OJU  Vol.1 No.3 , August 2011
Correlation of PSA Density to Prostate Cancer Based on Prostate Volume by 3.0 T MRI
Abstract: Purpose: Prostate specific antigen levels can be normalized by the prostate volume to give a prostate specific antigen density (PSAd). Magnetic resonance imaging (MRI) can more accurately determine prostate zonal anatomy and prostate volumes compared to transrectal ultrasound, and hence may lead to more accurate PSAd measurements. Methods: Imaging and pathology of men undergoing prostate MRI from April 2007 to May 2009 were reviewed in this retrospective study. 73 patients were included for analysis, of which 45 had prostate cancer and 28 did not have cancer. Total, transitional zone, and peripheral zone values were determined by ultrasound prolate ellipse, MRI prolate ellipse, and MRI segmentation methods. Results: The study population showed an average PSA of 6.3 ng/mL, with the control mean PSA (8.8 ng/mL) being greater than the cancer group (5.3 ng/mL). Transrectal ultrasound underestimated the prostate volume (mean 27.7 mL versus MRI volume of 38.3 mL, p ≤ 0.001). No difference was seen between cancer and control populations using PSAd. PSAd correctly categorized low (Gleason < 7) and high-grade cancers (Gleason ≥ 7) in patients with malignancy. Conclusion: Transrectal ultrasound underestimates prostate volumes and hence is inaccurate in calculating PSAd. MRI more accurately depicts PSAd, however PSAd is unable to differentiate between patients with cancer and benign disease such as BPH or prostatitis.
Cite this paper: nullR. Hardman, Y. Liang, S. Ware, A. Jung, Q. Peng, F. El-Merhi, Y. Chen and I. Thompson, "Correlation of PSA Density to Prostate Cancer Based on Prostate Volume by 3.0 T MRI," Open Journal of Urology, Vol. 1 No. 3, 2011, pp. 28-36. doi: 10.4236/oju.2011.13008.

[1]   J. Hernandez and I. Thompson, “Prostate-Specific Antigen: A Review of the Validation of the Most Commonly Used Cancer Biomarker,” A Cancer Journal for Clinicians, Vol. 101, No. 5, 2004, pp. 894-904.

[2]   S. Wilson and E. Crawford, “Screening for Prostate Cancer,” Clinical Genitourinary Cancer, Vol. 3, No. 1, 2004, pp. 21-25. doi:10.3816/CGC.2004.n.008

[3]   M. Bazinet, A. Meshref, C. Trudel, S. Aronson, F. Pèloquin, M. Nachabe, L. Bègin and M. Elhilali, “Prospective Evaluation of Prostate-Specific Antigen Density and Systematic Biopsies for Early Detection of Prosttic Carcinoma,” Urology, Vol. 43, No. 1, 1994, pp. 44-51. doi:10.1016/S0090-4295(94)80260-2

[4]   M. Benson, I. Whang, A. Pantuck, K. Ring, S. Kaplan, C. Olsson and W. Cooner, “Prostate Specific Antigen Density: A Means of Distinguishing Benign Prostatic Hypertrophy and Prostate Cancer,” The Journal of Urology, Vol. 147, No. 3, 1992, pp. 815-816.

[5]   E. Seaman, M. Whang, C. Olsson, A. Katz, W. Cooner and M Benson, “Psa Density (Psad). Role in Patient Evaluation and Management,” The Urologic Clinics of North America, Vol. 20, No. 4, 1993, pp. 653-663.

[6]   B. Djavan, M. Remzi, A. Zlotta, V. Ravery, P. Hammerer, A. Reissigl, P. Dobronski, A. Kaisary and M. Marberger, “Complexed Prostate-Specific Antigen, Complexed Prostate-Specific Antigen Density of Total and Transition Zone, Complexed/Total Prostate-Specific Antigen Ratio, Free-to-Total Prostate-Specific Antigen Ratio, Density of Total and Transition Zone Prostate-Specific Antigen: Results of the Prospective Multicenter European Trial,” Urology, Vol. 60, No. 4, 2002, pp. 4-9. doi:10.1016/S0090-4295(02)01

[7]   B. Djavan, A. Zlotta, C. Kratzik, M. Remzi, C. Seitz, C. Schulman and M. Marberger, “Psa, Psa Density, Psa Density of Transition Zone, Free/Total Psa Ratio, and Psa Velocity for Early Detection of Prostate Cancer in Men with Serum Psa 2.5 to 4.0 ng/ml,” Urology, Vol. 54, No. 3, 1999, pp. 517-522.

