Effect of prostate size on pathological outcome and biochemical recurrence after radical prostatectomy for prostate cancer: is it correlated with serum testosterone level?

Kwon, Taekmin,Jeong, In Gab,You, Dalsan,Park, Myung-Chan,Hong, Jun Hyuk,Ahn, Hanjong,Kim, Choung-Soo Blackwell Publishing Ltd 2010 BJU INTERNATIONAL Vol.106 No.5

<P>Study Type – Prognosis (case series)Level of Evidence 4</P><P>OBJECTIVE</P><P>To examine whether prostate size is associated with pathological outcome and biochemical recurrence (BCR) after radical prostatectomy (RP) in patients with prostate cancer, and to evaluate whether it is correlated with serum testosterone level.</P><P>PATIENTS AND METHODS</P><P>The study comprised 579 men treated with RP for prostate cancer between June 1991 and March 2008, with a prostate-specific antigen level of <20 ng/mL. We assessed the associations of prostate size (volume), measured using magnetic resonance imaging, and serum testosterone concentration, with adverse pathological outcomes and BCR.</P><P>RESULTS</P><P>There was a positive correlation between preoperative prostate volume and prostate weight (<I>r</I>= 0.685, <I>P</I> < 0.001). On multivariate analysis, prostate volume was inversely associated with the outcomes of high-grade prostate cancer (<I>P</I>= 0.044), extracapsular extension (<I>P</I>= 0.011) and BCR (<I>P</I>= 0.016). There was also a positive correlation between serum testosterone level and prostate volume (<I>r</I>= 0.136, <I>P</I>= 0.043). Multivariate analysis showed that lower serum testosterone levels correlated with adverse pathological stage and a pathological Gleason score of ≥8 (<I>P</I>= 0.042). However, there was no relationship between serum testosterone level and BCR after adjusting for covariates.</P><P>CONCLUSIONS</P><P>Men with smaller prostates had unfavourable pathological findings and were at greater risk of progression after RP. Low serum testosterone levels were not associated with tumour progression. Therefore, another mechanism, aside from hormonal factors, might be involved in unfavourable outcomes in patients with a small prostate.</P>

Comparison of Multiparametric and Biparametric MRI in First Round Cognitive Targeted Prostate Biopsy in Patients with PSA Levels under 10 ng/mL

이동훈,박성우,남종길,이승수,한지연,이준우,정문기 연세대학교의과대학 2017 Yonsei medical journal Vol.58 No.5

Purpose: To determine the efficacy of cognitive targeted prostate biopsy using biparametric magnetic resonance imaging (b-MRI) for patients with prostate-specific antigen levels under 10 ng/mL. Materials and Methods: We reviewed data from 123 consecutive patients who underwent cognitive targeted prostate biopsy usingprostate MRI. Of these patients, the first 55 underwent prostate biopsy using multiparametric MRI (mp-MRI), and the remaining68 underwent prostate biopsy using b-MRI. For b-MRI, we generated T2 weighted axial imaging and diffusion-weighted imaging sequences. We found that 62 of the 123 men had suspicious lesions on MRI (32 of the 55 men in the mp-MRI group and 30 of the 68 men in the b-MRI group). We compared the prostate cancer detection rates and the proportions of clinically significantprostate cancer between the different MRI sequences. Results: Between the two MRI groups, there were no statistically significant differences in prostate cancer detection rate and proportionsof clinically significant prostate cancer (41.8% vs. 30.9%, p=0.208 and 82.6% vs. 76.2%, p=0.598). Among the 62 men who had suspicious lesions on MRI, the prostate cancer detection rates were 62.5% and 63.3% (p=0.709) in the mp-MRI and b-MRI groups, respectively, and the proportions of clinically significant prostate cancer were 95.0% and 84.2% (p=0.267). Conclusion: Prostate biopsy using b-MRI showed similar performance to that using mp-MRI for detecting prostate cancer and clinically significant prostate cancer. Considering the satisfactory performance and cost effectiveness of b-MRI, this technique could be a good option for obtaining intraprostatic information for first round prostate biopsy.

