Diagnostic Accuracy of Prostate Cancer in TRUS-Guided Prostatic Biopsy in Patients with PSA Levels of 4–10 ng/mL

Open Access

Abstract

Background: Prostate carcinoma (CoP) remains a major health concern worldwide, with high incidence and mortality rates, particularly in developed countries, and early detection is critical to improving patient outcomes. The purpose of the study is to evaluate the diagnostic accuracy of TRUS-guided prostatic biopsy for detecting prostate cancer in patients with PSA levels of 4–10 ng/mL. Methods & Materials: This prospective observational study at the Department of Urology, Bangladesh Medical University (BMU), Dhaka, Bangladesh (April 2024–March 2025) included 120 men with PSA 4–10 ng/mL. All underwent DRE and systematic TRUS-guided prostate biopsy, with histopathology classified by ISUP Grade Group and TRUS findings correlated to assess diagnostic accuracy. Mean PSA was compared between cancer and benign groups (p < 0.05). Results: Among 120 men with PSA 4–10 ng/mL, the mean age was 64.5 ± 6.8 years, and mean PSA was 6.8 ± 1.7 ng/mL. Prostate cancer was detected in 58 patients (48.3%), including clinically significant disease in 38 (31.7%), while 62 (51.7%) had benign pathology. Suspicious TRUS findings correctly identified cancer in 45 cases, with 10 false positives and 13 false negatives, giving a sensitivity of 77.6%, specificity of 83.9%, PPV of 81.8%, NPV of 80.0%, and overall accuracy of 80.8%. Mean PSA was significantly higher in cancer patients than in those with benign disease (7.6 ± 1.9 vs. 6.3 ± 1.4 ng/mL; p < 0.0001). Conclusion: TRUS-guided prostatic biopsy is an effective and reliable method for detecting prostate cancer in patients with PSA levels of 4–10 ng/mL.