title: Comparison of prostate-specific antigen adjusted for transition zone volume versus prostate-specific antigen density in predicting prostate cancer by transrectal ultrasonography.
abstract: OBJECTIVE
  Prostate-specific antigen is an excellent tumor marker, but it is not specific for prostate cancer. We evaluated the efficacy of prostate-specific antigen adjusted for transition zone volume calculated by transrectal ultrasonography in predicting prostate cancer in men with intermediate prostate-specific antigen levels of 4.1 to 10.0 ng/mL compared with prostate-specific antigen density.
  
  
  METHODS
  Between June 1998 and December 2001, prostate-specific antigen adjusted for transition zone volume was obtained from 131 patients who underwent ultrasonographically guided biopsies and had prostate-specific antigen of 4.1 to 10.0 ng/mL. Prostate-specific antigen density was calculated by dividing total serum prostate-specific antigen by total prostate volume, and total serum prostate-specific antigen was divided by transition zone volume to yield prostate-specific antigen adjusted for transition zone volume. This was compared with prostate-specific antigen density via receiver operating characteristic curves.
  
  
  RESULTS
  Of 131 patients, 34 (26%) had prostate cancer, and 97 (74%) had benign prostatic hyperplasia on pathologic examination. Total prostate volume was correlated with transition zone volume (P < .001). Mean prostate-specific antigen adjusted for transition zone volume and prostate-specific antigen density were 0.71 +/- 0.25 and 0.27 +/- 0.09 ng x mL(-1) x mL(-1) in patients with prostate cancer and 0.32 +/- 0.09 and 0.16 +/- 0.05 ng x ml(-1) x mL(-1) in patients with benign prostatic hyperplasia. With a cutoff value of 0.35 ng mL(-1) x mL(-1), prostate-specific antigen adjusted for transition zone volume had sensitivity of 82% and specificity of 84%. Receiver operating characteristic curve analysis showed that prostate-specific antigen adjusted for transition zone volume predicted biopsy outcome significantly better than prostate-specific antigen density (P < .05).
  
  
  CONCLUSIONS
  Prostate-specific antigen adjusted for transition zone volume is more accurate than prostate-specific antigen density in distinguishing prostate cancer from benign prostatic hyperplasia in men with intermediate serum prostate-specific antigen of 4.1 to 10.0 ng/mL. Determination of transition zone volume by transrectal ultrasonography may be helpful for predicting the probability of positive biopsy results.
authors.affiliation: Department of Diagnostic Radiology, Korea University College of Medicine, Seoul, South Korea.
authors.forename: Deuk Jae
authors.initials: DJ
authors.lastname: Sung
authors.forename: Sung Bum
authors.initials: SB
authors.lastname: Cho
authors.forename: Yun Hwan
authors.initials: YH
authors.lastname: Kim
authors.forename: Yu Whan
authors.initials: YW
authors.lastname: Oh
authors.forename: Nam Joon
authors.initials: NJ
authors.lastname: Lee
authors.forename: Jung Hyuk
authors.initials: JH
authors.lastname: Kim
authors.forename: Kyoo Byung
authors.initials: KB
authors.lastname: Chung
authors.forename: Du Geon
authors.initials: DG
authors.lastname: Moon
mesh_terms: D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014463:Ultrasonography
chemical_list: D017430:Prostate-Specific Antigen