Springer Nature is making Coronavirus research free. View research | View latest news | Sign up for updates

Prostate-specific antigen density — a reliable parameter for the detection of prostate cancer?

  • 34 Accesses

  • 6 Citations


We compared the prostate-specific antigen density (PSAD) in clinically and surgically staged patients with specimen-confined prostate cancer (n=57) and in patients with benign hyperplasia (n=69), who underwent transvesical adenomectomy. The PSAD was calculated from the preoperative PSA level and the specimen volume. The prostate volume was determined by dividing the prostate weight by the specific gravity of the tissue. The mean tissue values used for PSAD calculation were 51.9 g in men with prostate cancer (PCA) and 62.9 g in men with benign prostatic hyperplasia (BPH). The PSAD values showed significant differences (BPH 0.19 versus PCA 0.37,P=0.029). Receiver operator characteristic (ROC) curves demonstrated the best cutoff value to be 0.15, with the sensitivity being 58%; the specificity, 51% and the positive predictive value of PCA, 49%. At a serum PSA level below 10 ng/ml, the best cutoff value was 0.1 and the positive predictive value was 51%. The PSAD results we calculated from an accurate prostate volume (surgical estimate) show that PSAD is not a significant predictor of prostate cancer.

This is a preview of subscription content, log in to check access.


  1. 1.

    Ackerman DA, Barry JM, Wicklund RA, Olson N, Lowe BA (1993) Analysis of risk factors associated with prostate cancer extension to the surgical margin and pelvic node metastasis at radical prostatectomy. J Urol 150:1845–1850

  2. 2.

    Armitage P, Berry G (1987) Statistical methods in medical research, 2nd edn. Blackwell, Oxford

  3. 3.

    Aumüller G (1979) Prostate gland and seminal vesicles. Springer, New York Berlin Heidelberg, p 51

  4. 4.

    Benson MC, Whang IS, Pantuck A, Ring K, Kaplan SA, Olsson CA, Cooner WH (1992) Prostate specific antigen density: a means of distinguishing benign prostatic hypertrophy and prostate cancer. J Urol 147:815–816

  5. 5.

    Benson MC, Whang IS, Olson CA, McMahon DJ, Cooner WH (1992) The use of prostate specific antigen density to enhance the predictive value of intermediate levels of serum prostate specific antigen. J Urol 147:817–821

  6. 6.

    Bernard R (1990) Fundamentals of biostatistics. PWS, Boston, pp 442–450

  7. 7.

    Blackwell KL, Bostwick DG, Myers RP, Zincke H, Oesterling JE (1994) Combining prostate specific antigen with cancer and gland volume to predict more reliably pathological stage: the influence of prostate specific antigen cancer density. J Urol 151:1565–1570

  8. 8.

    Brawer MK, Chetner MP, Beatie J, Buchner DM, Vessella RL, Lange PH (1992) Screening for prostatic carcinoma with prostate specific antigen. J Urol 147:841–845

  9. 9.

    Brawer MK, Aramburu EAG, Chen GL, Preston SD, Ellis WJ (1993) The inability of prostate specific antigen index to enhance the predictive value of prostate specific antigen in the diagnosis of prostatic carcinoma. J Urol 150:369–373

  10. 10.

    Carter HB, Pearson JD, Metter EJ, Brant LJ, Chan DW, Andres R, Fozard JL, Walsh PC (1992) Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease. JAMA 267:2215–2220

  11. 11.

    Catalona WJ, Smith DS, Ratliff TL, Dodds KM, Coplen De, Yuan JJJ, Petros JA, Andriole GL (1991) Measurement of prostate-specific antigen in serum as a screening test for prostate cancer. N Engl J Med 324:1156–1161

  12. 12.

    Catalona WJ, Smith DS, Ratliff TL, Basler JW (1993) Detection of organ-confined prostate cancer is increased through prostate specific antigen-based screening. JAMA 270:948–954

  13. 13.

    Catalona WJ, Richie JP, Ahmann FR (1994) Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: results of a multicenter clinical trial of 6,630 men. J Urol 151:1283–1290

  14. 14.

    Chadwick DJ, Kemple T, Astley JP, MacIver AG, Gillatt DA, Abrams P, Giugell JC (1991) Pilot study of screening for prostate cancer in general practice. Lancet 338:613–616

  15. 15.

    Coffey DS (1992) The molecular biology, endocrinology, and physiology of the prostate and seminal vesicles. In: Walsh PC, Retik AB, Stamey TA, Vaughan ED Jr (eds) Campell's urology, 6th en. Vol 1, ch 6. Saunders, Philadelphia, p 225

  16. 16.

    Cooner WH, Mosley BR, Rutherford CL Jr, Beard JH, Pond HS, Terry WJ, Igel TC, Kidd DD (1990) Prostate cancer detection in a clinical urological practice by ultrasonography, digital rectal examination and prostate specific antigen. J Urol 143:1146–1162

  17. 17.

    Epstein JI, Walsh PC, Brendler CB (1994) Radical prostatectomy for impalpable prostate cancer: the John Hopkins experience with tumors found on transurethral resection (stages T1a and T1b) and on needle biopsy (stage T1c). J Urol 152:1721–1729

  18. 18.

    Gleave ME, Hsieh J, Wu H, Eschenbach AC von, Chung LWK (1992) Serum prostate specific antigen levels in mice bearing human prostate LNCaP tumos are determined by tumor volume and endocrine and growth factors. Cancer Res 52:1598–1605

  19. 19.

    Gustafsson O, Norming U, Almgard L-E, Fredriksson A, Gustavson G, Harvig B, Nyman CR (1992) Diagnostic methods in the detection of prostate cancer: a study of a randomly selected population of 2,400 men. J Urol 148:1827–1831

  20. 20.