Changes in Serum Prostate-Specific Antigen Levels after Potassium-Titanyl-Phosphate (KTP) Laser Vaporization of the Prostate

심명선,권택민,김성철,하성헌,안태영 대한비뇨의학회 2010 Investigative and Clinical Urology Vol.51 No.2

Purpose: The prostate-specific antigen (PSA) level decreases after transurethral resection of the prostate (TURP). However, changes in the PSA level after potassium-titanyl-phosphate (KTP) laser vaporization of the prostate are not well known. The aim of this study was to investigate the effect of KTP laser vaporization of the prostate on PSA levels in patients with benign prostatic hyperplasia (BPH). Materials and Methods: Serum PSA levels were checked before and 1, 3, 6, and 12 months after the procedure in patients who underwent KTP laser vaporization between October 2004 and August 2008. Patients with prostate cancer, a history of urinary retention, or prostatitis during the follow-up period were excluded. The results for 278 patients were studied. Results: The mean age of the patients was 69.0±6.7 years (range, 50-91 years) and the mean preoperative PSA level was 2.72±2.93 ng/ml. The PSA level tended to be increased at 1 month after the operation (3.18±3.23 ng/ml, p=0.032) but decreased within 3 months and became stabilized after 6 months at 1.79±1.82 ng/ml (p<0.001). Conclusions: PSA levels may increase after KTP laser vaporization for a certain period of time, but eventually decrease and become stabilized after 6 months. Therefore, it may be appropriate to wait up to 3 months if the PSA level rises after the procedure, and further investigation should be considered if the PSA level still remains high after 6 months. Purpose: The prostate-specific antigen (PSA) level decreases after transurethral resection of the prostate (TURP). However, changes in the PSA level after potassium-titanyl-phosphate (KTP) laser vaporization of the prostate are not well known. The aim of this study was to investigate the effect of KTP laser vaporization of the prostate on PSA levels in patients with benign prostatic hyperplasia (BPH). Materials and Methods: Serum PSA levels were checked before and 1, 3, 6, and 12 months after the procedure in patients who underwent KTP laser vaporization between October 2004 and August 2008. Patients with prostate cancer, a history of urinary retention, or prostatitis during the follow-up period were excluded. The results for 278 patients were studied. Results: The mean age of the patients was 69.0±6.7 years (range, 50-91 years) and the mean preoperative PSA level was 2.72±2.93 ng/ml. The PSA level tended to be increased at 1 month after the operation (3.18±3.23 ng/ml, p=0.032) but decreased within 3 months and became stabilized after 6 months at 1.79±1.82 ng/ml (p<0.001). Conclusions: PSA levels may increase after KTP laser vaporization for a certain period of time, but eventually decrease and become stabilized after 6 months. Therefore, it may be appropriate to wait up to 3 months if the PSA level rises after the procedure, and further investigation should be considered if the PSA level still remains high after 6 months.

대사증후군과 전립샘비대증: 대사증후군 개별요소와 전립샘용적, 전립샘특이항원의 상관관계를 통한 고찰

장택환,손정환,김재일,장석흔 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.11

Purpose: To evaluate the relationship between metabolic syndrome and benign prostatic hyperplasia in Korean men, we investigated the relation between prostate volume and the serum prostate specific-antigen (PSA) level with the factors for metabolic syndrome. Materials and Methods: We reviewed the data of 1,412 men who had a general health check-up without significant evidence of disease between January 2004 and May 2007. The age, prostate volume, PSA, PSA density and metabolic factors were measured, and the relationships of these factors were evaluated. We also compared the prostate-related data between the metabolic syndrome(MS) group and non-metabolic syndrome(NMS) group. Results: The prostate volume was significantly larger in the MS group (23.0±7.1ml) than that in the NMS group(20.9±6.1ml)(p<0.001). There was no statistically significant difference of the PSA level between the two groups(MS group: 0.86±0.66, NMS group: 0.90±0.81), but the PSAD was significantly different between the two groups(MS group: 0.038±0.027, NMS group: 0.044±0.031)(p=0.0035). We concluded that there was a significant correlation between the prostate volume and the metabolic syndrome factors. However, when analyzing the influence of each metabolic syndrome factor on the prostate volume, only the BMI was a relatively influential factor. Conclusions: Our study showed that there was significant correlation between each metabolic syndrome factor and the prostate volume. This seemed to be the result of the commonly related pathophysiology of MS and an enlarged prostrate volume, and obesity was a significant factor. It was meaningful that the PSA level in the MS group was lower than that of the NMS group in case of the same prostate volume. Purpose: To evaluate the relationship between metabolic syndrome and benign prostatic hyperplasia in Korean men, we investigated the relation between prostate volume and the serum prostate specific-antigen (PSA) level with the factors for metabolic syndrome. Materials and Methods: We reviewed the data of 1,412 men who had a general health check-up without significant evidence of disease between January 2004 and May 2007. The age, prostate volume, PSA, PSA density and metabolic factors were measured, and the relationships of these factors were evaluated. We also compared the prostate-related data between the metabolic syndrome(MS) group and non-metabolic syndrome(NMS) group. Results: The prostate volume was significantly larger in the MS group (23.0±7.1ml) than that in the NMS group(20.9±6.1ml)(p<0.001). There was no statistically significant difference of the PSA level between the two groups(MS group: 0.86±0.66, NMS group: 0.90±0.81), but the PSAD was significantly different between the two groups(MS group: 0.038±0.027, NMS group: 0.044±0.031)(p=0.0035). We concluded that there was a significant correlation between the prostate volume and the metabolic syndrome factors. However, when analyzing the influence of each metabolic syndrome factor on the prostate volume, only the BMI was a relatively influential factor. Conclusions: Our study showed that there was significant correlation between each metabolic syndrome factor and the prostate volume. This seemed to be the result of the commonly related pathophysiology of MS and an enlarged prostrate volume, and obesity was a significant factor. It was meaningful that the PSA level in the MS group was lower than that of the NMS group in case of the same prostate volume.

