What is it about?

There have been several reports on different prostate cancer screening tests, which may improve the specificity in the early detection of prostate cancer. Cut-off values of these tests are mainly based on data from USA and Europe and may not be applicable to other races. We conducted this study to evaluate the utility of different screening tests for detecting prostate cancer.

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Why is it important?

Prostate cancer is one of the most common malignancies in men and is the second leading cause of cancer death for men in the United States. The use of prostate specific antigen (PSA) has revolutionized the diagnosis of prostate cancer. A total PSA (tPSA) level of 4.0 ng/ml has traditionally been considered as the threshold for prostate biopsy; however, with a PSA level from 4 to 10 ng/ml, positive findings on a prostate biopsy occur in less than 50% of the patients. PSA though highly sensitive, may lack specificity for the detection of the prostate cancer, especially with the intermediate levels of PSA between 4.0 and 10.0 ng/ml.


Despite the superiority of PSAD in the detection of prostate cancer, it should be considered that the need for TRUS is a limitation of PSAD compared to with f/t PSA and has prevented the widespread clinical acceptance of PSAD. PSAD has a limitation (compared to f/t PSA) that there is intra- and inter-observer variability. In case of multiple providers it can be possible cause of bias. But, in our study all of the TRUSes have been done by a same trained urologist. Clearly the limitation of f/t PSA is cost. In this study the PSAD is better in predictiveness of prostate cancer, and it also has the cost of the TRUS. But, the cost of missing cancer detection is more important. As anticipated, in this study also a higher percentage of men with positive than those with negative biopsy findings had a family history of prostate cancer, although the difference was not statistically significant.

Dr Mohammad Reza Safarinejad
University of Medical Sceices

Read the Original

This page is a summary of: Utility of Prostate Specific Antigen Density and Free to Total Prostate Specific Antigen Ratio for Detecting Prostate Cancer in Iranian Men: A Prospective Study of 187 Cases, Current Urology, January 2010, Karger Publishers, DOI: 10.1159/000253399.
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