Prostate-specific Antigen Results Research Articles

Association between patient ethnicity and prostate cancer diagnosis following a prostate-specific antigen test: a cohort study of 730,000 men in primary care in the UK

BackgroundBlack men have higher prostate-specific antigen (PSA) levels and higher prostate cancer incidence and mortality than White men, while Asian men tend to have lower prostate cancer incidence and mortality than White men. Much of the evidence comes from the USA, and information from UK populations is limited.MethodsThis retrospective cohort study used data on patients registered at general practices in England contributing to the Clinical Practice Research Datalink (CPRD) Aurum dataset. Those eligible were men aged 40 and over with a record of ethnicity and a PSA test result recorded between 2010 and 2017 with no prior cancer diagnosis.The aim was to assess the incidence of prostate cancer following a raised PSA test result in men from different ethnic groups. Additionally, incidence of advanced prostate cancer was investigated. Cancer incidence was estimated from multi-level logistic regression models adjusting for potential confounding factors.Results730,515 men with a PSA test were included (88.9% White). Black men and men with mixed ethnicity had higher PSA values, particularly for those aged above 60 years. In the year following a raised PSA result (using age-specific thresholds), Black men had the highest prostate cancer incidence at 24.7% (95% CI 23.3%, 26.2%); Asian men had the lowest at 13.4% (12.2%, 14.7%); incidence for White men was 19.8% (19.4%, 20.2%). The peak incidence of prostate cancer for all groups was in men aged 70–79. Incidence of prostate cancer diagnosed at an advanced stage was similar between Black and White men.ConclusionsMore prostate cancer was diagnosed in Black men with a raised PSA result, but rates of advanced prostate cancer were not higher in this group. In this large primary care-based cohort, the incidence of prostate cancer in men with elevated PSA levels increases with increasing age, even when using age-adjusted thresholds, with Black men significantly more likely to be diagnosed compared to White or Asian men. The incidence of advanced stage prostate cancer at diagnosis was similar for Black and White men with a raised PSA result, but lower for Asian men.

Detection of Prostate Cancer Screening Disparities Using Geospatial Analysis of Laboratory Results

Abstract Black men experience higher prevalence and mortality from prostate cancer (PCa) but are less likely to undergo PCa screening with prostate-specific antigen (PSA). The reasons for this disparity are multifactorial and include lack of access, PCa education, and mistrust in the healthcare system. Identifying geographic regions with low PSA screening and high positivity rates could potentially help inform targeted interventions. This study aimed to examine racial, socioeconomic, and geospatial disparities in PSA screening and positivity rates in the Siteman Cancer Center (St. Louis, MO) catchment region. The results of all PSA screening tests ordered in the Barnes-Jewish Healthcare Corporation (St. Louis, MO) and performed from 9/2019-12/2022 were retrieved from the laboratory information system with patient demographics. Patient addresses were geocoded using ArcGIS Pro (ESRI, Redlands, CA) and assigned to a census tract of residence. The PSA screening-eligible population was defined as the number of persons ≥50 years of age based on U.S. Census data. Social Vulnerability Index (SVI) values were retrieved from the Centers for Disease Control. The PSA screening rate was calculated by census tract as the total number of PSA tests performed/PSA screening-eligible population. The PSA positivity rate was calculated by census tract as the number of PSA positive tests/total PSA tests. All census tracts with fewer than 10 PSA tests performed were omitted from PSA positivity analysis. Hotspot analysis was performed by calculating Local Moran’s I statistic per census tract and comparing with 999 randomly-generated maps. A total of 90,994 screening tests for 60,005 patients (48,024 White [80%], 10,425 Black [17%], and 1,556 Other [3%]) were performed for patients in the catchment region. Black patients were 78% more likely to receive a positive PSA screen than White patients (p<0.001). Of those screening positive, Black patients had a significantly higher median[IQR] (7.94[6.2-13.7 ng/mL]) PSA result compared to White patients (7.4[6.2-10.1 ng/mL]) (p<0.001) and a median[IQR] age of 67[61-74 years] vs. 69[63-76 years] (p<0.001). In a multivariate logistic regression using age, race, and census tract of residence SVI to predict PSA positivity, only census tract SVI was not statistically significant. A model using only age and race demonstrated that every 10 years of age and Black race were associated with 11% and 7% increased odds of receiving a PSA positive test, respectively (p<0.001). 75 and 191 of 789 census tracts in the catchment region were identified as PSA positivity hotspots and PSA screening cold spots, respectively. In conclusion, this study confirms previous reports of higher PSA values among Black patients and suggests that geospatial analysis of PSA testing can identify geographic regions with low testing and high positivity rates.

