Diagnostic Efficacy of grey-zone Serum Prostate Specific Antigen level in patients with Benign Prostatic Hyperplasia and Prostate Carcinoma

Objective: Evaluation of diagnostic role of grey zone serum prostate specific antigen level(4-10ng/ml) in patients with benign prostatic hyperplasia (BPH) and prostate carcinoma keeping histopathology as gold standard. Study design and setting: Cross-sectional study conducted in Department of Urology and Chemical Pathology, Sheikh Zayed Hospital Rahim Yar Khan. Methodology: Patients with grey zone serum prostate specific antigen level (4-10ng/ml), lower urinary tract symptoms or abnormal DRE (digital rectal examination) were included and diagnosis was confirmed on the basis of histopathology. Chi square test used to see the statistically significant difference between subgroups. P value <0.05 was deemed as significant. Diagnostic role evaluated by ROC curve analysis. Results: Mean age of study subjects was 60.21±10.046 years and 155 (81.2%) subjects were having serum prostate specific antigen level in grey zone (4-10ng/ml). Of the total 191 study subjects, 59(30.9%) were histopathologically confirmed cases of benign prostatic hyperplasia and 34(17.8%) were confirmed cases of prostate carcinoma. 41 (26.45%) cases of benign prostatic hyperplasia were having serum PSA level in grey zone (4-10ng/ml) and 16(10.32%) cases with prostate carcinoma were having PSA level in grey zone (4-10ng /ml). ROC curve analysis shows AUC=0.584 in case of BPH and AUC=0.707 in case of CA prostate. Conclusion: On the basis of our study, it is concluded that grey zone serum PSA level in symptomatic individuals should be used in conjunction with other non-invasive diagnostic and clinical parameters to improve diagnosis and to avoid unnecessary biopsy in every symptomatic individual