Comparison of Prostate Specific Antigen Concentration Versus Prostate Specific Antigen Density in the Early Detection of Prostate Cancer: Receiver Operating Characteristic Curves
1994; Lippincott Williams & Wilkins; Volume: 152; Issue: 6 Part 1 Linguagem: Inglês
10.1016/s0022-5347(17)32299-1
ISSN1527-3792
AutoresWilliam J. Catàlona, Jerome P. Richie, Jean B. deKernion, Frederick R. Ahmann, Timothy L. Ratliff, Bruce L. Dalkin, Louis R. Kavoussi, Michael T. Macfarlane, Paula C. Southwick,
Tópico(s)Hepatitis B Virus Studies
ResumoNo AccessJournal of Urology1 Dec 1994Comparison of Prostate Specific Antigen Concentration Versus Prostate Specific Antigen Density in the Early Detection of Prostate Cancer: Receiver Operating Characteristic Curves William J. Catalona, Jerome P. Richie, Jean B. deKernion, Frederick R. Ahmann, Timothy L. Ratliff, Bruce L. Dalkin, Louis R. Kavoussi, Michael T. MacFarlane, and Paula C. Southwick William J. CatalonaWilliam J. Catalona , Jerome P. RichieJerome P. Richie , Jean B. deKernionJean B. deKernion , Frederick R. AhmannFrederick R. Ahmann , Timothy L. RatliffTimothy L. Ratliff , Bruce L. DalkinBruce L. Dalkin , Louis R. KavoussiLouis R. Kavoussi , Michael T. MacFarlaneMichael T. MacFarlane , and Paula C. SouthwickPaula C. Southwick View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)32299-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail We present the results of a prospective multicenter clinical trial of nearly 5,000 men in which prostate specific antigen (PSA) density was compared to the serum PSA concentration alone for early detection of prostate cancer. All men were evaluated with PSA and digital rectal examination. If PSA was elevated (greater than 4ng./ml., Hybritech Tandem assay) or digital rectal examination was suspicious, transrectal ultrasound guided biopsies were recommended. Prostate volume was estimated by transrectal ultrasound measurements using a prolate ellipse volume calculation and PSA density was calculated by dividing serum PSA concentration by gland volume. Using a PSA density cutoff of 0.15 as recommended in the literature enhanced specificity but at the cost of missing half of the tumors. Of the organ confined neoplasms 47% were detected by a PSA of greater than 4.0ng./ml. but they were missed by a PSA density of more than 0.15. PSA density may not be predictive for cancer because accurate estimation of transrectal ultrasound volume is difficult (r = 0.61 for estimated transrectal ultrasound volume versus pathological prostate weight). However, a relationship does exist among transrectal ultrasound volume, PSA and positive predictive value for cancer. PSA concentrations of less than 4.0ng./ml. did not indicate a need for biopsy (positive predictive value 12 to 17%) unless the digital rectal examination findings were suspicious for cancer. A high percentage of patients with a PSA of more than 10ng./ml. had cancer (30 to 75%), regardless of gland size. Patients with intermediate PSA concentrations (4.1 to 9.9ng./ml.) and a gland size of 50cc or less had a 35 to 51% positive predictive value, while those with intermediate PSA concentrations and a large gland (more than 50cc) had a 15% positive predictive value. We conclude that in men with a PSA level of 4.1 to 9.9ng./ml., and normal digital rectal examination and transrectal ultrasound findings, the use of a PSA density cutoff of more than 0.15 for biopsy results in half of the tumors being missed. Thus, we recommend that men in this group undergo biopsy based upon serum PSA concentration rather than PSA density. © 1994 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByLAM J, CHEUNG Y, BENSON M and GOLUBOFF E (2018) Comparison of the Predictive Accuracy of Serum Prostate Specific Antigen Levels and Prostate Specific Antigen Density in the Detection of Prostate Cancer in Hispanic-American and White MenJournal of Urology, VOL. 170, NO. 2, (451-456), Online publication date: 1-Aug-2003.POLASCIK T, OESTERLING J and PARTIN A (2018) PROSTATE SPECIFIC ANTIGEN: A DECADE OF DISCOVERY-WHAT WE HAVE LEARNED AND WHERE WE