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Value of prostate volume measurement using transabdominal ultrasonography for the improvement of prostate‐specific antigen‐based cancer detection
Author(s) -
KOBAYASHI TAKASHI,
KAWAHARA TAKASHI,
NISHIZAWA KOJI,
OGURA KEIJI,
MITSUMORI KENJI,
IDE YOSHIHIRO
Publication year - 2005
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/j.1442-2042.2005.01162.x
Subject(s) - medicine , transrectal ultrasonography , prostate cancer , prostate , urology , rectal examination , receiver operating characteristic , prostate specific antigen , biopsy , prostate biopsy , ultrasonography , area under the curve , cancer , radiology
Purpose: To examine value of prostate‐specic antigen (PSA) adjusted by prostate volume measured using transabdominal ultrasonography in prostate cancer detection among men with elevated PSA. Methods: 238 men aged 79 years or younger with serum PSA levels of 2.0–20.0 ng/mL and normal digital rectal examination ndings were studied in terms of total and free PSA, prostate volumes with transrectal (TRUS) and transabdominal (TAUS) ultrasonography and transition zone volumes with TRUS prior to transrectal 10‐core biopsy. In addition to sole PSA values and the free‐to‐total PSA ratio, volume‐adjusted PSA values, PSA densities determined by TRUS (PSAD TRUS ), and TAUS (PSAD TAUS ), and PSA transition zone densities (PSATzD) were compared using receiver operating characteristic (ROC) analysis. Results: Prostate cancer was diagnosed in 58 (24.4%) of the 238 men who underwent prostate biopsies. Of the areas under ROC curves (AUC) of studied parameters, PSATzD (AUC 0.751) was the best and signicantly superior to PSAD TAUS (AUC 0.664, P = 0.007). However, PSAD TAUS exceeded PSA (AUC 0.559, P = 0.004) and showed potential capability of a one‐fourth reduction in unnecessary biopsies without spoiling sensitivity (90%). Cancer detection rate was only 4.2% in the 48 patients whose prostate volume in TAUS was > 50 mL and PSAD TAUS was < 0.075. Conclusions: Since PSAD TRUS and PSATzD were signicantly superior to PSAD TAUS , TRUS is feasible as the standard fashion to determine prostate volume in the diagnosis of prostate cancers. However, TAUS is also worthwhile as it can improve the prostate cancer detection using sole PSA, and primary use of TAUS has the potential to reduce the substantial number of unnecessary biopsy safely.