Skip to main content
SpringerLink
Log in

An algorithm for prostate cancer detection in a patient population using prostate-specific antigen and prostate-specific antigen density

  • Published:
World Journal of Urology Aims and scope Submit manuscript

Summary

Prostate-specific antigen (PSA) is the most accurate serum marker for cancer of the prostate (CaP). However, its sensitivity and specificity are suboptimal, especially at values ranging between 4.1 and 10.0 ng/ml (monoclonal), because benign prostatic hypertrophy and hyperplasia (BPH) and CaP frequently coexist in this range. This study was undertaken to determine the value of incorporating prostate volume measurements with serum PSA levels in a quotient (PSA/volume) entitled PSA density (PSAD). A total of 3140 patients were analyzed and stratified by serum PSA, digital rectal examination (DRE), transrectal prostate ultrasound (TRUS), TRUS volume determination and PSAD. All patients were referred for evaluation and therefore do not represent a screened population. Patients underwent prostate biopsies when abnormalities in TRUS or DRE were detected. Although both PSA and PSAD have statistical significance when the serum PSA value is ≦4.0 ng/ml, neither has clinical significance in differentiating BPH from CaP. At serum levels ranging between 4.1 and 10.0 ng/ml, PSA has no ability to differentiate BPH from CaP, whereas PSAD does so with statistical and clinical significance. When the PSA value is between 10.1 and 20.0 ng/ml, only PSAD is statistically significant. When PSA exceeds 20 ng/ml, PSAD is redundant. We conclude that all patients with an abnormality on DRE or TRUS should undergo prostate biopsy. If the PSA value is ≦4.0 ng/ml, TRUS and PSAD are not warranted and routine biopsy is not recommended. For intermediate PSA levels, 4.1–10.0 ng/ml, TRUS, TRUS prostate volume, and PSAD are important. The use of PSAD provides unique information regarding the need for biopsy and the likelihood of CaP. At PSA levels ranging between 10.1 and 20.0 ng/ml, PSAD will identify those patients who are less likely to have CaP, but all should undergo biopsy. If the PSA value is >20 ng/ml, all patients should undergo a biopsy.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Wang MC, Valenzuela LA, Murphy GP, Chu TM (1979) Purification of a human prostate specific antigen. Invest Urol 17:159–163

    Google Scholar 

  2. Wang MC, Papsidero LD, Kuriyama M et al (1981) Prostatic antigen: a new potential marker for prostatic cancer. P Rostate 2:89–96

    Google Scholar 

  3. Babaian RJ, Fritsche HA, Evans RB (1990) Prostate gland volume: correlation and clinical application. J Clin Lab Anal 4:135–137

    Google Scholar 

  4. Guinan P, Bhatti R, Ray P (1987) An evaluation of prostate specific antigen in prostatic cancer. J Urol 137:686–689

    Google Scholar 

  5. Papsidero LD (1983) Monoclonal antibody (F5) to human prostate antigen. Hybridoma 2:139–147

    Google Scholar 

  6. Lange PH, Brawer MK (1989) Serum prostate-specific antigen: its use in diagnosis and management of prostate cancer. Urology 33 [Suppl]:13–17

    Google Scholar 

  7. Stamey TA, Yang N, Hay AR et al (1987) Prostate-specific antigne as a serum marker for adenocarcinoma of the prostate. N Engl J Med 317:909–916

    Google Scholar 

  8. Chan DW, Bruzek DJ, Oesterling JE et al (1987) Prostate specific antigen as a marker for prostatic cancer: a monoclonal and a polyclonal immunoassay compared. Clin Chem 33:1916–1920

    Google Scholar 

  9. Catalona WJ, Smith DS, Ratliff TL et al (1991) Measurement of prostate-specific antigen in serum as a screening test for prostate cancer. N Engl J Med 324:1156–1161

    Google Scholar 

  10. Cooner WH (1991) Prostate-specific antigen, digital rectal examination, and transrectal ultrasonic examination of the prostate in prostate cancer detection. In: Stamey TA (ed) 1991 Monographs in Urology, vol 12, pp 3–13

  11. Cooner WH, Mosley BR, Rutherford CL et al (1990) Prostate cancer detection in a clinical urological practice by ultrasonography, digital rectal examination and prostate specific antigen. J Urol 143:1146–1154

    Google Scholar 

  12. Cooner WH, Mosley BR, Rutherford CL et al (1988) Clinical application of transrectal ultrasonography and prostate specific antigen in the search for prostate cancer. J Urol 139:758–761

    Google Scholar 

  13. Waterhouse RL, Resnick MI (1989) The use of transrectal prostatic ultrasonography in the evaluation of patients with prostatic carcinoma. J Urol 141:233–239

    Google Scholar 

  14. Benson MC, Ring KS, Olsson CA (1989) The determination of stage D-0 carcinoma of the prostate utilizing PSA. Urol Correspondence Club September

  15. Benson MC, Whang IS, Pantuck A et al (1992) Prostate specific antigen density: a means of distinguishing BPH and prostate cancer. J Urol 147:815–816

    Google Scholar 

  16. Benson MC, Whang IS, Olsson CA et al (1992) The use of prostate specific antigen density (PSAD) to enhance the predictive value of intermediate levels of serum PSA. J Urol 147:817–821

    Google Scholar 

  17. Littrup PJ, Williams CR, Egglin TK, Kane RA (1991) Determination of prostate volume with transrectal ultrasound for cancer screening, part II. Radiology 179:49–53

    Google Scholar 

  18. Stamey TA, Kabalin JN (1989) Prostate specific antigen in the diagnosis and treatment of adenocarcinoma of the prostate. I. Untreated patients. J Urol 141:1070–1075

    Google Scholar 

  19. Stamey TA, Kabalin JN, McNeal JE et al (1989) Prostate specific antigen in the diagnosis and treatment of adenocarcinoma of the prostate. II. Radical prostatectomy treated patients. J Urol 141:1076–1083

    Google Scholar 

  20. Stamey TA, Kabalin JN, Ferrari M (1989) Prostate specific antigen in the diagnosis and treatment of adenocarcinoma of the prostate. III. Radiation treated patients. J Urol 141:1084–1087

    Google Scholar 

  21. Stamey TA, Kabalin JN, Ferrari M, Yang N (1989) Prostate specific antigen in the diagnosis and treatment of adenocarcinoma of the prostate. IV. Anti-androgen treated patients. J Urol 141:1088–1090

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Columbia University College of Physicians and Surgeons, J. Bentley Squier Urologic Clinic, Columbia-Presbyterian Medical Center New York, New York, USA

    M. C. Benson & C. A. Olsson

  2. Irving Center for Clinical Research, Columbia University College of Physicians and Surgeons New York, New York, USA

    D. J. McMahon

  3. Department of Urology, Emory University, Atlanta, Georgia, USA

    W. H. Cooner

Authors
  1. M. C. Benson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. J. McMahon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W. H. Cooner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. A. Olsson
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Benson, M.C., McMahon, D.J., Cooner, W.H. et al. An algorithm for prostate cancer detection in a patient population using prostate-specific antigen and prostate-specific antigen density. World J Urol 11, 206–213 (1993). https://doi.org/10.1007/BF00185070

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00185070

Keywords

Search

Navigation