Prostate-specific Antigen Ratio Research Articles

Is the Serum Prostate-Specific Antigen Level Affected by Urethral Catheterization in Patients with Acute Urinary Retention?

Background: The reason for elevated serum prostate-specific antigen (PSA) levels in patients undergoing urethral catheterization due to acute urinary retention (AUR) remains a significant and controversial issue. Objectives: To assess the serum PSA level in men with AUR and its changes after catheterization. Methods: This prospective quasi-experimental study (reviewer 1 - comment 7) was conducted on 43 patients who underwent transurethral catheterization following AUR caused by benign prostatic hyperplasia (BPH). Total PSA levels and free/total PSA ratios were measured before catheterization and one and three days after catheter insertion. Additionally, prostate volume and urine output after catheterization (UOAC) were recorded. Results: The mean age, prostate volume, and UOAC of the patients were 69.05 ± 9.45 years, 60.51 ± 26.35 g, and 844.04 ± 341.66 mL, respectively. The mean and median baseline total PSA levels were 12.59 ± 17.71 ng/mL and 6.30 ng/mL, respectively. These values changed to 13.73 ± 19.83 ng/mL (median = 4.80 ng/mL) and 11.57 ± 17.70 ng/mL (median = 4.40 ng/mL) after 1 and 3 days of catheterization, respectively. The changes in total PSA and free/total PSA levels during the study period were not statistically significant (P > 0.05). Moreover, the PSA levels showed no statistically significant difference before, 1 day, and 3 days after catheterization in groups with total PSA ≤ 4 and total PSA > 4 (P = 0.37; 0.22, respectively). Conclusions: Our results suggest an initial elevation in PSA levels in patients with AUR before urethral catheterization. Both PSA and free/total PSA ratios showed no statistically significant differences before and after urethral catheter insertion, and initial PSA levels did not affect their changes post-catheterization (reviewer 1 - comment 1).

Unveiling the intricate connection between per- and polyfluoroalkyl substances and prostate hyperplasia

The presence of perfluoroalkyl and polyfluoroalkyl substances (PFAS) in various everyday products has raised concerns about their potential impact on prostate health. This study aimed to investigate the effects of different types of PFAS on prostate health, including PFDeA, PFOA, PFOS, PFHxS, and PFNA. To assess the relationship between PFAS exposure and prostate injury, machine learning algorithms were employed to analyze prostate-specific antigen (PSA) metrics. The analysis revealed a linear and positive dose-dependent association between PFOS and the ratio of free PSA to total PSA (f/tPSA). Non-linear dose-response relationships were observed between the other four types of PFAS and the f/tPSA ratio. Additionally, the analysis showed a positive association between the mixture of PFAS and prostate hyperplasia, with PFNA having the highest impact followed by PFOS. These findings suggest that elevated serum levels of PFDeA, PFOA, PFOS, and PFNA are linked to prostate hyperplasia. Therefore, this study utilized advanced machine learning techniques to uncover potential hazardous effects of PFAS exposure on prostate health, specifically the positive association between PFAS and prostate hyperplasia.

Smartphone‐Based Free‐to‐Total Prostate Specific Antigen Ratio Detection System Using a Colorimetric Reaction Integrated with Proximity‐Induced Bio‐Barcode and CRISPR/Cas12a Assay

AbstractThe free‐to‐total prostate‐specific antigen (f/t‐PSA) ratio is of great significance in the accurate diagnosis of prostate cancer. Herein, a smartphone‐based detection system is reported using a colorimetric reaction integrated with proximity‐induced bio‐barcode and the clustered regularly interspaced short palindromic repeats (CRISPR)/Cas12a assay for f/t‐PSA ratio detection. DNA/antibody recognition probes are designed to bind f‐PSA or t‐PSA and induce the release of the DNA bio‐barcode. The CRISPR/Cas12a system is activated by the DNA bio‐barcode to release Ag+ from the C‐Ag+‐C structure of the hairpin DNA. The released Ag+ is used to affect the tetramethylbenzidine (TMB)‐H2O2‐based colorimetric reaction catalyzed by Pt nanoparticles (NPs), as the peroxidase‐like activity of the Pt NPs can be efficiently inhibited by Ag+. A smartphone with a self‐developed app is used as an image reader and analyzer to analyze the colorimetric reaction and provide the results. A limit of detection of 0.06 and 0.04 ng mL−1 is achieved for t‐PSA and f‐PSA, respectively. The smartphone‐based method showed a linear response between 0.1 and 100 ng mL−1 of t‐PSA or f‐PSA. In tests with clinical samples, the smartphone‐based method successfully diagnosed prostate cancer patients from benign prostatic hyperplasia patients and healthy cases with high sensitivity and specificity.

