Prostate Cancer Contemporary Prostate Cancer Prevalence among T1c Biopsy-Referred Men with a Prostate-Specific Antigen Level = 4.0 ng per Milliliter Sascha A. Ahyai a , Markus Graefen b , Thomas Steuber a , Alexander Haese a , Thorsten Schlomm a , Jochen Walz a , Jens Ko ¨ llermann c , Alberto Briganti d,e , Mario Zacharias a , Martin G. Friedrich a , Pierre I. Karakiewicz d , Francesco Montorsi e , Hartwig Huland a,b , Felix K.-H. Chun a, * a Department of Urology, University of Hamburg, Hamburg, Germany b Martini Clinic – Prostate Cancer Center, University of Hamburg, Hamburg, Germany c Department of Pathology, University of Hamburg, Hamburg, Germany d Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada e Department of Urology, Vita-Salute University, Milan, Italy european urology xxx (2007) xxx–xxx available at www.sciencedirect.com journal homepage: www.europeanurology.com Article info Article history: Accepted October 8, 2007 Published online ahead of print on October 17, 2007 Keywords: Prostate cancer prevalence Referral cohort Early detection Low PSA %fPSA Prostate volume Abstract Objective: To investigate the prostate cancer (PCa) prevalence and risk factors of men with prostate-specific antigen (PSA) level  4.0 ng/ml and an unsuspicious digital rectal examination (DRE) in a large biopsy referral cohort. Materials and methods: Between 1997 and 2005, 855 men underwent initial transrectal ultrasound (TRUS)-guided prostate biopsy at the University Hospital Hamburg- Eppendorf. Patients with any previous surgical or medical treatment were excluded from analyses. Logistic regression analyses were performed to determine risk factors of PCa at biopsy and high-grade PCa defined as biopsy Gleason sum  7. Results: Overall PCa detection rate was 23.1%. The majority had a biopsy Gleason sum of 6 (79.5%) and 20.5% had a biopsy Gleason sum  7. Total PSA (tPSA) and percentage of free PSA (%fPSA) were statistically significantly different in men with and without PCa (all p < 0.001). In tPSA strata  0.5, 0.6–1.0, 1.1–2.0, 2.1–3.0, and 3.1–4.0 ng/ml, PCa prevalence was 4.0%, 10.6%, 14.8%, 24.5%, and 32.1%, respec- tively. In logistic regression analyses addressing PCa and Gleason sum  7 at biopsy, %fPSA and prostate volume represented independent and most informative risk factors. Conclusion: Our data demonstrate that a substantial percentage (23.1%) of men with a PSA  4.0 ng/ml and an unsuspicious DRE in a biopsy referral population harbor PCa, with 20.5% being high grade. Our data suggest that, low %fPSA and low prostate volume represent important parameters in PCa and in high grade disease detection at biopsy, respectively. # 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved. * Corresponding author. Department of Urology, University of Hamburg-Eppendorf, 20246 Hamburg, Germany. Tel. +49 42803 3442; Fax: +49 42803 6837. E-mail address: chun@uke.uni-hamburg.de (Felix K.-H. Chun). EURURO-2245; No of Pages 8 0302-2838/$ – see back matter # 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.eururo.2007.10.017 Please cite this article in press as: Ahyai SA, et al., Contemporary Prostate Cancer Prevalence among T1c Biopsy-Referred Men with a Prostate-Specific Antigen Level  4.0 ng per Milliliter, Eur Urol (2007), doi:10.1016/j.eururo.2007.10.017