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Journals / Bozok Tıp Dergisi / 2026 / Cilt: 16 Sayı: 3

Is PSA Alone Sufficient in the Turkish Population? The Contribution of PSA Density in Predicting Prostate Cancer and Clinically Significant Prostate Cancer

TEK MERKEZLİ TÜRK KOHORTUNDA PSA TEK BAŞINA YETERLİ Mİ? PROSTAT KANSERİ VE KLİNİK OLARAK ANLAMLI PROSTAT KANSERİNİN ÖNGÖRÜLMESİNDE PSA DANSİTESİNİN KATKISI

Mostafa Sultanı Afghan(YOZGAT BOZOK ÜNİVERSİTESİ, TIP FAKÜLTESİ)0000-0001-6508-0628
Mehmet Şakir Taşpınar(YOZGAT BOZOK ÜNİVERSİTESİ, TIP FAKÜLTESİ)0000-0002-4640-7434
Alaattin Ekinci(YOZGAT BOZOK ÜNİVERSİTESİ, TIP FAKÜLTESİ)0009-0001-1900-623X
Emre Güdük(YOZGAT BOZOK ÜNİVERSİTESİ, TIP FAKÜLTESİ)0000-0002-0753-3630
Sercan Sarı(BOZOK ÜNİVERSİTESİ, TIP FAKÜLTESİ)0000-0002-0994-3799
Volkan Selmi(YOZGAT BOZOK ÜNİVERSİTESİ, TIP FAKÜLTESİ)0000-0003-2605-9935
Mehmet Caniklioğlu(YOZGAT BOZOK ÜNİVERSİTESİ, TIP FAKÜLTESİ)0000-0003-2216-5677
Pages
502–513
Publication Date
2026-09-25
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Receiver operating characteristic (ROC) curve analyses were performed to determine the optimal PSAD cutoff values for both the overall cohort and PSA-based subgroups.

📌 3 Key Takeaways

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Objective & Hypothesis:Objective: This study aimed to compare the diagnostic performance of serum total prostate-specific antigen (PSA) and prostate-specific antigen density (PSAD) in predicting prostate cancer (PCa) and clinically significant prostate cancer (csPCa) in patients undergoing prostate biopsy, and to determine dynamic PSAD cutoff values according to PSA subgroups specific to the single center Turkish cohort.
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Key Findings & Data:Material and Methods: Clinical, laboratory, and histopathological data of patients who underwent prostate biopsy between January 2018 and January 2026 were retrospectively reviewed.
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Conclusion & Impact:Receiver operating characteristic (ROC) curve analyses were performed to determine the optimal PSAD cutoff values for both the overall cohort and PSA-based subgroups.
🔬Design:Review & Systematic Survey
📍Scope:2018 Verileri
⚙️Variables:Kişiselleştirilmiş PSA Dansitesi · Prostat Kanseri · PSA

Abstract

Objective: This study aimed to compare the diagnostic performance of serum total prostate-specific antigen (PSA) and prostate-specific antigen density (PSAD) in predicting prostate cancer (PCa) and clinically significant prostate cancer (csPCa) in patients undergoing prostate biopsy, and to determine dynamic PSAD cutoff values according to PSA subgroups specific to the single center Turkish cohort. Material and Methods: Clinical, laboratory, and histopathological data of patients who underwent prostate biopsy between January 2018 and January 2026 were retrospectively reviewed. PSAD was calculated by dividing the serum PSA level by prostate volume. Receiver operating characteristic (ROC) curve analyses were performed to determine the optimal PSAD cutoff values for both the overall cohort and PSA-based subgroups. Results: PSAD demonstrated good diagnostic accuracy for detecting PCa (AUC=0.764) and showed even higher performance in predicting csPCa (AUC=0.812). In the overall cohort, the optimal PSAD cutoff values were 0.119 ng/mL/cc for PCa and 0.132 ng/mL/cc for csPCa. Subgroup analyses according to PSA levels revealed that the optimal PSAD cutoff values increased progressively with increasing PSA levels, ranging from 0.089 ng/mL/cc in patients with PSA ≤4 ng/mL to 0.168 ng/mL/cc in those with PSA >100 ng/mL. Correspondingly, sensitivity, specificity, and AUC values also demonstrated a gradual increase across PSA subgroups. Conclusion: PSAD may be considered a more effective biomarker than total PSA, particularly for predicting clinically significant prostate cancer. Rather than applying a single fixed PSAD cutoff value to all patients, the use of individualized, PSA-adjusted dynamic cutoff values may improve diagnostic accuracy, reduce unnecessary prostate biopsies, and support more effective clinical decision-making. These findings provide valuable evidence for optimizing prostate biopsy strategies in the Turkish cohort.

Özet

Amaç: Bu çalışmada, prostat biyopsisi uygulanan hastalarda serum total prostat spesifik antijeni (PSA) ile prostat spesifik antijen dansitesinin (PSAD), prostat kanseri ve klinik olarak anlamlı prostat kanserini (csPCa) öngörmedeki tanısal performanslarının karşılaştırılması ve tek merkezli Türk kohortunda özgü PSA alt gruplarına göre dinamik PSAD eşik değerlerinin belirlenmesi amaçlandı. Gereç ve Yöntemler: Ocak 2018-Ocak 2026 tarihleri arasında prostat biyopsisi yapılan hastaların klinik, laboratuvar ve histopatolojik verileri retrospektif olarak değerlendirildi. PSAD, serum PSA düzeyinin prostat hacmine bölünmesiyle hesaplandı. ROC analizleri kullanılarak genel kohort ve PSA alt grupları için optimal PSAD eşik değerleri belirlendi. Bulgular: Çalışmada PSAD, prostat kanserinin saptanmasında iyi düzeyde tanısal doğruluk gösterirken (AUC=0,764), klinik olarak anlamlı prostat kanserini öngörmede daha yüksek performans sergiledi (AUC=0,812). Genel kohortta optimal PSAD eşik değeri prostat kanseri için 0,119 ng/mL/cc, csPCa için ise 0,132 ng/mL/cc olarak belirlendi. PSA düzeylerine göre yapılan alt grup analizlerinde optimal PSAD eşik değerlerinin PSA ile birlikte düzenli olarak arttığı; ≤4 ng/mL grubunda 0,089 ng/mL/cc iken >100 ng/mL grubunda 0,168 ng/mL/cc'ye ulaştığı saptandı. Buna paralel olarak duyarlılık, özgüllük ve AUC değerlerinde de kademeli artış izlendi. Sonuç: PSAD, özellikle klinik olarak anlamlı prostat kanserinin öngörülmesinde total PSA'dan daha başarılı bir biyobelirteç olarak değerlendirilebilir. Tüm hastalar için tek bir sabit PSAD eşik değeri yerine, PSA düzeyine göre belirlenen kişiselleştirilmiş dinamik eşik değerlerinin kullanılması tanısal doğruluğu artırabilir, gereksiz prostat biyopsilerini azaltabilir ve klinik karar verme sürecine önemli katkı sağlayabilir. Bu bulgular, Türk kohortunda biyopsi stratejilerinin optimize edilmesine yönelik değerli kanıtlar sunmaktadır.

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Cite This Article

Afghan, M. S., Taşpınar, M. Ş., Ekinci, A., Güdük, E., Sarı, S., Selmi, V., Caniklioğlu, M. (2026). Is PSA Alone Sufficient in the Turkish Population? The Contribution of PSA Density in Predicting Prostate Cancer and Clinically Significant Prostate Cancer. Bozok Tıp Dergisi, Cilt: 16 Sayı: 3, 502–513. https://doi.org/10.16919/bozoktip.2002236

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