A correlation and red, amber, green (RAG) analysis of Boditech i-CHROMA™ Prostate Specific Antigen (PSA) Point of Care Test (POCT) Method and Roche PSA laboratory methods

Background: This study evaluated and compared the performance of the Boditech i-CHROMA™ point-of-care testing (POCT) method for the quantification of prostate-specific antigen (PSA) against traditional laboratory PSA method (Roche Methods – Roche Cobas c303/501/502/503, Roche Cobas e402/ e801 and Roche Cobas e411) using external quality control material from RIQAS. Materials and method: External quality control distributions from RIQAS were analysed using the Boditech i-CHROMA™ PSA method; these were then compared with the results of the Roche Methods – Roche Cobas c303/501/502/503, Roche Cobas e402/ e801 and Roche Cobas e411 provided by participants in the scheme. The mean results of the Roche methods were compared using linear regression and Red Amber Green (RAG) analysis, a scoring system where red is indicative of a raised PSA (>6.0 ng/mL), amber is indicative of a slightly raised PSA (5.0 – 6.0 ng/mL). Green indicates a normal PSA (<5.0 ng/mL). Results: The data showed that between the Boditech i-CHROMA™ PSA results and the Roche Cobas c303/501/502/503, there was an excellent correlation (r2 = 0.9843). The RAG analysis showed the Boditech i-CHROMA™ PSA method identified 26 reds, two ambers, and six greens compared with 27 reds, two ambers, and six greens determined by the Roche Cobas c303/501/502/503 method. The data showed an excellent correlation between the Boditech i-CHROMA™ PSA results and the Roche Cobas e402/ e801 PSA methods (r2 = 0.9842). The RAG analysis showed the Boditech i-CHROMA™ PSA method identified 30 reds, three ambers, and eight greens compared with 31 reds, two ambers, and eight greens identified by the Roche Cobas e402/ e801 PSA methods. The data showed an excellent correlation between the Boditech i-CHROMA™ PSA results and the Roche Cobas e411 PSA methods (r2 = 0.9851). The RAG analysis showed the Boditech i-CHROMA™ PSA method identified 30 reds, three ambers, and eight greens compared with 31 reds, two ambers, and eight greens identified Roche Cobas e411 PSA methods. Conclusion: The data showed that the Boditech i-CHROMA™ PSA method is comparable to the Roche Cobas c303/501/502/503, Roche Cobas e402/ e801 and Roche Cobas e411 PSA methods. This could effectively reduce the turnaround time to make prompt decisions on diagnosing, treating, and monitoring of patients with prostate-related disorders.

An Examination of Racial and Ethnic Disparities in the Use of Prostate Biopsy and Magnetic Resonance Imaging in Prostate Cancer Screening.

We assessed racial and ethnic disparities in the use of prostate biopsy or MRI following an elevated PSA result. We retrospectively evaluated insurance claims from Optum's de-identified Clinformatics Data Mart database from January 1, 2011 to December 31, 2017. This was a large commercially insured cohort from across the United States. We included all male enrollees over 40 years old receiving an elevated PSA result with no prior prostate biopsy or MRI and no confirmed urinary tract infection within 6 weeks of PSA test. A total of 765,409 participants met inclusion criteria with 43,711 (5.71%) receiving a PSA result above 4 ng/mL. Of these, 7,399 received either a prostate biopsy or MRI within 180 days. Men between ages 40-54 (29.48%) were most likely to receive prostate biopsy or MRI after an elevated PSA, followed by those between 55-64 (24.91%), 65-74 (18.56%), 75-84 (6.33%), and above 85 (3.62%). Compared to White patients, Black patients were more likely to receive either a prostate biopsy or MRI (OR: 1.16, 95% CI: 1.01, 1.32) following an elevated PSA level, while Asian (OR: 0.72, 95% CI: 0.54, 0.96) and Hispanic (OR: 0.83, 95% CI: 0.70, 0/97) patients were less likely. Physicians appear to be following the reported statistical incidence of prostate cancer by race and ethnicity when using prostate biopsy or MRI for patients with elevated PSA levels. These results demonstrate the importance of publishing statistical data on disease incidence by race and ethnicity for informing physicians' decision-making.

