Prostate specific antigen adjusted for transition zone volume: the most powerful method for detecting prostate...

Area of Science:

• Urology
• Oncology
• Diagnostic Imaging

Background:

• Prostate-specific antigen (PSA) is used to detect prostate cancer, but its clinical utility can be enhanced by various methods.
• The superiority of different methods for prostate cancer detection remains unclear in practical application.

Purpose of the Study:

• To prospectively identify the most effective method for detecting prostate carcinoma.
• To focus on patients with intermediate prostate-specific antigen (PSA) levels.

Main Methods:

• Systematic sextant biopsies were performed on 281 patients.
• Compared clinical values of PSA, free/total PSA ratio, PSA-ACT, PSAD, and PSATZD using ROC curves and logistic regression.
• Included 147 patients with PSA levels between 4.1 and 10.0 ng/mL.

Main Results:

• PSATZD demonstrated the largest area under the ROC curve in both overall and intermediate PSA populations.
• At 90% sensitivity, PSATZD avoided unnecessary biopsies in 68/117 patients, significantly more than PSA, free/total PSA ratio, or PSA-ACT.
• PSATZD and digital rectal examination findings were significant independent predictors of prostate carcinoma.

Conclusions:

• PSATZD exhibits the highest validity in distinguishing prostate carcinoma from benign prostatic enlargement.
• This finding holds true for the overall patient population and specifically for those with intermediate PSA levels.