Abstract
ObjectiveThe aim of this study was to develop a follow-up strategy based on the new model to reduce unnecessary prostate biopsies in patients with prostate specific antigen (PSA) ranging from 4 to 10 ng/ml.MethodsA total of 436 patients with PSA ranging from 4 to 10 ng/ml who had undergone transrectal ultrasound (TRUS)-guided prostate biopsy were evaluated during the first stage. Age, PSA, free PSA (fPSA), digital rectal examination (DRE) findings, ultrasonic hypoechoic mass, ultrasonic microcalcifications, prostate volume (PV) and PSA density (PSAD) were considered as predictive factors. A multiple logistic regression analysis involving a backward elimination selection procedure was applied to select independent predictors. After a comprehensive analysis of all results, we developed a new model to assess the risk of prostate cancer and an effective follow-up strategy.ResultsAge, PSA, PV, fPSA, rate of abnormal DRE findings and rate of hypoechoic masses detected by TRUS were included in our model. A significantly greater area under the receiver-operating characteristic curve was obtained in our model when compared with using PSA alone (0.782 vs. 0.566). Patients were grouped according to the value of prostate cancer risk (PCaR). In the second stage of our study, patients with PCaR>0.52 were recommended to undergo biopsies immediately while the rest of the patients continued close follow-up observation. Compared with the first stage, the detection rate of PCa in the second stage was significantly increased (33.0% vs 21.1%, p = 0.012). There was no significant difference between the two stages in distribution of the Gleason score (p = 0.808).ConclusionsWe developed a follow-up strategy based on the new model, which reduced unnecessary prostate biopsies without delaying patients’ diagnoses and treatments.
Highlights
Prostate specific antigen (PSA) is widely used for the screening of prostate cancer
An increasing level of PSA can been seen in benign prostatic hyperplasia (BPH) and prostatitis, which questioned the specificity of PSA in predicting prostate cancer [1]
#Age, PSA, free PSA (fPSA), prostate volume (PV), PSA density (PSAD), f/t, hypoechoic, digital rectal examination (DRE) findings and microcalcification were included in our logistic analysis with a backward elimination scheme
Summary
Prostate specific antigen (PSA) is widely used for the screening of prostate cancer. In patients with PSA levels of 4 to 10 ng/ml, the detection rate of PCa was merely 20% or less defining the region as a ‘‘gray zone’’ [2,3,4]. There is an urgent need for improving the detection rate and reducing unnecessary prostate biopsies in the ‘‘gray zone’’. Models combining PSA levels with other independent risk factors had shown advantages in screening PCa by avoiding unnecessary prostate biopsies [5]. To the best of our knowledge model that was specially designed to increase the PCa detection rate in the PSA ‘‘gray zone’’ was far from satisfactory
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