Abstract 38: External Quality Assessment for Prostate Specific Antigen Test Accuracy: A Needs Assessment of Nigerian Tertiary Hospitals

Abstract Purpose: Prostate cancer is a major cause of death in African men, and the accuracy of prostate specific antigen (PSA) test results is important to ensure patients have access to accurate early diagnosis and treatment. External Quality Assessment (EQA) is an established framework to improve the quality of PSA results. We aimed to determine the need for implementing an EQA program for PSA in Nigeria. Methods: We used mixed-method design to collect data from 6 tertiary hospitals across the six regions in Nigeria. We conducted an online survey using a structured questionnaire developed from the International Standard Organization (ISO) 15189 checklist for accreditation of diagnostic laboratories. Responses were analyzed to obtain descriptive categorical data that was analyzed on Microsoft Excel. Using an in-depth interview guide, 12 respondents (6 Urologists and 6 Chemical Pathologists) from sampled hospitals were interviewed virtually. Responses were recorded and transcribed and relevant themes were identified and generated from the transcribed data. Results: Five of six laboratories sampled (83%) reported conducting repeat PSA testing. No sampled lab (0%) was enrolled in an EQA program for PSA. Eleven of the twelve respondents confirmed occasional disparities between PSA results and patient’s clinical status. They gave the impact of an erroneous PSA result on patient care as: extra unnecessary cost to the patient due to repeat testing; delay in decision making and initiating appropriate treatment; unnecessary invasive procedures. Training of lab staff, adoption of standard operating procedures and quality measures for EQA were considered opportunities to encourage PSA EQA practice while lack of funds for EQA programs, weak logistics for distribution of EQA samples and results, poor staff motivation and commitment were mentioned as barriers to effective practice uptake. Conclusion: There is a clear need for the implementation of an EQA program for PSA in Nigeria. This will reduce the incidence of incongruous PSA results, thus promoting better clinician approach to disease treatment and better patient outcomes especially in resource-constrained environments. Citation Format: Ifeyinwa Nnakenyi, Tonia Onyeka, Ngozi Idemili-Aronu1, Justus Onu, Echezona Ezeanolue. External Quality Assessment for Prostate Specific Antigen Test Accuracy: A Needs Assessment of Nigerian Tertiary Hospitals [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 38.

The performance of prostate specific antigen (PSA) testing in the population based NPCC cohort.

5029 Background: Prostate cancer (PCa) screening using prostate-specific antigen (PSA) is controversial. Benign prostate hyperplasia increases PSA in aging men independent of PCa such that PSA’s test performance differs between younger and older men. Age-specific cut-off values might therefore be advisable. The large Norwegian Prostate Cancer Consortium (NPCC) database might be able to contribute with clinically relevant information on age-specific PSA cut-off values. Methods: The Norwegian Prostate Cancer Consortium (NPCC) collected 8 857 761 PSA tests from 1.291.151 men. Results were linked with the date of diagnosis and grade of PCa. Analyses were restricted to men aged 45-75 years. PSA results were grouped into two groups: PCa negative vs PCa positive. The PCa negative group comprised PSA measurements from 2005 to 2015 men being alive and without PCa diagnosis five years after PSA measurement, in total 1 775 986 PSA measurements from 533 216 men. The PCa positive group comprised PSA measurements from 2005 to 2020 of men diagnosed with PCa during this period. PCa diagnoses at autopsy, as incidental finding at cystectomy, with metastases or with PSA > 50 ng/ml were excluded, in total 242 874 PSA measurements from 48 659 men with PCa. Sensitivity, specificity, area under the curve (AUC) as well as top decile and proportion of PCa in the top decile were calculated. Results: For men of 50 years of age, PSA at a threshold of 3 ng/ml yielded a sensitivity and specificity of ~ 95%. In 70–74-year-old men, a 3 ng/ml PSA threshold resulted in a 95% sensitivity but declining specificity of 70%. Maintaining specificity requires increasing PSA cut-off values to 4.5, 6, 7 and 8 ng/ml for men aged 55-59, 60-64, 65-69 and 70-74 years, respectively. The increasing cut-off values for the top PSA decile as well as the decreasing proportion of PCA within the top decile are in line with a declining AUC in older men. Conclusions: PSA test performance declines with increasing age. PCa screening in well-informed men should take into account age adjusted PSA cut-off values. [Table: see text]

Re: WHO Classification of Tumours, 5th Edition, Volume 8: Urinary and Male Genital Tumours

