Role of prostatic specific antigen density and its correlation with histopathology in diagnosis of the carcinoma of prostrate
Keywords:Digital rectal examination, PSA, Transabdominal ultrasonography, PSA density, BPH, CaP
Background: The specific threshold for prostate-specific antigen (PSA) to delineate patients who are at the highest risk has been controversial. It is wiser to refine PSA by its derivative parameter like PSAD (PSA/vol) which can be used as a better diagnostic tool in early detection of carcinoma of prostrate. To evaluate sensitivity and specificity of PSAD in diagnosis of carcinoma of prostrate.
Methods: A study including 70 patients was done in Pravara Medical College and Rural Hospital, Loni. Patients were screened for prostatic diseases by DRE, blood PSA (ng/ml) estimation, prostatic volume by transabdominal ultrasonography and prostatic biopsy by FNAC or Tru cut Biopsy.
Results: In the present study maximum incidence of BPH and CaP manifested in the age group of 61-70 (i.e., 35.18%) and Ca prostate were in age group of 71-80 (i.e., 50%). The maximum number of patients with BPH were having PSA values between 3-10 ng/ml, where as in CaP the value varied between 10.1-20 ng/ml. The maximum number of patients were in the range of 3-10 ng/ml in which age group 61-70 were having highest (35.71% of the pts in that range) followed by PSA range 10.1-20 ng/ml in which, age group 71-80 have shown maximum number (54.54% of the pts in that range) . The sensitivity, specificity, accuracy of PSAD in diagnosing malignant prostatic diseases were analysed and values were as follows: sensitivity: 87.50%, specificity: 92.59%.
Conclusions: It was concluded that patients with PSAD >0.15 can be advised for prostatic biopsy and regular follow so that appropriate treatment is performed and mortality due to prostatic malignancy is reduced.
Abouassaly R, Thompson IM. Epidemiology, Etiology, and Prevention of Prostate Cancer. In: Walsh C, Wein AJ (eds). Urology. Philadelphia: Saunders Elsevier; 2012: 2690-2711.
Lotfi M, Assadsangabi R, Shirazi M, Jali 1 R, Assadsangabi1 A, Nabavizadeh SA. Diagnostic Value of Prostate Specific Antigen and Its Density in Iranian Men with Prostate Cancer. IRCMJ. 2009;11(2):170-5.
Arai Y, Maeda H, Ishitoya S, Okubo K, Okada T, Aoki Y. Prospective evaluation of prostate specific antigen density and systematic biopsy for detecting prostate cancer in Japanese patients with normal rectal examinations and intermediate prostate specific antigen levels. Int J Urol. 1997;158(3):861-4.
Tarcan T, Ozveri H, Biren T, Türkeri L, Akdas A, Evaluation of prostate specific antigen density and transrectal ultrasonography-guided biopsies in 100 consecutive patients with a negative digital rectal examination and intermediate serum prostate specific antigen levels, Int J Urol. 1997;4(4):362-7.
Bazinet M, Meshref AW, Trudel C, Aronson S, Péloquin F, Nachabe M, et al. Prospective evaluation of prostate-specific antigen density and systematic biopsies for early detection of prostatic carcinoma. Int J Urol 1994;43(1):44-51.
Oh JJ, Hong SK, Lee JK, Lee BK, Lee S, Kwon OS, et al, Prostate-specific antigen vs prostate-specific antigen density as a predictor of upgrading in men diagnosed with Gleason 6 prostate cancer by contemporary multicore prostate biopsy, BJU. 2012;110(11):494-9.
Lodeta B, Benko G, Car S, Filipan Z, Stajcar D, Dujmović T. Prostrate Specific Antigen Density can help avoid unnecessary prostrate biopsies at prostrate specific antigen range of 4-10ng/ml. Acta Clin Croat. 2009;48:153-5.
Mckelvie GB, Collins GN, Hehir M, Rogers ACN. A study of benign prostatic hyperplasia—a challenge to British urology. Brit J Urol. 1993;71(1):38-42.
Vesely S, Knutson T, Damber JE, Mauro DE, Christer D. Relationship between age, prostate volume, prostate-specific antigen, symptom score and uroflowmetry in men with lower urinary tract symptoms. Scand J Urol Nephrol. 2003;37(4):322-8.
Shahab AA, Soebadi DM, Djatisoesanto W, Hardjowijoto S, Soetojo S. Prostate-specific antigen and prostate-specific antigen density cutoff points among Indonesian population suspected for prostate cancer. Prostate Int. 2013;1(1):23-30.
Basawaraj NG, Arul DT, Ashok K, Srinath MG. Can sonographic prostate volume predict prostate specific antigen (PSA) levels in blood among non prostatic carcinoma patients? Int J Biol Med Res. 2012;3(3):1895-8.
Rosette JD, Alivizatos G, Madersbacher S, Rioja C, Nordling J, Emberton M, et al (eds). Guidelines on benign prostatic hyperplasia. 1st edition. 2004.
Men S, Cakar B, Conkbayir I, Hekimoglu B. Detection of prostatic carcinoma: the role of TRUS, TRUS guided biopsy, digital rectal examination, PSA and PSA density. J Exp Clin Cancer Res. 2001;20(4):473-80.
Lakshmi, Sudarsan, Madhusudan. In The Utility of PSA Density in the Detection of Carcinoma Prostate in Men with PSA levels of 4-10Ng/ml. IJSR. 2014;3(11):180-1.
Tauro, Rao, Shetty. Significance Of Prostate Specific Antigen And Prostate Volume In The Diagnosis Of Prostatic Diseases. IJSR. 2009;3(1):1274-84.
Billebaud T, Villers A, Astier L, Boccon-Gibod L, Dauge MC, Sibert A, et al. Advantage of systematic random ultrasound-guided biopsies, measurement of serum prostate-specific antigen level and determination of prostate volume in the early diagnosis of prostate cancer. Eur Urol. 1992;21(1):6-14.
Bruno JJ, Armenakas NA, Fracchia JA. Influence of prostate volume and percent free prostate specific antigen on prostate cancer detection in men with a total prostate specific antigen of 2.6 to 10.0 ng/ml. J Urol. 2007;177(5):1741-4.
Al-Azab R, Toi A, Lockwood G, Kulkarni GS, Fleshner N. Prostate volume is strongest predictor of cancer diagnosis at transrectal ultrasound-guided prostate biopsy with prostate-specific antigen values between 2.0 and 9.0 ng/mL. Urology. 2007;69(1):103-7.
Emberton M, Cornel EB, Bassi PF, Fourcade RO, Gomez JMF, Castro R. Benign prostatic hyperplasia as a progressive disease: a guide to the risk factors and options for medical management. Int J Clin Pract. 2008; 62(7):35-9.