title: Prevalence of high-grade or insignificant prostate cancer in Korean men with prostate-specific antigen levels of 3.0-4.0 ng/mL.
abstract: OBJECTIVE
  To investigate the prevalence of high-grade or insignificant prostate cancer in Korean men with prostate-specific antigen (PSA) levels of 3.0-4.0 ng/mL.
  
  
  METHODS
  The medical records of 4233 consecutive men with PSA levels of 3.0-10.0 ng/mL, who underwent prostate biopsy between 2007 and 2012 at our institute, were reviewed. The clinicopathologic characteristics were compared between patients with a PSA level of 3.0-4.0 ng/mL and those with a PSA level of 4.0-10.0 ng/mL. Predictive factors for high-grade (Gleason score ≥7) or insignificant cancer (defined according to the Epstein criteria) in men with a PSA level of 3.0-4.0 ng/mL were assessed.
  
  
  RESULTS
  The high-grade disease rates were similar between men with a PSA level of 3.0-4.0 ng/mL and those with a PSA level of 4.0-10.0 ng/mL (50.5% and 53.1%, respectively). The rates of clinically insignificant cancer were higher in men with a PSA level of 3.0-4.0 ng/mL than in those with a PSA level of 4.0-10.0 ng/mL (28.4% vs 12.5%; P <.001). However, among patients with clinically insignificant cancer who underwent radical prostatectomy, only 20% of those with a PSA level of 3.0-4.0 ng/mL and 16% of those with a PSA level of 4.0-10.0 ng/mL showed pathologically insignificant cancer. Prostate volume was an independent predictor of high-grade disease in men with PSA levels of 3.0-4.0 ng/mL.
  
  
  CONCLUSIONS
  More than half of the cancer patients had high-grade disease in men with a PSA level of 3.0-4.0 ng/mL, and most cases of clinically insignificant cancer were diagnosed as significant cancer on prostatectomy specimens, suggesting that the optimal PSA threshold for prostate biopsy in Korean men is 3.0 ng/mL.
authors.affiliation: Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Seung-Kwon
authors.initials: SK
authors.lastname: Choi
authors.affiliation: Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Cheryn
authors.initials: C
authors.lastname: Song
authors.affiliation: Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Myungsun
authors.initials: M
authors.lastname: Shim
authors.affiliation: Department of Urology, School of Medicine, Kyung Hee University, Seoul, Korea.
authors.forename: Gyeong Eun
authors.initials: GE
authors.lastname: Min
authors.affiliation: Department of Urology, Eulji University Hospital, Daejeon, Korea.
authors.forename: Jinsung
authors.initials: J
authors.lastname: Park
authors.affiliation: Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: In Gab
authors.initials: IG
authors.lastname: Jeong
authors.affiliation: Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Jun Hyuk
authors.initials: JH
authors.lastname: Hong
authors.affiliation: Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Choung-Soo
authors.initials: CS
authors.lastname: Kim
authors.affiliation: Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. Electronic address: hjahn@amc.seoul.kr.
authors.forename: Hanjong
authors.initials: H
authors.lastname: Ahn
mesh_terms: D000368:Aged; D044466:Asian People; D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011237:Predictive Value of Tests; D015995:Prevalence; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000453:epidemiology* / Q000473:pathology; D012189:Retrospective Studies
chemical_list: D017430:Prostate-Specific Antigen