    Handley MR, Stuart ME (1994) The use of prostate specific antigen for prostate cancer screening: a managed care perspective. J Urol 152:1689–1692

  21. 21.

    Hosmer DW Jr, Lemeshow S (1989) Applied logistic regression. Wiley and Sons, New York, pp 1–7

  22. 22.

    Keetch DW, Catalona WJ, Smith DS (1994) Serial prostatic biopsies in men with persistently elevated serum prostate specific antigen values. J Urol 151:1571–1574

  23. 23.

    Labrie F, Dupont A, Suburu R, Cusan L, Tremblay J, Gomez J-L, Emond J (1991) Serum prostate specific antigen as a prescreening test for prostate cancer. J Urol 147:846–852

  24. 24.

    Littrup PJ, Goodman AC, Mettlin CJ, the investigators of the American Cancer Society National Prostate Cancer Detection Project (1993) The benefit and cost of prostate cancer early detection. CA 43:134–149

  25. 25.

    Mettlin C, Lee F, Drago J, Murphy JP (1991) The American Cancer Society National Prostate Cancer Detection Project: findings of the detection of early prostate cancer in 2425 men. Cancer 67:2949–2958

  26. 26.

    Mettlin C, Jones G, Averette H, Gusberg SB, Murphy GP (1993) Defining and updating the American Cancer Society guidelines for the cancer-related checkup: prostate and endometrial cancer. CA 43:42–46

  27. 27.

    Mettlin C, Murphy GP, Lee F, the investigators of the American Cancer Society National Prostate Cancer Detection Project (1994) Characteristics of prostate cancer detected in the American Cancer Society National Prostate Cancer Detection Project. J Urol 152:1737–1740

  28. 28.

    Muschenheim F, Omarbasha B, Kardijan PM, Mondou EN (1991) Screening for carcinoma of the prostate with prostate specific antigen. Ann Clin Lab Sci 21:371–380

  29. 29.

    Neal DE Jr, Clejan S, Sarma D, Moon TD (1992) Prostate specific antigen and prostatitis. I. Effect of prostatitis on serum PSA in the human and nonhuman primate. Prostate 20:105–111

  30. 30.

    Oesterling JE, Martin SK, Bergstralh EJ, Lowe FC (1993) The use of prostate-specific antigen in staging patients with newly diagnosed prostate cancer. JAMA 269:57–60

  31. 31.

    Partin AW, Carter HB, Chan DW, Epstein J, Oesterling JE, Rock RC, Weber JP, Walsh PC (1990) Prostate specific antigen in the staging of localized prostate cancer: influence of tumor differentiation, tumor volume and benign hyperplasia. J Urol 143:747–752

  32. 32.

    Partin AW, Pound CR, Clemens JQ, Epstein JI, Walsh PC (1993) Serum PSA after anatomic radical prostatectomy. Urol Clin North Am 20:713–725

  33. 33.

    Pearson JD, Carter HB (1994) Natural history of changes in prostate specific antigen in early stage prostate cancer. J Urol 152:1743–1748

  34. 34.

    Perrin P, Maquet JH, Bringeon G, Devonec M (1991) Screening for prostate cancer. Comparison of transrectal ultrasound, prostate specific antigen and rectal examination. Br J Urol 68:263–265

  35. 35.

    Schmid HP, McNeal JE, Stamey TA (1992) Observation on the doubling time of prostate cancer: the use of serial prostate-specific antigen in patients with untreated disease as a measure of increasing cancer volume. Cancer 71:2031–2040

  36. 36.

    Shinohara K, Wolf JS Jr, Narayan P, Carroll PR (1994) Comparison of prostate specific antigen density for 3 clinical applications. J Urol 152:120–123

  37. 37.

    Smith D, Catalona W (1994) Rate of change in serum prostate specific antigen levels as a method for prostate cancer detection. J Urol 152:1163–1167

  38. 38.

    Stamey TA, Yang N, Hay AR, McNeal JE, Freiha F, Redwine E (1987) Prostate-specific antigen as a serum marker for adenocarcinoma of the prostate. N Engl J Med 317-909-916

  39. 39.

    Stamey TA, Kabalin JN, McNeal JE, Johnstone IM, Freiha F, Redwine EA, Yang N (1989) Prostate specific antigen in the diagnosis and treatment of adenocarcinoma of the prostate. II. Radical prostatectomy treated patients. J Urol 141:1076–1083

  40. 40.

    Terris MK, Stamey TA (1991) Determination of prostate volume by transrectal ultrasound. J Urol 145:984–987

  41. 41.

    Waehre H, Wanderaas EH, Paus E, Fossa SD (1992) Prediction of pelvic lymph node metastases by prostate specific antigen and prostatic acid phosphatase in clinical T3/4 M0 prostatic cancer. Eur Urol 22:33–38

  42. 42.

    Walsh PC (1992) Why make an early diagnosis of prostate cancer? J Urol 147:853–854

  43. 43.

    Watanabe H, Igari D, Tanahashi Y, Harada K, Saitoh M (1974) Measurements of size and weight of prostate by means of transrectal ultrasonotomography. Tohoku J Exp Med 114:277–285

Download references

Author information

Correspondence to W. F. Thon.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Thon, W.F., Gadban, F., Truss, M.C. et al. Prostate-specific antigen density — a reliable parameter for the detection of prostate cancer?. World J Urol 14, 53–58 (1996).

Download citation


  • Public Health
  • Prostate Cancer
  • Receiver Operator Characteristic
  • Benign Prostatic Hyperplasia
  • Specific Gravity