Contemporary prostate cancer prevalence among T1c biopsy-referred men with a prostate-specific antigen level <= 4.0 ng per milliliter

Objective: To investigate the prostate cancer (PCa) prevalence and risk factors of men with prostate-specific antigen (PSA) level <= 4.0 ng/ml and an unsuspicious digital rectal examination (DRE) in a large biopsy referral cohort. Materials and methods: Between 1997 and 2005, 855 men underwent initial transrectal ultrasound (TRUS)-guided prostate biopsy at the University Hospital Hamburg-Eppendorf. Patients with any previous surgical or medical treatment were excluded from analyses. Logistic regression analyses were performed to determine risk factors of PCa at biopsy and high-grade PCa defined as biopsy Gleason sum >= 7. Results: Overall PCa detection rate was 23.1%. The majority had a biopsy Gleason sum of 6 (79.S%) and 20.5% had a biopsy Gleason sum >= 7. Total PSA (tPSA) and percentage of free PSA (%fPSA) were statistically significantly different in men with and without PCa (all p < 0.001). In tPSA strata < 0.5, 0.6-1.0, 1.1-2.0, 2.1-3.0, and 3.1-4.0 ng/ml, PCa prevalence was 4.0%, 10.6%, 14.8%, 24.5%, and 32.1%, respectively. in logistic regression analyses addressing PCa and Gleason sum >= 7 at biopsy, %fPSA and prostate volume represented independent and most informative risk factors. Conclusion: Our data demonstrate that a substantial percentage (23.1%) of men with a PSA < 4.0 ng/ml and an unsuspicious DRE in a biopsy referral population harbor PCa, with 20.5% being high grade. Low %fPSA and low prostate volume represent important parameters in PCa and in high grade disease detection at biopsy, respectively. (C) 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved.