Diagnostic performance of total PSA an its derivatives for clinically significant prostate cancer and high-grade prostate cancer

Abstract

Abstract Background: Diagnostic value of total PSA an its derivatives for prostate cancer is still controversial. Our aim is to explore the diagnostic performance of total prostate-specific antigen (tPSA) and its derivatives for clinically significant prostate cancer (csPCa) and high-grade prostate cancer (hgPCa). Methods: Data of qualified 423 patients who received prostate biopsy from October 2020 to July 2022 was used to accomplish this study. Patient’s clinical characteristics were compared by Mann Whitney U test. Spearman rank correlation analysis was performed to calculate correlation coefficients. Univariate logistic regression analysis was used to screen the related variables of csPCa and hgPCa. Receiver-operating characteristic (ROC) curves and diagnostic tests were performed for assessing the diagnostic value of clinical variables. Results: Of these 423 patients, 131/423 (31.0%) were diagnosed with csPCa and 103/423 (24.3%) were diagnosed with hgPCa. By plotting ROC curves, PSAD had highest diagnostic accuracy for both csPCa (AUC: 0.840, 95%CI: 0.802-0.874) and hgPCa (AUC: 0.825, 95%CI: 0.785-0.860), tPSA and prostate volume had fair diagnostic value after PSAD, then, f/t PSA only had mediocre performance, but fPSA alone had very low diagnostic value. After stratifying patients into different subgroups of tPSA, prostate volume, PSA density (PSAD) and free/total PSA (f/t PSA). We found the detection rate will obvious rise following by increased tPSA, PSAD and decreased prostate volume, f/tPSA. The results of diagnostic tests found the sensitivity and negative predictive value were 79.4%, 83.0% for tPSA<10ng/ml, 80.8%, 76.2% for f/tPSA>0.20, 95.4%, 93.2% for prostate volume≥70ml and 96.9%, 96.0% for PSAD<0.15 ng/ml2 respectively. Conclusions: In this study, we evaluated the diagnostic value of tPSA and its derivatives for identification of prostate cancer. For patients with suspected prostate cancer, lower tPSA and PSAD, bigger prostate volume and higher f/tPSA value may mean smaller probability of csPCa.