Is Prostate Specific Antigen Density more Important than in the Diagnosis of Prostate Cancer in Patients with a Total Prostate Specific Antigen Value <10 ng/mL?

Objective: To retrospectively investigate the prostate specific antigen (PSA) level, PSA density and prostate volume in benign prostate hyperplasia (BPH), BPH+Chronic Prostatitis and Prostate Adenocarcinoma (PCa) patients undergoing transrectal prostate needle biopsy due to increased PSA values. Materials and Methods: The records of the patients who presented to Sevket Yilmaz Education and Research Hospital's Urology outpatients between January 2011 and December 2013 with lower urinary system symptoms and underwent prostate needle biopsy were reviewed and a total of 504 patients included in the study. The age, free PSA, total PSA, free/total PSA ratio, prostate volume, PSA density and pathology result were evaluated for each patient. The patients were divided into 3 groups as BPH, BPH + Chronic Prostatitis, and PCa. There were 309 (61.3%), 104 (20.6%) and 91 (18.1%) patients in the three groups respectively. Patients in whom PSA levels were >10 ng/mL and in whom small atypical acinar proliferation and high grade prostatic intraepithelial neoplasia were present were excluded. The relation between serum total PSA, free PSA, free/total PSA ratio, age, prostate volume and PSA density of the groups were evaluated. Results: The mean values for age, total PSA, free PSA, prostate volume, free/total PSA and PSA density were respectively as follows: 62.71 +/- 7.72 (range 40-79) years, 6.30 +/- 2.27 ng/mL; 1.65 +/- 0.69 ng/mL; 61.22 +/- 29.09 mL; 0.23 +/- 0.10; 0.12 +/- 0.06. The ages were similar in the three groups. There was a statistically significant difference between the groups for prostate volume and PSA density (p<0.001, p=0.01) while there were no significant differences for age, total PSA, free PSA and free/total PSA ratio (p=0.1, p=0.34, p=0.58, p=0.31 respectively). Conclusion: There was a significant difference for prostate volume and PSA density values between the BPH, Chronic Prostatitis and PCa groups of similar age. We therefore concluded that unnecessary biopsies might be prevented by using the PSA density value more actively in patients with a PSA value <10 ng/mL.