Percent Free Prostate-specific Antigen Research Articles

1477 WHEN TO RE-BIOPSY MEN WITH HIGH GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA?

You have accessJournal of UrologyProstate Cancer: Detection & Screening (II)1 Apr 20131477 WHEN TO RE-BIOPSY MEN WITH HIGH GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA? Juan Maria Bastaros, Ignacio Iztueta, Cristian Konstantinidis, Anna Celma, Jose Placer, Jacques Planas, and Juan Morote Juan Maria BastarosJuan Maria Bastaros Barcelona, Spain More articles by this author , Ignacio IztuetaIgnacio Iztueta Barcelona, Spain More articles by this author , Cristian KonstantinidisCristian Konstantinidis Barcelona, Spain More articles by this author , Anna CelmaAnna Celma Barcelona, Spain More articles by this author , Jose PlacerJose Placer Barcelona, Spain More articles by this author , Jacques PlanasJacques Planas Barcelona, Spain More articles by this author , and Juan MoroteJuan Morote Barcelona, Spain More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2942AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES High grade prostatic intraepithelial neoplasia (HGPIN) is considered a premalignant lesion that frequently coexists with undetected prostate cancer (PC). Consensus to repeat prostate biopsy (PB) after isolated HGPIN finding has been changing over the time. Nowadays the recommendation is to repeat PB after at least one year and according to PSA velocity (0.75 ng/ml/year). The aim of this study is to verify if we are doing well. METHODS 219 consecutive men with isolated HGPIN at the first TRUS guided biopsy (PB), due to elevated serum PSA or abnormal digital rectal exam, were advised to repeat PB between 2009 and 2012. The median age was 66 years (43-72). We analyse 149 men subjected to a second PB after 4 to 39 months of follow up, 23 with less than 12 months (18%), 85 between 12 to 24 (66.4%) and 20 with more than 24 months (15.6%). The number of cores with HGPIN involvement was assessed as well as baseline PSA density and percent free PSA. PSA velocity (PSAV) and PSA doubling time (PSADT) were calculated with at least three serum determinations. PSAV was higher than 0.75 ng/ml/year in 24 men (16.1%). Every PB obtained 10 cores plus 1 to 8 additional ones according to age and prostate volume. PC was detected in 34 men (22.8%). Univariate and multivariate analysis were done. RESULTS Binary logistic regression analysis showed that number of HGPIN involved cores was the only independent predictor of PC at repeated biopsy, OR: 1.64 (95%CI: 1.31-2.05), p <0.001. PC was founded in 5 of 79 men with 1 or 2 HGPIN involved cores (6.3%), in 21 of 61 men with 3 to 7 involved cores (34.4%) and 8 of 9 men with more than 7 HGPIN involved cores (88.9%), p <0.001. PC was detected in 4 of 23 (17.4%) men rebiopsied during the first 12 months of follow up, in 20/85 (23.5%) after 12 to 24 months and 7 of 20 (35.0%) later than 24 months, p =0.392. PC was detected in 28/125 (22.4%) men with PSAV lower than 0.75 ng/ml/year and 6 of 24 (25.0%) men with higher PSAV, p =0.817. In the specific subset of men with 3 to 7 HGPIN involved cores PSAV and time period between PBs were neither associated to PC detection. CONCLUSIONS The number of HGPIN involved cores at first PB predicts PC at repeated one, however PSAV and time period to repeat the biopsy seem not be associated to PC detection. Men with 1 or 2 HGPIN involved cores may not be rebiopsied because the probability to find PC was lower than 7%. In contrast, men with massive HGPIN involvement of the prostate gland (more than 7 cores) should be advise to immediate rebiopsy because a PC probability greater than 80%. The attitude in front of men with 3 to 7 HGPIN cores involvement remains unclear and more predictive parameters should be founded. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e605-e606 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Juan Maria Bastaros Barcelona, Spain More articles by this author Ignacio Iztueta Barcelona, Spain More articles by this author Cristian Konstantinidis Barcelona, Spain More articles by this author Anna Celma Barcelona, Spain More articles by this author Jose Placer Barcelona, Spain More articles by this author Jacques Planas Barcelona, Spain More articles by this author Juan Morote Barcelona, Spain More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

