. 2014;140(1):53-9.

Liu X, Tang J, Fei X, Li QY. Prostate-specific Antigen (PSA) density and free to total PSA ratio in diagnosing prostate cancer with prostate-specific antigen levels of 4.0 ng/ml or less. Iran J Public Health. 2015;44(11):1466-72.

Veneziano S, Pavlica P, Querze R, Viglietta G, Trenta A. Importance of specific prostatic antigen to prostatic volume ratio in the selection of patients for ultrasonography-guided biopsy of the prostate. Radiol Med. 1991;81(6):857-60.

Yamamoto S, Kin U, Nakamura K, Hamano M, Nishikawa Y, Takenouchi T, et al. Transperineal ultrasound-guided 12-core systematic biopsy of the prostate for patients with a prostate-specific antigen level of 2.5-20 ng/ml in Japan. Int J Clin Oncol. 2005;10(2):117-21.

Pepe P, Candiano G, Fraggetta F, Galia A, Grasso G, Allegro R, et al. Is PSA density still useful in diagnosing prostate cancer? Arch Ital Urol Androl. 2009;81(4):199-202.

Demura T, Takada T, Shimoda N, Hioka T, Iwaguchi Y, Ichihara S, et al. Mechanism underlying the negative effect of prostate volume on the outcome of extensive transperineal ultrasound-guided template prostate biopsy. Cancer Med. 2018;7(2):336-43.