Prostate-specific antigen (PSA) levels in midlife are strongly associated with the long-term risk of lethal prostate cancer in cohorts not subject to screening. This is the first study evaluating the association between PSA levels drawn as part of routine medical care in the Norwegian population and prostate cancer incidence and mortality.To determine the association between midlife PSA levels <4.0 ng/ml, drawn as part of routine medical care, and long-term risk of prostate cancer death.The Norwegian Prostate Cancer Consortium collected >8 million PSA results from >1 million Norwegian males ≥40 yr of age. We studied 176 099 men (predefined age strata: 40–54 and 55–69 yr) without a prior prostate cancer diagnosis who had a nonelevated baseline PSA level (<4.0 ng/ml) between January 1, 1995 and December 31, 2005.Baseline PSA.We assessed the 16-yr risk of prostate cancer mortality. We calculated the discrimination (C-index) between predefined PSA strata (<0.5, 0.5–0.9, 1.0–1.9, 2.0–2.9, and 3.0–3.9 ng/ml) and subsequent prostate cancer death. Survival curves were plotted using the Kaplan-Meier method.The median follow-up time of men who did not get prostate cancer was 17.9 yr. Overall, 84% of men had a baseline PSA level of <2.0 ng/ml and 1346 men died from prostate cancer, with 712 deaths (53%) occurring in the 16% of men with the highest baseline PSA of 2.0–3.9 ng/ml. Baseline PSA levels were associated with prostate cancer mortality (C-index 0.72 for both age groups, 40–54 and 55–69 yr). The fact that the reason for any given PSA measurement remains unknown represents a limitation.We replicated prior studies that baseline PSA at age 40–69 yr can be used to stratify a man's risk of dying from prostate cancer within the next 15–20 yr.A prostate-specific antigen level obtained as part of routine medical care is strongly associated with a man’s risk of dying from prostate cancer in the next two decades.

Role of PSA Density and MRI in PSA Interpretation. Comment on Lumbreras et al. Variables Associated with False-Positive PSA Results: A Cohort Study with Real-World Data. Cancers 2023, 15, 261.

Prostate-specific antigen (PSA) has been utilized as a prostate cancer screening test for its high sensitivity for prostate cancer but is often criticized for its low specificity [...].

MP44-08 RELATIONSHIP BETWEEN COVID 19 VACCINATION AND PSA LEVEL

You have accessJournal of UrologyCME1 Apr 2023MP44-08 RELATIONSHIP BETWEEN COVID 19 VACCINATION AND PSA LEVEL David Ahlborn, Ilene Staff, Tara Mclaughlin, Joseph Tortora, Jeff Mather, and Joseph Wagner David AhlbornDavid Ahlborn More articles by this author , Ilene StaffIlene Staff More articles by this author , Tara MclaughlinTara Mclaughlin More articles by this author , Joseph TortoraJoseph Tortora More articles by this author , Jeff MatherJeff Mather More articles by this author , and Joseph WagnerJoseph Wagner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003290.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Some reports have indicated that the COVID vaccine could affect parameters used for some cancer screenings. The effect of COVID vaccination on breast cancer screening mammograms has been hotly debated and anecdotal reports of a rise in prostate-specific antigen (PSA) after COVID vaccination have appeared in the media. We explored the relationship between PSA levels and COVID vaccination. METHODS: With IRB approval, we queried the electronic medical record for men who received at least two mRNA COVID vaccine injections (Pfizer or Moderna), at least one PSA test within two years prior to the first vaccine injection and at least one PSA within one year of their second injection and before any third injection. PSA results were grouped according to the timing of the post vaccination PSA. The pre-vaccine PSA closest to the first injection was used. Both within and between subject analyses were conducted. Wilcoxon signed rank tests were performed to compare PSAs pre- and post- vaccine for each time defined group. McNemar tests were used to assess the percentage of patients crossing a 4.0 ng/dl threshold when compared with their pre-vaccine PSA. Difference in relative PSA change across the groups was compared using a Kruskal Wallis test. RESULTS: 5713 men met inclusion criteria. Median pre-vaccine PSA was 1.2 ng/dl (IQR 0.6-2.7 ng/dl). The median time difference between vaccine injection 1 and 2 was 22 days (IQR 21-28 days). Within each time group, a significant increase in PSA was observed pre to post and a higher proportion of men went above 4.0 relative to those going below. However, no significant differences were observed across groups (Table 1). CONCLUSIONS: Due to the lack of intergroup differences, PSA increases most likely reflect natural progression rather than any temporal effect of vaccination. Source of Funding: Unfunded © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e613 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Ahlborn More articles by this author Ilene Staff More articles by this author Tara Mclaughlin More articles by this author Joseph Tortora More articles by this author Jeff Mather More articles by this author Joseph Wagner More articles by this author Expand All Advertisement PDF downloadLoading ...