1478 PATHOLOGIC OUTCOMES AFTER REPEAT PROSTATE BIOPSIES FOR ATYPICAL SMALL ACINAR PROLIFERATION

first TRUS guided biopsy (PB), due to elevated serum PSA or abnormal digital rectal exam, were advised to repeat PB between 2009 and 2012. The median age was 66 years (43-72). We analyse 149 men subjected to a second PB after 4 to 39 months of follow up, 23 with less than 12 months (18%), 85 between 12 to 24 (66.4%) and 20 with more than 24 months (15.6%). The number of cores with HGPIN involvement was assessed as well as baseline PSA density and percent free PSA. PSA velocity (PSAV) and PSA doubling time (PSADT) were calculated with at least three serum determinations. PSAV was higher than 0.75 ng/ml/year in 24 men (16.1%). Every PB obtained 10 cores plus 1 to 8 additional ones according to age and prostate volume. PC was detected in 34 men (22.8%). Univariate and multivariate analysis were done. RESULTS: Binary logistic regression analysis showed that number of HGPIN involved cores was the only independent predictor of PC at repeated biopsy, OR: 1.64 (95%CI: 1.31-2.05), p 0.001. PC was founded in 5 of 79 men with 1 or 2 HGPIN involved cores (6.3%), in 21 of 61 men with 3 to 7 involved cores (34.4%) and 8 of 9 men with more than 7 HGPIN involved cores (88.9%), p 0.001. PC was detected in 4 of 23 (17.4%) men rebiopsied during the first 12 months of follow up, in 20/85 (23.5%) after 12 to 24 months and 7 of 20 (35.0%) later than 24 months, p 0.392. PC was detected in 28/125 (22.4%) men with PSAV lower than 0.75 ng/ml/year and 6 of 24 (25.0%) men with higher PSAV, p 0.817. In the specific subset of men with 3 to 7 HGPIN involved cores PSAV and time period between PBs were neither associated to PC detection. CONCLUSIONS: The number of HGPIN involved cores at first PB predicts PC at repeated one, however PSAV and time period to repeat the biopsy seem not be associated to PC detection. Men with 1 or 2 HGPIN involved cores may not be rebiopsied because the probability to find PC was lower than 7%. In contrast, men with massive HGPIN involvement of the prostate gland (more than 7 cores) should be advise to immediate rebiopsy because a PC probability greater than 80%. The attitude in front of men with 3 to 7 HGPIN cores involvement remains unclear and more predictive parameters should be founded.

PCA3 in the detection and management of early prostate cancer

Although widely used, the value of prostate-specific antigen (PSA) in the detection of prostate cancer is controversial. The percentage of free PSA increases the specificity of PSA, but results are not enough. Prostate cancer gene 3 (PCA3) has been proposed as an option that may complement these markers in the detection and management of early prostate cancer. Our aim has been to review the value of PCA3 as tumor marker. The available results suggest that PCA3 is particularly useful to select in which patients the biopsy should be repeated when the first biopsy was negative. However, some points should be specified with further studies, including the most appropriate PCA3 cutoff level and the significance of a high PCA3 score in patients with negative biopsy. False-negative results are also a conflictive point in the use of PCA3, because prostate cancer, including aggressive tumors, may be present in patients with a low PCA3 score. Probably, a proper interpretation of this test requires its management together with other tests, through multivariate models for the detection of prostate cancer. On the other hand, several studies showed the relation between PCA3 score and Gleason score, and also the utility of PCA3 to select patients for active surveillance. To summarize, the available studies show the utility of PCA3 in the detection and management of early prostate cancer, although some aspects referred to its use need to be retested after further studies to confirm the actual value and the limitations of this test.

Suitability of quality control materials for prostate-specific antigen (PSA) measurement: inter-method variability of common tumor marker control materials

Quality control materials with minimal inter-assay differences and clinically relevant proportions of different molecular forms of the analyte are needed to optimize intra- and inter-laboratory accuracy and precision. We assessed if clinically relevant total prostate-specific antigen (tPSA) levels were present in seven commercially available Multi Constituent Tumor Marker Controls (MC-TMC). Further, we determined the concentration of free PSA (fPSA) and calculated the percentage of free PSA (%fPSA) in all materials. Finally, we determined variability of TMC materials across several commonly used PSA platforms. All MC-TMC materials contained at least one concentration of tPSA in normal and pathologic range. Control materials varied in the amount of fPSA and %fPSA, with most controls consisting of fPSA only and only one MC-TMC containing medically relevant levels of around 35% fPSA. Only a minority of MC-TMC materials showed minimal variability across four PSA methods while the majority of PSA controls showed wide inter-method differences. Use of many commercially available controls for PSA could lead to biased PSA measurements because they contain medically irrelevant proportions of fPSA and show significant variation among different PSA assay platforms.

Association between percent-free prostate-specific antigen and glomerular filtration rate in transrectal ultrasound-guided biopsy-proven patients with prostate-specific antigen levels ranging from 4 to 10 ng/ml

