Published 2016-03-23
Daniel Simanjuntak Ferry Safriadi


Objective: In Hasan Sadikin General Hospital Bandung prostate biopsy is recommended for patients with prostate specific antigen (PSA) levels above 10 ng/mL or PSA density (PSAD) above 0.15 if PSA in between 4–10 ng/mL. However, there were other factors beside of prostate cancer (PCa) that could influence PSA value, such as racial differences and prostatitis. Thus, the optimal cut-off point for PSA is still debatable in national level. This research aimed to determine PSA and PSAD cut-off point for patient suspected of PCa in Hasan Sadikin Hospital Bandung. Material & Methods: A total of 502 patients underwent prostate biopsy for suspicion PCa from 2010–2014. The cut-off point of PSA and PSAD is generated from receiver operating characteristic (ROC) curve. Results: The cut-off point for PSA was 14.6 ng/mL (sensitivity 81.4%, specificity 29.8%). The cut-off point for PSAD was 0.23 (sensitivity 81.4%, specificity 34.8%). Positive predictive value (PPV) for this new cut-off point of PSA and PSAD were 41.1% and 37.6% respectively. Conclusion: PSA and PSAD cut-off point for patients in our center was 14.6 ng/mL and 0.23 respectively. This value is relatively higher compared to the Indonesian consensus. The difference might occur due to high rate of urinary tract infection in patients attending Hasan Sadikin General Hospital Bandung.



Prostate specific antigen, prostate specific antigen density, prostate cancer


Boyle P, Ferlay J. Cancer incidence and mortality in Europe, 2004. Annals of oncology: Official Journal of the European Society for Medical Oncology. 2005; 16(3): 481-8.

American Cancer Society. Cancer facts and figures 2008. Atlanta: American Cancer Society; 2008.

Kim HW, Ko YH, Kang SH, Lee JG. Predictive factors for prostate cancer in biopsy of patients with prostate-specific antigen levels equal or to less than 4 ng/ml. Korean J Urol. 2011; 52: 166-71.

Reis LO, Zani EL, Alonso JC, Simoes FA, Rejowski RF, Ferreira U. Does the criterion for prostate biopsy indication impact its accuracy? A prospective population-based outpatient clinical setting study. Actas Urol ESP. 2011; 35: 10-14.

Catalona WJ, Smith DS, Ornstein DK. Prostate cancer detection in men with serum PSA concentrations of 2.6 to 4.0 ng/mL and benign prostate examination. Enhancement of specificity with free PSA measurements. JAMA. 1997; 277: 1452-5.

Thompson IM, Pauler DK, Goodman PJ. Prevalence of prostate cancer among men with a prostate-specific antigen level < 4.0 ng/mL. N. Engl. J. Med. 2004; 350: 2239-46.

Rahardjo D, Kamil S, Pakasi L. Rationale for using serum prostate-specific antigen (PSA) level and PSA density (PSAD) to detect prostatic malignancy in a country with low prostate cancer incidence. Gan to kagaku ryoho Cancer & chemotherapy. 2000; 27: 563-70.

Sugandi S, Putra M. PSA cut-off point for early prostate cancer detection in Hasan Sadikin Hospital Bandung. 2003; 6: 6-9.

Umbas R, Hardjowijoto S, Safriadi F, Mochtar C, Djatisoesanto W, Soedarso M, et al. Panduan penatalaksanaan kanker prostat 2011. IAUI. 2011; 1: 1-2.

Berger AP, Gozzi C, Steiner H, Frauscher F, Varkarakis J, Rogatsch H. Complication rate of transrectal ultrasound guided prostate biopsy: a comparison among 3 protocols with 6, 10 and 15 cores. The Journal of Urology. 2004; 171(4): 1478-81.

Tal R, Livne PM, Lask DM, Baniel J. Empirical management of urinary tract infections complicating transrectal ultrasound guided prostate biopsy. J Urol. 2003; 169: 1762.

Akduman B, Akduman D, Tokgöz H, Erol B, Türker T, Ayoğlu F. Long-term fluoroquinolone use before the prostate biopsy may increase the risk of sepsis caused by resistant microorganisms. Urology. 2011; 78(2): 250-5.

American Urological Association. Best Practice Policy Statement on Urologic Surgery Antimicrobial Prophylaxis; 2008. Accessed March 20, 2012.

Ghani KR, Dundas D, Patel U. Bleeding after transrectal ultrasonography-guided prostate biopsy: a study of 7-day morbidity after a six-, eight- and 12-core biopsy protocol. BJU Int. 2004; 94: 1014-20.

Soebadi DM, Shahab A, Djatisoesanto W, Hardjowijoto S, Soetojo S, Hakim L. Prostate-specific antigen and prostate-specific antigen density cutoff points among Indonesia population suspected for prostate cancer. Prostate Int. 2013; 1(1): 23-30.

Early detection of prostate cancer: AUA guideline. Linthicum (MD): American Urological Association Education and Research, Inc.; 2013. p.28

Schroder FH, Roobol MJ. PSA screening decisions-making aid. Rotterdam Netherlands. 2014; 2: 5.

Mottet N, Bastian PJ, Bellmunt J, van den Bergh RJ, Bolla M, van Casteren NJ, et al. Guidelines on prostate cancer. EAU. 2014; 6: 18.

Copyright Information
Department of Urology, Faculty of Medicine/Airlangga University