Complexed Prostate Specific Antigen Density is Better Than the Other PSA Derivatives for Detection of Prostate Cancer in Men with Total PSA between 2.5 and 20 ng/ml: Results of a Prospective Multicenter Study

• Published in: European urology Vol. 47; no. 3; pp. 302 - 307
• Main Authors: Sözen, Sinan, Eskicorapci, Saadettin, Küpeli, Bora, İrkilata, Lokman, Altinel, Mert, Özer, Gökhan, Uygur, Cemil, Alkibay, Turgut, Özen, Haluk
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier B.V 01.03.2005; Elsevier
• Subjects: Adult; Aged; Area Under Curve; Biological and medical sciences; Complexed prostate specific antigen; Derivatives; Diagnosis; Humans; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Prospective Studies; Prostate cancer; Prostate specific antigen; Prostate-Specific Antigen - blood; Prostatic Neoplasms - blood; Prostatic Neoplasms - diagnosis; Reference Values; Reproducibility of Results; Sensitivity and Specificity; Tumors of the urinary system; Urinary tract. Prostate gland; Urology - methods; Prostate specific antigen; Complexed prostate specific antigen; Derivatives; Diagnosis; Prostate cancer; Human; Nephrology; Urinary system disease; Prostate disease; Multicenter study; Male; Tumoral marker; Complexes; Density; Urology; Prospective; Total; Derivative; Adult; Male genital diseases; Derived product
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2004.10.009

This prospective, multicenter study was initiated to evaluate the diagnostic performance of PSA, free/total PSA (f/tPSA) and complexed PSA (cPSA) with volume-based parameters for early detection of prostate cancer in patients with PSA between 2.5 and 20 ng/ml. 408 subjects with serum PSA values between 2.5 and 20 ng/ml regardless of digital rectal examination (DRE) were included in to the study. The diagnostic validity, sensitivity, specificity and cut-off values were evaluated by Receiver Operating Characteristic (ROC) curve analysis. Of 408 patients 77 (18.9%) were positive for prostate cancer. Digital rectal examination was non-suspicious in 86% (351/408) of the patients. Area under curve (AUC) values for cPSA were better than PSA and f/tPSA in patients with PSA values of 2.5–10 ng/ml and 4–10 ng/ml, as well as the whole group. Furthermore, on ROC curve analysis cPSAD was the best predictor of prostate cancer for all PSA ranges regardless of the DRE findings except PSA values between 2.5 and 4 ng/ml. The cut-off value of cPSAD at 90% sensitivity was 0.06 ng/ml/cm 3 with a 35.3% specificity saving 126 unnecessary biopsies in the whole group. cPSA might be a better initial test than PSA for prostate cancer detection and measurement of cPSA alone and its derivatives obviate the need for additional fPSA testing.