Prostate specific antigen density. Is there a role for this parameter whenscreening for prostate cancer?

The objective of this paper is to validate prostate specific antigen (PSA) density (PSAD) routine use to enhance PSA specificity in men with normal di gital rectal examination and intermediate PSA values. It is a retrospective study of 235 men from a prostate cancer (PCa) screening program. All of th em presented PSA values between 4 and 10 mg/ml, normal digital rectal exami nation, and a transrectal ultrasound (TRUS) guided biopsy available (PSA gr eater than or equal to 4 ng/ml as the sole criterion for biopsy). Multivari ate analysis failed to demonstrate higher PSAD values in men with PCa. PSAD cutoff points higher than 0.07 ng/ml per cc were considered as unacceptabl e, with less than 95% sensitivity. When a cutoff point of 0.15 was consider ed, as many as, 30.6% of the cancers were missed. In conclusion we cannot r ecommend the use of this parameter for the above mentioned purpose.