Is prostate volume better than PSA density and free/total PSA ratio in predicting prostate cancer in patients with PSA 2.5–10 ng/mL and 10.1–30 ng/mL?

Figures & data

Table 1. Clinical characteristics of patients.

		SD
Age (years) (mean /min–max)	65.49(42–79)	6.8
total PSA (ng/mL) (mean /min–max)	9.55 (2.04–29.9)	5.42
free/total PSA (mean /min–max)	0.23 (0.045–0.574)	0.099
PV (mL) (mean /min–max)	63.8 (20–200)	30.7
BMI (kg/m^2) (mean /min–max)	26.9 (18.9–43.2)	3.28
PSAD (ng/mL/mL) (mean /min–max)	0.18 (0.029–1.197)	0.160
PCa patients (n)	74 (%35.07)
BPH patients (n)	137 (%64.93)
Total (n)	211

PV: prostate volume; BMI: body mass index; PSA: prostate-specific antigen; PSAD: prostate-specific antigen density; PCa; prostate cancer; BPH; benign prostatic hyperplasia; SD: standard deviation.

Table 2. Comparison of patients’age, bmi, total psa, prostate volume, PSAD between Cancer and non-cancer groups.

Parameters	Prostate cancer	Non prostate cancer	p value^a
	(n = 74)	(n = 137)
Age (years)			.044
Mean ± SD	67.0 ± 7.0	64.6 ± 6.5
Median (IQR)	68.0 (52–79)	65.0 (42–79)
BMI (kg/m2)			.976
Mean ± SD	27.0 ± 3.1	26.8 ± 3.3
Median (IQR)	26.4 (20.9–38.5)	27.0 (18.9–43.2)
Total psa (ng/mL)			.963
Mean ± SD	9.9 ± 6.1	9.3 ± 5.0
Median (IQR)	7.5 (2.5–29.9)	8.1 (3.0–29.0)
F/T psa			<.001
Mean ± SD	0.20 ± 0.09	0.25 ± 0.09
Median (IQR)	0.18 (0.06–0.50)	0.24 (0.04–0.57)
Prostate volume (mL)			<.001
Mean ± SD	47.0 ± 18.6	72.8 ± 32.2
Median (IQR)	41.5 (20–108)	65.0 (23–200)
PSAD (ng/mL/mL)			<.001
Mean ± SD	0.24 ± 0.19	0.14 ± 0.12
Median (IQR)	0.17 (0.03–1.03)	0.12 (0.04–1.20)

^a Mann–Whitney U test.

BMI: body mass index; F/T: free/total; PSAD: PSA density.

Table 3. Comparison of patients’age, BMI, total PSA, F/T PSA, prostate volume and PSAD between cancer and non-cancer groups with PSA 2.5–10 ng/ml and PSA 10.1–30 ng/ml.

	PSA 2.5–10 ng/ml			PSA 10.1–30 ng/ml
Parameters	Biopsy result		p value^a	Biopsy result		p value^a
	Cancer	Non-cancer		Cancer	Non-cancer
No. of patients. n	48	96		26	41
Age (years)			.924			<.001^b
Mean ± SD	65.9 ± 7.4	65.1±6.9		69.0±5.9	63.5±5.7
Median (IQR)	65 (52–79)	65 (42–79)		70 (55–79)	64 (49–78)
BMI (kg/m^2)			1.000			.749^b
Mean ± SD	26.8±3.1	26.8 ±3.5		27.3±3.2	27.0±3.0
Median (IQR)	26.4 (20.9–38.5)	26.6 (18.9–43.2)		26.5 (22.4–35.1)	27.3 (20.6–36.7)
Total PSA (ng/mL)			.101			.183
Mean ± SD	6.1±1.6	6.7±1.7		16.8±5.2	15.4±5.1
Median (IQR)	6.0 (2.0–9.6)	6.6 (3.0–9.9)		16.2 (10.2–29.9)	13.9 (10.1–29.0)
F/T PSA			.001			.009
Mean ± SD	0.22±0.09	0.26±0.09		0.16±0.08	0.22±0.10
Median (IQR)	0.19 (0.10–0.50)	0.25 (0.04–0.53)		0.14 (0.06–0.39)	0.20 (0.05–0.57)
Prostate volume (mL)			<.001			<0.001
Mean ± SD	47.2±17.8	66.9±25.2		46.6±20.3	86.7±41.7
Median (IQR)	42 (20–108)	61 (34–155)		40 (24–108)	78 (23–200)
PSAD (ng/mL/mL)			<.001			<0.001
Mean ± SD	0.14±0.07	0.11±0.03		0.43±0.22	0.23±0.19
Median (IQR)	0.14 (0.03–0.44)	0.11 (0.04–0.22)		0.39 (0.11–1.03)	0.14 (0.06–1.20)

^a Mann–Whitney U test.

