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Updated: Jan 12, 2026
Microarray-based Identification of Individual HERV Loci Expression: Application to Biomarker Discovery in Prostate Cancer
Published on: November 2, 2013
Incidental prostate cancer: is prostate-specific antigen density a valid predictor? A case-control study
Mahmoud Farzat1,2, Florian M Wagenlehner2
1Department of Robotic Urology, Diakonie Klinikum Siegen, Siegen, Germany.
Purpose:
To evaluate if prostate-specific antigen density (PSAD) predicts incidental prostate cancer (iPCa) in patients undergoing robot-assisted simple prostatectomy (RASP) for benign prostatic hyperplasia (BPH).
Methods:
A total of 100 consecutive patients undergoing RASP for BPH were analyzed. Patients were stratified into low-risk and higher-risk groups based on their iPCa risk: 60 patients (PSAD ⩽ 0.1 ng/mL/cc) and 40 patients (PSAD > 0.1 ng/mL/cc), respectively. Outcomes included iPCa detection rates, preoperative imaging/biopsy utilization, and postoperative complications. A multivariable logistic regression and an univariate linear regression analysis were conducted to assess whether PSAD can predict the incidence of PCA.
Results:
iPCa was detected in 8% of cases. Five patients had <5% tumor material in their final pathology (pT1a), while three had more than 5% (pT1b). iPCa was detected in eight patients, six with International Society of Urological Pathology (ISUP) 1 and 2 with ISUP > 2. Patients with ISUP 1 were managed with active surveillance; only one chose robot-assisted radical prostatectomy, and the two with ISUP 2 and 3 opted for external radiation. Seven iPCa cases occurred in the low-PSAD group (11.7%), and one in the high-PSAD group (2.5%). In multivariate logistic regression, only a prior negative prostate biopsy was the strongest predictor of iPCa (odds ratio = 5.2, p = 0.01). PSAD > 0.1 ng/mL/cc was not associated (p = 0.09). A univariate linear regression using PSAD as a continuous variable showed no significant association (p = 0.27).
Conclusion:
PSAD, whether dichotomized (threshold of >0.1 ng/mL/cc) or continuous, didn't predict iPCa in men with large prostates. To optimize cancer detection, patients with large prostates may profit from prostate MRI before bladder outlet surgery, especially those with a history of prior prostate biopsy. Further research, including larger multicenter studies, is needed to validate our results.
