Clinical evaluation of prostate biopsy parameters: gland volume and elevated prostate-specific antigen level.
OBJECTIVE
To determine whether excess prostate-specific antigen (PSA) improves the accuracy of predicting positive biopsy results.


METHODS
Results of prostate biopsy in 130 consecutive patients were correlated with transrectal ultrasound (TRUS) findings, digital rectal examination results, serum PSA level, and excess PSA (serum PSA level minus predicted PSA level [prostate volume x 0.12]), alone and in combination. Random sextant biopsy was performed in all patients, as well as directed biopsy of any suspicious lesion seen at TRUS.


RESULTS
Excess PSA alone was most accurate in the prediction of positive biopsy results. Use of an excess PSA of > or = 0 ng/mL instead of a serum PSA level of > 4 ng/mL to initiate prostate biopsy increased the positive yield from 49% to 56% and accuracy from 51% to 62%, eliminating 21% of biopsies while maintaining sensitivity at 94% (vs 95% with serum PSA level).


CONCLUSIONS
Use of only excess PSA of > or = 0 ng/mL to initiate prostate biopsy results in the best combination of sensitivity and specificity compared with the other standard parameters.
Rubens
D J
DJ
Department of Radiology, University of Rochester School of Medicine and Dentistry, New York, NY 14642-8648, USA.
Gottlieb
R H
RH
Maldonado
C E
CE
Frank
I N
IN
D000368:Aged; D001707:Biopsy, Needle / Q000379:methods; D006801:Humans; D008297:Male; D010808:Physical Examination; D011237:Predictive Value of Tests; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011470:Prostatic Hyperplasia / Q000175:diagnosis / Q000453:epidemiology; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods
D017430:Prostate-Specific Antigen