Prediction of clinically significant prostate cancer using extra-transitional zone prostate-specific antigen among...

To validate the use of estimated post-enucleation prostate-specific antigen (EPEPSA) and extra-transitional zone density (EtzD) in predicting clinically significant prostate cancer (csPC) in a Taiwanese cohort.

Between August 2017 and June 2022, patients with PSA levels <20 ng/mL who underwent prostate biopsy at the National Taiwan University Hospital were enrolled. According to a model built by a previous cohort, EPEPSA was calculated using the following formula: 1.068 + 0.016 × PSA +0.004 × prostate volume - 1.02 × adenoma volume/prostate volume. The EtzD was calculated by dividing the EPEPSA value by the peripheral zone volume, and csPC was defined as favorable-intermediate, unfavorable-intermediate, high, very-high-risk or metastatic prostate cancer, according to the National Comprehensive Cancer Network guidelines.

A total of 229 (32.1%) patients with csPC were diagnosed in the enrolled cohort (N = 714). Both EPEPSA and EtzD were statistically associated with csPC prediction (odds ratio [OR]: 29.56, 95% confidence interval [CI]: 5.41-161.6; OR: 4.11, 95% CI: 2.20-7.67, respectively). However, PSA density (PSAD) (area under the curve [AUC]: 0.77) still had the best predictive value compared with PSA, EPEPSA, and EtzD (AUC: 0.68, 0.64, and 0.67, respectively; all p < 0.05). There were no significant differences in the csPC prediction values of EPEPSA, EtzD, and PSA.

Although EPEPSA and EtzD can predict csPC in Taiwan, they failed to outperform PSAD and PSA. Therefore, PSAD is the best predictor for csPC.