title: Predictive value of the international prostate symptom score for positive prostate needle biopsy in the low-intermediate prostate-specific antigen range.
abstract: OBJECTIVE
  Serum prostate-specific antigen (PSA) has a restricted predictive value for prostate cancer in the low-intermediate PSA range (2.5-10 ng/ml). Our aim was to determine the predictive value of the International Prostate Symptom Score (IPSS) for positive prostate needle biopsy (PNB) in patients who underwent transrectal ultrasound (TRUS)-guided prostate biopsy with a low-intermediate PSA level.
  
  
  METHODS
  Between 2001 and 2004, the data of 389 consecutive patients applying for any urologic complaint to our department and who underwent TRUS-guided prostate biopsy due to an elevated serum PSA and/or abnormal digital rectal examination (DRE) were retrospectively analyzed. A total of 158 eligible patients with a low-intermediate PSA level were included in the study. The patient's age, PSA, free PSA, free/total PSA, prostate volume, PSA density (PSAD), pre-biopsy IPSS were compared in the positive and negative biopsy groups.
  
  
  RESULTS
  Fifty-eight of 158 patients (37%) who underwent TRUS-guided prostate biopsy had positive PNBs. Forty-eight patients (30%) had abnormal DREs. In the positive PNB group, the mean age was older and PSAD was higher, but the means of the prostate volumes and total IPSS were lower (p<0.05). Multivariate analysis demonstrated that age and IPSS were independent predictors of a positive PNB (p<0.05). The odds ratio of mild IPSS for positive PNB controlled for age was 3.0 (95% CI 1.5-6.7). Receiver-operating characteristics analysis revealed a mild IPSS (AUC=0.640) and was a considerable predictor for positive PNB as well as PSAD (AUC=0.648). The sensitivity and specificity of IPSS with a cutoff value of 7.5 points were 31 and 87% for prediction of prostate cancer detection.
  
  
  CONCLUSIONS
  In the low-intermediate PSA range, mild IPSS may be a predictive factor for positive PNB with a similar specificity of PSAD.
authors.affiliation: Department of Urology, Dokuz Eylul University School of Medicine, Izmir, Turkey. a.kefi@deu.edu.tr
authors.forename: Aykut
authors.initials: A
authors.lastname: Kefi
authors.forename: Bora
authors.initials: B
authors.lastname: Irer
authors.forename: Ismail
authors.initials: I
authors.lastname: Ozdemir
authors.forename: Burcin
authors.initials: B
authors.lastname: Tuna
authors.forename: Yigit
authors.initials: Y
authors.lastname: Goktay
authors.forename: Kutsal
authors.initials: K
authors.lastname: Yorukoğlu
authors.forename: Adil
authors.initials: A
authors.lastname: Esen
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D014408:Biomarkers, Tumor / Q000097:blood*; D001707:Biopsy, Needle / Q000379:methods; D003937:Diagnosis, Differential; D019160:Endosonography; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology*; D012007:Rectum; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen