Predict Prostate Cancer Detection Research Articles

External validation of two mpMRI-risk calculators predicting risk of prostate cancer before biopsy.

PurposeRisk calculators (RC) aim to improve prebiopsy risk stratification. Their latest versions now include multiparametric magnetic resonance imaging (mpMRI) findings. For their implementation into clinical practice, critical external validations are needed.MethodsWe retrospectively analyzed the patient data of 554 men who underwent ultrasound-guided targeted and systematic prostate biopsies at 2 centers. We validated the mpMRI-RCs of Radtke et al. (RC-R) and Alberts et al. (RC-A), previously shown to predict prostate cancer (PCa) and clinically significant PCa (csPCa). We assessed these RCs’ prediction accuracy by analyzing the receiver-operating characteristics (ROC) curve and evaluated their clinical utility using Decision Curve Analysis (DCA), including Net-Benefit and Net-Reduction curves.ResultsWe found that the Area Under the ROC Curve (AUC) for predicting PCa was 0.681 [confidence interval (CI) 95% 0.635–0.727] for RC-A. The AUCs for predicting csPCa were 0.635 (CI 95% 0.583–0.686) for RC-A and 0.676 (CI 95% 0.627–0.725) for RC-R. For example, at a risk threshold of 12%, RC-A needs to assess 334 and RC-R 500 patients to detect one additional true positive PCa or csPCa patient, respectively. At the same risk threshold of 12%, RC-A only needs to assess 6 and RC-R 16 patients to detect one additional true negative PCa or csPCa patient.ConclusionThe mpMRI-RCs, RC-R and RC-A, are robust and valuable tools for patient counseling. Although they do not improve PCa and csPCa detection rates by a clinically meaningful margin, they aid in avoiding unnecessary prostate biopsies. Their implementation could reduce overdiagnosis and reduce PCa screening morbidity.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00345-022-04119-8.

Prostate-specific antigen density during dutasteride treatment for 1year predicts the presence of prostate cancer in benign prostatic hyperplasia after the first negative biopsy (PREDICT study).

To prospectively evaluate the detection rate of prostate cancer, and to identify the risk factors of prostate cancer detection after a 1-year administration of dutasteride and first negative prostate biopsy. Patients with benign prostatic hyperplasia who presented high prostate-specific antigen levels after the first negative prostate biopsy were administered 0.5mg dutasteride daily for 1year. They underwent a repeat prostate biopsy after 1year. The primary end-point was the detection rate of prostate cancer. The secondary end-point was the ability of prostate-specific antigen kinetics to predict prostate cancer detection. Prostate-specific antigen was measured before the initial prostate biopsy and at 6, 9 and 12months after starting dutasteride. Patients were classified into a prostate cancer and a non-prostate cancer group. Prostate cancer was detected in 15 of 149 participants (10.1%). The total prostate-specific antigen change between the prostate cancer and non-prostate cancer group at 1year was significantly different (P=0.002). Although prostate-specific antigen levels at baseline did not significantly differ between study groups (P=0.102), prostate-specific antigen levels at 6, 9 and 12months were significantly different (P=0.002, P=0.001 and P<0.001, respectively). The mean reduction rate of prostate-specific antigen density between the prostate cancer and non-prostate cancer group at 1year was significantly different (-4.25±76.5% vs -38.0±28.7%, P=0.001). Using a multivariate analysis, a >10% increase of prostate-specific antigen density at 1year post-dutasteride treatment was the only predictive risk factor for prostate cancer after the first negative prostate biopsy (odds ratio 11.238, 95% confidence interval 3.112-40.577, P<0.001). In the present study cohort, >10% increase in prostate-specific antigen density represented the only significant predictive risk factor for prostate cancer diagnosis in patients with elevated prostate-specific antigen after the first negative prostate biopsy.

T2E (TMPRSS2-ERG) fusion transcripts are associated with higher levels of AMACR mRNA and a subsequent prostate cancer diagnosis in patients with atypical small acinar proliferation

Genetic rearrangements involving androgen-regulated transmembrane protease serine 2 (TMPRSS2) and genes from the ETS transcription factor family, most commonly ERG and ETV1, result in alteration that responsible for oncogenic activity in prostate cancer (PC). The aims of the present study were to: 1) investigate the frequency of these fusion transcripts in prostate tissue samples obtained from patients diagnosed with atypical small acinar proliferation (ASAP), 2) determine any clinical significance of T2E expression at the RNA level in predicting PC detection in subsequent biopsies, and 3) evaluate expression of the PC marker, alpha-methylacyl-CoA racemase (AMACR), according to T2E status by real-time quantitative reverse transcription PCR (RT-qPCR). T2E transcripts were detected in 31.7% (n=20) of the patients examined, and this was significantly associated with subsequent detection of PC in ASAP patients with a prostate specific antigen (PSA) level of 4-10ng/ml (p=0.045). AMACR expression was also significantly higher in the patients who were diagnosed with PC in subsequent biopsies than in the patients who were not diagnosed with PC (p=0.034) and in T2E-positive ASAP patients (p=0.002) compared to T2E-negative ASAP patients. Although these results need to be further clinically validated, we suggest that the presence of T2E transcript, in association with higher AMACR expression, is an indicator of PC risk from a T2E-positive focus or an unsampled malignant gland adjacent to a T2E-positive site in ASAP lesions.

Atypical small acinar proliferation and two or more cores of high-grade intraepithelial neoplasia on a previous prostate biopsy are significant predictors of cancer during a transperineal template-guided saturation biopsy aimed at sampling one core for each 1 mL of prostate volume.

ObjectiveThe objective of this study was to evaluate whether high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP) predict prostate cancer (PCa) during repeat transperineal template saturation biopsy with a high number of cores per prostate volume in patients with persistent clinical suspicion of PCa who underwent at least one previous negative transrectal ultrasound (TRUS)-guided biopsy.MethodsWe retrospectively evaluated 135 consecutive patients with persistent clinical suspicion of PCa, despite a set of negative TRUS-guided biopsies and increasing prostate-specific antigen levels; abnormal findings on digital rectal examination, TRUS, or magnetic resonance imaging; previous biopsy showing HGPIN; and previous biopsy showing atypical glands. Transperineal template saturation biopsy (TTSB) was performed at 5mm intervals to sample one core for each 1 mL of prostate volume.ResultsThe median rate of biopsy cores per prostate volume was 1.00 (range: 0.75–1.39). The PCa detection rates in patients who were diagnosed with HGPIN, or had two or more cores of HGPIN or ASAP, were 53% (9/17), 89% (8/9), and 83% (10/12), respectively. Two or more HGPIN cores and ASAP were positive predictors of PCa on TTSB. The high-grade cancer rates (Gleason score [GS] ≥7) in patients with ASAP and two or more cores of HGPIN were 20% and 80%, respectively. The cancer detection rate represented by a GS score ≥8 in patients with ASAP or two or more cores of HGPIN at a previous TRUS-guided biopsy was 5.5% (1/18).ConclusionASAP or two or more cores of HGPIN at a previous TRUS-guided biopsy strongly indicated the presence of PCa on TTSB.

Can PSA density and free-to-total PSA ratio improve our ability to predict prostate cancer on biopsy? Results from a prospective, multi-institutional, and contemporary cohort.

57 Background: Several studies have reported an increased value of PSA density (PSAD) and free−to−total PSA ratio (f/t PSA) over PSA alone in predicting prostate cancer (PCa). Despite this, they remain underutilized. This study analyzed a cohort of men referred for prostate biopsy (PB) to determine if PSAD and f/t PSA enhanced the prediction of any PCa and/or significant PCa (Gleason score ≥ 7) compared to PSA. Methods: 1,370 prospectively enrolled patients were referred for a PB across 26 urological centers. A phlebotomy was performed immediately prior to PB for PSA and f/t PSA measurement. PSAD was calculated using prostate volume obtained during the trans−rectal ultrasound (TRUS) guided PB. The area under the receiver operating characteristic curve (AUC) was used to assess the added discriminative value of PSAD and f/t PSA when added to a base model consisting of PSA, age, prior biopsy status, and DRE for the prediction of any and significant PCa. Results: Of the 1,290 men in the final cohort, 301 (23%) and 284 (22%) men were diagnosed with low−grade (Gleason score = 6) and significant PCa respectively. The median PSAD values in men with no PCa, low−grade PCa, and significant PCa were 0.09, 0.11, and 0.17 ng/mL/cc, respectively (P &lt; 0.0001). The median f/t PSA in men with no PCa, low−grade PCa, and significant PCa was 0.21, 0.17, and 0.12 respectively (P &lt; 0.0001). The AUC for a model incorporating PSAD showed superior predictive value compared to the base model for diagnosing any PCa (AUC 0.76 versus 0.70, P &lt; 0.0001) and significant PCa (AUC 0.82 versus 0.77, P &lt; 0.0001). Similarly, a model with f/t PSA showed superior predictive value compared to the base model for diagnosing any PCa (AUC 0.73 vs 0.70, P &lt; 0.0001) and significant PCa (AUC 0.82 versus 0.77, P &lt; 0.0001). While PSAD showed superior predictive value over f/t PSA for predicting any PCa (AUC 0.76 versus 0.73, P = 0.0062), there was no difference in their discrimination of significant PCa. Conclusions: PSAD and f/t PSA add substantial predictive power to the diagnostic armamentarium for any and significant PCa. Their calculation may reduce the number of unnecessary biopsies being performed for PCa detection.

Clinical utility of prostate-specific antigen mass ratio for prediction of prostate cancer detection on a repeated prostate biopsy.

To assess the clinical utility of the prostate-specific antigen mass ratio (PSA- MR), a newly developed PSA derivative, simply defined as the (i) PSA density (PSA-D) multiplied by the plasma volume or (ii) total PSA amount in circulation per prostate volume, for predicting prostate cancer (PCa) among men undergoing repeated prostate biopsy (PBx). Patients (n = 286), who underwent a repeated PBx, were analyzed. The various parameters associated with PCa detection were noted in each patient. PSA-MR was also calculated. PCa was detected in 63 (22.0%) of 286 patients. PSA-MR was the independent predictor in the univariate- and multivariate logistic regression analyses (OR = 3.448, p = 0.001 and OR = 13.430, p = 0.033, respectively). A nomogram that incorporated PSA-MR was considered a useful tool (predictive accuracy: 79.2%, 95% CI: 0.726-0.858, p < 0.001). Furthermore, a nomogram that incorporated PSA-MR would have avoided 59.6% of unnecessary repeated PBx. The predictive accuracy of PSA-MR was also superior to that of PSA or PSA-D (p = 0.013 and 0.009, respectively). PSA-MR was an independent predictor, and its consideration would have avoided 59.6% of unnecessary repeated PBx for PCa detection. PSA-MR was also superior than PSA or PSA-D. Our results support the use of PSA-MR to facilitate counseling with patients after a negative initial PBx, and use of PSA-MR might reduce further unnecessary biopsies.

MP67-06 VARIATION IN PROSTATE CANCER DETECTION RATES IN A STATEWIDE QUALITY IMPROVEMENT COLLABORATIVE

You have accessJournal of UrologyProstate Cancer: Detection & Screening IV1 Apr 2014MP67-06 VARIATION IN PROSTATE CANCER DETECTION RATES IN A STATEWIDE QUALITY IMPROVEMENT COLLABORATIVE Christopher B. Riedinger, Susan Linsell, Jun Ye, Rodney Dunn, James E. Montie, David C. Miller, and Brian R. Lane Christopher B. RiedingerChristopher B. Riedinger More articles by this author , Susan LinsellSusan Linsell More articles by this author , Jun YeJun Ye More articles by this author , Rodney DunnRodney Dunn More articles by this author , James E. MontieJames E. Montie More articles by this author , David C. MillerDavid C. Miller More articles by this author , and Brian R. LaneBrian R. Lane More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2073AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There remains significant controversy around the optimal criteria for recommending prostate biopsy. To examine this issue further, urologists in the Michigan Urological Surgery Improvement Collaborative (MUSIC) assessed statewide prostate biopsy practice patterns and variation in prostate cancer (PC) detection. METHODS MUSIC is a statewide physician-led collaborative designed to improve prostate cancer care. From 3/2012 through 6/2013, 17 MUSIC practices collected standardized clinical and pathological data for 3015 men undergoing first-time prostate biopsy. We examined pathologic biopsy outcomes across practices, stratifying men by age and PSA level. RESULTS The overall cancer detection rate was 52%, with significant variability across MUSIC practices (range: 43% to 70%, p<0.0001). 27% of all patients biopsied were > 69 years, ranging from 19% to 36% at individual practices. Men with a PSA < 4 ng/ml were 26% of our study population (range: 10% to 37%). Detection rates in patients > 69 years ranged from 42% to 86% for individual practices (p=0.0008). For patients with PSA < 4 (n=793), cancer detection rates ranged from 22% to 58% across individual practices (p=0.0065). The predicted probability of cancer detection varied significantly across MUSIC practices (p<0.0001) after adjusting for patient age, PSA, prostate size, family history and DRE findings. Prostate size 30 – 60 cc and > 60 cc were less likely to predict prostate cancer detection than size < 30 cc (odds ratio [OR] 0.53, 95% confidence interval [CI] 0.44-0.64 and OR 0.23, 95% CI 0.18-0.29, respectively). CONCLUSIONS Cancer detection rates are higher than previously reported. Practice patterns and cancer yield for prostate biopsy vary widely across urology practices in Michigan. These data serve as a foundation for our efforts to understand and improve patient selection for prostate biopsy. Percentage(%) of biopsies positive for PCa No. Overall Lowest Rate Among 17 Practices Highest Rate Among 17 Practices P Value All patients 3015 52 43 70 < 0.0001 Age < 55 years 434 45 18 73 0.1313 55 - 69 years 1766 50 32 67 0.0001 > 69 years 814 59 42 86 0.0008 PSA values < 4 793 38 22 58 0.0065 4 - 10 1853 54 47 63 0.2354 > 10 362 71 44 83 0.0526 Median prostate size < 30 596 62 49 100 0.0022 30 - 60 1641 52 33 75 < 0.0001 > 60 736 39 14 50 0.9222 Family history Negative 2339 50 41 71 < 0.0001 Positive 676 58 42 82 0.2604 DRE findings Negative 2085 49 40 66 < 0.0001 Positive 755 59 36 90 0.0005 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e750-e751 Peer Review Report Advertisement Copyright & Permissions© 2014MetricsAuthor Information Christopher B. Riedinger More articles by this author Susan Linsell More articles by this author Jun Ye More articles by this author Rodney Dunn More articles by this author James E. Montie More articles by this author David C. Miller More articles by this author Brian R. Lane More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP67-07 TRANS-RECTAL ULTRASOUND VISIBILITY OF PROSTATE LESIONS INCREASES ACCURACY OF MR-TRUS IMAGE-FUSION GUIDED BIOPSIES.

patients > 69 years ranged from 42% to 86% for individual practices (p1⁄40.0008). For patients with PSA 60 cc were less likely to predict prostate cancer detection than size < 30 cc (odds ratio [OR] 0.53, 95% confidence interval [CI] 0.440.64 and OR 0.23, 95% CI 0.18-0.29, respectively). CONCLUSIONS: Cancer detection rates are higher than previously reported. Practice patterns and cancer yield for prostate biopsy vary widely across urology practices in Michigan. These data serve as a foundation for our efforts to understand and improve patient selection for prostate biopsy.

The Impact of Prostate Volume, Number of Biopsy Cores and American Urological Association Symptom Score on the Sensitivity of Cancer Detection Using the Prostate Cancer Prevention Trial Risk Calculator

We assessed the independent predictive value of prostate volume, number of biopsy cores and AUASS (American Urological Association symptom score) compared to risk factors included in the PCPTRC (Prostate Cancer Prevention Trial risk calculator for prostate cancer) and PCPTHG (Prostate Cancer Prevention Trial risk calculator for high grade cancer [Gleason grade 7 or greater]). Of 5,519 PCPT (Prostate Cancer Prevention Trial) participants used to construct the PCPTRC 4,958 with AUASS and prostate specific antigen 10 ng/ml or less were included on logistic regression analysis. Risk algorithms were evaluated in 571 EDRN (Early Detection Research Network) participants using the ROC AUC. A total of 1,094 participants (22.1%) had prostate cancer, of whom 232 (21.2%) had high grade disease. For prostate cancer prediction higher prostate specific antigen, abnormal digital rectal examination, family history of prostate cancer and number of cores were associated with increased risk, while volume was associated with decreased risk. Excluding prostate volume and number of cores, a history of negative biopsy and increased AUASS were also associated with lower risk. For high grade cancer higher prostate specific antigen, abnormal digital rectal examination, black race and number of cores were associated with increased risk and volume, while AUASS was associated with decreased risk. The AUC of the PCPTRC adjusted for volume and number of cores was 72.7% (using EDRN data), 68.2% when adjusted for AUASS alone and 67.6% PCPTRC. For high grade disease the AUCs were 74.8%, 74.0% and 73.5% (PCPTHG), respectively. Adjusted PCPT risk calculators for volume, number of cores and AUASS improve cancer detection.

Value of prostate-specific antigen (PSA) mass ratio in the detection of prostate cancer in men with PSA levels of ≤10 ng/mL

A group of researchers introduced a parameter named PSA mass ratio, which is defined as total circulating PSA protein (PSA [ng/mL] x plasma volume [L]) per prostate volume, as a prostate cancer screening tool. They suggested that PSA mass ratio may be representative of a PSA value adjusted for potentially influencing factors, such as haemodilution and prostate volume. By adjusting for the combined effects of plasma volume and prostate volume, it can be hypothesized that PSA mass ratio would enhance the predictive value of the PSA test. Although PSA mass ratio appears to be an attractive alternative to serum PSA level, PSA mass ratio may not significantly enhance the currently available method to predict prostate cancer detection among men with PSA level of ≤10 ng/mL who are undergoing prostate biopsy. To investigate the value of prostate-specific antigen (PSA) mass ratio, defined as total PSA in circulation per prostate volume (PV), in the prediction of prostate cancer detection among men with PSA levels of ≤10 ng/mL who are undergoing prostate biopsy. We reviewed records of 2431 men aged 56-80 years who presented with PSA levels of ≤10 ng/mL and underwent multi (≥12)-core transrectal ultrasound-guided prostate biopsy at our institution. Predictive accuracies of relevant variables and multivariate models in the prostate cancer detection via biopsy were assessed with receiver operating characteristics-derived area under the curve and compared. When compared one-on-one, PSA mass ratio had a significantly higher accuracy than PSA in the prediction of prostate cancer among our subjects (0.638 vs 0.565, P < 0.001). Meanwhile, when multivariable model for the prediction of prostate cancer detection via prostate biopsy was devised incorporating patient age, body mass index, digital rectal examination findings, PV, number of biopsy cores, and PSA level, the replacement of PSA level with PSA mass ratio (P = 0.102) or the addition of PSA mass ratio (P = 0.164) in the model was not associated with significantly increased accuracy of model for predicting prostate cancer detection via biopsy. Although PSA mass ratio appears to be an attractive alternative to PSA level, PSA mass ratio may not significantly enhance the currently available method to predict prostate cancer detection among men with PSA levels of ≤10 ng/mL who are undergoing prostate biopsy.

Diagnosis of isolated high‐grade prostatic intra‐epithelial neoplasia: proposal of a nomogram for the prediction of cancer detection at saturation re‐biopsy

Study Type--Diagnostic (case series). Level of Evidence 4. What's known on the subject? And what does the study add? Multifocality, age, PSA values, and biopsy protocols regarding the predictive value of high grade PIN have been discussed extensively in the literature. Our study developed for the first time a predictive nomogram that could be helpful for patient counselling and to guide the urologist to perform rPBX after an initial diagnosis of isolated HGPIN. • To evaluate factors that may predict prostate cancer (PCa) detection after the initial diagnosis of high-grade prostatic intra-epithelial neoplasia (HGPIN) on prostate biopsy (PBx) with six to 24 random cores. • We retrospectively evaluated 262 patients submitted from 1998 to 2007 to prostate re-biopsy (rPBx) after an initial HGPIN diagnosis in tertiary academic centres. • HGPIN diagnosis was obtained on initial systematic PBx with six to 24 random cores. • All patients were re-biopsied with a 'saturation' rPBx with 20-26 cores, with a median time to rPBx of 12 months. • All slides were reviewed by expert uropathologists. • Plurifocal HGPIN (pHGPIN) was found in 115 patients and monofocal HGPIN (mHGPIN) was found in 147 patients. • In total, 108 and 154 patients, respectively, were submitted to >12-core initial PBx and ≤12-core initial PBx. • Overall PCa detection at rPBx was 31.7%. PSA level (7.7 vs 6.6 ng/mL; P= 0.031) and age (68 vs 64 years; P= 0.001) were significantly higher in patients with PCa at rPBx. • PCa detection was significantly higher in patients with a ≤12-core initial PBx than in those with a >12-core initial PBx (37.6% vs 23.1%; P= 0.01), as well as in patients with pHGPIN than in those with mHGPIN (40% vs 25.1%; P= 0.013). • At multivariable analysis, PSA level (P= 0.041; hazards ratio, HR, 1.08), age (P < 0.001; HR, 1.09), pHGPIN (P= 0.031; HR, 1.97) and ≤12-core initial PBx (P= 0.012; HR, 1.95) were independent predictors of PCa detection. • A nomogram including these four variables achieved 72% accuracy for predicting PCa detection after an initial HGPIN diagnosis. • PCa detection on saturation rPBx after an initial diagnosis of HGPIN is significantly higher in patients with a ≤12-core initial PBx than those with a >12-core initial PBx and in patients with pHGPIN than in those with mHGPIN. • We developed a simple prognostic tool for the prediction of PCa detection in patients with initial HGPIN diagnosis who were undergoing saturation rPBx.

PSA velocity may not be of value in prostate cancer detection

PSA velocity may not be of value in prostate cancer detection

PCA3 as a diagnostic marker for prostate cancer: A validation study on a Swedish patient population

Prostate cancer antigen 3 in urine (uPCA3) has been shown to perform better than total prostate-specific antigen in serum (tPSA) to predict prostate cancer (PCa) detection. The aim of this study was to validate the diagnostic precision of uPCA3 in a mixed set of patients with no previous history of PCa, including patients with previous negative biopsies. The study included 62 men scheduled for prostate biopsy at Skåne University Hospital Malmö, Sweden. Urine samples were obtained according to the Progensa™ uPCA3 assay. Logistic regression and receiver operating characteristic curves were used to test associations between levels of biomarkers and prostate cancer. According to pathological examination of core needle biopsies, PCa was found in 18 out of 62 patients. A one-step increase in uPCA3 was associated with an increase in the odds of cancer of 1.026 (p = 0.005). Differences in the odds ratio between uPCA3 and tPSA were not statistically significant. A model using both markers did not increase prediction of event. Areas under the curve for uPCA3, tPSA and a model combining uPCA3 and tPSA did not differ significantly. No significant correlation was found between uPCA3 and tPSA or prostate volume. In this small set of mixed patients uPCA3 alone and tPSA performed equally well as diagnostic markers for PCa. A combination of the two markers did not improve the diagnostic performance. This study does not support a role for the uPCA3 urine test to replace or be added to tPSA in PCa detection.

1851 VALUE OF MAGNETIC RESONANCE SPECTROSCOPY IMAGING (MRSI) AND DYNAMIC CONTRAST-ENHANCED IMAGING MR (DCEMR) FOR THE DETECTION OF PROSTATE ADENOCARCINOMA FOCI IN MEN WITH PRIOR NEGATIVE PROSTATE BIOPSY AND ELEVATED PROSTATE SPECIFIC ANTIGEN (PSA) LEVELS

You have accessJournal of UrologyProstate Cancer: Detection and Screening II1 Apr 20101851 VALUE OF MAGNETIC RESONANCE SPECTROSCOPY IMAGING (MRSI) AND DYNAMIC CONTRAST-ENHANCED IMAGING MR (DCEMR) FOR THE DETECTION OF PROSTATE ADENOCARCINOMA FOCI IN MEN WITH PRIOR NEGATIVE PROSTATE BIOPSY AND ELEVATED PROSTATE SPECIFIC ANTIGEN (PSA) LEVELS Alessandro Sciarra, Valeria Panebianco, Stefano Salciccia, Gentilucci Alessandro, Parente Ulderico, Alfarone Andrea, Susanna Cattarino, Roberto Passariello, and Vincenzo Gentile Alessandro SciarraAlessandro Sciarra More articles by this author , Valeria PanebiancoValeria Panebianco More articles by this author , Stefano SalcicciaStefano Salciccia More articles by this author , Gentilucci AlessandroGentilucci Alessandro More articles by this author , Parente UldericoParente Ulderico More articles by this author , Alfarone AndreaAlfarone Andrea More articles by this author , Susanna CattarinoSusanna Cattarino More articles by this author , Roberto PassarielloRoberto Passariello More articles by this author , and Vincenzo GentileVincenzo Gentile More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1790AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To prospectively analyse the role of magnetic resonance spectroscopy imaging (MRSI) and dynamic-contrast enhancement MR (DCEMR) in the detection of prostate tumor foci in patients with persistently elevated PSA levels (in the range of ¡Ý 4 ng/ml and < 10 ng/ml) and prior negative random TRUS-guided biopsy METHODS This is a prospective randomized single centre study on patients with prior negative random TRUS-guided prostate biopsy and persistent elevated PSA levels. One hundred and eighty eligible cases were included in the study.Patients in Group A were submitted to a second random prostate biopsy, whereas patients in Group B were submitted to a 1H-MRSI-DCEMR examination and samples targeted on suspicious areas were associated to the random biopsy. All examinations were performed on a commercially available 1.5 T scanner RESULTS At the second biopsy, a prostate adenocarcinoma histological diagnosis was found in 22/90 cases (24.4%) in Group A and in 41/90 cases (45.5%) in Group B (P=0.01). On a patient by patient basis, MRSI had a 92.3% sensitivity, 88.2% specificity, 85.7% PPV, 93.7% NPV and 90% accuracy; DCEMR had a 84.6 % sensitivity, 82.3% specificity, 78.5% PPV, 87.5% NPV and 83.3% accuracy and the association MRSI + DCEMR a 92.6% sensitivity, 88.8% specificity, 88.7% PPV, 92.7% NPV and 90.7% accuracy, for predicting prostate cancer detection CONCLUSIONS In our population, the combination of MRSI to DCEMR showed the potential to guide biopsy to cancer foci in patients with previously negative TRUS biopsy. Rome, Italy© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e719 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alessandro Sciarra More articles by this author Valeria Panebianco More articles by this author Stefano Salciccia More articles by this author Gentilucci Alessandro More articles by this author Parente Ulderico More articles by this author Alfarone Andrea More articles by this author Susanna Cattarino More articles by this author Roberto Passariello More articles by this author Vincenzo Gentile More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Value of Magnetic Resonance Spectroscopy Imaging and Dynamic Contrast-Enhanced Imaging for Detecting Prostate Cancer Foci in Men With Prior Negative Biopsy

This study aimed to prospectively analyze the role of magnetic resonance spectroscopy imaging (MRSI) and dynamic-contrast enhancement magnetic resonance (DCEMR) in the detection of prostate tumor foci in patients with persistently elevated prostate-specific antigen levels (in the range of >or=4 ng/mL to <10 ng/mL) and prior negative random trans-rectal ultrasound (TRUS)-guided biopsy. This was a prospective randomized single-center study. One hundred and eighty eligible cases were included in the study. Patients in group A were submitted to a second random prostate biopsy, whereas patients in group B were submitted to a (1)H-MRSI-DCEMR examination and samples targeted on suspicious areas were associated to the random biopsy. At the second biopsy, a prostate adenocarcinoma histologic diagnosis was found in 22 of 90 cases (24.4%) in group A and in 41 of 90 cases (45.5%) in group B (P = 0.01). On a patient-by-patient basis, MRSI had 92.3% sensitivity, 88.2% specificity, 85.7% positive predictive value (PPV), 93.7% negative predictive value (NPV), and 90% accuracy; DCEMR had 84.6 % sensitivity, 82.3% specificity, 78.5% PPV, 87.5% NPV, and 83.3% accuracy; and the association MRSI plus DCEMR had 92.6% sensitivity, 88.8% specificity, 88.7% PPV, 92.7% NPV, and 90.7% accuracy, for predicting prostate cancer detection. The combination of MRSI and DCEMR showed the potential to guide biopsy to cancer foci in patients with previously negative TRUS biopsy. To avoid a potential bias, represented from having taken more samples in group B (mean of cores, 12.17) than in group A (10 cores), in the future a MRSI/DCEMR directed biopsy could be prospectively compared with a saturation biopsy procedure.

Predictive Factors of Prostate Cancer at Repeat Biopsy in Patients with an Initial Diagnosis of Atypical Small Acinar Proliferation of the Prostate

PurposeThe factors that predict prostate cancer detection on repeat biopsy were evaluated in patients with atypical small acinar proliferation (ASAP) on the initial biopsy.Materials and MethodsFrom 2003 to 2008, 3,130 men with suspected prostate cancer underwent a prostate needle biopsy, and 244 (7.8%) were diagnosed as having ASAP. One hundred seventy of 244 patients were rebiopsied at least once more. They were classified into a prostate cancer group and a noncancer group according to the final pathological diagnosis. The database of rebiopsied patients included age, initial prostate-specific antigen (PSA), PSA density (PSAD), PSA velocity (PSAV), total prostate volume (TPV), and transitional zone volume of the prostate (TZV). We compared differences in the aforementioned parameters between the 2 groups.ResultsA total of 57 patients (33.5%) with ASAP were ultimately shown to have prostate cancer. Univariate analysis showed that PSAD (p=0.002), PSAV (p=0.001), TPV (p=0.035), and TZV (p=0.005) differed significantly between the cancer and noncancer groups. The results of the multivariate analysis showed that PSAD (p=0.022), PSAV (p<0.001), and TPV (p=0.037) had a statistically significant correlation with cancer detection.ConclusionsPSAD, PSAV, and TPV are predictive factors of prostate cancer in patients with an initial diagnosis of ASAP of the prostate. Although repeat biopsy is mandatory irrespective of PSA values, the follow-up of PSA may help to estimate the probability of cancer in these men.

Validation in a Multiple Urology Practice Cohort of the Prostate Cancer Prevention Trial Calculator for Predicting Prostate Cancer Detection

The Prostate Cancer Prevention Trial prostate cancer risk calculator was developed in a clinical trial cohort that does not represent men routinely referred for prostate biopsy. We assessed the generalizability of the Prostate Cancer Prevention Trial calculator in a cohort more representative of patients referred for consideration of prostate biopsy in American urology practice. Patients undergoing prostate biopsy by 12 urologists at 5 sites were enrolled in an Early Detection Research Network cohort. The Prostate Cancer Prevention Trial risk calculator was validated by examining area underneath the receiver operating characteristic curve, sensitivity, specificity and calibration comparing observed vs predicted risk of prostate cancer detection. Cancer incidence was greater (43% vs 22%, p = 0.001) in the Early Detection Research Network validation cohort (645) compared to the Prostate Cancer Prevention Trial group (5,519). Early Detection Research Network participants were younger and more racially diverse, and had more abnormal digital rectal examinations and higher prostate specific antigen than Prostate Cancer Prevention Trial participants (all p <0.001). Cancer severity was worse in the Early Detection Research Network cohort than in the Prostate Cancer Prevention Trial (Gleason 7 or higher 60% vs 21%, p <0.001). Nevertheless, the Prostate Cancer Prevention Trial risk calculator was superior to prostate specific antigen alone for predicting cancer in the Early Detection Research Network (AUC 0.691 vs 0.655, p = 0.009) and calibration confirmed that the Prostate Cancer Prevention Trial risk score accurately predicted individual risks in the Early Detection Research Network cohort. Differences between the Early Detection Research Network validation cohort and the Prostate Cancer Prevention Trial cohort underscore the importance of validating calculator performance in the multicenter urology practice setting. Our findings extend the applicability of the Prostate Cancer Prevention Trial calculator for measuring the risk of prostate cancer detection on biopsy to the routine American urology practice setting.

Predictors of prostate cancer after initial diagnosis of atypical small acinar proliferation at 10 to 12 core biopsies

To evaluate the factors that predict prostate cancer detection by means of 10 to 12 core repeat biopsies in patients with atypical small acinar proliferation (ASAP) results on initial biopsy. From 1998 to 2004, 110 of 127 patients (87%) with a diagnosis of ASAP were rebiopsied with the same technique plus additional biopsies on the ASAP site (12.6 +/- 1.1 cores [mean +/- standard deviation]). Each histologic slide was reviewed blindly by a single experienced pathologist, who also differentiated highly suspicious (ASAPH) and not highly suspicious (ASAPB) lesions for cancer. On initial biopsy, a concomitant high-grade prostatic intraepithelial neoplasia (HGPIN) was present in 26 patients (23%) with ASAP. The overall cancer detection rate was significantly higher in patients who had ASAP associated with HGPIN (58%), compared with patients who had isolated ASAP (35%; P = 0.04). The cancer detection rate was not significantly higher in patients with ASAPH than in those with ASAPB (49% versus 33%, respectively; P = 0.11). In the group of patients who had isolated ASAP, the rate of cancer detection was significantly higher in patients who had a prostatic volume less than 50 mL (56%) than in patients with a prostatic volume of 50 mL or more (27%; P = 0.03). The cancer detection rate was significantly higher in patients with an ASAP associated with HGPIN on initial biopsy than in patients with isolated ASAP. In ASAP patients, the detection rate was lower for patients with a larger prostate than in those with a smaller prostate.

PROSTATE CANCER DETECTION IN MEN WITH PRIOR HIGH GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA OR ATYPICAL PROSTATE BIOPSY

We used clinical variables to predict prostate cancer detection on re-biopsy among patients diagnosed with high grade prostatic intraepithelial neoplasia (PIN) or atypia on initial prostate biopsy. A total of 45 men with atypia and 43 with high grade PIN were eligible for our study. Clinical variables were tested with univariate and multivariate logistic regression to predict who would have cancer on re-biopsy. We also calculated the odds of detecting cancer with various repeat sampling strategies and determined whether the location of initial atypia or high grade PIN is correlated to that of cancer on re-biopsy. Of the patients in the atypia and high grade PIN groups 51% had cancer on re-biopsy. Cancer was diagnosed significantly earlier in the high grade PIN than in the atypia cohort (average 7.5 versus 22.9 months, respectively, p = 0.005). Multivariate logistic modeling showed that digital rectal examination and patient age were independent predictors of cancer in atypia, whereas no variables were significantly predictive for high grade PIN. Of cancers in the atypia and high grade PIN 65% and 74%, respectively, would have been detected if re-biopsy was focused only at the initial site of disease. Men with atypia or high grade PIN merit close followup because 50% will have cancer on re-biopsy as will those who are older with an abnormal digital rectal examination. Although re-biopsy should focus primarily on the original site of atypia or high grade PIN, cancer detection significantly increases with the sampling of adjacent sites.