Interim analyses from the PROSPET-BX trial: [G8Ga]PSMA PET/CT vs. mpMRI in patients with suspicion of prostate cancer and previous negative biopsy.

282 Background: Herein we present the results of the interim analyses of our prospective trial (Identifier: NCT05297162), designed to compare [68Ga]PSMA PET/CT with mpMRI in men with a high suspicion of prostate cancer (PCa) after at least one previous negative biopsy. Methods: From April 2022 until September 2023, overall, 94 patients were screened, 78 were enrolled and 64 completed all study investigations. Inclusion criteria: PSA>4.0ng/ml; free-to-total PSA ratio <20%; progressive rise of PSA levels in two consecutive samples; at least one previous negative biopsy; negative digital rectal examination. [68Ga]PSMA PET/CT and 3T mpMRI were performed within one month, followed by TRUS-fusion prostate biopsy. Target lesions were defined based on PI-RADS v2.1 for mpMRI and Primary Score, SUVmax and SUVratio for [68Ga]PSMA PET/CT, then correlated to pathology findings. Results: Median age was 64 years (range 51-83) and median PSA 10.4 ng/ml (range 4.3-25,9). Most patients (76.6%) had one previous negative biopsy. According to re-biopsy results, 10 patients presented with clinically significant PCa (csPCa), 4 with GS 6, while the majority had a negative biopsy (78%). mpMRI results were: 40 patients with PI-RADS 2 (62.5%), 3 with PI-RADS 3 (4.7%), 15 with PI-RADS 4 (23.4%), and 6 with PI-RADS 5 (9.4%). Primary scores were: 45 score 1-2 (70%), and 19 score 3-5. PI-RADS and Primary scores were significantly correlated (P=0.0006). Median SUVmax and SUVratio were 3.7 and 1.35 for benign versus 8.9 and 3 for malignancy, respectively (P<0.001). ROC analyses identified optimal cut-off points for csPCA, with SUVmax>7.48 (AUC 0.756; 95%CI 0.633-0.855) and SUVratio>2.79 (AUC 0.748; 95%CI 0.624-0.848). PI-RADS, Primary score, SUVmax and SUVratio proved significantly associated to biopsy results. When combining [68Ga]PSMA PET/CT with mpMRI data, the detection rate was 90% for csPCa, and the combination of both modalities could spare 87.5% of unnecessary re-biopsies. Conclusions: In these interim results, [68Ga]PSMA PET/CT parameters predict biopsy results as mpMRI in patients who are candidates to re-biopsy; the combination of both modalities can spare most unnecessary re-biopsies, by granting a 90% detection rate for csPCa. Clinical trial information: NCT05297162 .

SERS-Temperature Dual-Mode T-type Lateral Flow Strip for Accurate Detection of Free and Total Prostate-Specific Antigens in Blood.

Accurate point-of-care (POC) analysis of cancer markers is the essence in the comprehensive early screening and treatment of cancer. Dual-mode synchronous detection is one of the effective approaches to reduce the probability of false negatives or false positives. As a result, this can greatly improve the accuracy of diagnosis. In this work, a surface-enhanced Raman scattering (SERS)-temperature dual-mode T-type lateral flow strip was fabricated to direct and simultaneous POC detection of total and free prostate-specific antigens (t-PSA and f-PSA) in blood. With the advantage of high stability of T-type lateral flow strip and simultaneous acquirement of assay results for t-PSA and f:t PSA ratio, the proposed method has high accuracy in the diagnosis of prostate cancer, especially in the diagnostic gray zone between 4.0 and 10.0 ng/mL. The SERS-temperature dual-signal has a good linear correlation with either f-PSA or t-PSA. To evaluate the clinical diagnostic performance of the proposed method, spiked human serum samples and the whole blood sample were analyzed. The assay results showed good recovery, and compared with traditional electrochemiluminescence immunoassay (ECLIA) method (t-PSA: 43.151; f/t ratio: 0.08), the results obtained by the proposed method were similar (t-PSA: 40.15 (SERS), 36.21 (temperature); f/t ratio: 0.08 (SERS), 0.08 (temperature), but the detection time (15 min) and cost ($0.05) had been greatly reduced. Therefore, the proposed SERS-temperature synchronous dual-mode T-type lateral flow strip has a strong application potential in the field of accurate large-scale diagnostics of prostate cancer on-site by simultaneous POC detection of t-PSA and f-PSA in blood.