전립선생검 전 단기전립선특이항원속도 측정

박종탁,김세중,안현수,김영수,최종보,김선일 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.6

Purpose: We investigated whether a short-term follow-up prostate-specific antigen (PSA) measurement before prostate biopsy is useful in predicting the presence of prostate cancer. Materials and Methods: From January 2004 to May 2008, 670 patients underwent transrectal ultrasound-guided prostate biopsy. The initial PSA (PSA1) was measured at the first outpatient visit. The second PSA (PSA2) was measured the evening before prostate biopsy. Only the patients with a PSA1 between 2.5 and 20 ng/ml and an interval between PSA1 and PSA2 of between 7 and 90 days were included in this study. The short-term PSA velocity (PSAVm) was defined as {(PSA2−PSA1/interval (days)}x30. Prostate volume (PV), PSA1, PSA2, and PSAVm were compared between the patients with prostate cancer and those with benign histology. Results: Of the 362 patients who fulfilled the entry criteria, 365 prostate biopsies were performed. The PSAVm differed significantly between patients with prostate cancer and those with benign histology (p=0.021). In patients with a PSA1 of 10-20 ng/ml, age, PV, PSA1, PSA2, and PSAVm were significantly different between patients with prostate cancer and those with benign histology, whereas in patients with a PSA1 of 2.5-10 ng/ml, only PV was significantly different. In multivariate logistic regression analysis excluding PSA1 and PSA2, PSAVm was a significant predictor of prostate cancer overall and in patients with a PSA1 of 10-20 ng/ml, but not in patients with a PSA1 of 2.5-10 ng/ml. Conclusions: PSAVm was significantly different between the benign group and the prostate cancer group. But, this difference was mainly the result of a falsely elevated PSA, and PSAVm was not a significant predictor of prostate cancer when the PSA1 was 2.5-10 ng/ml. Purpose: We investigated whether a short-term follow-up prostate-specific antigen (PSA) measurement before prostate biopsy is useful in predicting the presence of prostate cancer. Materials and Methods: From January 2004 to May 2008, 670 patients underwent transrectal ultrasound-guided prostate biopsy. The initial PSA (PSA1) was measured at the first outpatient visit. The second PSA (PSA2) was measured the evening before prostate biopsy. Only the patients with a PSA1 between 2.5 and 20 ng/ml and an interval between PSA1 and PSA2 of between 7 and 90 days were included in this study. The short-term PSA velocity (PSAVm) was defined as {(PSA2−PSA1/interval (days)}x30. Prostate volume (PV), PSA1, PSA2, and PSAVm were compared between the patients with prostate cancer and those with benign histology. Results: Of the 362 patients who fulfilled the entry criteria, 365 prostate biopsies were performed. The PSAVm differed significantly between patients with prostate cancer and those with benign histology (p=0.021). In patients with a PSA1 of 10-20 ng/ml, age, PV, PSA1, PSA2, and PSAVm were significantly different between patients with prostate cancer and those with benign histology, whereas in patients with a PSA1 of 2.5-10 ng/ml, only PV was significantly different. In multivariate logistic regression analysis excluding PSA1 and PSA2, PSAVm was a significant predictor of prostate cancer overall and in patients with a PSA1 of 10-20 ng/ml, but not in patients with a PSA1 of 2.5-10 ng/ml. Conclusions: PSAVm was significantly different between the benign group and the prostate cancer group. But, this difference was mainly the result of a falsely elevated PSA, and PSAVm was not a significant predictor of prostate cancer when the PSA1 was 2.5-10 ng/ml.

Cumulative Probability of Prostate Cancer Detection Using the International Prostate Symptom Score in a Prostate-specific Antigen-based Population Screening Program in Japan

Kitagawa, Yasuhide,Urata, Satoko,Narimoto, Kazutaka,Nakagawa, Tomomi,Izumi, Kouji,Kadono, Yoshifumi,Konaka, Hiroyuki,Mizokami, Atsushi,Namiki, Mikio Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.17

The International Prostate Symptom Score (IPSS) is often used as an interview sheet for assessing lower urinary tract symptoms (LUTS) at the time of prostate-specific antigen (PSA) testing during population-based screening for prostate cancer. However, the relationship between prostate cancer detection and LUTS status remains controversial. To elucidate this relationship, the cumulative probability of prostate cancer detection using IPSS in biopsy samples from patients categorized by serum PSA levels was investigated. The clinical characteristics of prostate cancer detected using IPSS during screening were also investigated. A total of 1,739 men aged 54-75 years with elevated serum PSA levels who completed the IPSS questionnaire during the initial population screening in Kanazawa City, Japan and underwent systematic transrectal ultrasonography-guided prostate biopsy between 2000 and 2013 were enrolled in the present study. Of the 1,739 men, 544 (31.3%) were diagnosed with prostate cancer during the observation period. The probability of cancer detection at 3 years in the entire study population was 27.4% and 32.7% for men with $IPSS{\leq}7$ and those with $IPSS{\geq}8$, respectively; there was no statistically significant difference between groups. In men with serum PSA levels of 6.1 to 12.0ng/mL at initial screening, the probability of cancer detection was significantly higher in men with $IPSS{\leq}7$ than in those with $IPSS{\geq}8$. There were no significant differences in clinical characteristics between groups of patients stratified by IPSS. These findings indicate that the use of IPSS for LUTS status evaluation may be useful for prostate cancer detection in the limited range of serum PSA levels.

Significance of Serum Testosterone for Prostate-Specific Antigen (PSA) Elevation and Prediction of Prostate Cancer in Patients with PSA Above 10 ng/ml

구진모,심봉석 대한비뇨의학회 2010 Investigative and Clinical Urology Vol.51 No.12

Purpose: Testosterone is essential for the prostate gland’s normal growth and development and is also a possible risk factor for prostate cancer. This study’s aim was to determine the significance of serum testosterone for prostate-specific antigen (PSA) elevation and prostate cancer prediction in high-risk men. Materials and Methods: The study included 120 patients with PSA >10 ng/ml who underwent a transrectal-prostate biopsy. Serum testosterone, prostate volume, and PSA density (PSAD) were checked in all patients. Patients were divided into two groups, patients with and those without prostate cancer; and testosterone-related factors, prostate volume, PSA, PSAD, age, prostate cancer prediction rate, and cancer aggressiveness were evaluated. Results: Thirty-five patients (30.2%) were confirmed as having prostate cancer. The average serum testosterone level in patients without and in those with prostate cancer was 452.25±154.62 ng/dl and 458.10±158.84 ng/dl, respectively; average PSA was 17.58±9.02 ng/ml and 18.62±6.53 ng/ml, respectively; and average age was 69.02±7.52 years and 70.69±7.02 years, respectively (p>0.05). Hypogonadal and eugonadal patients showed no significant difference in cancer prevalence (30.3% vs. 32.0%, respectively). The testosterone level did not differ significantly in patients with and those without prostate cancer in either hypogonadal or eugonadal men (p>0.05). Serum testosterone showed no correlation with PSA, PSAD, or age in either group (p>0.05) and was unrelated to prostate cancer risk or aggressiveness (p>0.05). Conclusions: In our study’s results, serum testosterone at the time of diagnosis was unrelated to PSA elevation, prostate cancer risk, and aggressiveness. Purpose: Testosterone is essential for the prostate gland’s normal growth and development and is also a possible risk factor for prostate cancer. This study’s aim was to determine the significance of serum testosterone for prostate-specific antigen (PSA) elevation and prostate cancer prediction in high-risk men. Materials and Methods: The study included 120 patients with PSA >10 ng/ml who underwent a transrectal-prostate biopsy. Serum testosterone, prostate volume, and PSA density (PSAD) were checked in all patients. Patients were divided into two groups, patients with and those without prostate cancer; and testosterone-related factors, prostate volume, PSA, PSAD, age, prostate cancer prediction rate, and cancer aggressiveness were evaluated. Results: Thirty-five patients (30.2%) were confirmed as having prostate cancer. The average serum testosterone level in patients without and in those with prostate cancer was 452.25±154.62 ng/dl and 458.10±158.84 ng/dl, respectively; average PSA was 17.58±9.02 ng/ml and 18.62±6.53 ng/ml, respectively; and average age was 69.02±7.52 years and 70.69±7.02 years, respectively (p>0.05). Hypogonadal and eugonadal patients showed no significant difference in cancer prevalence (30.3% vs. 32.0%, respectively). The testosterone level did not differ significantly in patients with and those without prostate cancer in either hypogonadal or eugonadal men (p>0.05). Serum testosterone showed no correlation with PSA, PSAD, or age in either group (p>0.05) and was unrelated to prostate cancer risk or aggressiveness (p>0.05). Conclusions: In our study’s results, serum testosterone at the time of diagnosis was unrelated to PSA elevation, prostate cancer risk, and aggressiveness.