The aim of this study was to investigate the relationship between percent-free prostate-specific antigen (PSA) and estimated glomerular filtration rate (GFR) in men whose PSA level was 4-10 ng/ml with biopsy-proven prostate status. Between 2004 and 2010, the medical records of 495 cases (404 cases without prostate cancer and 91 cases with prostate cancer) who underwent prostate biopsy were reviewed and their GFR was calculated using the Cockcroft-Gault equation, adjusted for body surface area. Correlation and multivariate regression analyses were conducted among percent-free PSA, body mass index, prostate size, and GFR in patients with and without prostate cancer, respectively. The mean patient age was 64.6 years, and the median PSA and free PSA were 5.64 and 0.87 ng/ml. The mean GFR was 61.02 mL/min/1.73 m2, and mean percent-free PSA was 18.9%. Correlation analysis showed that percent-free PSA was correlated with GFR, age, and prostate size in the non-cancer cohort and correlated with only prostate size in the cancer cohort. Multivariate regression analysis showed that percent-free PSA was influenced by GFR (p < 0.001) and prostate size (p < 0.001) independently in the non-cancer cohort, while only by prostate size (p = 0.008) in the cancer cohort. Percent-free PSA has a negative relationship with GFR in the benign prostate group, while it does not in the prostate cancer group. Screening with current cutoff value of percent-free PSA can be applied to the patients with impaired renal function.

Multicenter Evaluation of [−2]Proprostate-Specific Antigen and the Prostate Health Index for Detecting Prostate Cancer

Total prostate-specific antigen (tPSA) is flawed for prostate cancer (PCa) detection. [-2]proprostate-specific antigen (p2PSA), a molecular isoform of free PSA (fPSA), shows higher specificity compared with tPSA or percentage of free PSA (%fPSA). The prostate health index (Phi), a measure based on p2PSA and calculated as p2PSA/fPSA × √tPSA, was evaluated in a multicenter study for detecting PCa. A total of 1362 patients from 4 different study sites who had tPSA values of 1.6-8.0 μg/L (668 patients with PCa, 694 without PCa) underwent ≥10 core biopsies. Serum concentrations of tPSA, fPSA (both calibrated against a WHO reference material), and p2PSA were measured on Access2 or DxI800 analyzers (Beckman Coulter). The percentage ratio of p2PSA to fPSA (%p2PSA) and Phi were significantly higher in all PCa subcohorts (positive initial or repeat biopsy result or negative digital rectal examination) (P < 0.0001) compared with patients without PCa. Phi had the largest area under the ROC curve (AUC) (AUC = 0.74) and provided significantly better clinical performance for predicting PCa compared with %p2PSA (AUC = 0.72, P = 0.018), p2PSA (AUC = 0.63, P < 0.0001), %fPSA (AUC = 0.61) or tPSA (AUC = 0.56). Significantly higher median values of Phi were observed for patients with a Gleason score ≥7 (Phi = 60) compared with a Gleason score <7 (Phi = 53; P = 0.0018). The proportion of aggressive PCa (Gleason score ≥7) increased with the Phi score. The results of this multicenter study show that Phi, compared with tPSA or %fPSA, demonstrated superior clinical performance in detecting PCa at tPSA 1.6-8.0 μg/L (i.e., approximately 2-10 μg/L in traditional calibration) and is better able to detect aggressive PCa.

Prospective Multicenter Evaluation of the Beckman Coulter Prostate Health Index Using WHO Calibration

Reported prostate specific antigen values may differ substantially among assays using Hybritech® or WHO standardization. The Beckman Coulter® Prostate Health Index and [-2]proPSA are newly approved serum markers associated with prostate cancer risk and aggressiveness. We studied the influence of assay standardization on these markers. Prostate specific antigen, percent free prostate specific antigen and [-2]proPSA were measured using Hybritech calibration in 892 men from a prospective, multicenter study undergoing prostate biopsy. We calculated the Prostate Health Index using the equation, ([-2]proPSA/free prostate specific antigen) × PSA. Index performance characteristics for prostate cancer detection were then determined using recalculated WHO calibration prostate specific antigen values. The median Prostate Health Index was significantly higher in men with prostate cancer than in those with negative biopsies using WHO values (47.4 vs 39.8, p <0.001). The index offered improved discrimination of prostate cancer detection on biopsy (AUC 0.704) compared to percent free or total prostate specific antigen using the WHO calibration. The Prostate Health Index can be calculated using Hybritech or WHO standardized assays. It significantly improved prediction of the biopsy outcome over that of percent free or prostate specific antigen alone.

Value of Prostate Specific Antigen Density and Percent Free Prostate Specific Antigen for Prostate Cancer Prognosis