Assessment the Ability of Free/Total Ratio of Serum PSA in Diagnosing Prostate Cancer and Benign Prostatic Hyperplasia

Background: The Prostate gland is the male secondary sexual organ most commonly affected by benign or malignant neoplasm. Prostate cancer (Ca-P) is one of the most commonly diagnosed cancers in men and is now the third commonest cause of cancer death in western countries.The aim of the study was to evaluate the use of serum prostate-specific antigen levels in differentiating prostate cancer from benign prostatic hyperplasia. Methods:The present study is a cross-sectional observational study.The study was conducted at the outpatient department and indoor patients at the department of Urology, Rajshahi Medical College Hospital (RMCH), Rajshahi, and different private clinic in Rajshahi City during the period from July 2019 to June 2020.The study population included male patients above 50 years of age, who attended in the department of Urology, Rajshahi Medical College Hospital (RMCH), Rajshahi, and different private clinic in Rajshahi City complaining of irritative or obstructive lower urinary tract symptoms (LUTS) suspected as clinically prostate cancer or benign prostatic hyperplasia (BPHStatistical analysis of the results was obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-24). Results: The age distribution of the prostatic carcinoma and BPH patients. Prostatic carcinoma was observed to be significantly higher from 80 years onwards, while BPH was common between 60 - 80 years (p = 0.00001). Table 10shows the validity or accuracy of the free/total ratio of serum PSA as a diagnostic test in differentiating prostatic carcinoma from BPH in patientswith total PSA levels between 4-10ng/ml. The percentage of false positives was significantly higher when total PSA ratio was used to diagnose the disease compared to when free to total PSA was used as a diagnostic tool (p<0.000001). The overall accuracy of total PSA was also significantly lower (61.45%) than that of free/total PSA (91.67%) (p< 0.011526). Conclusion: Free and total prostate specific antigen (PSA) is increased significantly in carcinoma prostate than benign prostatic hyperplasia but free/total ratio of serum prostate- specific antigen level significantly decreases in prostatic carcinoma than benign prostatic hyperplasia. TAJ 2023; 36: No-2: 215-230

Ability of Free/Total Serum PSA Ratio in Diagnosing Prostate Cancer and Benign Prostatic Hyperplasia

Ability of Free/Total Serum PSA Ratio in Diagnosing Prostate Cancer and Benign Prostatic Hyperplasia

The effect of the combination of prostate-specific antigen derivatives with multiparametric prostate magnetic resonance imaging scores on the negative predictive value of it in grey zone patients

ObjectiveTo calculate the negative predictive value (NPV) of negative multiparametric prostate magnetic resonance imaging (mpMRI), accepted as no lesions on images, when combined with prostate-specific antigen density (PSAD) and free/total prostate-specific antigen ratio (f/t PSA) in grey zone patients. Methods191 patients with PSA levels between 4−10 mg/mL and negative mpMRI were analyzed. The NPV of negative mpMRI was calculated according to a PSAD level of <0.15 ng/mL/mL, f/t PSA ratio of >0.15, and a combination of both. Patients were divided into three risk groups according to these two parameters, which were PSAD 0.01−0.07 ng/mL/mL and f/t PSA ratio ≥25 in a low-risk group, PSAD 0.08−0.15 ng/mL/mL, and f/t PSA ratio 0.15−0.24 in an intermediate-risk group and high-risk group, in which PSAD > 0.15 ng/mL/mL and f/t PSA ratio <15. ResultsNPV of negative mpMRI was 92.6% for clinically significant prostate carcinoma (CSPCa). It increased to 97.5% in a low-risk group and decreased to 33.3% for CSPCa in a high-risk group. NPV of negative mpMRI results were so close when combined with PSAD < 0.15 ng/mL/mL and f/t PSA > 15. Conclusionf/t PSA ratio might also be used to increase the NPV of mpMRI, like PSAD. We advise not to avoid prostate biopsy when PSAD is >0.15 ng/mL/mL and the f/t PSA ratio is <0.15. However, we need randomized controlled studies with more patients to confirm our study.

