Predictive Factors and Characteristics of the Prostate Cancer in Patients with Serum PSA Levels Equal or Less than 4.0ng/ml

Sohn, Dong Wan; Byun, Seok Soo; Lee, Sang Eun

Abstract

PURPOSE: We identified preoperative factors and characteristics of prostate cancer with prostate-specific antigen (PSA) levels equal to or less than 4.0ng/ml, with an elevated PSA above age reference range, abnormal transrectal ultrasonography (TRUS) or digital rectal examination (DRE).
MATERIALS AND METHODS
A total of 322 patients underwent 12 cores prostate biopsy guided TRUS between May 2003 and July 2004. Of these, 92 had a total PSA level of 4ng/ml or less. The indications for a biopsy were an elevated PSA above the age reference range, and an abnormal DRE and TRUS. The age, abnormalities of the DRE or TRUS, and the prostate volume, PSAD, International Prostate Symptom Score (IPSS) and maximal flow rate (Qmax) were measured, and the relationships of theses factors between the cancer and non-cancer groups evaluated.
RESULTS
Of the 92 patients with a total PSA level of 4ng/ml or less, 19 were confirmed with prostate cancer; a cancer detection rate of 20.6%. The mean ages of patients in the cancer and non-cancer groups were 70.3 and 62.0 years, respectively. The mean prostate volumes, PSA levels, IPSS and Qmax were 31.4 and 48.9ml, 3.23 and 3.17ng/ml, 19.3 and 16.3 and 15.8 and 13.9ml/sec, respectively, in the cancer and non-cancer groups. The advanced age (p<0.05) and a decreased prostate volume (p<0.05) were associated with a positive prostate biopsy. The PSA level, abnormalities of DRE or TRUS, IPSS and Qmax were not associated with a positive biopsy.
CONCLUSIONS
The detection rates of prostate and insignificant cancers rate were 20.6 and 36.8%, respectively. An advanced age and a decreased prostate volume were significant predictive factors of cancer in patients with PSA level equal to or less than 4.0ng/ml, with an elevated PSA above age reference range, abnormal TRUS or DRE. (Korean J Urol 2005; 46:565-568)