Limited data exist on the relationship of percent free prostate specific antigen and prostate specific antigen density with prostate cancer prognosis. Therefore, we compared percent free prostate specific antigen and prostate specific antigen density with prostate specific antigen, Gleason sum and stage to predict prostate cancer prognosis in a large cohort using a single prostate specific antigen and free prostate specific antigen assay. Between 1999 and 2007 a total of 1,656 patients with prostate cancer underwent laparoscopic radical prostatectomy at the Charité Berlin. There were 322 patients excluded from analysis for a variety of reasons. The final 1,334 patients had prostate specific antigen, free prostate specific antigen, prostate volume and complete pathological analysis available. Median followup was 60.3 months (range 0.2 to 135). Median age (63 years, range 43 to 75) did not differ between the 1,092 patients without and the 242 with biochemical recurrence (p = 0.956), but prostate volume, prostate specific antigen and percent free prostate specific antigen differed significantly (p <0.0001). While prostate specific antigen and prostate specific antigen density increased significantly in patients with Gleason less than 7, 7 and greater than 7 tumors, percent free prostate specific antigen decreased significantly (p <0.0001). Prostate specific antigen, percent free prostate specific antigen and prostate specific antigen density differed significantly between pT2 and pT3 tumors, and between patients with vs without positive surgical margins. On univariate analysis Gleason sum, pathological stage, positive surgical margin, total prostate specific antigen, percent free prostate specific antigen and prostate specific antigen density were predictors of biochemical recurrence-free survival. Multivariate Cox regression analysis identified Gleason sum, pathological stage, positive surgical margin and prostate specific antigen density as independent predictors of biochemical recurrence-free survival, while percent free prostate specific antigen and total prostate specific antigen failed to be significant. Few models for prostate cancer prognosis include prostate specific antigen density. There is substantial value in prostate specific antigen density but not in percent free prostate specific antigen for improving prostate cancer prognosis and biochemical recurrence prediction.

Combined application of information theory on laboratory results with classification and regression tree analysis: Analysis of unnecessary biopsy for prostate cancer

BackgroundThe probability of a prostate cancer-positive biopsy result varies with PSA concentration. Thus, we applied information theory on classification and regression tree (CART) analysis for decision making predicting the probability of a biopsy result at various PSA concentrations. MethodsFrom 2007 to 2009, prostate biopsies were performed in 664 referred patients in a tertiary hospital. We created 2 CART models based on the information theory: one for moderate uncertainty (PSA concentration: 2.5–10ng/ml) and the other for high uncertainty (PSA concentration: 10–25ng/ml). ResultsThe CART model for moderate uncertainty (n=321) had 3 splits based on PSA density (PSAD), hypoechoic nodules, and age and the other CART for high uncertainty (n=160) had 2 splits based on prostate volume and percent-free PSA. In this validation set, the patients (14.3% and 14.0% for moderate and high uncertainty groups, respectively) could avoid unnecessary biopsies without false-negative results. ConclusionsUsing these CART models based on uncertainty information of PSA, the overall reduction in unnecessary prostate biopsies was 14.0–14.3% and CART models were simplified. Using uncertainty of laboratory results from information theoretic approach can provide additional information for decision analysis such as CART.

Serum Index Test %[-2]proPSA and Prostate Health Index are More Accurate than Prostate Specific Antigen and %fPSA in Predicting a Positive Repeat Prostate Biopsy

We tested the hypothesis that serum isoform [-2]proPSA derivatives %p2PSA and Prostate Health Index are accurate predictors of prostate cancer in men scheduled for repeat biopsy. The study was an observational prospective evaluation of a clinical cohort of men with 1 or 2 previous negative prostate biopsies, with persistent suspicion of prostate cancer. They were enrolled in the study to determine the diagnostic accuracy of %p2PSA using the formula, (p2PSA pg/ml)/(free prostate specific antigen ng/ml × 1,000)]× 100, and Beckman-Coulter Prostate Health Index using the formula, (p2PSA/free prostate specific antigen) × √total prostate specific antigen), and to compare it with the accuracy of established prostate cancer serum tests (total prostate specific antigen, free prostate specific antigen and percent free prostate specific antigen). Multivariable logistic regression models were complemented by predictive accuracy analysis and decision curve analysis. Prostate cancer was found in 71 of 222 (31.9%) subjects. %p2PSA and Prostate Health Index were the most accurate predictors of disease. %p2PSA significantly outperformed total prostate specific antigen, free prostate specific antigen, percent free prostate specific antigen and p2PSA in the prediction of prostate cancer (p ≤0.01), but not Prostate Health Index (p = 0.094). Prostate Health Index significantly outperformed total prostate specific antigen and p2PSA (p ≤0.001) but not free prostate specific antigen (p = 0.109) and free/total prostate specific antigen (p = 0.136). In multivariable logistic regression models %p2PSA and Prostate Health Index achieved independent predictor status, and significantly increased the accuracy of multivariable models including prostate specific antigen and prostate volume with or without percent free prostate specific antigen and prostate specific antigen density by 8% to 11% (p ≤0.034). At a %p2PSA cutoff of 1.23, 153 (68.9%) biopsies could have been avoided, missing prostate cancer in 6 patients. At a Prostate Health Index cutoff of 28.8, 116 (52.25%) biopsies could have been avoided, missing prostate cancer in 6 patients. Serum %p2PSA and Prostate Health Index are more accurate than standard reference tests in predicting repeat prostate biopsy outcome, and could avoid unnecessary repeat biopsies.

Association between family history of prostate cancer and positive biopsies in a Brazilian screening program

To test the association between family history of prostate cancer (FH) and prostate cancer (PCa) risk in a large screening program in Brazil, as no conclusive study has yet investigated this. Between 2004 and 2007, 17,569 men were screened in 231 small municipalities using mobile screening units. Positive FH was defined as any relative having PCa among screened men. Men were biopsied if they had digital rectal examination suggestive of PCa or PSA >4.0 ng/mL or PSA of 2.5-4 ng/mL with percent free PSA ≤ 15 %. We analyzed the association between FH and PCa using multivariable logistic regression in the first screening round of the program. Positive FH was present in 735 men (4.2 % of total), and they were younger, better educated and more likely to have had previous PCa screening (41.5 vs. 28.5 %; P < 0.001) compared to men with negative FH. FH status did not affect compliance rates in men recommended to undergo biopsy (P = 0.94). In first round, PCa was detected in 3.1 % of screened men (n = 552). In multivariable analysis, positive FH was associated with increased PCa risk (OR = 1.79; 95 % CI, 1.21-2.65; P = 0.003). However, Gleason scores (P = 0.78) or percent of positive cores (P = 0.32) among men with positive biopsies were similar, regardless of FH status. In Brazil, men with positive FH were at increased PCa risk, which could not be explained by differential biopsy rates. This finding suggests that FH is also a true PCa risk factor in Brazil, a country with highly diverse population in terms of race, ethnicity, culture and socioeconomic status.

The value of percentage free prostate specific antigen (PSA) in the detection of prostate cancer among patients with intermediate levels of total PSA (4.0–10.0 ng/mL) in Nigeria

ObjectivesTo assess the value of percentage free prostate-specific antigen (%fPSA) in the detection of prostate cancer among Nigerian men with an intermediate total PSA level (4–10ng/mL), and to show if the optimum threshold for biopsy is different from Caucasian values when the widely used (six-core, digitally directed) prostate biopsy protocol in Nigerians is applied. Patients and methodsThe study included 105 patients aged >50years, with a palpably benign prostate gland and intermediate levels of total PSA (4–10ng/mL). These patients had a free PSA assay and a transrectal digitally directed six-core biopsy of the prostate. The %fPSA was calculated and the optimum threshold value for detecting prostate cancer was determined. ResultsThe mean (SD) age of the patients was 64.4 (6.6) years and their mean (SD) total PSA level was 6.6 (1.7)ng/mL. Of these men 14 (13.3%) had cancer of the prostate detected by the prostate biopsy. The %fPSA level related directly to sensitivity values but inversely to the specificity and the positive predictive values. The best threshold of %fPSA for detecting cancer in these men was <40%, with a sensitivity of 100%, specificity of 93.4% and a positive predictive value of 70% (P<0.05). ConclusionsIn evaluating Nigerian patients with a palpably benign prostate gland and within the intermediate total PSA range, when digitally directed biopsy protocol is adopted, a %fPSA threshold of <40% will detect significant percentage of those with prostate cancer, with a minimal number of unnecessary biopsies. This value differs from that reported in western studies in which transrectal ultrasonography-directed biopsy was used.

A novel equation and nomogram including body weight for estimating prostate volumes in men with biopsy-proven benign prostatic hyperplasia

Anthropometric measurements, e.g., body weight (BW), body mass index (BMI), as well as serum prostate-specific antigen (PSA) and percent-free PSA (%fPSA) have been shown to have positive correlations with total prostate volume (TPV). We developed an equation and nomogram for estimating TPV, incorporating these predictors in men with benign prostatic hyperplasia (BPH). A total of 1852 men, including 1113 at Tokyo Medical and Dental University (TMDU) Hospital as a training set and 739 at Cancer Institute Hospital (CIH) as a validation set, with PSA levels of up to 20 ng ml(-1), who underwent extended prostate biopsy and were proved to have BPH, were enrolled in this study. We developed an equation for continuously coded TPV and a logistic regression-based nomogram for estimating a TPV greater than 40 ml. Predictive accuracy and performance characteristics were assessed using an area under the receiver operating characteristics curve (AUC) and calibration plots. The final linear regression model indicated age, PSA, %fPSA and BW as independent predictors of continuously coded TPV. For predictions in the training set, the multiple correlation coefficient was increased from 0.38 for PSA alone to 0.60 in the final model. We developed a novel nomogram incorporating age, PSA, %fPSA and BW for estimating TPV greater than 40 ml. External validation confirmed its predictive accuracy, with AUC value of 0.764. Calibration plots showed good agreement between predicted probability and observed proportion. In conclusion, TPV can be easily estimated using these four independent predictors.

The role of three dimensional transrectal ultrasonography (3-D TRUS) and power Doppler sonography in prostatic lesions evaluation

Aim of workTo evaluate the role of three dimensional (3D), two dimensional (2D) as well as power Doppler transrectal ultrasound (TRUS) in diagnosis of different prostatic lesions. Patients and methods2-D TRUS, power Doppler and Transrectal 3-D US were performed for 100 patients between April 2009 and April 2010. All patients had been examined clinically with digital rectal examination (DRE) and had serum prostatic specific antigen (PSA) level (total and free). Patient age ranges from 42 to 67years and the mean age was 55years. TRUS guided biopsies were done for 77 cases showing any of the followings: abnormal focal lesion with ultrasound, abnormal vascularity with power Doppler exam, abnormal DRE, elevated serum total PSA>4ng/ml or when the percent-free PSA is 10% or less in an outpatient setting. The results were recorded and analyzed. Results3-D TRUS was more sensitive, specific and more accurate than 2-D TRUS in detecting prostate cancer as it showed estimated sensitivity 78.9% and specificity 94.8% with total accuracy 90.9% with respect to an estimated sensitivity 63.1%, specificity 86.2% and total accuracy 80.5% with 2-D TRUS and was more accurate than 2-D ultrasound in identifying the capsular breaks with an estimated sensitivity 80% with respect to 40% with 2-D TRUS.Power Doppler showed 84.2% sensitivity in detecting prostatic cancer and was of 100% sensitivity in detecting prostatitis. 3-D TRUS was more accurate in estimating the volume of adenoma in cases of BPH with an estimated error not more than +6% with respect to an estimated error not more than +18% for 2-D TRUS. Conclusion3-D transrectal ultrasound and power Doppler sonography have specific diagnostic capabilities which added significantly to the ultrasound in detecting and staging of prostatic cancer and in the planning for management. They proved highly valuable in the diagnosis of prostatitis and 3-D TRUS was more accurate than 2-D TRUS in estimating the volume of adenomas in patients with BPH.

Relationship between Chronic Inflammation at Prostate Biopsy and Transition Zone Prostate Volume Enlargement in a Prospectively UK Screened Population

Objective: The aim of this study was to evaluate the relationship between histological prostatic inflammation and prostate volume at the time of prostate biopsy. Patients and methods: From a prospective prostate cancer screening study, 137 men aged 50–65 years, underwent prostate biopsies negative for cancer, forming the study population. Biopsy criteria were prostate specific antigen (PSA) &gt;4 ng/ml ( n = 40), or between 1.1 and 4ng/ml with a percent free PSA (%fPSA) &lt;25% ( n = 97). Total gland (TG) and transition zone (TZ) volumes were measured prior to TRUS guided biopsy. Histological classification included chronic inflammation (CIlymphocyte predominant), active inflammation (AI-neutrophil predominant), and benign prostatic tissue (BPT-no inflammatory cells). A logistic regression analysis was performed using age, TPSA, %fPSA, histology, TZ and TG volume, TZ/TG ratio, PSA density, and transition zone PSA density as continuous variables. We also mailed validated self-administered symptom scores to men in the three histological subgroups (men without cancer) at a median of follow up of 6.5 years (range 5.9–7.1 years) after screening and biopsy. Results: Histological chronic inflammation ( n = 78, 57%) at biopsy was associated with a larger mean TG volume (30.8cc) than active inflammation ( n =7, 22.7cc) and benign prostatic tissue ( n = 52, 25.9cc). On bivariate analysis, chronic inflammation was associated with greater TZ volume ( p = 0.0015) and TZ/TG ratio ( p = 0.0008). On multivariate analysis, chronic inflammation was the only independent variable associated with a greater ratio of the TZ to TG volume (odds ratio 478, p = 0.005). IPPS symptoms scores were completed and returned by 88 men (66% compliance). In men with chronic inflammation (49), active inflammation (5), and benign tissue (30), the mean IPSS scores were 10.9, 7.2, and 8.7, respectively. These differences did not reach statistical significance p &gt; 0.05. Conclusions: In this younger screened population, chronic inflammation was associated with greater prostate gland volume secondary to transition zone volume enlargement. Further research is needed to establish a causally related link for this observation.

To screen or not to screen

To screen or not to screen

1921 DIFFERENCES IN PROSTATE CANCER DETECTION RATES ACCORDING TO THE LEVEL OF GLOMERULAR FILTRATION RATE IN PATIENTS WHOSE PSA LEVELS OF 4.0 TO 10.0 NG/ML

You have accessJournal of UrologyProstate Cancer: Detection and Screening III1 Apr 20121921 DIFFERENCES IN PROSTATE CANCER DETECTION RATES ACCORDING TO THE LEVEL OF GLOMERULAR FILTRATION RATE IN PATIENTS WHOSE PSA LEVELS OF 4.0 TO 10.0 NG/ML Jae-Seung Yeon, Jae Hyun Jung, Sung Yong Cho, Seung Bae Lee, Hwancheol Son, and Hyeon Jeong Jae-Seung YeonJae-Seung Yeon Seoul, Korea, Republic of More articles by this author , Jae Hyun JungJae Hyun Jung s, Korea, Republic of More articles by this author , Sung Yong ChoSung Yong Cho Seoul, Korea, Republic of More articles by this author , Seung Bae LeeSeung Bae Lee Seoul, Korea, Republic of More articles by this author , Hwancheol SonHwancheol Son Seoul, Korea, Republic of More articles by this author , and Hyeon JeongHyeon Jeong Seoul, Korea, Republic of More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2078AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To investigate differences in prostate cancer detection rates according to the level of glomerular filtration rates (GFR). METHODS Patients with PSA levels within 4.0 to 10.0 ng/ml were analyzed. Age, serum creatinine, estimated GFR, body mass index, total PSA (tPSA), free PSA (fPSA), percent free PSA (%fPSA), comorbidities, biopsy Gleason sum, and percent positive core were retrospectively reviewed. All parameters were compared to show whether patients with GFR <60 ml/min/1.73m2 (group A) have higher risk of prostate cancer than patients with GFR ¡Ã60 (group B). The primary endpoint was cancer detection rate and the secondary endpoints were differences in mean tPSA, fPSA, %fPSA and pathologic outcomes. RESULTS A total of 524 men (127 cancer cases) were included. Mean age was 66.6 ¡¾ 7.7 yr. No differences in age and tPSA were found between groups A and B. Mean fPSA, %fPSA and cancer detection rate were significantly higher in group A than group B. The incidence of %fPSA <25% was significantly lower in group A than in group B. Old age, GFR <60, and %fPSA <25% were significant predictors for being prostate cancer. For groups A and B, the probability of being prostate cancer was 35.7% vs 22.9% (p = 0.036). CONCLUSIONS Cancer detection rates were higher in group A than in group B whose PSA levels are within 4.0 to 10.0 ng/ml. Performing prostate biopsy should be actively considered in healthy-looking patients with well-controlled CKD. Table. Differences in cancer-related parameters between patients with CKD stage 3 or higher versus stages 1 and 2. Total Group A Group B p-value n (%) 524 56(10.6%) 468(89.4%) Age (year) 65.8 65.4 ± 8.9 66.3 ± 7.5 40-59, n(%) 96(18.3%) 9(16.1%) 87(18.6%) 60-69, n (%) 242(46.2%) 16(28.6%) 226(48.3%) 70-79, n (%) 186(35.5%) 31(55.4%) 155(33.1%) Body mass index 24.4 ± 2.3 24.7 ± 2.9 24.4 ± 2.2 0.471 Diabetes, n (%) 81(15.5%) 14(25.0%) 67(14.3%) 0.040* Hypertension, n (%) 230(43.9%) 42(75.0%) 188(40.2%) <0.001* GFR (ml/min/1.73m2) 80.6 ± 36.1 40.6 ± 16.8 85.4 ± 34.8 <0.001* ≥ 90 (stage 1), n (%) 0(0%) 125(23.9%) 60-89 (stage 2), n (%) 0(0%) 343(65.5%) 30-59 (stage 3), n (%) 40(7.6%) 0(0%) 15-29 (stage 4), n (%) 10(1.9%) 0(0%) < 15 (stage 5), n (%) 6(1.1%) 0(0%) PSA (ng/ml) 6.0 ± 1.7 6.2 ± 1.7 5.9 ± 1.7 0.208 Free PSA (ng/ml) 1.3 ± 0.6 1.6 ± 0.6 1.3 ± 0.6 <0.001* Percent free PSA (%) 22.0 ± 8.9 26.3 ± 8.2 21.4 ± 8.8 <0.001* Prostate volume (ml) 43.5 ± 22.4 42.2 ± 14.2 44.3 ± 23.1 0.208 Cancer detection rates 127(24.2%) 20(35.7%) 107(22.9%) 0.034* Percent free PSA (< 25%) 374(71.4%) 26(46.4%) 348(74.4%) <0.001* Biopsy Gleason sum 6 62(48.8%) 9(45.0%) 53(49.5%) 0.931 7 39(30.7%) 7(35.0%) 32(29.9%) 8 20(15.7%) 3(15.0%) 17(15.9%) 9 4(3.1%) 1(5.0%) 3(2.8%) 10 2(1.6%) 0(0%) 0(0%) Biopsy Gleason sum (⩾8) 26(20.5%) 4(20.0%) 22(20.6%) 0.955 Percent positive core (%) 27.4 ± 15.8 29.2 ± 14.5 27.1 ± 16.1 0.580 © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e775 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jae-Seung Yeon Seoul, Korea, Republic of More articles by this author Jae Hyun Jung s, Korea, Republic of More articles by this author Sung Yong Cho Seoul, Korea, Republic of More articles by this author Seung Bae Lee Seoul, Korea, Republic of More articles by this author Hwancheol Son Seoul, Korea, Republic of More articles by this author Hyeon Jeong Seoul, Korea, Republic of More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Age-specific reference ranges for prostate-specific antigen among healthy Syrian men

