Background: The specific threshold for prostate-specific antigen and density (PSA, PSAD) to delineate which patients are at the highest risk has been controversial. The purpose of this study was to evaluate the diagnostic value of PSA and PSAD in Iranian patients with prostate cancer.Methods: Three hundred men with the serum PSA greater than 4.0 ng/ml, abnormal digital rectal examination and/or suspicious transrectal ultrasound underwent transrectal ultrasound-guided prostate biopsies. PSAD was calculated by dividing the serum PSA in ng/ml by the volume of the entire prostate in cm3. Correlation with Gleason grade of the tumor was also made. The patients were divided into three groups according to their PSA values. The receiver operator characteristic (ROC) curve was produced from the raw data on all patients.Results: One hundred and two patients showed a cancer rate of 34%. The mean PSA and PSAD of the cancer group were significantly higher than those of the non-cancer group with better performance of PSAD as confirmed by ROC curve. In patients with PSA levels between 4 and 10 ng/ml, mean PSAD values in positive and negative biopsy groups showed a significant difference while mean PSA values between these biopsy groups revealed no significant difference. The PSAD cutoff of more than 0.1 had higher sensitivity than 0.15 at the expense of increasing the number of unnecessary biopsies. Among those the patients with PSA levels above 10ng/ml, both mean PSA and PSAD values of positive and negative biopsy groups had significant differences. The sensitivity of PSAD cutoff of 0.1 was not significantly higher than 0.15 while PSAD of 0.15 showed a higher specificity. PSAD >0.15 missed cancer in 18 out of 102 patients, nearly half of those with clinically significant mid and high grade cancers.Conclusion: Overall, PSAD is a better diagnostic tool for the detection of prostate cancer than PSA, especially in patients with PSA between 4 and 10ng/ml. PSAD cutoff of 0.15 is not inclusive enough in patients with PSA levels between 4 and 10ng/ml and we propose PSAD of 0.1 as a better threshold for prostate biopsy in men with PSA at this range to detect clinically important cancers. Also, we recommend transrectal ultrasound guided biopsy in any patient with PSAD greater than 0.15 and PSA more than 4 ng/ml.

Purpose: The Prostate Imaging-Reporting and Data System (PI-RADS) category 3 is the most ambiguous lesion with a variable clinically significant prostate cancer (CsPCa) detection rate. Prostate-specific antigen density (PSAD) has been investigated as an adjunctive factor to improve the diagnostic efficiency of PI-RADS categories. This study aimed to investigate the utility of PSAD as an adjunctive factor in predicting CsPCA risk in patients with PI-RADS 3 lesions. Materials and Methods: The patients with an initial PI-RADS 3 category lesion (n=142) scheduled for systematic and magnetic resonance imaging-guided prostate biopsy between 2018 and 2022 were retrospectively evaluated. Demographic and clinical variables, including PSAD, were collected. The rate of CsPCa was the primary outcome. The impact of PSAD on the CsPCa detection rate was the secondary outcome. Results: The median age was 62 years. The rate of CsPCa was 8. 5% (n=12). The patients with CsPCa have significantly lower prostate volüme and higher PSAD levels than those without CsPCa (p=0. 016 and p=0. 012). The cut-off values of PSAD in predicting CsPCa in all PI-RADS 3 patients and patients with CsPCa and clinically insignificant prostate cancer (n=26) were ≥0. 181 ng/ml2. The sensitivity and specificity values for PSAD ≥0. 181 ng/ml2 were of 75% (95% CI: 42. 8%-94. 5%) and 81. 5% (95% CI: 73. 4%-88. 0%) in predicting CsPCa among PI-RADS 3 category. Conclusion: PSAD values higher than 0. 181 ng/ml2 can be used as an adjunctive clinical parameter in predicting CsPCa in patients with PI-RADS 3 lesions and differentiating CsPCa from clinically insignificant prostate cancer cases.