Prognostic Value of the De Ritis Ratio for Overall Survival in Patients with Metastatic Castration-Resistant Prostate Cancer Undergoing [177Lu]Lu-PSMA-617 Radioligand Therapy.

The De Ritis ratio (=aspartate transaminase/alanine transaminase) has shown prognostic value in different cancer types. This is the first such analysis in prostate cancer patients undergoing radioligand therapy (RLT) with [177Lu]Lu-PSMA-617. This retrospective monocentric analysis included 91 patients with a median of 3 RLT cycles (range 1-6) and median cumulative activity of 17.3 GBq. Univariable Cox regression regarding overall survival (OS) included age, different types of previous treatment, metastatic patterns and different laboratory parameters before RLT. Based on multivariable Cox regression, a prognostic score was derived. Seventy-two patients (79%) died (median follow-up in survivors: 19.8 months). A higher number of previous chemotherapy lines, the presence of liver metastases, brain metastases, a higher tumor load on PSMA-PET, a higher prostate-specific antigen (PSA) level, lower red blood cell count, lower hemoglobin, higher neutrophil-lymphocyte ratio and higher De Ritis ratio were associated with shorter OS (each p < 0.05). In multivariable Cox, a higher number of chemotherapy lines (range, 0-2; p = 0.036), brain metastases (p < 0.001), higher PSA (p = 0.004) and higher De Ritis ratio before RLT (hazard ratio, 1.27 per unit increase; p = 0.023) remained significant. This prognostic score separated five groups with a significantly different median OS ranging from 4.9 to 28.1 months (log-rank test, p < 0.001). If validated independently, the De Ritis ratio could enhance multifactorial models for OS after RLT.

Initial-to-nadir Prostate-specific Antigen Ratio Predicts Response to First-line Enzalutamide in Metastatic Castration-resistant Prostate Cancer.

No practical biomarkers predict the response to enzalutamide in chemotherapy-naïve metastatic castration-resistant prostate cancer (mCRPC). The present study aimed to evaluate the prognostic value of the initial-to-nadir prostate-specific antigen (PSA) ratio (I/N PSA) in primary hormone therapy for metastatic hormone-naïve prostate cancer associated with the response to first-line enzalutamide in mCRPC. Twenty-eight patients with mCRPC received first-line enzalutamide to determine the associations between I/N PSA in combined androgen blockade and clinical outcomes. The PSA response was defined as ≥90% decline from baseline in patients with mCRPC. The optimal cutoff I/N PSA value for PSA response was 1,219 (sensitivity=71.4%, specificity=92.9%, area under the receiver operating characteristic curve=0.85). The PSA response was 90.9% in the high I/N PSA group and 23.5% in the low I/N PSA group. The median overall survival, prostate cancer-specific survival, and radiographic progression-free survival after initiation of enzalutamide were statistically greater for the high I/N PSA group than the low group. Multivariable analysis showed that I/N PSA was an independent predictor of overall survival (hazard ratio=0.23; p=0.026). In chemotherapy-naïve patients with mCRPC, I/N PSA was a predictive and prognostic biomarker for first-line enzalutamide. The I/N PSA can enable optimization of individual treatment in real-world clinical practice.

Serum testosterone to prostate specific antigen ratio as predictor of prostate cancer: a diagnostic test evaluation

