2133 [-2]PROPSA AND PROSTATE HEALTH INDEX (PHI) IMPROVE DETECTION OF PROSTATE CANCER AT INITIAL AND REPEATED BIOPSIES IN YOUNG MEN (

Abstract

You have accessJournal of UrologyProstate Cancer: Markers (I)1 Apr 20132133 [-2]PROPSA AND PROSTATE HEALTH INDEX (PHI) IMPROVE DETECTION OF PROSTATE CANCER AT INITIAL AND REPEATED BIOPSIES IN YOUNG MEN (<60 YEAR OLD) PREFERENTIALLY DETECTING CLINICALLY SIGNIFICANT CANCER Carsten Stephan, Sébastien Vincendeau, Alain Houlgatte, Kurt Miller, and Axel Semjonow Carsten StephanCarsten Stephan Berlin, Germany More articles by this author , Sébastien VincendeauSébastien Vincendeau Rennes, France More articles by this author , Alain HoulgatteAlain Houlgatte Paris, France More articles by this author , Kurt MillerKurt Miller Berlin, Germany More articles by this author , and Axel SemjonowAxel Semjonow Münster, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2042AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate-specific antigen (PSA) screening reduced prostate cancer (PCa) mortality but due to overdiagnosis and overtreatment of indolent PCa, PSA based screening is not recommended. Detailed analysis of large randomised studies has shown that the benefit of PSA based screening is maximal for young men. A molecular isoform of free PSA, [-2]proPSA, demonstrated improved clinical specificity for the detection of PCa compared with total PSA (tPSA) or percent free PSA (%fPSA). The [-2]proPSA results can be combined with tPSA and fPSA in an innovative prostate health index (Phi). The clinical performance of Phi (p2PSA/fPSA × √tPSA) for PCa detection was evaluated in a multicenter study. METHODS A total of 1362 patients schedule for initial or repeated prostate biopsy (668 with, 694 without PCa, all confirmed with í>10 cores biopsy) were recruited in 4 different sites based on PSA level 1.6-8.0 ng/mL WHO calibration (ie 2-10 ng/mL with classical calibration). Serum samples were taken before DRE examination. The serum concentrations of tPSA, fPSA and [-2]proPSA were measured with Beckman Coulter immunoassays on Access2 or DxI800 instruments. RESULTS Univariate analysis showed that [-2]proPSA/fPSA (%p2PSA) and Phi were the best predictors or PCa detection in patients at initial biopsy (AUC: 0.72 and 0.73) and repeated biopsy (AUC: 0.74 and 0.74). In multivariate analysis by using artificial neural networks and binary logistic regression models, %p2PSA and Phi significantly improved the prediction of a model based on age, prostate volume, DRE, tPSA and %fPSA at initial (AUC from 0.69 to 0.73) or repeated biopsy (AUC from 0.74 to 0.80). Analysis of the data for men <60 years old (n=472) showed that Phi and %p2PSA significantly improved PCa detection (AUC: 0.72) as compared with tPSA (AUC: 0.53) or %fPSA (AUC: 0.62). When the detection of significant cancer (based on the PRIAS criteria) was assessed, %p2PSA and Phi also demonstrated the best performance for detection of clinically relevant cancer in the whole cohort of patients but also in younger men aged <60 (AUC: 0.70 and 0.73 respectively). CONCLUSIONS This multicenter study demonstrated that %p2PSA and Phi have a superior clinical performance in detecting PCa in the tPSA range of 2-10 ng/mL compared with tPSA or %fPSA at initial or repeated biopsy but also improve detection of clinically relevant PCa in young men (<60 years old). © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e873-e874 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Carsten Stephan Berlin, Germany More articles by this author Sébastien Vincendeau Rennes, France More articles by this author Alain Houlgatte Paris, France More articles by this author Kurt Miller Berlin, Germany More articles by this author Axel Semjonow Münster, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...