Korean J Urol Oncol.  2022 May;20(2):123-132. 10.22465/kjuo.2022.20.2.123.

Prostate-Specific Antigen Variation as a Predictor of Prostate Cancer in Patients With Prostate-Specific Antigen ≤20 ng/mL Who Underwent Magnetic Resonance Imaging-Targeted Prostate Biopsy

• Hwang TH
• Lee KS
• Koo KC
• Chung BH
• Yoo JW

• KMID: 2530298
• DOI: http://doi.org/10.22465/kjuo.2022.20.2.123

Abstract

Purpose
We investigated the role of prostate-specific antigen (PSA) variation as a predictor of prostate cancer in patients who underwent prebiopsy multiparametric magnetic resonance imaging (MRI).
Materials and Methods
The clinicopathological data of 266 patients with PSA ≤20 ng/mL who underwent prebiopsy MRI and prostate biopsy between September 2019 and February 2021 were included. PSA variation was defined as the difference in PSA values taken when a prostate biopsy was recommended and performed (median 20 days). Receiver operating characteristic (ROC) curves and area under the ROC curves (AUCs) for predicting prostate cancer were analyzed through 4 models that considered conventional clinical variables and PSA variation.
Results
Of the 258 patients, 166 (64.3%) were diagnosed with prostate cancer. The prostate cancer (+) group had a lower median PSA variation (-0.09 mg/mL vs. -0.27 ng/mL, p=0.006) and higher proportion of patients with PSA variation within -0.54 to 0.05 ng/mL (40 ng/mL [range, 24.1%] vs. 9 ng/mL [9.8%], p=0.002) than the prostate cancer (-) group. There was no significant difference in the duration between the 2 PSA measurements. When PSA variation and conventional variables, such as age, PSA density, prostate biopsy history, number of target lesions, were considered, the highest AUC value was 0.870. In a subgroup analysis of patients with PSA ≤10 ng/mL, the highest AUC value was 0.860 when PSA variation and conventional variables were considered.
Conclusions
A large PSA variation within 1 month was a negative predictor of prostate cancer among patients who underwent prebiopsy MRI.

Keyword

Biopsy; Magnetic resonance imaging; Prostate-specific antigen; Prostate cancer; Variation