Background: Prostate cancer is suspected by an increase in serum PSA level, and the diagnosis is confirmed with a systematic biopsy. There is no established cutoff value of PSA levels for recommending biopsy and it shows a lack of specificity when PSA levels are in the “gray zone”. The objectives are to study the diagnostic ability and effectiveness of serum testosterone-PSA ratio in predicting prostate cancer and its severity in patients with normal DRE and serum PSA level of 4-20 ng/ml. Methods: Patients more than 40 years of age with normal DRE and elevated serum PSA (4-20 ng/ml) admitted in the Department of Urology, Government medical college Kozhikode will be included. The sTT-PSA ratio will be calculated with sTT and PSA in ng/ml. 12 core prostate biopsy is performed. The HPR results will be depicted as benign and malignant, with malignancy as grade groups (1-5) based on Gleason scoring. Results: In our study cancer detection rate is 20.8%. Mean PSA and testosterone levels are 10.01ng/ml and 4.84 ng/ml in benign group, 15.45 ng/ml and 4.03ng/ml in cancer group. Mean T-PSA ratio are 0.52 and 0.27 in benign and cancer group respectively. Based on ROC curve with a cut off 0.336, T-PSA has the diagnostic ability for Ca prostate with sensitivity of 79.17% and specificity of 89.01%. There is a positive correlation between T-PSA ratio and grade group but it is statistically not significant. Conclusions: The present study suggests that the sTT/PSA ratio might be considered a predictor of the risk of prostate cancer.

Diagnostic Performance of the Free to Total PSA Ratio in the Detection of Prostate Cancer in Patients Over 50 Years of Age at the Brazzaville Hospital Center, Congo

Objective: To evaluate the diagnostic performance of total PSA, free PSA and the ratio of free to total PSA in identifying prostate cancer. Patients and methods: This was a descriptive, cross-sectional study from March 2019 to November 2021. Blood samples were analysed by sandwich ELISA and the ratio of free to total PSA (f/tPSA) was calculated. Prostate biopsies underwent histological analysis and the WHO 2012 Gleason Differentiation Score grading system was used. Results: 54 patients were selected; after histological examination 26 (48.15%) had prostate cancer (PCa) and 28 (51.85%) had Benign Prostatic Hyperplasia (BPH) (P&lt;0.001). The mean total PSA (tPSA) of patients with PCa (26.1 ± 32.8 ng/ml) was higher than that of patients with BPH (9.64 ± 6.72 ng/ml) (p=0.019). The mean f/tPSA ratio of patients with PCa (14.3 ± 16.3%) was significantly lower than those with BPH (21.8 ± 19.3%). Gleason score was poorly differentiated in patients with tPSA &lt; 4ng/ml and &gt; 10ng/ml in 11.5% and 26.9% respectively. 61.5% of patients with f/tPSA &lt;15% had SG≤6, SG=7 and SG ≥8 in 12.5%, 37.5% and 50.0% respectively. AUC/ROC was significantly higher for f/tPSA ratio (AUC, 0.67; 95% CI, 0.52 to 0.81) than for tPSA (AUC, 0.62; 95% CI, 0.46 to 0.77) and fPSA (AUC, 0.49; 95% CI, 0.34 to 0.65). Conclusion: Early diagnosis of prostate cancer requires the contribution of different PSA derivatives and the use of cut-off values.

Evaluación del valor predictivo negativo de la resonancia magnética multiparamétrica de próstata al combinar su puntuación con parámetros del antígeno prostático específico en pacientes con PSA en zona gris

ObjectiveTo calculate the negative predictive value (NPV) of negative multiparametric prostate magnetic resonance imaging (mpMRI), accepted as no lesions on images, when combined with prostate-specific antigen density (PSAD) and free/total prostate-specific antigen ratio (f/t PSA) in grey zone patients. MethodsOne hundred ninety-one patients with PSA levels between 4-10mg/ml and negative mpMRI were analyzed. The NPV of negative mpMRI was calculated according to a PSAD level of <0.15 ng/ml/ml, f/t PSA ratio of >0.15, and a combination of both. Patients were divided into three risk groups according to these two parameters:•PSAD 0.01-0.07 ng/ml/ml and f/t PSA ratio ≥25 in a low-risk group.•PSAD 0.08-0.15 ng/ml/ml, and f/t PSA ratio 0.15-0.24 in an intermediate-risk group and high-risk group.•PSAD>0.15 ng/ml/ml and f/t PSA ratio <15 in high-risk group, ResultsNPV of negative mpMRI was 92.6% for clinically significant prostate carcinoma (CSPCa). It increased to 97.5% in a low-risk group and decreased to 33.3% for CSPCa in a high-risk group. NPV of negative mpMRI results were so close when combined with PSAD <0.15 ng/ml/ml and f/t PSA>15. Conclusionf/t PSA ratio might also be used to increase the NPV of mpMRI, like PSAD. We advise not to avoid prostate biopsy when PSAD is >0.15 ng/ml/ml and the f/t PSA ratio is <0.15. However, we need randomized controlled studies with more patients to confirm our study.

