DOES PROSTATE-SPECIFIC ANTIGEN DENSITY ALTER DECISION-MAKING ON BIOPSY

Objective: The ability of prostate-specific antigen density (PSAD) to predict prostate cancer in biopsy specimens is evaluated in patients w ith benign digital rectal examination (DRE) and prostate-specific anti gen (PSA) between 4.0 and 10.0 ng/ml. Material and Methods: 144 referr ed patients with a benign DRE and PSA > 4.0 ng/ml were additionally ev aluated by transrectal ultrasonography and transrectal biopsies. PSAD values were calculated and statistical analysis was performed. Results : The mean PSAD value was able to distinguish significantly between be nign prostate conditions and prostate cancer in patients with PSA > 4. 0 ng/ml. However, in 73 patients with 4.0 < PSA less than or equal to 10.0 ng/ml no significant stratification was obtained. At a PSAD value of 0.15 the pretest probability of 18% for positive biopsy was lowere d to a posttest probability of 8.1% and PSAD appeared to be of limited value regarding sensitivity and specificity at different cutoff value s (ROC curve). Applying age-specific reference ranges would have reduc ed diagnostic procedures for men between 60 and 79 years old with 7.0% without missing prostate cancer. Conclusions: In this study PSAD was shown to have only a moderate additive value in decision making to omi t biopsy for the individual patient with benign DRE and PSA between 4. 0 and 10.0 ng/ml. Age-specific reference ranges of PSA can prevent unn ecessary diagnostic procedures.