Prostate-specific antigen density in prostate cancer screening in diabetes mellitus patients

Year 2025, EARLY ONLINE, 1 - 9

Atilla Satır , Hakan Demirci , Gökhan Ocakoğlu , Anıl Erkan , Gül Ayşen Öztürk

https://doi.org/10.18621/eurj.1622393

Abstract

Objectives: The purpose of this study was to examine the function of prostate-specific antigen (PSA) and prostate-specific antigen density (PSAd) in the screening of prostate cancer in individuals with Diabetes Mellitus (DM).

Methods: This study was retrospective and cross-sectional. 467 patients who underwent transrectal ultrasound-guided 10-12 core prostate biopsy between 01 January and 31 December 2022 were included. Through the hospital information management system, the demographics, radiological, biochemical, and pathological results of the patients were scanned.

Results: PSAd>0.15 ng/mL/cm³ and total PSA (t-PSA)>8.58 ng/mL were substantially associated with an elevated probability of the existence of cancer when all patients were included. PSAd>0.19 ng/mL/cm³ and t-PSA>11.34 ng/mL were shown to be strongly associated with an elevated risk of cancer in patients with DM (P<0.001). PSAd>0.14 ng/mL/cm³ and t-PSA>8.49 ng/mL were substantially associated with an elevated probability of cancer presence in individuals without a diagnosis of DM. PSAd>0.15 ng/mL/cm³ and t-PSA>8.58 ng/mL were substantially associated with an elevated probability of cancer presence in individuals with fasting blood glucose (FBG) <126 mg/dL (P<0.001). It has been established that PSAd cannot be utilized as a marker to predict cancer in people with FBG≥126 mg/dL (P=0.070). Higher cancer risk was substantially correlated with t-PSA values of >5.73 ng/mL (P=0.001).

Conclusions: The change in prostate volume brought on by high blood glucose levels might be the cause of PSAd's lack of selectivity. Patients with DM are a special group in prostate cancer screening, and this should be considered when establishing cancer screening algorithms.

Keywords

Prostate-specific antigen (PSA), PSA density, prostate cancer, diabetes mellitus, risk estimation

Ethical Statement

The study was approved by the Bursa Yüksek İhtisas Training and Research Hospital Clinical Research Ethics Committee (Decision no: 2011-KAEK-25 2022/05-13 and date: 18.05.2022).