MP11-16 PROSTATE-SPECIFIC ANTIGEN ANALYSES IN PROPEL: ABIRATERONE AND OLAPARIB VERSUS ABIRATERONE AND PLACEBO AS FIRST-LINE THERAPY FOR METASTATIC CASTRATION-RESISTANT PROSTATE CANCER

MP11-16 PROSTATE-SPECIFIC ANTIGEN ANALYSES IN PROPEL: ABIRATERONE AND OLAPARIB VERSUS ABIRATERONE AND PLACEBO AS FIRST-LINE THERAPY FOR METASTATIC CASTRATION-RESISTANT PROSTATE CANCER

The proportion of false-positives in positive Seratec® prostate-specific antigen SemiQuant test results in postmortem screening for seminal fluid

Prostate-specific antigen (PSA) tests are used in forensics to conduct rapid screening for semen in vaginal swab samples from alleged victims of sexual abuse. Although PSA membrane tests have been applied to autopsy specimens, no study has evaluated predictors of false-positive test results in relation to factors such as age, cause of death, postmortem interval, drugs, and alcohol. This study describes the results obtained with the Seratec® PSA SemiQuant Kit test in 283 deceased women, with or without a history of sexual assault. Overall, 18.4% (52/283) of the vaginal swab samples tested positive for PSA. However, 63.5% (33/52) of the PSA-positive vaginal swab samples had no sperm detected. The proportion of false-positives in positive PSA results was 94.4% in those aged over 60 years. Multivariate logistic regression for PSA-positive samples showed that the proportion of false-positives in positive PSA results increased with the age of the deceased. However, the cause of death, postmortem interval, and presence of drugs or alcohol in the blood or urine of the deceased did not affect the PSA determination. These results show that PSA membrane tests are relatively unreliable and can be misleading, especially when derived from vaginal swab samples of older women, obtained at autopsy. In forensic cases, positive PSA screening test results may have an impact on subsequent legal actions and criminal charges brought against the accused. These findings are important for both forensic pathologists and the police to ensure accurate screening of older women in cases of suspected sex crimes.

Sensitive determination of prostate-specific antigen with graphene quantum dot-based fluorescence aptasensor using few-layer V2CTx MXene as quencher

A novel fluorescence aptasensor of prostate-specific antigen (PSA) was established using few-layer vanadium carbide (FL-V2CTx) nanosheet as a quencher. First, FL-V2CTx was prepared by the delamination of multi-layer V2CTx (ML-V2CTx) with tetramethylammonium hydroxide. The aptamer-carboxyl graphene quantum dots (CGQDs) probe was prepared by combining the aminated PSA aptamer and CGQDs. Then, the aptamer-CGQDs were absorbed onto the surface of FL-V2CTx by hydrogen bond interaction, which led to the decrease in fluorescence of aptamer-CGQDs due to photoinduced energy transfer. After addition of PSA, PSA-aptamer-CGQDs complex was released from FL-V2CTx. The fluorescence intensity of aptamer-CGQDs-FL-V2CTx with PSA was higher than that without PSA. The FL-V2CTx-based fluorescence aptasensor provided a PSA detection linear range from 0.1 to 20 ng mL−1 with detection limit of 0.03 ng mL−1. The ΔF value of fluorescence intensities for aptamer-CGQDs-FL-V2CTx with and without PSA was 5.6, 3.7, 7.7, and 5.4 times of ML-V2CTx, few-layer titanium carbide (FL-Ti3C2Tx), ML-Ti3C2Tx and graphene oxide aptasensors, respectively, indicating the advantage of FL-V2CTx. The aptasensor had high selectivity for PSA detection compared with some proteins and tumor markers. This proposed method had convenience and high sensitivity for PSA determination. The determination results of PSA in human serum samples using the aptasensor were consistent with those by chemiluminescent immunoanalysis. The fluorescence aptasensor can be successfully applied for PSA determination in serum samples of prostate cancer patients.

Managing the impact of inter-method bias of prostate specific antigen assays on biopsy referral: the key to move towards precision health in prostate cancer management.

