Effect of Prostate Volume on the Predictive Value of Prostate-specific Antigen Density for Prostate Cancer

Overview

Journal Transl Androl Urol

Date 2025 Feb 20

PMID 39974811

Authors

Zejun Liu

Ying Yu

Rui Hu

Tengteng Jian

Kai Yu

Ji Lu

Affiliations

Soon will be listed here.

Abstract

Background: In clinical practice, we observed that some patients with larger prostate volume (PV) and prostate-specific antigen (PSA) values below 20 ng/mL still yielded negative biopsy results. We aim to establish a more precise volume range for guiding biopsies in patients with enlarged prostate glands.

Methods: We conducted a retrospective analysis of 424 cases involving patients who underwent prostate biopsy. The patients were categorized into three groups based on their body mass index: small (PV <45 cm), medium (45 cm≤ PV <70 cm), and large (PV ≥70 cm). Logistic regression, receiver operating characteristic (ROC) curves, restricted cubic spline (RCS) curves, and decision trees were employed for comparison purposes.

Results: In the multivariate logistic regression analysis, a statistically significant association was observed between prostate-specific antigen density (PSAD) ≥0.15 ng/mL/cm and the need for biopsy to confirm prostate cancer diagnosis when the volume was less than 45 cm [odds ratio (OR) =4.587; 95% confidence intervals (CI): 1.667-15.091; P=0.006]. The point of intersection between the RCS curve and the reference line occurred at PV =45 cm, indicating a higher risk of prostate cancer (PCa) increased with decreasing PV size. After constructing a decision tree model, it was found that when the volume was less than approximately 26 cm, there was a significantly increased probability (approximately 69%) of having prostate cancer after biopsy.

Conclusions: The likelihood of developing prostate cancer is higher in patients with small PVs (PV <45 cm), especially those with (PV <26 cm), when PSAD exceeds 0.15 ng/mL/cm. Patients with larger volumes (PV ≥70 cm) can be regularly monitored and followed up.

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