[8]   J. Kalish, W. Cooner and S. Graham Jr., “Serum Psa Adjusted for Volume of Transition Zone (Psat) Is More Accurate than Psa Adjusted for Total Gland Volume (Psad) in Detecting Adenocarcinoma of the Prostate,” Urology, Vol. 43, No. 5, 1994, pp. 601-606. doi:10.1016/0090-4295(94)90170-8

[9]   D. Lin, M. Gold, S. Ransom, W. Ellis and M. Brawer, “Transition Zone Prostate Specific Antigen Density: Lack of Use in Prediction of Prostatic Carcinoma,” The Journal of Urology, Vol. 160, No. 1, 1998, pp. 77-82. doi:10.1016/S0022-5347(01)63036-2

[10]   M. Remzi, B. Djavan, R. Wammack, M. Momeni, C. Seitz, B. Erne, M. Dobrovits, S. Alavi and M. Marberger, “Can Total and Transition Zone Volume of the Prostate Determine whether to Perform a Repeat Biopsy?” Urology, Vol. 61, No. 1, 2003, pp. 161-166. doi:10.1016/S0090-4295(02)02099-X

[11]   H. Maeda, Y. Arai, S. Ishitoya, K. Okubo, Y. Aoki and T. Okada, “Prostate Specific Antigen Adjusted for the Transition Zone Volume as an Indicator of Prostate Cancer,” The Journal of Urology, Vol. 158, No. 6, 1997, pp. 2193- 2196. doi:10.1016/S0022-5347(01)68193-X

[12]   M. Nathan, K. Seenivasagam, Q. Mei, J. Wickham and R. Miller, “Transrectal Ultrasonography: Why Are Estimates of Prostate Volume and Dimension So Inaccurate,” British Journal of Urology, Vol. 77, No. 3, 1996, pp. 401- 407.

[13]   M. Terris and T. Stamey, “Determination of Prostate Volume by Transrectal Ultrasound,” The Journal of urology, Vol. 145, No. 5, 1991, p. 984.

[14]   A. Graser, A. Heuck, B. Sommer, J. Massmann, M. Reiser and U. Mueller-Lisse, “Mri-Based Psa Density and Psa Density of the Transitional Zone Compared with Psa Alone: Correlation with Prostate Cancer Gleason Score,” Journal of Computer Assisted Tomography, Vol. 30, No. 6, 2006, pp. 891-895. doi:10.1097/01.rct.0000221947.68016.d1

[15]   T. Hoshii, T. Nishiyama, S. Toyabe, K. Akazawa, S. Komatsu, M. Kaneko, N. Hara and K. Takahashi, “Evaluation of Magnetic Resonance Imaging-Based Prostate-Specific Antigen Density of the Prostate in the Diagnosis of Prostate Cancer,” International Journal of Urology, Vol. 14, No. 4, 2007, pp. 305-310. doi:10.1111/j.1442-2042.2007.01686.x

[16]   Y. Kubota, S. Kamei, M. Nakano, H. Ehara, T. Deguchi and O. Tanaka, “The Potential Role of Prebiopsy Magnetic Resonance Imaging Combined with Prostate-Specific Antigen Density in the Detection of Prostate Cancer,” International Journal of Urology, Vol. 15, No. 4, 2008, pp. 322-326. doi:10.1111/j.1442-2042.2008.01991.x

[17]   U. Mueller-Lisse, U. Mueller-Lisse, S. Haller, P. Schneede, J. Scheidler, N. Schmeller, A. Hofstetter and M. Reiser, “Likelihood of Prostate Cancer Based on Prostate-Specific Antigen Density by Mri: Retrospective Analysis,” Journal of Computer Assisted Tomography, Vol. 26, No. 3, 2002, pp. 432-437. doi:10.1097/00004728-200205000-00020

[18]   E. DeLong, D. DeLong and D. Clarke-Pearson, “Comparing the Areas under Two or More Correlated Receiver Operating Characteristic Curves: A Nonparametric Approach,” Biometrics, Vol. 44, No. 3, 1988, pp. 837-845. doi:10.2307/2531595

[19]   I. Thompson, D. Pauler, P. Goodman, C. Tangen, M. Lucia, H. Parnes, L. Minasian, L. Ford, S. Lippman and E. Crawford, “Prevalence of Prostate Cancer among Men with a Prostate-Specific Antigen Level <= 4.0 ng per Milliliter,” New England Journal of Medicine, Vol. 350, No. 22, 2004, pp. 2239-2321. doi:10.1056/NEJMoa031918

[20]   G. Andriole, E. Crawford, R. Grubb III, S. Buys, D. Chia, T. Church, M. Fouad, E. Gelmann, P. Kvale and D. Reding, “Mortality Results from a Randomized Prostate-Cancer Screening Trial,” The New England Journal of Medicine, Vol. 360, No. 13, 2009, pp. 1310-1319. doi:10.1056/NEJMoa0810696

[21]   F. Schroder, J. Hugosson, M. Roobol, T. Tammela, S. Ciatto, V. Nelen, M. Kwiatkowski, M. Lujan, H. Lilja and M. Zappa, “Screening and Prostate-Cancer Mortality in a Randomized European Study,” New England Journal of Medicine, Vol. 360, No. 13, 2009, pp. 1320-1328. doi:10.1056/NEJMoa0810084

[22]   W. Catalona, J. Richie, F. Ahmann, M. Hudson, P. Scardino, R. Flanigan, J. DeKernion, T. Ratliff, L. Kavoussi and B. Dalkin, “Comparison of Digital Rectal Examination and Serum Prostate Specific Antigen in the Early Detection of Prostate Cancer: Results of a Multicenter Clinical Trial of 6,630 Men,” The Journal of Urology, Vol. 151, No. 5, 1994, pp. 1283-1290.