Introduction: The objective of this study was to evaluate the value of serum prostate-specific antigen (PSA) and prostate-specific antigen density (PSAD) in the diagnosis of prostate cancer.Materials and Methods: A total of 330 consecutive patients suspected of having prostate cancer due to either abnormal digital rectal examination or elevated serum PSA levels underwent transrectal ultrasonography-guided sextant biopsy of the prostate. The PSA and PSAD values were assessed based on the biopsy results.Results: One hundred and twenty-one patients (36.7%) had prostate cancer. In this group, the mean PSA was 31.60±30.85 ng/mL (range, 1.9 ng/Ml to 166.0 ng/mL) and the mean PSAD was 0.83±1.01 (range, 0.04 ng/mL/ cm3 to 6.38 ng/mL/cm3). In those without prostate cancer the mean PSA and PSAD levels were 13.80±18.72 ng/mL (range, 0.4 ng/mL to 130.0 ng/ mL; P<.001) and 0.24±0.32 (range of 0.01 ng/mL/cm3 to 2.29 ng/mL/ cm3; P<.001). The receiver operating characteristic curve analysis revealed that the discriminating power of serum PSA for detecting prostate cancer, as estimated by the area under the curve, was 0.74 while that for PSAD was 0.81 (P<.001). For the PSA range of 3.5 ng/mL to 41 ng/mL (gray zone) the areas under the curve was 0.68 for PSA, while it was 0.78 for PSAD (P<.001).Conclusion: The use of PSAD instead of PSA in the diagnosis of prostatic cancer improves the diagnostic accuracy.

Background: To determine a cut-off point of tPSA and PSAD to prevent unnecessary invasive cancer-diagnosing tests in the community.Methods: This study was performed on 688 consecutive patients referred to our center due to prostatism, suspicious lesions on digital rectal examination and/or elevated serum PSA levels. All patients underwent transrectal ultrasound guided biopsies and obtained PSAD. Serum levels of tPSA and fPSA were measured by chemiluminescence. Comparisons were done using tests of accuracy (AUC-ROC).Results: Prostate cancer was detected in 334 patients, whereas the other 354 patients were suffering from benign prostate diseases. The mean tPSA in case and control groups were 28.32±63.62 ng/ml and 7.14±10.04 ng/ml; the mean f/tPSA ratios were 0.13±0.21 and 0.26±0.24 in PCa and benign prostate disease groups; the mean PSAD rates were 0.69±2.24, 0.12±0.11, respectively. Statistically significant differences were found (P<0.05). Using ROC curve analysis, it was revealed that AUC was 0.78 for tPSA and 0.80 for f/tPSA. Sensitivity was 71% for the cut-off value of 7.85ng/ml. For f/tPSA ratio, the optimal cut-off value was 0.13 which produced the sensitivity of 81.4% and for PSAD, it was15%.Conclusions: As this trial is different from the European and American values, we should be more cautious in dealing with the prostate cancer upon the obtained sensitivity and specificity for PCa diagnosis (7.85ng/mLfor tPSA, 15% for PSAD and 0.13 for f/tPSA ratio).

Objective: We aimed to investigate the association between prostate specific antigen (PSA) density and Gleason score of the positive surgical (PSM) margin after radical prostatectomy with biochemical recurrence in patients with prostate cancer. Methods: In this retrospective cohort study, patients with prostate cancer referred to Hasheminejad Hospital in Tehran, Iran, during 2009-2019, who underwent radical prostatectomy were enrolled through the convenience sampling method. The follow-up period was determined as at least one year after radical prostatectomy to determine biochemical recurrence. Prostate-specific antigen density (PSAD) and the Gleason score of surgical specimen and positive surgical margins (PSM) were evaluated and their association with biochemical recurrences was investigated. Results: One hundred and three patients were assessed. The overall biochemical recurrence rate was 48. 5% with a mean follow-up of 24 months (12-42 months) and an average time to biochemical recurrence of 18 months (16-20 months). BCR-free (Biochemical recurrence-free) survival rates of patients divided based on the PSAD cut-off point (0. 205 ng/ml/cc) were significantly different using the log-rank test (P= 0. 008) (85. 7%, 57. 1%, and 14. 3% for values ·,0. 205 ng/ml/c versus 55. 8%, 20. 9%, and 0% for values 0. 205 ng/ml/cc, respectively for 1-, 2-and 3-year survival). Moreover, Cox regression showed that the Gleason score of PSM, the Gleason score of the surgical specimen, and the PSAD predicted biochemical recurrence more, respectively. Conclusions: PSAD and PSM Gleason scores were strong predictors of biochemical recurrence after radical prostatectomy and their use along with other common indicators including tumor grade and stage and PSA level can increase the accuracy of risk assessment in patients with prostate cancer.

