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Volume 23, Issue 4 (July 2021) 23, 415–420; 10.4103/aja.aja_72_20

Peripheral zone PSA density: a predominant variable to improve prostate cancer detection efficiency in men with PSA higher than 4 ng ml-1

Cheng Wang1,2, Yue-Yang Wang3, Shi-Yuan Wang3, Ji-Xiang Ding2, Mao Ding3, Yuan Ruan3, Xiao-Hai Wang3, Yi-Feng Jing3, Bang-Min Han3, Shu-Jie Xia3, Chen-Yi Jiang3, Fu-Jun Zhao3,4

1 Department of Urology, Jiangsu Jiangyin People's Hospital, Jiangyin 214400, China
2 Department of Urology, Shanghai General Hospital of Nanjing Medical University, Shanghai 200080, China
3 Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
4 Department of Urology, Kashgar Prefecture Second People's Hospital, Kashi 844000, China

Correspondence: Dr. FJ Zhao (fujunzhao@yeah.net) or Dr. CY Jiang (chenyi_jiang@126.com)

Date of Submission 19-Oct-2019 Date of Acceptance 22-Sep-2020 Date of Web Publication 15-Jan-2021


To improve the diagnostic efficiency of prostate cancer (PCa) and reduce unnecessary biopsies, we defined and analyzed the diagnostic efficiency of peripheral zone prostate-specific antigen (PSA) density (PZ-PSAD). Patients who underwent systematic 12-core prostate biopsies in Shanghai General Hospital (Shanghai, China) between January 2012 and January 2018 were retrospectively identified (n = 529). Another group of patients with benign prostatic hyperplasia (n = 100) were randomly preselected to obtain the PSA density of the non-PCa cohort (N-PSAD). Prostate volumes and transition zone volumes were measured using multiparameter magnetic resonance imaging (mpMRI) and were combined with PSA and N-PSAD to obtain the PZ-PSAD from a specific algorithm. Receiver operating characteristic (ROC) curve analysis was used to assess the PCa detection efficiency in patients stratified by PSA level, and the area under the ROC curve (AUC) of PZ-PSAD was higher than that of PSA, PSA density (PSAD), and transition zone PSA density (TZ-PSAD). PZ-PSAD could amend the diagnosis for more than half of the patients with inaccurate transrectal ultrasonography (TRUS) and mpMRI results. When TRUS and mpMRI findings were ambiguous to predict PCa (PIRADS score ≤3), PZ-PSAD could increase the positive rate of biopsy from 21.7% to 54.7%, and help 63.8% (150/235) of patients avoid unnecessary prostate biopsy. In patients whose PSA was 4.0–10.0 ng ml−1, 10.1–20.0 ng ml−1, and >20.0 ng ml−1, the ideal PZ-PSAD cut-off value for predicting clinically significant PCa was 0.019 ng ml−2, 0.297 ng ml−2, and 1.180 ng ml−2, respectively (sensitivity >90%). Compared with PSA, PSAD, and TZ-PSAD, the efficiency of PZ-PSAD for predicting PCa is the highest, leading to fewer missed diagnoses and unnecessary biopsies.

Keywords: benign prostate hyperplasia; detection efficiency; peripheral zone prostate-specific antigen density; prostate biopsy; prostate-specific antigen; prostatic neoplasm

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