| BackgroundProstate-specific antigen (PSA) test is the most significant tumor marker used as initial criterion for the early clinical screening and detection of prostate cancer CaP, However, serum PSA do not have the disease-specific. PSA levels frequently rise in non-malignant disorders (NMD), such as benign prostatic hyperplasia (BPH) or prostatitis, the elevation of PSA does not necessarily indicate the presence of CaP. the sensitivity and specificity are subject to certain restrictions, especially in the PSA gray zone, the specificity of diagnosis of prostate cancer, only 30% ~ 35%, leading to a large number of patients suffered unnecessary puncture, as well as economic, mental burden. To improve the sensitivity and specificity of PSA in the gray area, foreign scholars introducted concepts of PSA-related, such as free PSA ratio (f/tPSA), prostate-specific antigen density (PSAD), prostate-specific antigen density of transition zone (PSAT), etc. but at present it has been a controversial issue that the application of these indicators in clinical research, and we still lack uniform standards of the critical cut-off value, how to balance balance between benefit and harm of screening for prostate cancer using prostate specific antigen which should to be further explored problem by urology doctors.ObjectiveTo investigate the relationships of the patients'age, prostatevolume(PV), Transition zone volume(TZV), fPSA and tPSA. And the effect of tPSA, f/tPSA, PSAD and PSADTZ in diagnosis and differential diagnosis of BPH and CaP.MethodsWe studied continuous 192 cases with serum PSA level between 4~10ng/ml who were in the beijing university shen zhen hospital consecutively from January of 2004 to March of 2009. Serum tPSA, fPSA, f/tPSA, Transrectal Ultrasound test of prostate were collected for every patient. Figure out f/tPSA, the PV, PSAD, and PSADTZ. And analyzed the relationships between age, tPSA, f/tPSA, PSAD, and PSADTZ in CaP and BPH group.ResultsThere are 29 cases (15.1%) whoes were diagnosed with prostate cancer. There was no difference in patient ages, tPSA, fPSA, and f/tPSA ration level between CaP group and BPH group(P>0.05),whereas PV and TZV were significantly smaller than that of BPH,and there were significant difference between two groups(P<0.01); In contrast PSAD and PSADTZ level of CaP group were significantly higher than that of BPH group, there were significant difference between two groups (P<0.05)There are positive relevant between the values of the age, PV, TZV, TPSA, and fPSA in BPH group, and their coefficient respectively were 0.275,0.245,0.213和0.296 (p <0.05), while the CaP group was the lack of correlation between the opposite .There are positive linear regression relevant in PV, TZV, and tPSA of BPH group. In contrast, the age, PV, and TZV of CaP group by multiple linear regression analysissing were not statistically significant with TPSA of CaP (P>0.10).The area under ROC curve of three indexes in descending order was PSADTZ, PSAD, tPSA and f/tPSA radio. And there was no significant difference in the AUC between PSADTZ and PSAD (p>0.05). The youden index (YI) of PSADTZ at a cutoff value of 0.315ng/ml~2 was the best, and the sensitivity and the specificity respectively were 90.5% and 71.1%, respectively.ConclusionIn this study, when serum PSA level between 4-10ng/ml,The sensitivity and specificity of PSADTZ at a cutoff value of 0.315 ng/ml~2 was the best, which could work as another index of the differential diagnosis between CaP and BPH, besides PSAD,tPSA and f/tPSA.
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