title: Prostate-specific Antigen Density Variation Rate as a Potential Guideline Parameter for Second Prostate Cancer Detection Biopsy.
abstract: BACKGROUND
  The diagnostic value of current prostate-specific antigen (PSA) tests is challenged by the poor detection rate of prostate cancer (PCa) in repeat prostate biopsy. In this study, we proposed a novel PSA-related parameter named PSA density variation rate (PSADVR) and designed a clinical trial to evaluate its potential diagnostic value for detecting PCa on a second prostate biopsy.
  
  
  METHODS
  Data from 184 males who underwent second ultrasound-guided prostate biopsy 6 months after the first biopsy were included in the study. The subjects were divided into PCa and non-PCa groups according to the second biopsy pathological results. Prostate volume, PSA density (PSAD), free-total PSA ratio, and PSADVR were calculated according to corresponding formulas at the second biopsy. These parameters were compared using t-test or Mann-Whitney U-test between PCa and non-PCa groups, and receiver operating characteristic analysis were used to evaluate their predictability on PCa detection.
  
  
  RESULTS
  PCa was detected in 24 patients on the second biopsy. Mean values of PSA, PSAD, and PSADVR were greater in the PCa group than in the non-PCa group (8.39 μg/L vs. 7.16 μg/L, 0.20 vs. 0.16, 14.15% vs. -1.36%, respectively). PSADVR had the largest area under the curve, with 0.667 sensitivity and 0.824 specificity when the cutoff was 10%. The PCa detection rate was significantly greater in subjects with PSADVR >10% than PSADVR ≤10% (28.6% vs. 6.5%, P< 0.001). In addition, PSADVR was the only parameter in this study that showed a significant correlation with mid-to-high-risk PCa (r = 0.63, P = 0.03).
  
  
  CONCLUSIONS
  Our results demonstrated that PSADVR improved the PCa detection rate on second biopsies, especially for mid-to-high-risk cancers requiring prompt treatment.
authors.affiliation: Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China.
authors.forename: Gan-Sheng
authors.initials: GS
authors.lastname: Xie
authors.affiliation: Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China.
authors.forename: Jin-Xing
authors.initials: JX
authors.lastname: Lyv
authors.affiliation: Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Li
authors.affiliation: Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China.
authors.forename: Chun-Yin
authors.initials: CY
authors.lastname: Yan
authors.affiliation: Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China.
authors.forename: Jian-Quan
authors.initials: JQ
authors.lastname: Hou
authors.affiliation: Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China.
authors.forename: Jin-Xian
authors.initials: JX
authors.lastname: Pu
authors.affiliation: Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Ding
authors.affiliation: Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China.
authors.forename: Yu-Hua
authors.initials: YH
authors.lastname: Huang
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011467:Prostate / Q000378:metabolism / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis*; D012372:ROC Curve
chemical_list: D017430:Prostate-Specific Antigen