Background: We aimed to value the usefulness of free to total prostate-specific antigen and Prostate-specific antigen (PSA) density for prostate cancer in the patients with PSA levels of 4.0 ng/ml or less.Methods: A total of 343 subjects with PSA levels of 4.0 ng/ml or less were biopsied. All patients were divided into four groups according to the PSA levels: 0 to 1.0 ng/ml, 1.1 to 2.0 ng/ml, 2.1 to 3.0 ng/ml, and 3.1 to 4.0 ng/ml. The reliability of cancer detection in relation to the f/t PSA ratio and PSAD were estimated.Results: Overall, 65 people were diagnosed with prostate cancer. The detection rate was 16.28%、17.17%, 21.82%, 25.00% in subjects with PSA levels of 0 to 1.0 ng/ml, 1.1 to 2.0 ng/ml, 2.1 to 3.0 ng/ml, and 3.1 to 4.0 ng/ml, respec-tively. The f/t PSA ratio was significantly lower in patients with prostate cancer and PSA levels of 2.1 to 4.0 ng/ml (P<0.05). The PSAD had no statistical significance between the two groups.Conclusions: Routine prostate biopsy should be undertaken if the f/t PSA ratio less than 15% with /without abnor-mal DRE/TRUS findings.

Background: Prostate cancer is the most common malignancy among the male population in the United States and the 3rd most common non-skin cancer among men in Iran. Its prevalence has shown a rising trend in recent decades. The aim of this study was to report the epidemiological features of prostate cancer in patients referred for prostate biopsy in the south of Iran and to evaluate the accuracy of the levels of the prostatespecific antigen (PSA) and the PSA-density (PSAD) as well as the extension of the disease in the prediction of the biological behavior of prostate cancer. Methods: This is a retrospective study on the medical records of 1982 consecutive patients who underwent transrectal ultrasoundguided biopsy due to an abnormal digital rectal examination and/ or an elevated PSA level following referral from the Urology Ward to the Radiology Department of Shahid Faghihi Hospital in Shiraz, southern Iran, between December 2003 and July 2014. Results: The overall cancer detection rate was 33. 1%. Although the cancer was more prevalent among the elderly patients, a significant fraction (7%) of the patients were aged < 55 years. The sensitivity and specificity of the PSA were 97. 4% and 8. 7% and those of the PSAD were 82. 9% and 52%, respectively. Of the 637 patients with prostate cancer, 250 (39. 2%) had unilateral disease, 378 (59. 4%) had bilateral disease, and 9 (1. 4%) had inner-gland involvement. Most of the patients with bilateral involvement had high-grade Gleason scores. Conclusion: Our study underlines the relationship between age and the frequency of cancer; the levels of the PSA and the PSAD and the Gleason score; and the extent of tumor involvement and the grade of prostate cancer and also highlights the significance of screening, especially in younger patients.

Purpose: To present the medium-term results for the modified Lich-Gregoir (LG) reimplantation technique in the treatment of unilateral primary vesicoureteral reflux (VUR) by comparing patients under and over 12 months of age. Materials and Methods: Data for patients who underwent modified LG surgery between January 2006 and December 2018 were retrospectively reviewed from the hospital data-recording system and patients under the age of 18 years were included in the study. After exclusion criteria, 55 patients in total were included in advanced analysis. The patients were grouped as ≤ 12 months and >12 months. Demographic characteristics, operative, and postoperative follow-up data were comparatively analyzed. Results: The mean± SD (range) of age was 10. 4 ± 2. 8 (6-12) and 41. 4 ± 18. 5 (13-96) months in the ≤ 12 months and >12 months groups, respectively. Mean operation time and hospitalization time were not significant between the groups. Mean follow-up times were 39. 5 ± 14. 1 and 38. 4 ± 13. 2 months, in the ≤ 12 months and >12 months groups, respectively. There was no difference in terms of complications between the groups and all of the complications in both groups were in grade 1 category according to the Modified Clavien complication classification. One (6. 6%) patient in the ≤ 12 months group and 3 (7. 5%) patients in the >12 months group had late (>30 days) febrile UTI, but none of them had a recurrence of VUR. Febrile infection did not recur during the follow-up period in these patients. While recurrent VUR was not seen in any patient in the ≤ 12 months group (success: 100%), it was observed in 2 (5%) patients in the >12 months group (success rate: 95%) (p = 0. 38). Conclusion: The open LG ureteral reimplantation technique is an effective procedure for the treatment of unilateral primary VUR in children both under 12 months and over 12 months of age with minor morbidity.