title: Accuracy of a high prostate-specific antigen level for prostate cancer diagnosis upon initial biopsy in Korean men.
abstract: OBJECTIVE
  This study aimed to evaluate the cancer detection rate in a Korean population with prostate-specific antigen (PSA) levels greater than or equal to 20.0 ng/mL.
  
  
  METHODS
  A total of 174 men 50 to 79 years old (median 69) included in the study. The median prostate volume of the patients was 44.8 mL (range 14.1 to 210.0) and their serum PSA ranged from 20.0 to 9725.0 ng/mL (median 44.8).
  
  
  RESULTS
  Of 174 men 141 (81.0%) were diagnosed with prostate cancer on initial biopsy. In the total number of patients, the positive predictive value (PPV) was 62.9% for PSA 20 to 29.9, 72.7% for PSA 30 to 39.9 and 100% for PSA 40 to 49.9 ng/mL. In patients with an abnormal digital rectal examination (DRE), the values for these PSA ranges increased to 89.5%, 91.7% and 100%, respectively. The PPV was 81.0% for PSA cutoff of 20, 89.2% for a cutoff of 30, 95.4% for a cutoff of 40, and 94.7% for a cutoff of 50 ng/mL. In conjunction with an abnormal DRE, the values for these PSA cutoffs increased to 95.9%, 98.1%, 100%, and 100%, respectively.
  
  
  CONCLUSIONS
  Our data suggest the ability to predict the presence of prostate cancer reliably on initial biopsy when PSA threshold is greater than or equal to 50 ng/mL. This PSA threshold may be lowered to 40 ng/mL in the presence of an abnormal DRE. In Korean men with high PSA, the detection rate of prostate cancer on biopsy appears to be comparable to that for American men.
authors.affiliation: Department of Urology, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744, Korea.
authors.forename: Hong Bang
authors.initials: HB
authors.lastname: Shim
authors.forename: Sang Eun
authors.initials: SE
authors.lastname: Lee
authors.forename: Hyoung Keun
authors.initials: HK
authors.lastname: Park
authors.forename: Ja Hyeon
authors.initials: JH
authors.lastname: Ku
mesh_terms: D000368:Aged; D001706:Biopsy; D015331:Cohort Studies; D051517:Digital Rectal Examination; D006801:Humans; D007723:Korea; 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* / Q000378:metabolism / Q000473:pathology
chemical_list: D017430:Prostate-Specific Antigen