Citation: BJU International. 2012, 109, 17
Author: Ekwueme K.C.; Simpson H.; Zakhour H.D.; Parr N.J.
Abstract: Introduction and Objective: Persistent suspicion of PCa despite negative TRUSB presents a dilemma. TTSB is useful, although expensive and associated with significant morbidity. To improve predictive value of PSA additional serum forms and modifications are reported, but are unreliable in the setting of TRUSB, probably because the technique fails to detect a significant proportion of tumours. We postulated that predictive values should be superior in relationship to TTSB. Patients and Methods: A modified TTSB was performed on 139 patients with persistently elevated PSA despite median of 2 (1-6) negative TRUSB. Prior to TTSB, serum PSA (sPSA), PSAD and %fPSA were documented and evaluated for ability to predict PCa diagnosis, GS and CaV (maximum % core, MPC, aggregate of tumour lengths from positive cores, ATLPC and maximum tumour length, MTL). Results: Median age was 63 (48-85), PSA 10 ng/ml (2-114), prostate volume 44cc (18-90), PSAD 0.21 (0.01-2.99), %fPSA 10 (1-32) and number of cores taken 29 (16-43). 71 were diagnosed with PCa (51%). 343 (17%) of total 2004 cores were positive, Gleason 6 (20%), 7 (60%) and 8-10 (20%). Mean MPC was 51% (1-100), ATLPC 51 mm (1-139) and MTL 5 mm (1-16). PSA, PSAD and %fPSA showed linear correlation (r = 0.44, 0.54 & -0.36 respectively). AUC for PSA (0.81) was superior to sPSA and %fPSA (0.76&0.29). PSAD predicted GS 7-10 (p = 0.004), MPC (p = 0.001), ATLPC (p = 0.002) and MTL (p = 0.001). At cut-off of 0.10, PSAD has sensitivity 96%, avoiding unnecessary biopsy in 20%. %fPSA was unreliable predictor of GS (p = 0.58) and CaV. Conclusions: PSAD reliably predicts PCa diagnosis, high grade and CaV in men undergoing TTSB. PSAD >0.10 has high sensitivity and value in deciding to offer TPSB.
