par Zlotta, Alexandre ;Schulman, Claude ;Djavan, Bob ;Marberger, Michael Johann
Référence British journal of urology, 80, SUPPL. 2, page (244)
Publication Publié, 1997
Article révisé par les pairs
Résumé : The value of Prostate Specific Antigen Density (PSAD) to enhance prostate cancer (PCa) detection remains controversial. Most PSA leakage from the benign prostate into the serum was demonstrated to come from the transition zone (TZ). Therefore, in patients with PSA levels<10 ng/ml and proved benign or cancer disease, we compared PSAD and Prostate Specific Antigen Density of the TZ (PSA-TZ), dividing serum PSA by TZ volume. Measuring total prostate and TZ volume by ultrasound using the prolate ellipsoid method, PSAD and PSA-TZ were calculated in 162 patients, 88 diagnosed with localized PCa and operated by radical prostatectomy and 74 patients with BPH and proven benign disease (sextant biopsies and in 19 patients retropubic adenomectomy). PSAD in benign disease averaged 0.11 (SD 0.09) and 0.21 ng/ml/cc (SD 0.11) in PCa (p<0.01). PSA-TZ averaged 0.20 ng/ml/cc (SD 0.14) in BPH and 1.05 ng/ml/cc (SD 0.70) in PCa (p<.0001). If a PSAD of 0.15 had been chosen, the cancer would have been missed in 34% of the patients compared to 10% if a cut-off value of 0.35 for PSA-TZ had been chosen (p<0.001). Overall, in patients with a PSA of 0.25-10 ng/ml, the sensitivity and specificity of PSA-TZ for PCa prediction at a 0.35 cut-off value were 90 and 93% respectively, compared to 94 and 89%, respectively, for those with a PSA of 4 to 10 ng/ml. In this study, PSA-TZ was much more accurate in predicting PCa than PSAD for PSA< 10 ng/ml. The validity of this concept must be further evaluated in large populations seen for early diagnosis. If confirmed in large prospective studies, PSA-TZ could become a routine tool for urologists in the prediction of prostate cancer in men with a PSA< 10 ng/ml.

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