References

• 1. Giovannucci E, Harlan DM, Archer MC, et al. Diabetes and cancer: a consensus report. Diabetes Care. 2010;33(7):1674-1685. doi: 10.2337/dc10-0666.
• 2. Abudawood M. Diabetes and cancer: A comprehensive review. J Res Med Sci. 2019;24:94. doi: 10.4103/jrms.JRMS_242_19.
• 3. Wang M, Yang Y, Liao Z. Diabetes and cancer: Epidemiological and biological links. World J Diabetes. 2020;11(6):227-238. doi: 10.4239/wjd.v11.i6.227.
• 4. Drab A, Wdowiak K, Kanadys W, et al. Diabetes Mellitus and Prostate Cancer Risk-A Systematic Review and Meta-Analysis. Cancers (Basel). 2024;16(23):4010. doi: 10.3390/cancers16234010.
• 5. Gandaglia G, Leni R, Bray F, et al. Epidemiology and Prevention of Prostate Cancer. Eur Urol Oncol. 2021;4(6):877-892. doi: 10.1016/j.euo.2021.09.006.
• 6. Feng X, Song M, Preston MA, et al. The association of diabetes with risk of prostate cancer defined by clinical and molecular features. Br J Cancer. 2020;123(4):657-665. doi: 10.1038/s41416-020-0910-y.
• 7. Pagano AP, da Silva BR, Vieira FT, et al. Association Between Diabetes and Risk of Prostate Cancer: A Systematic Review and Meta-Analysis of Observational Studies. World J Mens Health. 2024 June 24. doi: 10.5534/wjmh.240022. Online ahead of print.
• 8. Cai H, Xu Z, Xu T, Yu B, Zou Q. Diabetes mellitus is associated with elevated risk of mortality amongst patients with prostate cancer: a meta-analysis of 11 cohort studies. Diabetes Metab Res Rev. 2015;31(4):336-343. doi: 10.1002/dmrr.2582.
• 9. Satir A, Demirci H. Total Prostate Specific Antigen in Prostate Cancer Screening in Hyperglycemic Individuals. Clin Genitourin Cancer. 2023;21(2):e53-e57. doi: 10.1016/j.clgc.2022.09.007.
• 10. Ali MK, Pearson-Stuttard J, Selvin E, Gregg EW. Interpreting global trends in type 2 diabetes complications and mortality. Diabetologia. 2022;65(1):3-13. doi: 10.1007/s00125-021-05585-2.
• 11. Olson P, Wagner J. Established and emerging liquid biomarkers for prostate cancer detection: A review. Urol Oncol. 2025;43(1):3-14. doi: 10.1016/j.urolonc.2024.05.011.
• 12. Stephan C, Stroebel G, Heinau M, et al. The ratio of prostate-specific antigen (PSA) to prostate volume (PSA density) as a parameter to improve the detection of prostate carcinoma in PSA values in the range of < 4 ng/mL. Cancer. 2005;104(5):993-1003. doi: 10.1002/cncr.21267.
• 13. Moe A, Hayne D. Transrectal ultrasound biopsy of the prostate: does it still have a role in prostate cancer diagnosis? TranslAndrol Urol. 2020;9(6):3018-3024. doi: 10.21037/tau.2019.09.37.
• 14. D'Amico AV. Risk-based management of prostate cancer. N Engl J Med. 2011;365(2):169-171. doi: 10.1056/NEJMe1103829.
• 15. Ye GC, Yang YX, Luo KD, Wang SG, Xia QD. The association between diabetes mellitus and prostate cancer: a meta-analysis and Mendelian randomization. Aging (Albany NY). 2024;16(11):9584-9598. doi: 10.18632/aging.205886.
• 16. Tsilidis KK, Allen NE, Appleby PN, et al. Diabetes mellitus and risk of prostate cancer in the European Prospective Investigation into Cancer and Nutrition. Int J Cancer. 2015;136(2):372-81. doi: 10.1002/ijc.28989.
• 17. Leitzmann MF, Ahn J, Albanes D, et al. Ovarian Trial Project Team. Diabetes mellitus and prostate cancer risk in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Cancer Causes Control. 2008;19(10):1267-1276. doi: 10.1007/s10552-008-9198-6.
• 18. Szablewski L. Insulin Resistance: The Increased Risk of Cancers. Curr Oncol. 2024;31(2):998-1027. doi: 10.3390/curroncol31020075.
• 19. Ghai S, Haider MA. Multiparametric-MRI in diagnosis of prostate cancer. Indian J Urol. 2015;31(3):194-201. doi: 10.4103/0970-1591.159606.
• 20. Yusim I, Krenawi M, Mazor E, Novack V, Mabjeesh NJ. The use of prostate specific antigen density to predict clinically significant prostate cancer. Sci Rep. 2020;10(1):20015. doi: 10.1038/s41598-020-76786-9.
• 21. Omri N, Kamil M, Alexander K, et al. Association between PSA density and pathologically significant prostate cancer: The impact of prostate volume. Prostate. 2020;80(16):1444-1449. doi: 10.1002/pros.24078.
• 22. Bernal-Soriano MC, Lumbreras B, Hernández-Aguado I, Pastor-Valero M, López-Garrigos M, Parker LA. Untangling the association between prostate-specific antigen and diabetes: a systematic review and meta-analysis. Clin Chem Lab Med. 2020;59(1):11-26. doi: 10.1515/cclm-2020-0145.
• 23. Mottet N, van den Bergh RCN, Briers E, et al. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2021;79(2):243-262. doi: 10.1016/j.eururo.2020.09.042.
• 24. Whittemore AS, Wu AH, Kolonel LN, et al. Family history and prostate cancer risk in black, white, and Asian men in the United States and Canada. Am J Epidemiol. 1995;141(8):732-740. doi: 10.1093/oxfordjournals.aje.a117495.
• 25. Ilic D, Djulbegovic M, Jung JH, et al. Prostate cancer screening with prostate-specific antigen (PSA) test: a systematic review and meta-analysis. BMJ. 2018;362:k3519. doi: 10.1136/bmj.k3519.
• 26. Roddam AW, Duffy MJ, Hamdy FC, et al; NHS Prostate Cancer Risk Management Programme. Use of prostate-specific antigen (PSA) isoforms for the detection of prostate cancer in men with a PSA level of 2-10 ng/ml: systematic review and meta-analysis. Eur Urol. 2005;48(3):386-399. doi: 10.1016/j.eururo.2005.04.015.
• 27. Shakir NA, George AK, Siddiqui MM, et al. Identification of threshold prostate specific antigen levels to optimize the detection of clinically significant prostate cancer by magnetic resonance imaging/ultrasound fusion guided biopsy. J Urol. 2014;192(6):1642-1648. doi: 10.1016/j.juro.2014.08.002.
• 28. Pelzer A, Bektic J, Berger AP, et al. Prostate cancer detection in men with prostate specific antigen 4 to 10 ng/ml using a combined approach of contrast enhanced color Doppler targeted and systematic biopsy. J Urol. 2005;173(6):1926-1929. doi: 10.1097/01.ju.0000158444.56199.03.