Serum prostate-specific antigen, radiologic findings and Gleason score in prostate biopsies in Jordan

Prostate-specific antigen (PSA) and the PSA ratio are good screening tests for prostate carcinoma. The significance of PSA may be different from one ethnic group to another. Radiologic findings may be helpful in detecting prostate carcinoma.

We reviewed the findings of 348 prostate biopsies performed in a 4-year period. Of these, 278 cases were performed under ultrasound guidance and 70 were performed transrectally under digital guidance. PSA, PSA ratio, Gleason score and radiology findings were determined.

Forty-three percent of the cases were diagnosed as having adenocarcinoma. The mean age for cancer patients was 68.4 years. The mean PSA level for patients with carcinoma was 23.4 ng/mL compared to 11.2 ng/mL for benign cases. Carcinoma occurred in 11% (PSA <4 ng/mL); 48.7% (PSA=4-10 ng/mL); 50.6% (PSA= 10-30 ng/mL); 72% (PSA >30 ng/mL). The PSA ratio for cancer cases was 9.9% compared to 13.7% for benign cases. The average Gleason score for all cancers was 7 of 10. There was no relationship between PSA level and Gleason score. The higher the Gleason score, the higher the percentage of carcinoma present in the cores. Most of the carcinomas (100/122) showed hypoechoic areas on ultrasound exam, while heterogeneous areas favored a benign lesion in 54/76, with a sensitivity of 82% and specificity of 38%.

The higher the PSA, the greater the chance of having cancer. PSA has a low positive predictive value for prostate carcinoma. Twenty-eight percent of PSA >30 can be attributed to benign conditions. A PSA ratio <10 is suggestive of carcinoma. A radiologic finding of a hypoechoic lesion is a sensitive tool for detecting prostate carcinoma, but its specificity is low.