Predicting Positive Repeat Prostate Biopsy Outcomes: Comparison of Machine Learning Approaches to Identify Key Parameters and Optimal Algorithms.

Innovative strategies are necessary to enhance prostate cancer diagnosis whilst reducing unnecessary and invasive repeat biopsies. This study aimed to determine the significant parameters affecting repeat prostate biopsy outcomes and develop an optimal machine learning algorithm for predicting positive repeat prostate biopsy results. We analysed data from 174 men who underwent repeated prostate biopsies between January 2008 and December 2022. Systematic multiple-core, ultrasound-targeted prostate biopsies were performed, each two samples from prostatic transitional zone and peripheral zone were obtained bilaterally. Clinical characteristics were collected, including patients' age, initial prostate volume, prostate-specific antigen (PSA) level, free PSA (fPSA)/PSA ratio, biopsy core numbers, pathological result; The time interval between first and latest prostate biopsy; Latest PSA level, fPSA/PSA ratio, biopsy core numbers; And final pathological diagnosis. Six feature selection methods, namely, variable ranking, correlation matrix, random forest regression, recursive feature elimination, cross-validation and forward selection, were employed to identify key influencing factors for repeat biopsy outcomes. Subsequently, the performance of seven machine learning algorithms, namely, multivariable logistic regression (LR), K-nearest neighbour search (KNN), support vector classification (SVC), decision tree (DT), random forest classifier (RF), naïve Bayes classifier (NBC) and gradient booster tree (GB), was assessed based on accuracy, misclassification, recall, specificity, precision and receiver operating characteristic (ROC) area under the curve (AUC). About 70% of patients were used as the training dataset, meanwhile remaining 30% as validation dataset. 52 were ultimately diagnosed with prostate cancer following the final pathological examination. The remaining 122 patients were negative. Amongst six feature selection methods, the variable ranking emerged as the most effective method for identifying the essential factors influencing repeat biopsy results. Amongst the machine learning algorithms, SVC demonstrated superior accuracy (0.7365), low recall rate (0.2500) and low misclassification rate (0.2093) for both patients with cancer and healthy individuals. Meanwhile, the ROC curve of SVC showed a relatively high AUC (0.6871). We developed an SVC-based machine learning algorithm for predicting positive repeat prostate biopsy results. Our analysis revealed that initial and latest prostate volumes, initial and latest PSA levels, latest fPSA/PSA ratio and age are significant factors for this model.

A pilot study of an organised population-based testing programme for prostate cancer.

To determine the feasibility of a digitally automated population-based programme for organised prostate cancer testing (OPT) in Southern Sweden. A pilot project for a regional OPT was conducted between September 2020 and February 2021, inviting 999 randomly selected men aged 50, 56, or 62 years. Risk stratification was based on prostate-specific antigen (PSA) level, PSA density (PSAD), and bi-parametric prostate magnetic resonance imaging (MRI). Men with a PSA level of 3-99 ng/mL had an MRI, and men with elevated PSA level (≥3 ng/mL) had a urological check-up, including a digital rectal examination and transrectal ultrasonography (TRUS). Indications for targeted and/or systematic transrectal prostate biopsies were suspicious lesions on MRI (Prostate Imaging-Reporting and Data System [PI-RADS] 4-5) and/or PSAD > 0.15 ng/mL/mL. Additional indications for prostate biopsies were palpable tumours, PSA ratio < 0.1, or cancer suspicion on TRUS. Patient selection, mail correspondence, data collection, and algorithm processing were performed by an automated digital management system. Feasibility is reported descriptively. A total of 418 men had a PSA test (42%), with increasing participation rates by age (50 years, 38%; 56 years, 44%; and 62 years, 45%). Among these, 35 men (8%) had elevated PSA levels (≥3 ng/mL: one of 139, aged 50 years; 10/143, aged 56 years; and 24/146, aged 62 years). On MRI, 16 men (48%) had a negative scan (PI-RADS < 3), seven men (21%) had PI-RADS 3, nine men (27%) had PI-RADS 4, and one man (3%) had PI-RADS 5. All men with PI-RADS 4 or 5 underwent prostate biopsies, as well as two men with PI-RADS 3 due to PSAD > 0.15 ng/mL/mL or a suspicious finding on TRUS. Prostate cancer was diagnosed in 10 men. Six men underwent active treatment, whereas four men were assigned to active surveillance. Our OPT model is feasible from an operational point of view, but due to the limited scale of this study no conclusions can be made regarding the efficacy of the diagnostic model or outcome.

