PD40-02 RE-EXAMINING PSA DENSITY: DEFINING THE OPTIMAL PSA RANGE AND PATIENTS FOR USING PSA DENSITY TO PREDICT PROSTATE CANCER USING EXTENDED TEMPLATE BIOPSY

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening V1 Apr 2017PD40-02 RE-EXAMINING PSA DENSITY: DEFINING THE OPTIMAL PSA RANGE AND PATIENTS FOR USING PSA DENSITY TO PREDICT PROSTATE CANCER USING EXTENDED TEMPLATE BIOPSY Joshua Jue, Marcelo Panizzutti, Nachiketh Prakash, Vivek Venkatramani, Varsha Sinha, Nicola Pavan, Bruno Nahar, Pratik Kanabur, Michael Ahdoot, Ramgopal Satyanarayana, Dipen Parekh, and Sanoj Punnen Joshua JueJoshua Jue More articles by this author , Marcelo PanizzuttiMarcelo Panizzutti More articles by this author , Nachiketh PrakashNachiketh Prakash More articles by this author , Vivek VenkatramaniVivek Venkatramani More articles by this author , Varsha SinhaVarsha Sinha More articles by this author , Nicola PavanNicola Pavan More articles by this author , Bruno NaharBruno Nahar More articles by this author , Pratik KanaburPratik Kanabur More articles by this author , Michael AhdootMichael Ahdoot More articles by this author , Ramgopal SatyanarayanaRamgopal Satyanarayana More articles by this author , Dipen ParekhDipen Parekh More articles by this author , and Sanoj PunnenSanoj Punnen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1742AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous guidelines to screen for prostate cancer (PCa) using serum PSA levels led to millions of unnecessary prostate biopsies that revealed no PCa or low-risk PCa that was unlikely to affect survival. PSA density has shown promise as a better marker to indicate prostate biopsy and has been well investigated in the past using sextant or octant biopsies. While most prior studies only showed that PSA density could distinguish between BPH and PCa, we compared the sensitivity and specificity of PSA density versus PSA to detect any and significant PCa across different PSA ranges using the current standard of extended template prostate biopsies. METHODS Participants were a prospective cohort of men referred for prostate biopsy using an extended template biopsy scheme to evaluate PCa at 26 sites throughout the US. We analyzed the area under the receiver operating characteristic curve to assess the predictive accuracy of PSA density versus PSA across three PSA ranges (<4, 4-10, >10 ng/mL) and in men with or without a prior negative biopsy. We assessed the detection of any and significant (Gleason score ≥ 7) PCa. RESULTS Among 1,290 patients with available data, 585 (45%) and 284 (22%) men had any PCa and significant PCa, respectively. PSA density was significantly more predictive than PSA for detecting any and significant PCa in the PSA ranges of 4-10 and >10 ng/mL. AUC for significant prostate cancer was 0.72 (0.68, 0.77), p<0.0001 for PSA 4-10 ng/mL and 0.82 (0.75, 0.89), p<0.0001 for PSA >10 ng/mL. PSA density was significantly more predictive than PSA in detecting any and significant PCa in men with and without a prior negative biopsy. However, the incremental AUC value was larger for significant PCA than any PCA in men who had a prior negative prostate biopsy (AUC 0.81 vs 0.70, p = 0.0042), and those who did not (AUC 0.77 vs 0.73, p = 0.0026). CONCLUSIONS In contrast to previous studies, we found that PSA density outperformed PSA most within the PSA range >10 ng/mL, suggesting that PSA density will save large volume prostate patients from the costs associated with the over-diagnosis of PCa. Additionally, PSA density performed best among men with a prior negative biopsy, saving these men from the burden of repeated biopsies that are likely to be negative in this population. With the current need for better markers to indicate prostate biopsy, PSA density may have significant value as a more sensitive and specific test than PSA to detect PCa when used with an extended template biopsy scheme. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e750-e751 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Joshua Jue More articles by this author Marcelo Panizzutti More articles by this author Nachiketh Prakash More articles by this author Vivek Venkatramani More articles by this author Varsha Sinha More articles by this author Nicola Pavan More articles by this author Bruno Nahar More articles by this author Pratik Kanabur More articles by this author Michael Ahdoot More articles by this author Ramgopal Satyanarayana More articles by this author Dipen Parekh More articles by this author Sanoj Punnen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...