Prostatic volume and volume-adjusted prostate-specific antigen as predictive parameters for T1c prostate cancer

Area of Science:

• Urology
• Oncology
• Medical Imaging

Background:

• Prostate-specific antigen (PSA) is a key biomarker for prostate cancer detection.
• Volume-adjusted PSA parameters like PSA density (PSAD) and PSA indexed to transition zone volume (PSATZD) may improve diagnostic accuracy.
• Distinguishing T1c prostate cancer in patients with elevated PSA but normal digital rectal examination (DRE) and transrectal ultrasonography (TRUS) findings remains challenging.

Purpose of the Study:

• To evaluate the predictive usefulness of volume-adjusted PSA parameters for detecting T1c prostate cancer.
• To compare the diagnostic performance of PSA, prostate volume (PV), transition zone volume (TZV), PSAD, and PSATZD.

Main Methods:

• Analysis of 210 patients with abnormal PSA levels but normal DRE/TRUS findings.
• Assessment of PSA, PV, TZV, PSAD, and PSATZD using receiver operating characteristic (ROC) curves and area under the curve (AUC).
• Application of simple and stepwise logistic regression to determine odds ratios and identify significant predictive parameters.

Main Results:

• Prostate cancer was diagnosed in 25.2% of all patients and 19.9% of those with intermediate PSA levels.
• PSA, PV, TZV, PSAD, and PSATZD showed significant predictive values for prostate cancer detection.
• PSATZD emerged as the strongest independent predictor of prostate cancer in both overall and intermediate PSA groups.

Conclusions:

• Volume-adjusted PSA parameters, particularly PSATZD, significantly enhance the prediction of T1c prostate cancer.
• PV and TZV also contribute to discriminating prostate cancer, alongside PSAD and PSATZD.
• PSATZD offers the most robust predictive capability for prostate cancer detection in this patient cohort.