Prostate Cancer Screening Methods and Its Management Along Its Precision Medicine Recent Approach in The Light of ESMO Guidelines, A Review Article

Risk of clinically significant prostate cancer is related to age, family history, PSA level, free and total PSA ratio as well as finding of digital rectal examination DRE, subclinical prostate cancer is common in men over 50 years of age, hence PSA (Prostate specific Antigen) testing Has been recommended in men over 60years of age if PSA level is more than 2ng/ml. The 5 - year survival rate for prostate cancer in India is 64%. Although many cancers deem fit for cancer screening but prostate cancer screening having limited role author will try described about current recommendation of prostate cancer screening, recent data of HBCR Hospital based cancer registry shall also be discussed in order to understand disease burden in Indian context, along with management of prostate cancer in depth. Recently precision medicine has opened its wings for prostate cancer as well what we achieve out of it shall further address in this review article.

Predictive value of kallikrein forms and β-microseminoprotein in blood from patients with evidence of detectable levels of PSA after radical prostatectomy.

To determine whether β-microseminoprotein or any of the kallikrein forms in blood-free, total or intact PSA or total hK2-predict metastasis in patients with evidence of detectable levels of PSA in blood after radical prostatectomy. We determined marker concentrations in blood from 173 men treated with radical prostatectomy and evidence of detectable levels of PSA in the blood (PSA ≥ 0.05) after surgery between 2014 and 2015 and at least 1year after any adjuvant therapy. We used Cox regression to determine whether any marker was associated with metastasis using both univariate and multivariable models that included standard clinical predictors. Overall, 42 patients had metastasis, with a median follow-up of 67months among patients without an event. The levels of intact and free PSA and free-to-total PSA ratio were significantly associated with metastasis. Discrimination was highest for free PSA (c-index: 0.645) and free-to-total PSA ratio (0.625). Only free-to-total PSA ratio remained associated with overall metastasis (either regional or distant) after including standard clinical predictors (p = 0.025) and increased discrimination from 0.686 to 0.697. Similar results were found using distant metastasis as an outcome (p = 0.011; c-index increased from 0.658 to 0.723). Our results provide evidence that free-to-total PSA ratio can risk stratifying patients with evidence of detectable levels of PSA in blood after RP. Further research is warranted on the biology of prostate cancer markers in patients with evidence of detectable levels of PSA in blood after radical prostatectomy. Our findings on the free-to-total ratio for predicting adverse oncologic outcomes need to be validated in other cohorts.

Prostate imaging-reporting and data system version 2 in combination with clinical parameters for prostate cancer detection: a single center experience.

The diagnostic performance of the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) has been challenged due to its lower diagnostic accuracy and higher false-positive rates for prostate cancer detection. This study aimed to analyze the diagnostic performance of PI-RADS v2 in combination with clinical parameters in patients with suspected prostate cancer. A total of 424 men with suspicion of prostate cancer were retrospectively analyzed. Logistic regression analyses were performed to identify predictors of clinically significant prostate cancer defined as a Gleason score of 3 + 4 or greater. The prediction performance was compared with prostate specific antigen (PSA), free/total PSA ratio (f/t PSA), PSA density (PSAD), PI-RADS v2 alone, and PI-RADS v2 plus PSAD using receiver operating characteristics (ROCs). In total, 231 out of 424 cases (54.48%) were pathologically diagnosed as prostate cancer. The percentage of clinically significant prostate cancer was higher in patients with PI-RADS v2 score of 4 or greater compared to PI-RADS v2 score of less than 4 (90.86% vs. 55.88%, P < 0.001). Age, PSA level, f/t PSA, PSAD, and PI-RADS v2 were significant independent predictors of clinically significant prostate cancer. The ROC area under the curve of PI-RADS v2 plus PSAD (0.952) was larger compared with PSA (0.845), f/t PSA (0.719), PSAD (0.920), and PI-RADS v2 alone (0.885). PI-RADS v2 in combination with PSAD may help detect clinically significant prostate cancer and provide benefit in making the decision to biopsy men at suspicion of prostate cancer.

