NE-AUA 2006 Annual Meeting, September 28 - 30, 2006, The Westin Hotel & Rhode Island Convention Center Providence, Rhode Island
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Does PSA Density Predict Positive Prostate Biopsy and Prostate Cancer Aggressiveness?
Mazen Abdelhady, MD, MSc, Ashraf J. Abusamra, MD, FRCSC, Donal Downey, MD, FRCPC, Jonathan Izawa, MD, BSc, FRCSC, Joseph Chin, MD, FRCSC.
London Health Sciences Centre, University of Western Ontario, London, ON, Canada.

Does PSA density predict positive prostate biopsy and prostate cancer aggressiveness?
Introduction: Prostate Specific Antigen Density (PSAD) value < 0.15 ng/ml/cc has been used to assist in selecting patients (pts) for prostate biopsy (Bx). However, PCa is not uncommon in the low PSAD range and the value of PSAD in predicting aggressiveness of PCa on Bx has not been explored previously. The objective of this study was to analyze the predictors of PCa detection on transrectal ultrasound (TRUS) guided Bx in pts with PSAD < 0.15, and test our hypothesis that PSAD ≥ 0.15 may predict the presence of aggressive pathological features of PCa on TRUS Bx.
Methods: Retrospective review of TRUS and pathology reports of all pts who underwent TRUS Bx in 1 year period was done. Ptís age, family history of PCa, DRE, PSA, free/total PSA, prostate volume, PSAD, TRUS appearance (graded 1-5 based on level of suspicion), number of cores obtained, findings on pathology report [Gleason score, % of cancer in specimen, extraprostatic extension (EPE), perineural invasion (PNI)], and history of HGPIN & ASAP were reviewed according to Bx results. Univariate and multivariate logistic regression analyses, unpaired t-test and Chi-square test were used for statistical analysis. Separate analyses of subjects with PSA < 4 and PSA < 10 were done
Results: In 2004, 1005 men underwent TRUS guided biopsy by one physician (DD). Of these men, 635 had PSAD < 0.15 ng/ml/cc. 545 men had PSA < 10 and 162 had PSA < 4. 481 pts were diagnosed with PCa, of these, 226 pts had PSAD < 0.15 and 366 pts had PSA < 10. In univariate analysis of the predictors of PCa detection on TRUS Biopsy in men with PSAD < 0.15, all the variables tested were significant except history of ASAP, but only ptís age, prostate volume, TRUS findings, and history of HGPIN continued to show significance in multivariate analysis. PSAD ≥ 0.15 was associated with worse pathological features of PCa on TRUS Biopsy (higher Gleason score, higher % of cancer, EPE, and perineural invasion)
Conclusions: PCa is detected on TRUS BX in 35-45% of pts with PSAD < 0.15. The predictive factors identified can help guide the biopsy strategies in pts with PSAD < 0.15. PSAD ≥ 0.15 correlated with worse pathological features on Bx. This finding should permit appropriate counseling of pts as to the likelihood of finding adverse pathological PCa features.


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