OBJECTIVE: To investigate the prevalence of high-grade or insignificant prostate cancer in Korean men with prostate-specific antigen (PSA) levels of 3.0-4.0 ng/mL.
METHODS: The medical records of 4233 consecutive men with PSA levels of 3.0-10.0 ng/mL, who underwent prostate biopsy between 2007 and 2012 at our institute, were reviewed. The clinicopathologic characteristics were compared between patients with a PSA level of 3.0-4.0 ng/mL and those with a PSA level of 4.0-10.0 ng/mL. Predictive factors for high-grade (Gleason score ≥7) or insignificant cancer (defined according to the Epstein criteria) in men with a PSA level of 3.0-4.0 ng/mL were assessed.
RESULTS: The high-grade disease rates were similar between men with a PSA level of 3.0-4.0 ng/mL and those with a PSA level of 4.0-10.0 ng/mL (50.5% and 53.1%, respectively). The rates of clinically insignificant cancer were higher in men with a PSA level of 3.0-4.0 ng/mL than in those with a PSA level of 4.0-10.0 ng/mL (28.4% vs 12.5%; P < .001). However, among patients with clinically insignificant cancer who underwent radical prostatectomy, only 20% of those with a PSA level of 3.0-4.0 ng/mL and 16% of those with a PSA level of 4.0-10.0 ng/mL showed pathologically insignificant cancer. Prostate volume was an independent predictor of high-grade disease in men with PSA levels of 3.0-4.0 ng/mL.
CONCLUSION: More than half of the cancer patients had high-grade disease in men with a PSA level of 3.0-4.0 ng/mL, and most cases of clinically insignificant cancer were diagnosed as significant cancer on prostatectomy specimens, suggesting that the optimal PSA threshold for prostate biopsy in Korean men is 3.0 ng/mL.
Choi SK, Song C, Shim M, Min GE, Park J, Jeong IG, Hong JH, Kim CS, Ahn H. Are you the author?
Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Urology, School of Medicine, Kyung Hee University, Seoul, Korea; Department of Urology, Eulji University Hospital, Daejeon, Korea.
Reference: Urology. 2015 Jan 10. pii: S0090-4295(14)01287-4.