The prognostic value of androgen to PSA ratio in predictive modeling of prostate cancer

Prostate specific antigen (PSA) is the ubiquitous biomarker used in mathematical and artificial intelligence models of prostate cancer. Yet, it is imperfect. The growth of prostate and cancer cells produces PSA, but their growth is dependent on androgen in most cases. Thus, looking at PSA by itself ignores the impact of androgen. Here, we propose the use of androgen as a reference framework for better integration of PSA in prostate cancer models. The binding of androgen to androgen receptors activates signals that promote prostate cancer growth and the production of PSA, so higher levels of androgen should correlate to higher growth of the tumor and higher production of PSA. Thus, PSA and androgen fall and rise almost synchronously during the start and stop of androgen deprivation therapy (ADT), respectively. Yet, when cancer cells become resistant to ADT, we observe a divergence to this trend, leading to a high level of PSA even during ADT. Therefore, we hypothesize that the cancer evolutionary dynamics can be represented by the ratio of androgen to PSA and its integration into prostate cancer models may help improve their predictive power.

MP09-10 PROSTATE IMAGING-REPORTING AND DATA SYSTEM VERSION 2 IN COMBINATION WITH CLINICAL PARAMETERS FOR PROSTATE CANCER DETECTION

You have accessJournal of UrologyCME1 Apr 2023MP09-10 PROSTATE IMAGING-REPORTING AND DATA SYSTEM VERSION 2 IN COMBINATION WITH CLINICAL PARAMETERS FOR PROSTATE CANCER DETECTION Lei Wang, Yi Luo, Tongzu Liu, Ming Deng, Hiroaki Wakimoto, and Xing Huang Lei WangLei Wang More articles by this author , Yi LuoYi Luo More articles by this author , Tongzu LiuTongzu Liu More articles by this author , Ming DengMing Deng More articles by this author , Hiroaki WakimotoHiroaki Wakimoto More articles by this author , and Xing HuangXing Huang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003224.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The purpose of this study was to analyze the diagnostic performance of the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) in combination with clinical parameters in patients with suspected prostate cancer (PCa). METHODS: A total of 424 men with suspicion of PCa were retrospectively analyzed, who underwent multiparametric magnetic resonance imaging (mpMRI) evaluated with PI-RADS v2 prior to transperineal ultrasound guided systematic biopsy. Clinical parameters including age, prostate volume, prostate specific antigen (PSA), free/total PSA ratio (f/t PSA), PSA density (PSAD) and PI-RADS v2 score were investigated. Logistic regression analyses were performed to identify predictors of clinically significant PCa defined as a Gleason score of 3 + 4 or greater. The prediction performance was compared with PSA level, f/t PSA, PSAD, PI-RADS v2 alone, and PI-RADS v2 plus PSAD using receiver operating characteristics (ROCs). RESULTS: In total, 231 out of 424 cases (54.48%) were pathologically diagnosed as PCa. The percentage of clinically significant PCa was higher in patients with PI-RADS v2 score of 4 or greater compared to PI-RADS v2 score of less than 4 (90.86% vs. 55.88%, p < 0.001). Age, PSA level, f/t PSA, PSAD, and PI-RADS v2 were significant independent predictors of clinically significant PCa (Figure 1). The ROC area under the curve of PI-RADS v2 plus PSAD (0.952) was larger compared with PSA (0.845), f/t PSA (0.719), PSAD (0.920), and PI-RADS v2 alone (0.885) (Table 1, Figure 2). CONCLUSIONS: PI-RADS v2 in combination with PSAD may help detect clinically significant PCa and provide benefit in making the decision to biopsy men at suspicion of PCa. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e108 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lei Wang More articles by this author Yi Luo More articles by this author Tongzu Liu More articles by this author Ming Deng More articles by this author Hiroaki Wakimoto More articles by this author Xing Huang More articles by this author Expand All Advertisement PDF downloadLoading ...