Comparison of Prostate Specific Antigen and Prostate Specific Antigen Density for Predicting the Degree of Gleason Score of Prostate Cancer


  • Mehrzad Lotfi Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  • Naghmeh Roshan Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  • Amin Abolhasani Foroughi Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran



Prostate specific antigen, Prostate cancer, Gleason’s score, Tumor Grading, Gleason Grading


Introduction: In this study we evaluate the relationship of PSA and PSAD with the degree of Gleason score of prostate cancer in transrectal ultrasound guided biopsy specimens.

Methods: From March 2003 to October 2009, 1025 transractal ultrasound guided biopsies were performed in our hospital. PSA was measured by monoclonal antibody method and PSAD was calculated. The Gleason grade of the detected tumors in the biopsy specimens was classified as low, moderate and high grade. Data were analyzed by SPSS software.

Results: 292 patients were diagnosed to have prostate adenocarcinoma. There was an acceptable correlation between PSA (P=0.001) and PSAD of the specimens (P = 0.013) with Gleason grades. PSA level showed a statistically significant difference between the low and high grade groups (P=0.005) and the intermediate and high grade groups (p=0.014). A statistically significant difference of PSAD level was seen only between the low and high grade (P=0.006) groups

Conclusions: PSA and PSAD are both effective diagnostic tools for detection of prostate cancer; PSA level has a valuable role in predicting Gleason pattern higher than 7/10 and it can be the predictor of advanced pathological features but PSAD is effective in prediction of Gleason pattern lower than 5/10.


Jemal A TR, Murray T Ghafoor A, Samuels A, Ward E, Feuer EJ, Thun MJ. American Cancer Society. Cancer statistics. CA Cancer J Clin 2004; 54(1)): 8-29.

Catalona WJ RJ, Ahmann FR, Hodson MA, Scardino PT, Flanigan RC, deKernion JB, Ratliff TL, Kavoussi LR, Dalkin BL. Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer : Results of a multicenter clinical trial of 6630 men. J Urol 1994; 15(5): 1283-90.

Narayan PA, Badrinath K. Prostate cancer: Part I. Diagnosis and staging. Hosp Physician 1996; 34: 10-24.

Baradaran N AH, Salem S, lotfi M, Jahani Y, Mehrsai AR, Pourmand G. The protective effect of diabetes mellitus against prostate cancer: role of sex hormones. Prostate 2009; 69(16): 1744-50.

Lima NG, Soares Dde F, Rhoden EL. Importance of prostate-specific antigen (PSA) as a predictive factor for concordance between the Gleason scores of prostate biopsies and RADICAL prostatectomy specimens. Clinics (Sao Paulo, Brazil) 2013; 68(6): 820-4.

Blbchjlhc A. Assessment of intra-individual variation in prostate-specific antigen levels in a biennial randomized prostate cancer screening program in Sweden. Prostate 2005; 65(3): 216-21.

Benson MC WI, Olsson CA, McMahor DJ, Cooner WH. The use of prostate specific antigen density to enhance predictive value of intermediate levels of serum prostate specific antigen. J Urol 1992; 147(3): 817-21.

FreedlandSJ KC, Presti JC Jr, Terris Mk, Amling CL, Dorey F, Aronson Wj. Comparison of preoperative prostate specific antigen density and prostate specific antigen for predicting recurrence after radical prostatectomy: result from the search data base. J Urol 2003; 169(3): 969-73.

Brawer MK AE, Chen GL, Preston SD, Ellis WJ. The inability of prostate specific antigen index to enhance the predictive the value of prostate specific antigen in the diagnosis of prostatic carcinoma. J Urol 1993; 150(2): 369-73.

Brassell SA KT, Sun L, Moul JW. Prostatic-specific antigen versus Prostatic-specific antigen density as predictor of tumor volume, margin status, pathologic state, and biochemical recurrence of prostate cancer. Urology 2005; 66(6): 1229-33.

McNeal JE BD, Kindrachuk RA, Redwine EA, Freiha FS, Stamey TA. Pattern of progression in men with prostate cancer. Lancet 1986; 1(8472): 60-3.

Stamey TA MJ, Yemoto CM, Sigak BM, Johnstone IM. Biological determinants of cancer progression in men with prostate cancer. JAMA 1999; 281(15): 1395-400.

Albertsen PC. PSA and the conservative treatment of early prostate cancer. Archivio italiano di urologia, andrologia: organo ufficiale

Radwn MH YY, Luly JR, Figenshau RS, Brands SB, Bhayani SB, Bullock AD, Liefu Y, Andriole GL, Kibel AS. Prostate-Specific Antigen density predicts adverse pathology and increased risk of biochemical failure. J Urology 2007; 69: 1112-27.

Lotfi M AR, Shirazi M, Jali R, Assadsangabi A, Nabavizadeh SA. Diagnostic Value of Prostate Specific Antigen and Its Density in Iranian Men with Prostate Cancer. IRCMJ 2009; 11(2): 170-5.

Carvalhal GF HP, Yan Y, Ramos CG, Catalona WJ. Visual estimate of the percentage of carcinoma is an independent predictor of prostate carcinoma recurrence after radical prostatectomy. Cancer 2000; 15(89(6)): 1308-14.<1308::AID-CNCR16>3.0.CO;2-3

Corcoran NM, Casey RG, Hong MK, Pedersen J, Connolly S, Peters J, et al. The ability of prostate-specific antigen (PSA) density to predict an upgrade in Gleason score between initial prostate biopsy and prostatectomy diminishes with increasing tumour grade due to reduced PSA secretion per unit tumour volume. BJU international 2012; 110(1): 36-42.

Corcoran NM, Hovens CM, Hong MK, Pedersen J, Casey RG, Connolly S, et al. Underestimation of Gleason score at prostate biopsy reflects sampling error in lower volume tumours. BJU Int 2012; 109(5): 660-4.

Partin AW KM, Subong EN, Walsh PC, Wojno KJ, Oesterling JE, Scardino PT, Pearson JD. Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. JAMA 1997; 14(277(18)): 1445-51.

Hosseini sy MM, Ghadian AR, Hooshyar H, Lashay AR, Safarinejad MR. Population based screening for prostate cancer by measuring total serum prostate-specific antigen in Iran. Int J Urol 2007; 14(5): 406-11.

Khezri AA SM, Ayatollahi SM, lotfi M, Ariafar A, Afrasiabi MA. Age specific reference levels of serum prostate-specific antigen, prostate volume and prostate specific antigen density in healthy Iranian men. ran J Immunol 2009; 6(1): 40-8.

Mehrabi S GSH, Rasti M, bayat B. . Analysis of serum prostate-specific antigen levels in men aged 40 years and older in Yasuj, Iran. Urol J 2005; 2(4): 189-92.

Bradley D. Figler AMR, Nivedita Dhar, Howard Levin, Cristina Magi-Galluzzi MZ, and Eric A. Klein. Preoperative PSA Is Still Predictive of Cancer Volume and Grade in Late PSA Era. Urology 2007; 70(4): 711-6.




How to Cite

Mehrzad Lotfi, Naghmeh Roshan, & Amin Abolhasani Foroughi. (2015). Comparison of Prostate Specific Antigen and Prostate Specific Antigen Density for Predicting the Degree of Gleason Score of Prostate Cancer. Journal of Analytical Oncology, 4(1),  39–43.