TY  - EJOU
AU  - Wang, Qi 
AU  - Xin, Jiayan 
AU  - Zhang, Minghao 
AU  - Wang, Yong 

TI  - The significance of prostate-specific antigen density and free prostate-specific antigen density in the early detection of prostate cancer in individuals experiencing acute urinary retention
T2  - Canadian Journal of Urology

PY  - 
VL  - 
IS  - 
SN  - 1488-5581

AB  -  <b>Backgrounds:</b> Early detection of prostate cancer (PCa) in patients with acute urinary retention (AUR) is complicated by transient, non-malignant elevations of prostate-specific antigen (PSA). Density-based biomarkers such as PSAD and fPSAD may help overcome this limitation. This study aims to assess the diagnostic significance of prostate-specific antigen density (PSAD) and free prostate-specific antigen density (fPSAD) in the early diagnosis of prostate cancer (PCa) among patients with acute urinary retention (AUR). <b>Methods:</b> The clinical data of 1343 patients with AUR were retrospectively analyzed. The differences in the indexes between the PCa group and the benign prostatic hyperplasia (BPH) group were compared. The performance of PSAD and fPSAD for detecting overall PCa and csPCa was analyzed. Diagnostic value was assessed using multivariate Logistic regression, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA). <b>Results:</b> Of the 1343 patients, 647 (48.2%) were diagnosed with prostate cancer (PCa), of whom 512 (79.1%) had clinically significant PCa (csPCa). Both PSAD and fPSAD were independent predictors of PCa and csPCa. For overall PCa detection, the AUC of PSAD was 0.795 and that of fPSAD was 0.776, both significantly higher than the AUC of total PSA alone (0.682, <i>p</i> &lt; 0.01). Subgroup analysis indicated that within the range of 4–10 ng/mL, fPSAD demonstrated better discriminatory ability (AUC = 0.701) compared to PSAD (0.625). In the range of 10–20 ng/mL, PSAD outperformed fPSAD (AUC = 0.812 vs. 0.742). When PSA &gt; 20 ng/mL, fPSAD was once again superior (AUC = 0.826 vs. 0.789). Decision curve analysis confirmed a positive net benefit for this stratified marker approach. <b>Conclusion:</b> PSAD and fPSAD demonstrate significant predictive value for PCa, particularly csPCa, in AUR patients, with their efficacy being dependent on PSA levels. Therefore, as a hypothesis-generating finding, a stratified approach using fPSAD for PSA 4–10 ng/mL and PSAD for PSA 10–20 ng/mL is proposed, which requires prospective external validation before clinical application.
KW  - prostate cancer; acute urinary retention; prostate-specific antigen; prostate-specific antigen density; predictive value

DO  - 10.32604/cju.2026.080510