The effectiveness of prostate specific antigen density in predicting prostate cancer and clinically significant prostate cancer in patients aged 70 years and over

Abstract

Objectives: To evaluate the effects of free-to-total prostate specific antigen ratio, prostate specific antigen density and prostate volume in predicting prostate cancer and clinically significant cancer in patients aged 70 years or older and in establishing eligible cut-off levels. Materials and Method: A retrospective study was done on the data of 1848 men who underwent prostate biopsy in our clinic between January 2015 and October 2019. Patients with prostate specific antigen levels >10ng/mL were excluded. Volumes were obtained by transrectal ultrasound. A clinically significant cancer was defined as having a Gleason score of ≥7. Results: 130 patients with available data were enrolled in the study. Prostate specific antigen density, prostate volume and free-to-total prostate specific antigen ratio were significantly different in patients with or without cancer. Regarding area under curve, prostate specific antigen density and prostate volume showed similar efficacy, and both performed better than free-to-total prostate specific antigen ratio (Area under curves for prostate specific antigen density, prostate volume and free-to-total prostate specific antigen ratio were= 0.770, 0.769 and 0.627, respectively). A multivariate analysis showed that only prostate specific antigen density was an independent predictor for prostate cancer and clinically significant prostate cancer, with cut-off values of 0.11 and 0.199, respectively. Conclusion: Prostate specific antigen density is seen as one step ahead of prostate volume and free-to-total prostate specific antigen ratio in predicting prostate cancer and clinically significant prostate cancer. Prostate specific antigen density may play an active role in deciding prostate biopsies to prevent unnecessary tests in elderly.