Redefining Serum PSA Cut-off in Indian Population to Avoid Unnecessary Biopsies - A Descriptive Study

Abstract

INTRODUCTION: Prostate cancer is the second most common cancer diagnosed in men with an estimated 1.2 million diagnoses worldwide. The incidence of Prostate cancer is higher in western countries and low in Asian countries. The need for prostate biopsy is based on PSA levels. The general cut off PSA value for the Indian population is 4.0 ng/mL. The reported cancer detection rate of TRUS-guided biopsies is around 30 percent in western countries and lesser in Asian countries, including India, particularly for serum PSA values less than 20 ng/mL indicating that many of the Indian patients are subjected to unnecessary biopsy which adds up to distress to these patients.PURPOSE: To determine the cancer detection rate of TRUS-guided prostate biopsy in the Indian population at different serum Prostate-Specific Antigen levels and determine a PSA cut-off level to avoid unnecessary biopsies.MATERIALS AND METHODS:All symptomatic patients who underwent TRUS guided biopsy for raised serum PSA levels between 4 - 20 ng/mL were included. The patients were categorized into four groups corresponding to the PSA levels ranging between 4-6 ng/mL, 6- 8 ng/mL, 8-10 ng/mL, and 10-20 ng/mL respectively, and cancer detection rate in each group were statistically analyzed.RESULTS:The sensitivity, specificity, and positive predictive value of TRUS guided biopsy are 75%, 95%, and 98% respectively in our study. The overall cancer detection rate of TRUS biopsy in our series was 18.4%. The PSA cut-off to do biopsy was derived by ROC curve as 8.9 ng/ml for all the men. CONCLUSION: The PSA cut-off of 4.0 ng/mL is currently used as an indication for biopsy among men of all ages in the Indian population. We recommend a raise in cut-off to 8.9 ng/mL to avoid unnecessary TRUS-guided biopsies in the Indian population.