We assessed the inter-method bias of total (tPSA) and free (fPSA) prostate-specific antigen (PSA) immunoassays to establish if tPSA-based risk thresholds for advanced prostate cancer (PCa), obtained from one method (Roche) can be converted into the corresponding concentrations assayed by other methods. Then we evaluated the impact of the bias of tPSA and fPSA on theestimation of the %f/tPSA ratio and performed a re-calibration of the proposed thresholds for the %f/tPSA ratio according to the assay used. tPSA and fPSA were measured in 135 and 137 serum samples, respectively by Abbott Alinity i, Beckman Access Dxl, Roche Cobas e801, and Siemens Atellica IManalytical platforms. Scatterplots, Bland-Altman diagrams, Passing-Bablok (PB) were used to inspect and estimate the systematic and proportional bias between the methods. The linear equations with confidence intervals of the parameter estimates were used to transform the tPSA risk thresholds for advanced PCa into the corresponding concentrations measurable by the other analytical methods. To construct a correction coefficient for converting the %f/tPSA ratio from one method to the other, PB and non-parametric boostrapping were used. The inter-method bias is not constant but strictly linear allowing the conversion of PSA results obtained from Roche into the other assays, which underestimate tPSA vs. Roche. Siemens and Abbott vs. Roche and Beckman assays, being characterized by a positive and a negative proportional bias for tPSA and fPSA measurements, tend to overestimate the %f/tPSA ratio. There is a consistent risk to miss advanced PCa, if appropriate conversion factors are not applied.

Rates of False-Negative Screening in Prostate Specific Antigen Secondary to 5-Alpha Reductase Inhibitor Usage: A Quality-Improvement Initiative.

ABSTRACTPurpose Patients often take 5-alpha reductase inhibitors (5-ARIs) for the management of benign prostatic hyperplasia. However, 5-ARIs can decrease prostate specific antigen (PSA) by approximately half and therefore may lead to false negative PSA tests. We investigated false-screening rates in men on 5-ARIs undergoing PSA testing and whether ordering physicians noticed false negative findings.Materials and Methods A single institution, retrospective study was conducted on patients with a PSA value documented between 2014 and 2017. Patient demographics, PSA results, 5-ARI usage, and providing clinician characteristics were collected. Published normal PSA values were used to determine PSA test positivity; values for those on 5-ARIs were doubled.Results A total of 29,131 men were included. 1,654 (5.7%) were prescribed 5-ARIs at least 12 months prior to PSA evaluation. 118 men (7.1%) had a value that would be positive if corrected for 5-ARI usage, 33 (27.9%) of which had no indication that the provider had noted this. There was no effect on rates of false negative values if the PSA was ordered by a different provider than the one who prescribed the 5-ARI (p = 0.837). However, if the provider who ordered the PSA test was an urologist, the likelihood that a false negative value would be identified was lower (p=0.001).Conclusions More than a quarter of men with false negative tests were missed. This occurred more often when the ordering provider was not an urologist. An educational opportunity exists to improve the quality of PSA testing by preventing false negative tests.

3D laparoscopic prostatectomy: results of multicentre study

Introduction Three-dimensional laparoscopic prostatectomy (3D LRP) is a potentially cost-effective option for robot-assisted laparoscopic prostatectomy (RALP). Results for two-dimensional LRP and RALP are well documented; however, little has been published on the outcomes of 3D LRP. Our objective was to report the perioperative and short-term results of 3D LRP in a multicentre study. Materials and methods In total, 496 unselected men with prostate cancer underwent 3D LRP by three surgeons between December 2013 and December 2018. Median age was 64 (43–76) years. Median prostate-specific antigen (PSA) was 7.9 (0.7–148) ng/ml. Preoperative and perioperative data and complications according to the Clavien–Dindo classification were collected. PSA and continence results were reported at 3 and 12 months postoperatively. Data were analysed with IBM SPSS statistics (25). Results Pathological Gleason score was 6 in 29%, 7 in 55.4%, 8 in 9.1%, 9 in 5.2% and 10 in 1.2% of patients. Pathological tumour classification was T2c in 59.5%, T3a in 19.5% and T3b in 10.9% of cases. Positive surgical margins occurred in 27.2%. Lymphadenectomy was performed in 36.3%, with positive lymph nodes in 11.8%. Median operative time was 137 (78–334) min and median blood loss 200 (10–1100) ml. Clavien–Dindo IIIa and IIIb complications occurred in 6.9% and 1.6%, respectively. At 3 and 12 months postoperatively, 90.2% and 91.4% of patients, respectively, had PSA <0.2 ng/ml, while 77.1% and 87.7% of patients were completely dry or using a maximum of one pad daily. Conclusions 3D LRP shows promising results, comparable to similar studies published on RALP.

