Adult urologyCME articleEvidence suggesting PSA cutpoint of 2.5 ng/mL for prompting prostate biopsy: Review of 36,316 biopsies
Section snippets
Material and methods
From 1997 and 2001, all 233,889 prostate biopsy specimens submitted to DIANON Systems (Stratford, Conn) were retrospectively reviewed and analyzed for patient age and the presence of prostate adenocarcinoma. Because the patients were not individually identified, institutional review board approval was not indicated. The overall prostate cancer detection rates were calculated. A total of 36,316 cases were identified with available DIANON PSA tests performed within 6 months of prostate biopsy.
Results
The detection rate for prostate cancer varied according to the PSA level, with a greater percentage of cancers detected in direct correlation with rising PSA levels. The number of submitted biopsies also increased with rising PSA levels, except for the PSA group of greater than 10.0 ng/mL, for which fewer biopsies were submitted compared with the 4.1 to 10.0 ng/mL range (8802 versus 20,984 biopsies). The largest number of biopsies submitted was for elevated PSA levels in the 4.1 to 10.0 ng/mL
Comment
In the current study, 36,316 of 233,889 biopsies submitted to DIANON Systems were reviewed and stratified according to the PSA level. The detection rates were similar for the PSA subgroups of less than 2.0 and 2.1 to 2.5 ng/mL (18.67% and 21.89%, respectively). The cancer detection rate for the PSA subgroups 2.6 to 4.0 and 4.1 to 10.0 ng/mL was 27.48% and 30.08%, respectively. A total of 2940 biopsies were submitted in the lower PSA range between 2.6 and 4.0 ng/mL and 808 cancers diagnosed. As
Conclusions
In an analysis of 36,316 biopsies submitted to a reference laboratory with prebiopsy PSA determinations available, the detection rate of prostate cancer for a PSA level of 2.5 to 4.0 ng/mL was similar (27.48%) to that for a PSA level of 4.0 to 10.0 ng/mL (30.08%). Recently, the standard cutpoint of 4.0 ng/mL has been critically assessed, and several studies have supported a lower absolute PSA threshold for recommending prostate biopsy. Our results indicate that the prevalence of prostate cancer
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