What should be the PSA threshold value? 2.5 or 4 ng/mL?

Abstract

Background: In this study, author aimed to detect of threshold value of prostate-specific antigen (PSA) to distinguish malignant or benign prostatic lesions in PSA evaluation.Methods: A total of 61 patients underwent TRUSBP due to high PSA values (2.5-4 ng/mL) at the clinic between 2012-2017. Digital rectal examinations of all patients were normal. Cases with PSA elevation were divided into groups according to the pathology by benign (group 1) or malign (group 2). Author evaluated the predictive factors with the exception of digital rectal examination findings in two groups.Results: Benign prostate hyperplasia was detected in 35 patients (57.4%) and prostate adenocarcinoma was detected in 26 patients (42.6%). The patient’s age, tPSA, fPSA and PSA density were 62.07 years, 3.55 ng/mL, 0.65 ng/mL and 0.09 ng/ml2 in group 1 and 58.54 years, 3.55 ng/mL, 0.74 ng/mL and 0.10 ng/ml2 in group 2, respectively. Patient’s age was statistically significant between in two groups (p<0.05). Number of received cores and rate of f/tPSA were 12.24-12 and 20.51-18.45% in group 1 and 2, respectively. tPSA, fPSA and PSA density, number of received cores and rate of f/tPSA were similar in both groups. In group 2, prostate adenocarcinoma was most common detected with Gleason score 3+3 in 19 of 26 patients (73.1%).Conclusions: There is a need different assessment to distinguish of malignant lesions from benign lesions. Nowadays, it was impossible to make this difference in patients without digital rectal examination findings, so accepted threshold of PSA should be 2.5 ng/mL.

Prostate incidentaloma on 18F-fluorodeoxyglucose positron emission tomography: Diagnostic value of volumetric positron emission tomography parameters

“…In most studies that included SUVmax values in PI, the malignant group's average SUVmax values were higher than in the benign group [6,8,10,11,12,13,14,19]. The difference was not statistically significant [17,20,21,22,23,24], except for a few studies [8,14]. Yang et al stated that the SUVmax values of the malignant group were higher than in the benign group, and the difference was statistically significant (p < 0.01), but they reported that there was considerable overlap between the two groups, as in other studies [14].…”

“…These statistical differences compared with other studies were considered to be due to the use of more selective criteria in determining the benign group. While creating the benign group in our study, a lower cutoff value of 2.5 was used for PSA, taking into account recent publications [20,22]. Also, because 18F-FDG PET/CT is a preferred examination in the follow-up of oncology patients in our hospital, it was possible to examine the changes of PIs in previous and subsequent PET/CTs.…”