What question did this study set out to answer?

This study aimed to evaluate the effectiveness of PSA and various PSA-derived indices in differentiating prostate cancer from benign prostatic hyperplasia.

June 27, 2026Open Access

Discriminatory Ability of Prostate Specific Antigen -Derived Indices in Differentiating Prostate Cancer from Benign Prostatic Hyperplasia

Key Points

This study aimed to evaluate the effectiveness of PSA and various PSA-derived indices in differentiating prostate cancer from benign prostatic hyperplasia.
Retrospective review of 326 Korean men undergoing PSA tests, transrectal ultrasonography, and prostate biopsies from January 2016 to June 2024.
All cases were confirmed through biopsy results to assess diagnostic accuracy of PSA and its derived indices.
Data analysis included AUC (area under the curve) values for various indices to determine their discriminatory ability.
PSA showed the highest AUC of 0.789, followed by PSA TZ density at 0.759 and PSA density at 0.745.
In men aged ≥ 70 years, free-to-total PSA demonstrated the highest specificity of 95.8%.
Within the 4-10 ng/mL PSA gray zone, f/t PSA achieved the highest discriminatory ability with an AUC of 0.714.

Abstract

Background: Prostate-specific antigen (PSA) is widely used to distinguish prostate cancer from benign conditions, but its limited specificity often results in unnecessary biopsies.To improve diagnostic performance, various PSA-derived indices have been developed, including free PSA (fPSA), the free-to-total PSA ratio (f/t PSA), PSA density, PSA transition zone density (PSA TZ density), and fPSA density.This study aimed to compare the discriminatory ability of PSA and PSA-derived indices, including fPSA TZ density, for differentiating prostate cancer from benign prostatic hyperplasia (BPH).Methods: We retrospectively reviewed 326 Korean men who underwent PSA, fPSA, transrectal ultrasonography, and prostate biopsy at Nowon Eulji Medical Center between January 2016 and June 2024.All cases were biopsy-confirmed.The discriminatory ability of PSA and PSA-derived indices for distinguishing prostate cancer from BPH was assessed.Results: In the overall biopsy-confirmed study population, PSA, PSA density, and PSA TZ density performed best.PSA showed the highest AUC (0.789), followed by PSA TZ density (0.759) and PSA density (0.745).In men aged ≥ 70 years, f/t PSA showed the highest specificity (95.8%).Within the PSA gray zone (4-10 ng/mL), f/t PSA yielded the highest discriminatory ability (AUC 0.714), supporting its use in biopsy decision-making.Stage-stratified analyses showed stage-specific differences in AUC values, with higher values observed in advanced-stage disease.Conclusions: Among PSA-derived indices, PSA, PSA density, and PSA TZ density provided the best overall accuracy, and f/t PSA was most valuable in the PSA gray zone and in older age groups.These findings support individualized interpretation of PSA indices according to age, PSA interval, and disease stage.

Bookmark

View Full Paper