2027 DIAGNOSTIC MERIT OF PERCENT FREE/TOTAL PROSTATE SPECIFIC ANTIGEN VALUES IN THE DIAGNOSIS OF ADENOCARCINOMA OF THE PROSTATE IN DIFFERENT AGE GROUPS

Abstract

You have accessJournal of UrologyProstate Cancer: Detection and Screening1 Apr 20112027 DIAGNOSTIC MERIT OF PERCENT FREE/TOTAL PROSTATE SPECIFIC ANTIGEN VALUES IN THE DIAGNOSIS OF ADENOCARCINOMA OF THE PROSTATE IN DIFFERENT AGE GROUPS Joseph Zadra, Dylan Hoare, Andrew Ray, Cory Hartsburg, Angelo Iocca, and Homa Khonsari Joseph ZadraJoseph Zadra Barrie, Canada More articles by this author , Dylan HoareDylan Hoare Barrie, Canada More articles by this author , Andrew RayAndrew Ray Barrie, Canada More articles by this author , Cory HartsburgCory Hartsburg Barrie, Canada More articles by this author , Angelo IoccaAngelo Iocca Barrie, Canada More articles by this author , and Homa KhonsariHoma Khonsari Barrie, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2256AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Percent free/total PSA ratio (%FPR) is an important decision test in the diagnosis of prostatic adenocarcinoma (CaP). We evaluated the validity of %FPR as a decision making tool to proceed towards Trans Rectal Ultrasound (TRUS) guided prostate biopsy and investigated the possible confounding effects of age. METHODS 1581 TRUS Bx were performed at our centre between 2005–2010. All patients met the following inclusion criteria: (a) ten or twelve core TRUS biopsy for clinical and/or biochemical suspicion of CaP, (b) a total PSA value between 4 and 10 ng/mL, (c) at least one %FPR measurement. The predictive nature of patient factors-PSA, %FPR, age–were then assessed. RESULTS A total of 1233 men underwent 1581 biopsies. 59.0% (932) of biopsies were negative for CaP. 41.0% (649) were positive for adenocarcinoma. As expected, among the 528 patients with recorded %FPR, higher ratios correlated with negative biopsy findings. Within the entire sample of TRUS patients, ascending values of %FPR were significantly correlated with descending percentages of positive biopsies (limit of 1% FPR to 24% FPR, r=−0.83, p<0.0001). Patient age was found to significantly impact the predictive nature of %FPR. When analyzing specific %FPR brackets, patients aged ≥ 70 years were positive for CaP, on average, 21.3% more often than those ≤ 70 years. When age was considered, both the old (r=−0.95, p<0.0001) and young (r=−0.97, p<0.0001) cohorts maintained high correlations between %FPR and descending rates of prostatic adenocarcinoma. However, for every 5 %FPR interval increase, the younger cohort, continually exhibited the lesser rate of CaP detection. Of special interest in the older cohort, biopsies of patients with %FPR greater than 21% were returned positive for CaP at a rate 3.2 times the respective rate of the younger cohort. CONCLUSIONS The decision for prostate biopsy cannot be made through single variable analysis of serum PSA values or %FPR. Age is an important confounding variable that must be considered when interpreting %FPR. As one increases in age, it appears the diagnostic efficacy of %FPR declines. New age-related %FPR cut-offs need to be established to improve the diagnostic accuracy of this test. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e810-e811 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph Zadra Barrie, Canada More articles by this author Dylan Hoare Barrie, Canada More articles by this author Andrew Ray Barrie, Canada More articles by this author Cory Hartsburg Barrie, Canada More articles by this author Angelo Iocca Barrie, Canada More articles by this author Homa Khonsari Barrie, Canada More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...