Purpose: We evaluated the utility of free-to total PSA (F/T PSA) ratio, PSA density (PSAD) and PSA density of the transition zone (PSATZ) in diagnosis of prostate cancer with intermediate PSA level (4.1-10 ng/ml).
Patients and methods: Between January 2000 and December 2003, systematic prostate biopsies were performed on 178 patients with intermediate PSA level. The clinical values of F/T PSA ratio, PSAD and PSATZ for the detection of prostate cancer were compared by using receiver operating characteristic (ROC) curves.
Results: Overall, 57 of the 178 (32%) patients had prostate carcinoma. The ROC curve analysis showed PSAD and PSATZ were superior to F/T PSA ratio in patients with intermediate PSA level. In patients with total prostate volume greater than 30 cm3, the area under the ROC curve for F/T PSA ratio was greater than that for PSAD and PSATZ.
Conclusions: PSAD and PSATZ were more powerful predictors of prostate cancer than F/T PSA ratio in patients with intermediate PSA level. While F/T PSA ratio was effective for diagnosis of prostate cancer in prostate volume greater than 30 cm3.