Strategy for Prostate Cancer Patients with Low Prostate Specific Antigen Level (2.5 to 4.0 ng/mL)

Background: To evaluate the strategy for detection of prostate cancer (PCa) with low prostate specific antigen (PSA) level (2.5-4.0 ng/mL), prostate biopsy patients with low PSA were assessed.We evaluated the risk of low PSA PCa and the strategy for screening low-PSA patients.Methods: We retrospectively analyzed the patients who underwent prostate biopsy with low PSA level.Baseline characteristics, PSA level before prostate biopsy, prostate volume, prostate specific antigen density (PSAD), and pathological data were assessed.Results: Among the 1986 patients, 24.97% were diagnosed with PCa.The PSAD was 0.12 ± 0.04 ng/mL 2 in the PCa-diagnosed group and 0.10 ± 0.04 ng/mL 2 in non-cancer-diagnosed group (P < 0.001).Of the 496 patients diagnosed with PCa, 302 (60.89%) were in the intermediate-or high-risk group.PSAD was 0.13 ± 0.04 ng/mL 2 in the intermediate-or highrisk group and 0.11 ± 0.03 ng/mL 2 in the very low-and low-risk group (P < 0.001).Of 330 patients who underwent radical prostatectomy, 85.15% were diagnosed as having significant cancer.There was significant correlation between PSAD and PCa (r = 0.294, P < 0.001).PSAD with a specificity of 80.00% of a clinically significant cancer diagnosis was assessed at 0.1226 ng/mL 2 .Conclusion: The PCa detection rate in the low-PSA group was not lower than that of previous studies of patients with PSA from 4.0 to 10.0 ng/mL.Further, it may be helpful to define a strategy for PCa detection using PSAD in the low-PSA group.