Comparative Analysis of Outcomes after Transurethral Resection of the Prostate according to Prostate Shape Shown by Transrectal Ultrasonography

이효석,김성진,송재만,김광진,정현철 대한비뇨의학회 2010 Investigative and Clinical Urology Vol.51 No.7

Purpose: Transrectal ultrasonography (TRUS) is a non-invasive modality widely used in urology on an outpatient basis to measure the volume and anatomical structure of the prostate. However, the prostate volume measured by TRUS often varies from test to test. The aim of this study was to determine the clinical significance of the different shapes of the prostate, as shown by TRUS before and after transurethral resection of the prostate (TURP). Materials and Methods: We evaluated 103 patients who underwent TURP. TRUS was performed preoperatively, and the International Prostatic Symptom Score (IPSS) and quality of life (QoL) were assessed preoperatively and at 6 months postoperatively. Patients were classified into two groups: patients with a bilaterally enlarged transitional zone were assigned to group A, and those with a protruding retrourethral zone were assigned to group B. Results: There were no statistically significant differences between the two groups in preoperative variables. However, postoperative IPSS scores were lower in group A than group B (9.87±6.15 vs. 13.18±8.07, p=0.02). With regard to postoperative IPSS scores relative to preoperative IPSS scores, both groups showed a significant decrease, but group A experienced a significantly greater decrease than group B (13.43±7.47 vs. 8.67±8.33, p=0.005). Conclusions: Patients with a prostate protruding into the bladder have less of a decrease in their IPSS scores after TURP, compared to patients that do not have prostate protrusion, meaning that patients with protrusion experience less symptomatic relief. Purpose: Transrectal ultrasonography (TRUS) is a non-invasive modality widely used in urology on an outpatient basis to measure the volume and anatomical structure of the prostate. However, the prostate volume measured by TRUS often varies from test to test. The aim of this study was to determine the clinical significance of the different shapes of the prostate, as shown by TRUS before and after transurethral resection of the prostate (TURP). Materials and Methods: We evaluated 103 patients who underwent TURP. TRUS was performed preoperatively, and the International Prostatic Symptom Score (IPSS) and quality of life (QoL) were assessed preoperatively and at 6 months postoperatively. Patients were classified into two groups: patients with a bilaterally enlarged transitional zone were assigned to group A, and those with a protruding retrourethral zone were assigned to group B. Results: There were no statistically significant differences between the two groups in preoperative variables. However, postoperative IPSS scores were lower in group A than group B (9.87±6.15 vs. 13.18±8.07, p=0.02). With regard to postoperative IPSS scores relative to preoperative IPSS scores, both groups showed a significant decrease, but group A experienced a significantly greater decrease than group B (13.43±7.47 vs. 8.67±8.33, p=0.005). Conclusions: Patients with a prostate protruding into the bladder have less of a decrease in their IPSS scores after TURP, compared to patients that do not have prostate protrusion, meaning that patients with protrusion experience less symptomatic relief.

Outcome of Prostate Biopsy in Men Younger than 40 Years of Age with High Prostate-Specific Antigen (PSA) Levels

양진백,정병창,서성일,전성수,최한용,이현무 대한비뇨의학회 2010 Investigative and Clinical Urology Vol.51 No.1

Purpose: Prostate cancer is rarely diagnosed in men younger than 40 years of age. At present, the available data show a low rate of cancer detection from prostate-specific antigen (PSA) screening of this group of young men. We analyzed the outcome of prostate biopsy results in patients of this age group with a high PSA. Materials and Methods: Between October 1997 and August 2008, a total of 81 men less than 40 years of age were referred from the Health Care Promotion Center as the result of elevated PSA levels. Six men with prostatitis were excluded. The remaining 75 men were asymptomatic and had normal findings on the digital rectal examination (DRE) and were selected to have a transrectal ultrasound-guided prostate biopsy for suspected prostate cancer. The patients with sustained high PSA levels underwent repeat biopsies. Results: The median age of the 75 men was 33 years (range, 26-40 years) and the mean PSA level was 6.57 ng/ml (range, 4.32-13.45 ng/ml). The results of the primary biopsy was 1 (1.3%) case of prostate cancer, 70 cases (93%) with benign tissue, 2 cases (2.6%) with inflammation, and 1 case each (1.3%) with high grade intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP). Of the 10 men who underwent a second biopsy, all had benign findings. Three of the men who underwent a third biopsy all had benign tissue findings. Conclusions: The prostate cancer detection rate in young men less than 40 years of age with high PSA levels and normal DREs was very low. Repeat biopsy for sustained high PSA levels in young men less than 40 years of age may not be indicated. Purpose: Prostate cancer is rarely diagnosed in men younger than 40 years of age. At present, the available data show a low rate of cancer detection from prostate-specific antigen (PSA) screening of this group of young men. We analyzed the outcome of prostate biopsy results in patients of this age group with a high PSA. Materials and Methods: Between October 1997 and August 2008, a total of 81 men less than 40 years of age were referred from the Health Care Promotion Center as the result of elevated PSA levels. Six men with prostatitis were excluded. The remaining 75 men were asymptomatic and had normal findings on the digital rectal examination (DRE) and were selected to have a transrectal ultrasound-guided prostate biopsy for suspected prostate cancer. The patients with sustained high PSA levels underwent repeat biopsies. Results: The median age of the 75 men was 33 years (range, 26-40 years) and the mean PSA level was 6.57 ng/ml (range, 4.32-13.45 ng/ml). The results of the primary biopsy was 1 (1.3%) case of prostate cancer, 70 cases (93%) with benign tissue, 2 cases (2.6%) with inflammation, and 1 case each (1.3%) with high grade intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP). Of the 10 men who underwent a second biopsy, all had benign findings. Three of the men who underwent a third biopsy all had benign tissue findings. Conclusions: The prostate cancer detection rate in young men less than 40 years of age with high PSA levels and normal DREs was very low. Repeat biopsy for sustained high PSA levels in young men less than 40 years of age may not be indicated.

Predictive Factors for Prostate Cancer in Biopsy of Patients with Prostate-Specific Antigen Levels Equal to or Less Than 4 ng/ml

김형우,고영휘,강석호,이정구 대한비뇨의학회 2011 Investigative and Clinical Urology Vol.52 No.3

Purpose: This study was conducted to identify the predictive factors for prostate cancer in patients with prostate-specific antigen (PSA) levels equal to or less than 4 ng/ml. Materials and Methods: A retrospective study of medical records was conducted on 292 patients with initial serum PSA ≤4 ng/ml among 2,305 patients who underwent prostate biopsy from January 2003 to December 2008. Prostate biopsy was performed on patients with PSA ≤4 ng/ml in the case of abnormal findings in the digital rectal examination (DRE) or transrectal ultrasonography (TRUS) or in those with a PSA level higher than the age-adjusted PSA levels. The patients were divided into the group diagnosed with prostate cancer and the non-prostate-cancer group. Subsequently, the variables of the two groups were compared. Results: The patients’ mean age was significantly higher in the prostate cancer group (n=28) than in the non-prostate-cancer group (n=264; p=0.033). In addition, for the patients with a PSA range of 2.0-2.9 ng/ml, their age (p=0.049) and PSA density (PSAD; p=0.042) were significantly higher and the prostate volume (p=0.028) was significantly smaller in the prostate cancer group than in the non-prostate-cancer group. Conclusions: Of the patients with PSA ≤4 ng/ml, the age of the patients who showed abnormal findings in the DRE or TRUS or who had a PSA level higher than the age-adjusted PSA level was a significant predictive factor for prostate cancer. In particular, for the PSA range of 2.0-2.9 ng/ml, a thorough screening test for prostate cancer was required if the patients had conditions such as higher age, smaller prostate, and higher PSAD.