To evaluate the effectiveness of PSA density in distinguishing between benign prostatic hyperplasia (BPH) and prostate cancer in patients with intermediate PSA levels (4 - 10 ng/ml) and to reduce unnecessary biopsies. Patients and Methods: 90 patients with PSA levels in the “Gray Zone” PSA (4 - 10 ng/ml) were included. Prostate volumes were estimated using transrectal ultrasonography. Serum PSA levels were measured using an enzyme immunoassay. PSA density was calculated and compared with histopathological results. Statistical analysis was performed using SPSS, t-test, and Contingency Coefficient test. Results: A PSA density cutoff of 0.15 ng/ml/cm3 was used for prostate cancer detection. Mean PSA density for BPH patients: 0.0844 ng/ml/cm3. Mean PSA density for prostate cancer patients: 0.172 ng/ml/cm3. Sensitivity: 92.3%, Specificity: 93.5%, Positive Predictive Value: 70.5%, Accuracy: 93.3%. PSA density significantly reduced unnecessary biopsies (p < 0.001). Conclusions: PSA density can be effective in reducing unnecessary biopsies in patients with intermediate PSA levels, particularly those with organ-confined prostate cancer who are candidates for radical treatment.
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