Prostate-specific Antigen Ratio Research Articles

Change in Free To Total Prostate Specific Antigen Ratio Following Transurethral Resection of Prostate in Patient With Benign Prostatic Hyperplasia

Objective- To determine the changes in free to total serum prostate specific antigen (PSA) ratio level after transurethral resection of prostate (TURP) in BPH patients at different interval of time. Materials & Methods- A total of 93 patients undergoing TURP for benign enlargement of prostate were included in the study. Serum total PSA and free PSA were assessed before operation and on the Ist and 7th postoperative day and at month 3 to determine the changes in total PSA, free PSA and free to total PSA ratio following TURP. Result- The preoperative mean total PSA, free PSA and free to total PSA ratio were 3.5 :L 1.7 ng/ml, 0.781 0.21 ng/ml and 0.28 + 0.07. In terms of IPSS, 75(80.7%) patients had severe lower urinary tract obstruction and 18(19.3%) moderate obstruction. Histopathological examination of the resected prostatic tissue revealed that all the 93 patients had benign prostatic lesion. Conclusion-The free and total PSA in first few days increases and thereafter it decreases in 3 months period following transurethral resection of prostate in men with BPH. As both these parameters decrease proportionately, the free to total PSA ratio remains consistent. If free to total PSA ratio decreases it raises suspicision about the early changes in malignancy. Bangladesh Journal of Urology, Vol. 18, No. 2, July 2015 p.83-87

Potential Utility of Prostate Health Index Density for Prostate Cancer Detection and Prediction in Korean Men: A Prospective Multicenter Study

Purpose We evaluated the clinical performance of Prostate Health Index (PHI) density with [-2]proPSA (p2PSA) and its derivatives in predicting the presence of prostate cancer (PCa) in Korean men. Materials and Methods A total of 706 men with total prostate-specific antigen (tPSA)≥2.5 ng/mL who underwent their first prostate biopsy were included in this prospective, multicenter, observational study. Diagnostic accuracy of tPSA, free-to-total PSA ratio (%fPSA), p2PSA, %p2PSA, the Beckman Coulter PHI, and PHI density was assessed by receiver operating characteristic curve analyses and logistic regression analyses. PHI was calculated as [(p2PSA/free PSA)×tPSA½], and density calculations were performed using prostate volume as determined by transrectal ultrasonography. Results Overall, PCa was detected in 367 of all subjects (52%). In men with tPSA 2.5–10 ng/mL, the detection rate of PCa was 41.1% (188 of 457). In this group, PHI and PHI density were the most accurate predictors of PCa and significantly outperformed tPSA and %fPSA; area under the curve for tPSA, %fPSA, %p2PSA, PHI, and PHI density was 0.58, 0.68, 0.70, 0.75, 0.73 respectively. PHI and PHI density were also the strongest predictor of PCa with Gleason score ≥7. Conclusions Based on the present prospective multicenter experience, PHI and PHI density demonstrate the superior clinical performance in predicting the presence of PCa in Korean men with tPSA 2.5–10 ng/mL. Key Words: Biomarkers; Biopsy; Early diagnosis; Prostatic cancer; Prostate-specific antigen; Protein isoforms.

Clinical factors for predicting malignancy in patients with PSA < 10 ng/mL and PI‐RADS 3 lesions

To determine clinical risk factors in patients with PI-RADS 3 lesions and prostate-specific antigen (PSA)<10ng/mL. In this prospective study, all patients underwent multiparametric magnetic resonance imaging. Following the 2-5 core fusion-targeted biopsy, standard 12-core prostate biopsy was performed in each patient (combined biopsy). The cutoff values were calculated with receiver-operating characteristic analysis. First, univariate logistic regression analysis was used to evaluate the relationship between total eight parameters and prostate cancer. Subsequently, multiple logistic regression analysis was performed to the parameters associated with prostate cancer. Two hundred and eighty-eight patients were included in the study. Some clinical parameters are determined to be significant in univariate and multiple logistic regression analyses, including PSA, free/total PSA ratio, PSA density (PSA/total prostate volume), positive family history of PCa, and PI-RADS 3 lesion diameter. Patients were classified between 0 and 5 according to the number of risk factors. While the risk of cancer was 7.1% in patients with one or less risk factors, the PCA rate was 45.2% among patients with all risk factors. In patients with PI-RADS 3 lesion and PSA<10ng/mL, histopathological results of biopsy can be estimated with higher accuracy using some clinical parameters.

PSA-based machine learning model improves prostate cancer risk stratification in a screening population.