Racial and Ethnic Disparities in the Use of Prostate Magnetic Resonance Imaging Following an Elevated Prostate-Specific Antigen Test

Prostate cancer screening and diagnosis exhibit known racial and ethnic disparities. Whether these disparities persist in prostate magnetic resonance imaging (MRI) utilization after elevated prostate-specific antigen (PSA) results is poorly understood. To assess potential racial and ethnic disparities in prostate MRI utilization following elevated PSA results. This cohort study of 794 809 insured US men was drawn from deidentified medical claims between January 2011 and December 2017 obtained from a commercial claims database. Eligible participants were aged 40 years and older and received a single PSA result and no prior PSA screening or prostate MRI claims. Analysis was performed in January 2021. Multivariable logistic regression was used to examine associations between elevated PSA results and follow-up prostate MRI. For patients receiving prostate MRI, multivariable regressions were estimated for the time between PSA and subsequent prostate MRI. PSA thresholds explored included PSA levels above 2.5 ng/mL, 4 ng/mL, and 10 ng/mL. Analyses were stratified by race, ethnicity, and age. Of 794 809 participants, 51 500 (6.5%) had PSA levels above 4 ng/mL; of these, 1524 (3.0%) underwent prostate MRI within 180 days. In this sample, mean (SD) age was 59.8 (11.3) years (range 40-89 years); 31 350 (3.9%) were Asian, 75 935 (9.6%) were Black, 107 956 (13.6%) were Hispanic, and 455 214 (57.3%) were White. Compared with White patients, Black patients with PSA levels above 4 ng/mL and 10 ng/mL were 24.1% (odds ratio [OR], 0.78; 95% CI, 0.65-0.89) and 35.0% (OR, 0.65; 95% CI, 0.50-0.85) less likely to undergo subsequent prostate MRI, respectively. Asian patients with PSA levels higher than 4 ng/mL (OR, 0.76; 95% CI, 0.58-0.99) and Hispanic patients with PSA levels above 10 ng/mL (OR, 0.77; 95% CI, 0.59-0.99) were also less likely to undergo subsequent prostate MRI compared with White patients. Black patients between ages 65 and 74 years with PSA above 4 ng/mL and 10 ng/mL were 23.6% (OR, 0.76; 95% CI, 0.64-0.91) and 43.9% (OR, 0.56; 95% CI, 0.35-0.91) less likely to undergo MRI, respectively. Race and ethnicity were not significantly associated with mean time between PSA and MRI. Among men with elevated PSA results, racial and ethnic disparities were evident in subsequent prostate MRI utilization and were more pronounced at higher PSA thresholds. Further research is needed to better understand and mitigate physician decision-making biases and other potential sources of disparities in prostate cancer diagnosis and management.

Lifestyle factors and prostate-specific antigen

Background: Increasing prostate cancer awareness has meant that more men are seeking out prostate-specific antigen (PSA) testing than ever before. Prostate cancer is now the most common malignancy in men, affecting one in eight. This article addresses lifestyle factors that may elevate PSA readings. Methods: A systematic review of the literature was performed using Medline for studies examining the association of PSA and lifestyle factors, including exercise, diet, sexual function as well as medication use. Further resources were identified from the reference list of retrieved articles. Results: Minimal level 1 evidence on the association of PSA with lifestyle factors was identified. Weak and generally inconsistent evidence was found on the effect of cycling and sexual activity. Diabetes and obesity did have inversely proportional effects on PSA values in large cohort studies. There was no evidence for an independent effect of different types of food to PSA. With regard to medications, the greatest impact is from 5-alpha reductase inhibitors, and these are used as a hair-loss treatment. Statins, non-steroidal anti-inflammatory drugs and thiazide diuretics can also have a clinically significant impact on PSA levels but unlikely to alter management. Discussion: For a small group of patients, cautious counselling on the factors summarised here before they have their blood tests may prevent undue stress and anxiety, particularly in those with borderline PSA results. Due to the inconsistency of results and lack of level 1a evidence, if there is reasonable suspicion for prostate cancer, a patient should still always be referred to a specialist. Level of evidence: Level 4.

Correlations between prostate cancer with prostate specific antigen levels in patients

Background: The influence of geographical, ethnic differences, different races possess their respective reference ranges of serum Prostate-Specific Antigen (PSA). The distribution of serum PSA in men without prostate cancer. Aims: We have investigated the importance of early detection in patients with Lower Urinary Tract Symptoms (LUTS), in whom prostate cancer has been suspected despite a negative trans rectal ultrasound (TRUS) biopsy, by the transition zone of prostate cancer by transurethral resection of the prostate (TURP). Methods: A total of 63 patients undergoing TURP were evaluated of the period from July 2019 to March 2020. TRUS biopsy patients before TURP (group with cancer) and not (without cancer) were compared to the prostate detection rates. All charts, including prostate-specified antigen (PSA), digital rectal exam (DRE) results, TURP (including volume of resection and a pathology report), and TRUS biopsy results, were evaluated retrospectively. Ethnicity has not been recorded since Al-Najaf is multi-ethnic. Description statistics, statistic tables, the arithmetic medium, standard error, default and two extremes used to analyze the results. Results: PSA values in different age groups were non-significantly different in cancer detection rate between with and without biopsy groups, the PSA mean was 4.7± 1.6 ng / ml and 3.4± 0.8 ng / ml, and also IPSS was 10.8± 1.4 and 9.1± 2.65 and p&gt;0.05 and while APEL (%) mean was 5.65± 2.5 ng / ml and 10.5± 1.35 ng / ml that showed significant difference between with and without biopsy groups and p&lt;0.05. The detection rate for prostate cancer and PSA (p=0.01) have been positively correlated. Conclusion: The results of serum PSA must be standardized by country and ethnic group. Ultimately, the diagnosis of prostatic carcinoma in a particular region will increase accuracy.

