Association between PSA density and pathologically significant prostate cancer: The impact of prostate volume

Abstract

Background: The early diagnosis of prostate cancer (PCa) is mainly based on prostate-specific antigen (PSA) blood levels and digital rectal examination. However, this approach may result in a high rate of negative biopsies and increased detection of clinically insignificant PCa (CS-PCa). An important prognostic biomarker, PSA density (PSA-D) demonstrated improved performance in PCa detection compared to PSA. The relationship between prostate volume and the prognostic accuracy of PSA-D remains mostly unclear. The aim of our study is to investigate the PSA-D predictive value of CS-PCa detection at different prostate volumes. Methods: Using our local radical prostatectomy registry, patients were divided into three prostate size subgroups based on preoperative sonographic prostate volume assessment: less than 50, 50-75, and more than 75 cc. Patients' and PCa characteristics were recorded, including age, body mass index, PSA at diagnosis, prostate volume, PSA-D, D'Amico risk classification, Gleason grade group, and pathological staging following surgery. Results: The study cohort included 364 patients who underwent Robotic Radical prostatectomy for biopsy-proven clinically localized PCa. 221 (61%) and 143 (39%) patients had PSA-D less than 0.15 and PSA-D more than 0.15, respectively. ISUP GG 1-2 PCa (CS-PCa) was observed in 220 patients (60%), while 144 (40%) had ISUP GG 3-5 PCa at final pathology. PSA-D correlated with CS-PCa only in small and medium-size prostates, but not in large glands (p = .03, p = .01, and p = .36, respectively). The highest sensitivity (72.7%) was observed in small prostates, compared to 3.2% in large prostates. The highest specificity (89.4%) was noted in large prostates. Positive predictive value in small and medium-size prostates was similar (~50%), compared to 20% in large glands. The negative predictive value was slightly better for small and medium-size prostates compared with large glands (68.9%, 73.7%, and 53.1%, respectively). An association between PSA-D and harboring CS-PCa was detected only in small and medium-size glands (72.7% and 43%, respectively). Conclusion: PSA-D is associated with CS-PCa detection in radical prostatectomy specimens in small and medium-size prostates. The level of PSA-D is directly associated with the ISUP PCa grade group. Therefore, PSA-D is a beneficial, available,

Any Correlation Between Prostate Volume and Incidence of Prostate Cancer: A Review of Reported Data for the Last Thirty Years

“…Therefore, many clinical researchers and investigators have recommended that clinicians should counsel patients with large prostates and elevated PSA to consider conservative management such as sequential PSA measurements and not to proceed with biopsies. 22,23 As outlined in this systemic review, many recent, statistically significant and powerful studies are confirming that BPH may be protective against prostatic cancer supporting the proposed mathematical model by Lorenzo et al that growth of the TZ due to BPH causes increased hydrostatic pressure and compresses the PZ (where 80-85% of PCa originates). As mentioned earlier, this histoanatomical process leads to fibrosis and glandular atrophy of the PZ, and thus likely lowers the risk of clinically significant PCa.…”

Can Prostate-Specific Antigen Density and Free / Total Prostate-Specific Antigen Ratio Predict Clinically Significant Prostate Cancer (Gleason ≥ 7) in Pati̇ents Diagnosed Prostate Cancer on Biopsy With a Prostate-Specific Antigen Level of 2.5 -10 Ng/Ml?

“…Recent studies have shown that PSAD is associated with CSPCa. In Omri et al's study found that PSAD is correlated with CSPCa (based on radical prostatectomy pathology reports) in small (< 50 cc) and medium (50-75cc) size prostates and level of PSAD is directly associated with the ISUP grade groups (13). In Liu et al's study, univariate and multivariate logistic regression analyses demonstrated that PSAD predicted CSPCa (based on prostate biopsy pathology reports) in the PSA level of 4-10 ng/ml (9).…”

The Role of Prostate Combination Biopsy Consisting of Targeted and Additional Systematic Biopsy

“…According to Omri et al, PSA density is associated with csPCa in radical prostatectomy specimens in small- and medium-sized prostate [ 29 ]. In our study, most patients had a small prostate size (<50 mL), PSA density was significantly associated with the PI-RADS score, and there were significant differences in G/S between the three PI-RADS groups.…”