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Preventing Unnecessary Invasive Cancer-Diagnostic Tests: Changing the Cut-off Points
G Pourmand1, R Ramezani, B Sabahgoulian
1Urology Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Iranian Journal of Public Health
|November 1, 2012
Summary
This study identified optimal cut-off values for total prostate-specific antigen (tPSA) and prostate-specific antigen density (PSAD) to reduce unnecessary prostate cancer biopsies. The findings suggest specific thresholds for tPSA, free/total PSA ratio, and PSAD for improved diagnostic accuracy.
Area of Science:
- Urology
- Oncology
- Diagnostic Medicine
Background:
- Elevated prostate-specific antigen (PSA) levels often lead to invasive diagnostic procedures.
- There is a need to establish reliable cut-off values for PSA-based markers to prevent unnecessary biopsies.
Purpose of the Study:
- To determine optimal cut-off points for total PSA (tPSA) and PSA density (PSAD).
- To reduce the rate of unnecessary invasive diagnostic tests for prostate cancer in the community.
Main Methods:
- The study analyzed 688 patients with prostatism or elevated PSA.
- Transrectal ultrasound-guided biopsies, tPSA, and free/total PSA (f/tPSA) ratio measurements were performed.
- Area Under the Curve (AUC) Receiver Operating Characteristic (ROC) analysis was used.
Main Results:
- Prostate cancer was diagnosed in 334 patients; 354 had benign prostate diseases.
- Significant differences in tPSA, f/tPSA, and PSAD were observed between groups (P <0.05).
- Optimal cut-off values: tPSA 7.85 ng/mL (sensitivity 71%), f/tPSA 0.13 (sensitivity 81.4%), and PSAD 15%.
Conclusions:
- The established cut-off values (tPSA: 7.85 ng/mL, PSAD: 15%, f/tPSA: 0.13) aid in prostate cancer diagnosis.
- Caution is advised when applying these values due to differences from European/American data.
- These markers can help refine decisions for invasive prostate cancer testing.
