title: [Detection of prostatic cancer in the PSA range between 3 and 3.9 ng/ml].
abstract: OBJECTIVE
  In our study, we analyze the benefit of lowering the PSA cutoff point for which a prostate biopsy is indicated from 4 to 3 ng/ml.
  
  
  METHODS
  We have considered 4.278 individuals coming from a prostate cancer screening program. We studied 1.217 interventions in which PSA was determined, indicating the prostate biopsy with PSA > or = 3 ng/ml. Digital rectal examination was never the indication for the biopsy. All biopsies were sextant and assisted by transrectal ultrasound. We compared the performance of the biopsy using 4 and 3 ng/ml as cut points.
  
  
  RESULTS
  Of the 1.217 interventions performed, 947 had PSA values lower than 3 ng/ml, 80 between 3 and 3.9 ng/ml and 190 over 4 ng/ml. A total of 189 patients (70% of these two last groups) underwent a prostate biopsy. With 4 ng/ml as the cut point, 134 biopsies were indicated, detecting 28 cancers (positive predictive value 20.9%). However 189 biopsies were indicated and 34 cancers detected by lowering the cut point to 3 ng/ml (positive predictive value 17.9%). The reduction in the biopsy performance was not statistically significant (OR = 0.89). None of the 6 additional cancers detected was palpable or ecographically visible (T1c), all of them had a Gleason score under 7 and half of them could be considered clinically relevant.
  
  
  CONCLUSIONS
  Lowering PSA cutoff point from 4 to 3 ng/ml improved the detection rate in 21.4% not jeopardizing the biopsy performance. Therefore we think that the group of patients with PSA between 3 and 3.9 ng/ml as candidates for prostate biopsy, should be included in screening programs.
authors.affiliation: Servicio de Urología, Hospital Universitario de Getafe, Madrid.
authors.forename: J M
authors.initials: JM
authors.lastname: Gómez De Vicente
authors.forename: M
authors.initials: M
authors.lastname: Luján Galán
authors.forename: A
authors.initials: A
authors.lastname: Páez Borda
authors.forename: I
authors.initials: I
authors.lastname: Romero Cagigal
authors.forename: A
authors.initials: A
authors.lastname: Moreno Santurino
authors.forename: D
authors.initials: D
authors.lastname: Santos Arrontes
authors.forename: A
authors.initials: A
authors.lastname: Berenguer Sánchez
mesh_terms: D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood*
chemical_list: D017430:Prostate-Specific Antigen