CORRELATION OF PROSTATE-SPECIFIC ANTIGEN AND PROSTATE-SPECIFIC ANTIGEN DENSITY WITH OUTCOME OF PROSTATE BIOPSY

Objective. We attempt to correlate prebiopsy serum prostate-specific a ntigen (PSA) concentration and prostate-specific antigen density (PSAD ) with histologic results of prostate biopsy. Method. Sixty-two consec utive patients underwent prostate biopsy because of elevated PSA great er than 4 ng/mL and/or abnormal findings on digital rectal examination (DRE). PSAD was calculated from dividing the serum PSA concentration by the prostate volume as determined by transrectal ultrasound (TRUS). PSA and PSAD were compared to biopsy outcome. Results. The mean PSAD values of the cancer versus noncancer (benign prostatic tissue, benign prostatic hyperplasia, and prostatitis) groups were significantly dif ferent (p < 0.019). However, there was great overlap in individual val ues. The mean PSA levels of the cancer versus noncancer groups also we re significantly different (p < 0.0079). In patients with PSA levels b etween 4 and 10 ng/mL, 11 of 32 (34%) had positive biopsy findings for cancer. Eleven of 29 patients (38%) with normal DRE findings and elev ated PSA levels (> 4 ng/mL) had positive biopsy findings for cancer. S even of 19 patients (37%) with normal DRE findings and elevated PSA le vels between 4 and 10 ng/mL had positive biopsy specimens for cancer. Conclusions. PSAD, though suggestive, is not definitive for cancer or noncancer. Patients with inflammation (prostatitis) present in their b iopsy specimens have serum PSA levels and PSAD values intermediate bet ween those with benign tissue (without inflammation) and cancer. We th ink that prostate biopsy is important in patients with PSA levels betw een 4 and 10 ng/mL even if their DRE result is normal, as our data ind icate that over one third of these patients harbor detectable prostate cancer