Prostate-specific antigen (PSA) has become the most useful serum tumor marker in adjunct to digital rectal examination (DRE) for the management of prostate cancer (PC). The currently cited reference range of normal PSA levels (between 0 and 4.0 ng/mL) is deficient in terms of both sensitivity and specificity. Age-adjusted PSA have been proposed as an alternative to serum PSA. The primary objective of the present study is to determine the age-specific PSA and the percentage of free PSA (%FPSA) in healthy Syrian men. A total of 3,000 healthy Syrian men over 40 years old participated in this study. All men were asked to have total serum (TPSA) and free PSA (FPSA) tested, a DRE, and, when recommended, a prostate biopsy. Serum TPSA levels correlated with age (r=0.30, p<0.001). The 95th percentile TPSA values ranged from 1.7 ng/mL in the age group 40-49 years to 5.8 ng/mL in the group 70-80 years. The general pattern for medians and the percentile values for FPSA across age groups were similar to those seen for TPSA concentrations (r=0.37, p<0.001). However, the %FPSA was fairly constant across age groups except for the higher ratios in the youngest age group. These findings confirm that the serum TPSA and FPSA levels correlate with age. Interestingly, however, Syrian men have lower PSA values compared with other races. Racial differences of PSA concentrations were observed. Our results may help increasing the sensitivity and specificity of PSA measurements in the diagnosis of prostate cancer in Syria and probably in the surrounding regions.

Association Between Smoking Status, and Free, Total and Percent Free Prostate Specific Antigen

There are scant data available on the relationship between smoking and total prostate specific antigen, free prostate specific antigen and percent-free prostate specific antigen. Given the high prevalence of smoking and the frequency of prostate specific antigen screening, it is important to determine any association between smoking and prostate specific antigen values using nationally representative data. Included in the final study population were 3,820 men 40 years old or older who participated in the 2001-2006 NHANES (National Health and Nutrition Examination Survey) and met the eligibility criteria for prostate specific antigen testing. The distributions of total, free and percent free prostate specific antigen were estimated by sociodemographic and clinical characteristics. Multivariate linear regression models were fit to determine the adjusted relationship between smoking and total and percent free prostate specific antigen while simultaneously controlling for these characteristics. For all ages combined the median total and free prostate specific antigen levels were 0.90 (0.81-0.90) and 0.26 (0.25-0.28) ng/ml, respectively. Multivariate linear regression analysis showed that total prostate specific antigen was 7.9% and 12.2% lower among current and former smokers, respectively, than among never smokers. High body mass index and diabetes were also statistically significantly associated with a lower total prostate specific antigen. Approximately a third of the men had a percent free prostate specific antigen less than 25%. Current smokers had a significantly lower percent free prostate specific antigen than former smokers. Our finding that smoking is inversely associated with total prostate specific antigen may have potential implications for the interpretation of prostate specific antigen levels in men who are current or former smokers. Given the high prevalence of smoking, obesity and diabetes, additional research on the combined effect of these health risk factors is warranted.

Abstract A40: Association between smoking status and free, total, and percent free prostate-specific antigen

Abstract Background: There are scant data available on the relationship between smoking and total prostate-specific antigen (tPSA), free PSA (fPSA) and percent-free PSA (%fPSA). Given the high prevalence of smoking and frequency of PSA screening, it is important to determine any association between smoking and PSA values using nationally representative data. Materials and Methods: Included in the final study population were 3,820 men aged ≥40 years who participated in the 2001-2006 National Health and Nutrition Examination Survey and met eligibility criteria for PSA testing. The distributions of tPSA, fPSA, and %fPSA were estimated by sociodemographic and clinical characteristics. Multivariate linear regression models were fit to determine the adjusted relationship between smoking and tPSA and %fPSA while controlling for these characteristics simultaneously. Results: For all ages combined, the median tPSA and fPSA were 0.90 (0.81–0.90) ng/ml and 0.26 (0.25–0.28) ng/ml, respectively. The multivariate linear regression analysis showed that tPSA was 7.9% and 12.2% lower among current and former smokers, respectively, than that among never smokers. High body mass index and diabetes were also statistically significantly associated with lower tPSA level. About one third of the men had a %fPSA&amp;lt;25. Current smokers had significantly lower %fPSA compared with former smokers. Conclusions: Our findings that smoking is inversely associated with tPSA may have potential implications for the interpretation of PSA levels in men who are current or former smokers. Given the high prevalence of smoking, obesity, and diabetes, additional research on the combined effect of these health risk factors is warranted. Citation Format: Jun Li, Trevor Thompson, Djenaba Joseph, Viraj Master. Association between smoking status and free, total, and percent free prostate-specific antigen [abstract]. In: Proceedings of the AACR Special Conference on Advances in Prostate Cancer Research; 2012 Feb 6-9; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2012;72(4 Suppl):Abstract nr A40.