title: Contemporary prostate cancer prevalence among T1c biopsy-referred men with a prostate-specific antigen level < or = 4.0 ng per milliliter.
abstract: OBJECTIVE
  To investigate the prostate cancer (PCa) prevalence and risk factors of men with prostate-specific antigen (PSA) level< or =4.0 ng/ml and an unsuspicious digital rectal examination (DRE) in a large biopsy referral cohort.
  
  
  METHODS
  Between 1997 and 2005, 855 men underwent initial transrectal ultrasound (TRUS)-guided prostate biopsy at the University Hospital Hamburg-Eppendorf. Patients with any previous surgical or medical treatment were excluded from analyses. Logistic regression analyses were performed to determine risk factors of PCa at biopsy and high-grade PCa defined as biopsy Gleason sum> or =7.
  
  
  RESULTS
  Overall PCa detection rate was 23.1%. The majority had a biopsy Gleason sum of 6 (79.5%) and 20.5% had a biopsy Gleason sum> or =7. Total PSA (tPSA) and percentage of free PSA (%fPSA) were statistically significantly different in men with and without PCa (all p<0.001). In tPSA strata < or = 0.5, 0.6-1.0, 1.1-2.0, 2.1-3.0, and 3.1-4.0 ng/ml, PCa prevalence was 4.0%, 10.6%, 14.8%, 24.5%, and 32.1%, respectively. In logistic regression analyses addressing PCa and Gleason sum > or = 7 at biopsy, %fPSA and prostate volume represented independent and most informative risk factors.
  
  
  CONCLUSIONS
  Our data demonstrate that a substantial percentage (23.1%) of men with a PSA< or =4.0 ng/ml and an unsuspicious DRE in a biopsy referral population harbor PCa, with 20.5% being high grade. Low %fPSA and low prostate volume represent important parameters in PCa and in high grade disease detection at biopsy, respectively.
authors.affiliation: Department of Urology, University of Hamburg, Hamburg, Germany.
authors.forename: Sascha A
authors.initials: SA
authors.lastname: Ahyai
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Thomas
authors.initials: T
authors.lastname: Steuber
authors.forename: Alexander
authors.initials: A
authors.lastname: Haese
authors.forename: Thorsten
authors.initials: T
authors.lastname: Schlomm
authors.forename: Jochen
authors.initials: J
authors.lastname: Walz
authors.forename: Jens
authors.initials: J
authors.lastname: Köllermann
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.forename: Mario
authors.initials: M
authors.lastname: Zacharias
authors.forename: Martin G
authors.initials: MG
authors.lastname: Friedrich
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Hartwig
authors.initials: H
authors.lastname: Huland
authors.forename: Felix K-H
authors.initials: FK
authors.lastname: Chun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001706:Biopsy; D016009:Chi-Square Distribution; D005858:Germany / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011237:Predictive Value of Tests; D015995:Prevalence; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000453:epidemiology* / Q000473:pathology; D012307:Risk Factors; D018084:Ultrasonography, Interventional
chemical_list: D017430:Prostate-Specific Antigen