Prostate Volume and PSA Trends – Clinical Predictors of Malignancy in Benign and Malignant Prostatic Diseases

Open Access

Abstract

Background: Prostate volume (PV) and prostate-specific antigen (PSA) are widely used clinical parameters in evaluating prostatic diseases. While PSA levels may increase in both benign and malignant conditions, smaller prostate volumes combined with elevated PSA improve malignancy prediction. Identifying reliable predictors is essential for timely diagnosis and appropriate management. Aim of the study: To evaluate the role of prostate volume and PSA trends as clinical predictors of malignancy in patients presenting with benign and malignant prostatic diseases. Methods & Materials: A prospective study was conducted at BIRDEM General Hospital, Dhaka, Bangladesh from July 2017 to June 2019. A total of 110 men aged ≥50 years with suspected prostatic disease underwent clinical assessment, transabdominal ultrasonography for prostate volume estimation, serum PSA measurement, and systematic prostate biopsy. Histopathology served as the diagnostic reference standard. Data were analyzed using SPSS version 26.0. Logistic regression identified independent predictors of malignancy. Diagnostic performance was evaluated through sensitivity, specificity, PPV, NPV, and accuracy. Result: Malignancy was confirmed in 15.45% of participants. Malignant cases had significantly higher mean PSA levels (25.48±11.62 ng/mL) and larger PV (57.4±16.2 mL). PSA >10 ng/mL was the strongest predictor (OR 27.8; p<0.001), followed by PV Grade III/IV (OR 3.2; p=0.02). PSA >10 ng/mL demonstrated high specificity (94.6%) and accuracy (89.1%), while combining PSA >10 with PV Grade III/IV increased specificity to 97.8%.