Single center retrospective analysis of fifty-two prostate cancer patients with customized MR-guided transurethral ultrasound ablation (TULSA)

ObjectivesMR-guided transurethral ultrasound ablation (TULSA) has primarily been investigated for whole-gland prostate ablation, even though the technology is also well-suited for partial gland treatment. The objectives were to perform a clinical service evaluation of partial to whole-gland TULSA for patients with localized prostate cancer (CaP). TULSA was also evaluated as a combined therapy for a subset of patients presenting with both cancer and concurrent benign prostate hyperplasia (BPH). Subjects and methodsThis retrospective, consecutive clinical service evaluation included men with histopathologically-confirmed CaP who underwent TULSA either as primary or salvage treatment. The planned ablation was dependent on the individual tumor characteristics, concurrent BPH and patient preferences. The Clavien-Dindo classification was used to record complications. Surgeon-assessed functional outcomes were reported. Early treatment success was defined by negative multiparametric MRI (mpMRI) and lack of prostate specific antigen (PSA) recurrence. ResultsFifty-two consecutive patients (47 treatment-naïve and 5 salvage) were included, with median follow-up of sixteen months and a max of thirty-six months. Baseline median (IQR) age and PSA were 67 years (63–76) and 8.0 ng/ml (5.2–13), respectively. Two Grade IIIa adverse events were observed, with no bowel-related complications. For urinary continence outcomes, 1 patient worsened to 1 pad per day. All patients who were previously potent maintained erectile potency. Of the patient subgroup also seeking treatment for BPH, 83% reported symptom improvement. Median (IQR) PSA nadir after primary treatment was 1.1 ng/ml (0.5–2.1). Early treatment success was 88%. Nine patients underwent a single repeat TULSA. ConclusionCustomized prostate ablation with TULSA offers flexible ablation according to patients’ disease characteristics and treatment expectations, providing favorable safety and promising early MRI and PSA results. TULSA is a feasible combination therapy for patients with both cancer and concurrent BPH.

Analysis of the usefulness of magnetic resonance imaging and clinical parameters in the detection of prostate cancer in the first systematic biopsy combined with targeted cognitive biopsy.

IntroductionThe study aimed to assess the suitability of multiparametric magnetic resonance prostate imaging (mpMRI) in combination with clinical parameters [prostate-specific antigen (PSA), digital rectal examination (DRE)] in the identification of men at risk of the presence of prostate cancer (PCa) and clinically significant prostate cancer (csPCa, Gleason Score ≥3+4) in the cognitive fusion with systematic prostate biopsy.Material and methodsWe retrospectively evaluated a population of 215 biopsy – naive patients with a clinical suspicion of prostate cancer. The results of mpMRI, DRE, PSA and biopsy were analyzed. MpMRI of the prostate according to the Prostate Imaging Reporting and Data System (PI-RADS) v.2.0 scheme preceded cognitive fusion and systematic transrectal prostate biopsy. Uni- and multivariable logistic regression analysis (MVA) was used to identify the variables determining the risk of detecting PCa overall and csPCa.ResultsIn MVA, it was established that the combination of variables such as PSA level [odds ratio (OR) 1.195; p = 0.002], PI-RADS ≥3 (OR 7.7; p = 0.002), prostate volume (OR 0.98; p = 0.017) significantly determines the probability of PCa detection in biopsy, while for csPCa it is PSA level (OR 1.14; p = 0.004), DRE (+) (OR 5.75; p <0.001), PI-RADS ≥4 (OR 6.5; p <0.001). Analysis of mpMRI diagnostic value for PI-RADS ≥4 revealed better sensitivity (88.9% vs 82.6%) and better negative predictive value (NPV) (94.5% vs 82.4%) for detection of csPCa than for PCa overall.ConclusionsMpMRI results combining with DRE and PSA parameters help to identify men at high – or low risk of csPCa detection in the first – time biopsy.