^b Independent t-test.

BMI: body mass index; F/T: free/total; PSAD: PSA density.

Figure 1. The ROC analysis for F/T PSA, prostate volume and PSA density alone in predicting prostate cancer with a PSA of 2.5–10.0 ng/ml.

Figure 2. The ROC analysis for F/T PSA, prostate volume and PSA density alone in predicting prostate cancer with a PSA of 10.1–30.0 ng/ml

Table 4. The AUCs for F/T PSA, prostate volume and PSA density in predicting risk of prostate cancer stratified by PSA.

	AUC	%95 CI	p value
PSA 2.5–10 ng/ml
F/T psa	0.671	0.574–0.768	0.001
Prostate volume	0.773	0.688–0.858	<0.001
PSAD	0.693	0.595–0.791	<0.001
PSA 10.1–30 ng/ml
F/T psa	0.689	0.553–0.826	0.009
Prostate volüme	0.816	0.711–0.921	<0.001
PSAD	0.801	0.691–0.911	<0.001

AUC: area under the curve; CI: confidence Interval; F/T: free/total; PSAD: PSA density.

Table 5. Comparison of patients’age, BMI, total PSA, prostate volume, PSAD, biopsy result and Gleason score according to the cutoff value of prostate volume with PSA 2.5–10 ng/ml and PSA 10.1–30 ng/ml.

	PSA 2.5–10 ng/ml			PSA 10.1–30 ng/ml
Parameters	Prostate volume (mL)		p value^a	Prostate volume (mL)		p value^a
	<43.5	>43.5		<61.5	>61.5
No. of patients. n	42	102		31	36
Age (years)			.572			.407^b
Mean  ±  SD	64.6 ± 7.4	65.7 ± 6.9		66.3 ± 7.0	65.0 ± 5.6
Median (IQR)	65 (42–78)	65 (47–79)		68 (49–77)	64 (55–79)
BMI (kg/m2)			.740			.303^b
Mean  ±  SD	26.8 ± 3.0	26.8  ± 3.5		27.6 ± 3.6	26.7 ± 2.5
Median (IQR)	26.7 (18.9–38.5)	26.4 (18.9–43.2)		27.2 (21.1–36.7)	27.1 (20.6–35.1)
Total PSA (ng/mL)			.043			.117
Mean  ±  SD	6.0 ± 1.3	6.7 ± 1.7		16.7 ± 5.0	15.3 ± 5.2
Median (IQR)	5.8 (2.6–9.6)	6.6 (2.0–9.9)		16.8 (10.2–29.9)	13.6 (10.1–29.0)
F/T PSA			<.001			.003
Mean  ±  SD	0.21 ± 0.09	0.26 ± 0.09		0.16 ± 0.08	0.23 ± 0.10
Median (IQR)	0.19 (0.04–0.50)	0.25 (0.06–0.53)		0.14 (0.05–0.39)	0.20 (0.05–0.57)
PSAD (ng/mL/mL)			<.001			<.001
Mean  ±  SD	0.17 ± 0.06	0.10 ± 0.03		0.47 ± 0.23	0.17 ± 0.08
Median (IQR)	0.15 (0.08–0.44)	0.10 (0.03–0.19)		0.41 (0.20–1.20)	0.14 (0.06–0.43)
Biopsy result
Prostate cancer n(%)	29 (69.0)	19 (18.6)	<.001^c	21 (67.7)	5 (13.9)	<.001^c
Non-cancer n(%)	13 (31.0)	83 (81.4)		10 (32.3)	31 (86.1)
Gleason score			.488^d			.004^d
< =6	21	16		5	5
> =7	8	3		16	0

^a Mann–Whitney U test.

^b Independent t-test.

^c Pearson Chi-square.

^d Fischer exact test Chi-square.

BMI: body mass index; F/T: free/total; PSAD: PSA density.

Table 6. Multivariate analyses for patients with PSA of PSA 2.5–10 ng/ml and PSA 10.1–30 ng/ml.

	PSA 2.5–10 ng/ml		PSA 10.1–30 ng/ml
	OR	p value	OR	p value
F/T psa	0.071	.234	0.145	.608
Prostate volume
as continuous	0.958	.007	0.952	.012
as categorical^a	0.135	<.001	0.114	.005
PSAD	2.818	.872	0.676	.848

F/T: free/total; PSAD: PSA density.

^a Cut off values of PV for PSA 2.5–10 ng/ml and PSA 10.1–30 ng/ml are 43.5 cc and 61.5 cc, respectively.