2124 PREDICTING PROSTATE BIOPSY OUTCOME IN A SCREENING SETTING. PSA, PCA3, A KALLIKREIN PANEL, THE RISKCALCULATOR OR A COMBINATION? ERSPC ROTTERDAM

Abstract

You have accessJournal of UrologyProstate Cancer: Markers II1 Apr 20102124 PREDICTING PROSTATE BIOPSY OUTCOME IN A SCREENING SETTING. PSA, PCA3, A KALLIKREIN PANEL, THE RISKCALCULATOR OR A COMBINATION? ERSPC ROTTERDAM Monique J. Roobol, Daphne Hessels, Andrew J. Vickers, Jack A. Schalken, Pim van Leeuwen, Tineke Wolters, Roderick C.N. van den Bergh, Fritz H. Schröder, and Hans Lilja Monique J. RoobolMonique J. Roobol Rotterdam, Netherlands More articles by this author , Daphne HesselsDaphne Hessels Nijmegen, Netherlands More articles by this author , Andrew J. VickersAndrew J. Vickers New York, NY More articles by this author , Jack A. SchalkenJack A. Schalken Nijmegen, Netherlands More articles by this author , Pim van LeeuwenPim van Leeuwen Rotterdam, Netherlands More articles by this author , Tineke WoltersTineke Wolters Rotterdam, Netherlands More articles by this author , Roderick C.N. van den BerghRoderick C.N. van den Bergh Rotterdam, Netherlands More articles by this author , Fritz H. SchröderFritz H. Schröder Rotterdam, Netherlands More articles by this author , and Hans LiljaHans Lilja Nijmegen, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2212AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The mainstay of early detection of prostate cancer (PC) is the serum Prostate Specific Antigen (PSA) test, while it lacks sensitivity and specificity. Research focuses on more PC specific sub-forms of PSA, molecular based tests and multivariate approaches (nomograms). The current study enables a head to head comparison of these different approaches. METHODS During a side study of the Dutch part of the ERSPC study 965 men, screened for the 3rd or 4th time (4 year interval) were biopsied based on either an elevated PSA level >= 3.0 ng/ml (Beckman Hybritech) or a PCA3 level >= 10 (Genprobe Inc). Additional analyses of a kallikrein panel (Kpanel) consisting of Free PSA (Perkin-Elmer), hK2 and intact PSA (F(ab′)2 fragments, Lund University) were done on stored serum samples. The riskcalculator (www.prostatecancer-riskcalculator.com) is a multivariate prediction model based on PSA, total prostate volume and outcome of DRE and TRUS. Univariate and multivariate logistic regression and ROC curve analyses of the calculated probabilities of a positive biopsy outcome were performed to compare the predictive capabilities of the available markers and combinations. RESULTS Of the 965 men screened, 722 (75%) men were actually biopsied and 122 PC cases (16.9%) were detected. Median/range of PSA and PCA3 were 1.8 (0.2-23.0 ng/ml) and 33 (0-984) res. Of 710 men (119 PC cases) data on biomarkers was complete. Separate analyses were performed on men with PSA>= 3.0 ng/ml (N = 224; 41 PC).Results are shown in table. CONCLUSIONS Combination of tests increases the predictive capability significantly. The riskcalculator, using clinical data, performs best with moderate but similar improvements with the addition of the Kpanel or the PCA3 score. PCA3 has additional value over the entire PSA range while the Kpanel is superior in men with PSA >= 3.0 ng/ml. Multiplex approaches all have their potential drawbacks like the need of subjective information, considerable additional costs, limited availability and bothersome implementation into daily practice. Nevertheless they all perform better than PSA alone. Further development and use of these models therefore is a first requirement for PC screening to become next to effective also efficient. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e825 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Monique J. Roobol Rotterdam, Netherlands More articles by this author Daphne Hessels Nijmegen, Netherlands More articles by this author Andrew J. Vickers New York, NY More articles by this author Jack A. Schalken Nijmegen, Netherlands More articles by this author Pim van Leeuwen Rotterdam, Netherlands More articles by this author Tineke Wolters Rotterdam, Netherlands More articles by this author Roderick C.N. van den Bergh Rotterdam, Netherlands More articles by this author Fritz H. Schröder Rotterdam, Netherlands More articles by this author Hans Lilja Nijmegen, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...