ARE GOINGJournal of Urology, VOL. 162, NO. 2, (293-306), Online publication date: 1-Aug-1999.LIN D, GOLD M, RANSOM S, ELLIS W and BRAWER M (2018) TRANSITION ZONE PROSTATE SPECIFIC ANTIGEN DENSITY: LACK OF USE IN PREDICTION OF PROSTATIC CARCINOMAJournal of Urology, VOL. 160, NO. 1, (77-82), Online publication date: 1-Jul-1998.DJAVAN B, ZLOTTA A, BYTTEBIER G, SHARIAT S, OMAR M, SCHULMAN C and MARBERGER M (2018) PROSTATE SPECIFIC ANTIGEN DENSITY OF THE TRANSITION ZONE FOR EARLY DETECTION OF PROSTATE CANCERJournal of Urology, VOL. 160, NO. 2, (411-418), Online publication date: 1-Aug-1998.LETRAN J, BLASE A, LOBERIZA F, MEYER G, RANSOM S and BRAWER M (2018) REPEAT ULTRASOUND GUIDED PROSTATE NEEDLE BIOPSY: USE OF FREE-TO-TOTAL PROSTATE SPECIFIC ANTIGEN RATIO IN PREDICTING PROSTATIC CARCINOMAJournal of Urology, VOL. 160, NO. 2, (426-429), Online publication date: 1-Aug-1998.Irani J, Millet C, Levillain P, Dore B, Begon F and Aubert J (2018) Serum-to-Urinary Prostate Specific Antigen Ratio: Its Impact in Distinguishing Prostate Cancer When Serum Prostate Specific Antigen Level is 4 to 10 ng./ml.Journal of Urology, VOL. 157, NO. 1, (185-188), Online publication date: 1-Jan-1997.Arai Y, Maeda H, Ishitoya S, Okubo K, Okada T and Aoki Y (2018) 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 LevelsJournal of Urology, VOL. 158, NO. 3, (861-864), Online publication date: 1-Sep-1997.Collins G, Martin P, Wynn-Davies A, Brooman P and O'Reilly P (2018) The effect of Digital Rectal Examination, Flexible Cystoscopy and Prostatic Biopsy on Free and Total Prostate Specific Antigen, and the Free-to-Total Prostate Specific Antigen Ratio in Clinical PracticeJournal of Urology, VOL. 157, NO. 5, (1744-1747), Online publication date: 1-May-1997.Zlotta A, Djavan B, Marberger M and Schulman C (2018) Prostate Specific Antigen Density of the Transition Zone: A New Effective Parameter for Prostate Cancer PredictionJournal of Urology, VOL. 157, NO. 4, (1315-1321), Online publication date: 1-Apr-1997.Presti J, Hovey R, Bhargava V, Carroll P and Shinohara K (2018) Prospective Evaluation of Prostate Specific Antigen and Prostate Specific Antigen Density in the Detection of Carcinoma of the Prostate: Ethnic VariationsJournal of Urology, VOL. 157, NO. 3, (907-912), Online publication date: 1-Mar-1997.Presti J, Hovey R, Carroll P and Shinohara K (2018) Prospective Evaluation of Prostate Specific Antigen and Prostate Specific Antigen Density in the Detection of Nonpalpable and Stage T1C Carcinoma of the ProstateJournal of Urology, VOL. 156, NO. 5, (1685-1690), Online publication date: 1-Nov-1996.Elgamal A, Cornillie F, Van Poppel H, Van de Voorde W, McCabe R and Baert L (2018) Free-to-Total Prostate Specific Antigen Ratio as a Single Test for Detection of Significant Stage T1c Prostate CancerJournal of Urology, VOL. 156, NO. 3, (1042-1049), Online publication date: 1-Sep-1996.Keetch D, McMurtry J, Smith D, Andriole G and Catalona W (2018) Prostate Specific Antigen Density Versus Prostate Specific Antigen Slope as Predictors of Prostate Cancer in Men with Initially Negative Prostatic BiopsiesJournal of Urology, VOL. 156, NO. 2, (428-431), Online publication date: 1-Aug-1996.Flanigan R (2018) Editorial: Prostate CancerJournal of Urology, VOL. 154, NO. 3, (1084-1084), Online publication date: 1-Sep-1995. Volume 152Issue 6 Part 1December 1994Page: 2031-2036 Advertisement Copyright & Permissions© 1994 by The American Urological Association Education and Research, Inc.KeywordsROC curveantigens, neoplasmprostatic neoplasmsMetricsAuthor Information William J. Catalona More articles by this author Jerome P. Richie More articles by this author Jean B. deKernion More articles by this author Frederick R. Ahmann More articles by this author Timothy L. Ratliff More articles by this author Bruce L. Dalkin More articles by this author Louis R. Kavoussi More articles by this author Michael T. MacFarlane More articles by this author Paula C. Southwick More articles by this author Expand All Advertisement PDF DownloadLoading ...
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