Skip to main content

Advertisement

SpringerLink
Log in

Role of PSA density in diagnosis of prostate cancer in obese men

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

To compare the performance of prostate-specific antigen (PSA) density in the diagnosis of prostate cancer in obese and non-obese Chinese men.

Methods

The results of transrectal ultrasound-guided (TRUS) prostate biopsies of Chinese men with PSA <20 ng/mL were reviewed. Parameters including age, body mass index (BMI), TRUS prostate volume, and TRUS biopsy results were recorded. The diagnostic yields of PSA density (>0.15 ng/mL as positive) in obese and non-obese men with PSA <20 ng/mL were compared. Obesity was defined as BMI ≥ 27 kg/m2 according to WHO recommendation for Hong Kong Chinese.

Results

TRUS biopsy, BMI, and PSA density data were available for 854 men (mean age 65.9 ± 7.3). The mean PSA values for the obese and non-obese patients were 7.9 ± 3.7 and 8.2 ± 4.1 ng/mL, respectively (p = 0.416). TRUS volumes in obese and non-obese men were 63.2 ml and 51.6 ml, respectively (t test, p < 0.001), and PSA density was significantly lower in obese men (0.145 vs. 0.188, p < 0.001). For obese men, positive PSA density was associated with four times (41.1 vs. 9.5 %, p < 0.001) the risk of prostate cancer, compared to only twice the risk (18.8 vs. 9.7 %, p = 0.001) in non-obese men. The specificity and area under the curve of PSA density were 74.2 % and 0.731, respectively, for obese men, and 51.4 % and 0.653, respectively, for non-obese men. Among patients with a diagnosis of prostate cancer, the obese patient group had a significantly higher proportion of patients with Gleason 7–10 prostate cancer than the non-obese patient group (48.9 vs. 32.7 %, Chi-square test, p = 0.035), and a trend toward a higher proportion of bilateral lobe involvement.

Conclusion

PSA density had better performance in obese men. Positive PSA density in obese men was associated with four times the risk of prostate cancer.

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. Swinburn BA, Sacks G, Hall KD et al (2011) The global obesity pandemic: shaped by global drivers and local environments. Lancet 378(9793):804–814

    Article  PubMed  Google Scholar 

  2. World Health Organization Expert Consultation (2004) Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363(9403):157–163

    Article  Google Scholar 

  3. Buschemeyer WC 3rd, Freedland SJ (2007) Obesity and prostate cancer: epidemiology and clinical implications. Eur Urol 52(2):331–343

    Article  PubMed  Google Scholar 

  4. Dahle SE, Chokkalingam AP, Gao YT et al (2002) Body size and serum levels of insulin and leptin in relation to the risk of benign prostatic hyperplasia. J Urol 168(2):599–604

    Article  CAS  PubMed  Google Scholar 

  5. Freedland SJ, Platz EA, Presti JC et al (2006) Obesity, serum prostate specific antigen and prostate size: implications for prostate cancer detection. J Urol 175(2):500–504

    Article  PubMed  Google Scholar 

  6. Grubb RL 3rd, Black A, Izmirlian G et al (2009) Serum prostate-specific antigen hemodilution among obese men undergoing screening in the prostate, lung, colorectal, and ovarian cancer screening trial. Cancer Epidemiol Biomark Prev 18(3):748–751

    Article  CAS  Google Scholar 

  7. Ohwaki K, Endo F, Muraishi O et al (2010) Relationship between prostate-specific antigen and hematocrit: does hemodilution lead to lower PSA concentrations in men with a higher body mass index? Urology 75(3):648–652

    Article  PubMed  Google Scholar 

  8. Chiu PK, Wong AY, Hou SM et al (2011) Effect of body mass index on prostate-specific antigen levels among patients presented with lower urinary tract symptoms. Asian Pac J Cancer Prev 12(8):1937–1940

    PubMed  Google Scholar 

  9. Freedland SJ, Aronson WJ, Kane CJ et al (2004) Impact of obesity on biochemical control after radical prostatectomy for clinically localized prostate cancer: a report by the Shared Equal Access Regional Cancer Hospital database study group. J Clin Oncol 22(3):446–453

    Article  PubMed  Google Scholar 

  10. Strom SS, Kamat AM, Gruschkus SK et al (2006) Influence of obesity on biochemical and clinical failure after external beam radiotherapy for localized prostate cancer. Cancer 107(3):631–639

    Article  PubMed  Google Scholar 

  11. Benson MC, Whang IS, Pantuck A et al (1992) Prostate specific antigen density: a means of distinguishing benign prostatic hypertrophy and prostate cancer. J Urol 147(3 Pt 2):815–816

    CAS  PubMed  Google Scholar 

  12. Bazinet M, Meshref AW, Trudel C et al (1994) Prospective evaluation of prostate-specific antigen density and systematic biopsies for early detection of prostatic carcinoma. Urology 43(1):44–51

    Article  CAS  PubMed  Google Scholar 

  13. Djavan B, Remzi M, Zlotta AR et al (2002) Complexed prostate-specific antigen, complexed prostate-specific antigen density of total and transition zone, complexed/total prostate-specific antigen ratio, free-to-total prostate-specific antigen ratio, density of total and transition zone prostate-specific antigen: results of the prospective multicenter European trial. Urology 60(4 Suppl 1):4–9

    Article  PubMed  Google Scholar 

  14. Bazinet M, Meshref AW, Trudel C et al (1994) Prospective evaluation of prostate-specific antigen density and systematic biopsies for early detection of prostatic carcinoma. Urology 43(1):44–51

    Article  CAS  PubMed  Google Scholar 

  15. Catalona WJ, Richie JP, deKernion JB et al (1994) Comparison of prostate specific antigen concentration versus prostate specific antigen density in the early detection of prostate cancer: receiver operating characteristic curves. J Urol 152(6 Pt 1):2031–2036

    CAS  PubMed  Google Scholar 

  16. Andersson SO, Wolk A, Bergstrom R et al (1997) Body size and prostate cancer: a 20-year follow-up study among 135006 Swedish construction workers. J Natl Cancer Inst 89(5):385–389

    Article  CAS  PubMed  Google Scholar 

  17. Ferro M, Bruzzese D, Perdona S et al (2013) Prostate Health Index (Phi) and Prostate Cancer Antigen 3 (PCA3) significantly improve prostate cancer detection at initial biopsy in a total PSA range of 2–10 ng/ml. PLoS one 8(7):e67687

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Scattoni V, Lazzeri M, Lughezzani G et al (2013) Head-to-head comparison of prostate health index and urinary PCA3 for predicting cancer at initial or repeat biopsy. J Urol 190(2):496–501

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong

    Peter Ka-Fung Chiu, Jeremy Yuen-Chun Teoh, Samson Yun-Sang Chan, See-Ming Hou & Chi-Fai Ng

  2. Department of Surgery, Tuen Mun Hospital, Tuen Mun, Hong Kong

    Peggy Sau-Kwan Chu & Chi-Wai Man

Authors
  1. Peter Ka-Fung Chiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeremy Yuen-Chun Teoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Samson Yun-Sang Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peggy Sau-Kwan Chu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chi-Wai Man
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. See-Ming Hou
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Chi-Fai Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chi-Fai Ng.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chiu, P.KF., Teoh, J.YC., Chan, S.YS. et al. Role of PSA density in diagnosis of prostate cancer in obese men. Int Urol Nephrol 46, 2251–2254 (2014). https://doi.org/10.1007/s11255-014-0826-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-014-0826-7

Keywords

Search

Navigation