The value of adjusted PSAD in prostate cancer detection in the Chinese population

To investigate the value of adjusted prostate-specific antigen density (PSAD^adj) in the diagnosis of prostate cancer (PCa).

Data from 410 patients who underwent transrectal ultrasound-guided prostate biopsy were retrospectively analyzed in Beijing Tsinghua Changgung Hospital between November 2014 and March 2024. All patients were divided into PCa and benign prostatic hyperplasia (BPH) groups according to pathological results. Multivariate logistic regression analyses were performed to evaluate the odd ratios (ORs) of predictors for PCa occurrence. Receiver operating characteristic curves were plotted, and the area under the curve (AUC) values were used to assess and compare the diagnostic accuracies of total PSA (tPSA), free-to-total (f/t) PSA, free PSA (fPSA), PSAD, and PSAD^adj (PSAD×weight).

There were 166 patients in the PCa group and 244 in the BPH group. Multivariate analyses demonstrated that PSAD was positively correlated with the presence of PCa, with the highest OR value among all PSA-related parameters (OR = 19.075, p<0.001). tPSA, fPSAD, PSAD, and PSAD^adj had high accuracy in predicting PCa, with AUC values of 0.633, 0.730, 0.778, and 0.780. Of note, PSAD^adj had the highest AUC with a sensitivity of 63.3% and specificity of 81.6%. Similarly, in patients with a PSA level in the gray zone, the diagnostic accuracy of PSAD^adj in predicting PCa (AUC, 0.709; 95% CI, 0.616-0.802) remained better than other PSA-related markers.

PSAD^adj has an advantage over other PSA-related markers in detecting PCa and could be used for making biopsy decisions.