The majority of prostate cancer diagnoses are facilitated by testing serum Prostate Specific Antigen (PSA) levels. Despite this, there are limitations to the diagnostic accuracy of PSA. Consideration of patient demographic factors andbiochemical adjuncts to PSA may improve prostate cancer risk stratification. We aimed to develop a contemporary, accurate and cost-effective model based on objective measures to improve the accuracy of prostate cancer risk stratification. Data were collated from a local institution and combined with patient data retrieved from the Prostate, Lung, Colorectal and Ovarian Cancer screening Trial (PLCO) database. Using a dataset of 4548 patients, a machine learning model was developed and trained usingPSA, free-PSA, age andfree-PSA to total PSA (FTR) ratio. The model was trained on a dataset involving 3638 patients and was then tested on a separate set of 910 patients. The model improved prediction for prostate cancer (AUC 0.72) compared to PSA alone (AUC 0.63), age (AUC 0.52), free-PSA (AUC 0.50) and FTR alone (AUC 0.65). When an operating point is chosen such that the sensitivity of the model is 80% the specificity of the model is 45.3%. The benefit in AUC secondary to the model was related to sample size, with AUC of 0.64 observed when a subset of the cohort was assessed. Development of a dense neural network modelimproved the diagnostic accuracy in screening for prostate cancer. These results demonstrate an additional utility of machine learning methods in prostate cancer risk stratification when using biochemical parameters.

The Value of Prostate-Specific Antigen-Related Indexes and Imaging Screening in the Diagnosis of Prostate Cancer.

ObjectiveThe aim of this study was to explore the value of the prostate-specific antigen (PSA) levels, the ratio of free PSA to total PSA (fPSA/TPSA), the PSA density (PSAD), digital rectal examination (DRE), transrectal prostate ultrasound (TRUS), and multiparameter MRI (MP-MRI) in the differential diagnosis of benign prostatic hyperplasia (BPH) and prostate cancer (PCa).MethodsFrom February 2016 to September 2019, data from 620 patients who underwent systematic transrectal ultrasound-guided prostate biopsy (STURS-PB) in our hospital were retrospectively collected, including the PSA levels, the fPSA/TPSA ratio, the PSAD, DRE, TRUS, MP-MRI, prostate volume, and other clinical data.ResultsAmong the 620 patients, 249 patients were in the PCa group, and 371 patients in the BPH group. The positive puncture rate was 40.16%. The positive predictive values of DRE, TRUS, mpMRI, and TPSA levels for PCa were 39.91%, 39.38%, 64.14%, and 41.57%, respectively; the sensitivity of these parameters was 37.35%, 51.41%, 74.69%, and 57.43%, respectively; and the specificity of these parameters was 62.26%, 46.90%, 71.97%, and 45.82%, respectively. When the TPSA concentration was in the range of 4–20 ng/mL, the positive puncture rate of STURS-PB was 23.18%, with a high rate of misdiagnosis. When the TPSA concentration was in the range of 4–20 ng/mL, the fPSA/TPSA ratio was 0.15, the PSAD was 0.16, the comprehensive evaluation of PCa was optimal (the sensitivity of these parameters was 88.85% and 84.09%, respectively; the specificity was 80.17% and 67.29%, respectively; the positive predictive value was 57.41% and 51.39%, respectively). When the TPSA concentration >4 ng/mL, the fPSA/TPSA ratio ≤0.15 and the PSAD ≥0.16, the sensitivity, specificity, and correctness index of the PCa and BPH diagnosis were 80.54%, 82.75%, and 67.07%, respectively.ConclusionWhen using DRE, TRUS, and MP-MRI to screen for PCa, MP-MRI has a relatively high sensitivity and specificity. Using these three thresholds (TPSA >4 ng/mL combined with an fPSA/TPSA ratio ≤0.15 and a PSAD ≥0.16) is significantly better than using TPSA levels alone for the differential diagnosis of PCa and BPH.

Diagnostic value of PCA3, TMPRSS2:ERG and prostatic specific antigen derivatives in the detection of prostate cancer

Background . Prostate cancer (PCa) is one of the most common malignancy in men. A traditional marker in the laboratory diagnosis ofPCa is the prostatic specific antigen (PSA). However, the low specificity of this marker leads to a large number of unnecessary biopsies. The emergence of various modifications of PSA and tumor-specific genetic markers such as PCA3 and TMPRSS2ERG, have improved the diagnosis of PCa. Objective . Investigation of the diagnostic significance of molecular genetic markers, PCA3 and TMPRSS2:ERG, and their comparison with markers based on PSA isoforms: free/total PSA ratio (%fPSA) and prostate health index (PHI). Materials and methods. The study included 58 men with suspected PCa. All patients were defined PCA3 score and the presence of TMPRSS2:ERG fusion transcript in the urine sediment. Also, PHI and %fPSA were determined in 48 and 51 men, respectively. Results. The area under the ROC-curve regardless of the value of PSA was higher for PCA3 score (0.773, p 95 % PCA3 score had the highest specificity, positive and negative predictive values in men, regardless of the level of PSA: 65.22, 80.95, and 93.75 %, respectively. In men with PSA level of 2—10 ng/ml the area under the ROC-curve for PCA3, %fPSA and PHI was 0.776 (p = 0.001), 0.629 (p = 0.144) and 0.729 (p = 0.009), respectively. At high sensitivity (>95 %) characteristics of the diagnostic test PCA3 in men with a PSA level of 2—10 ng/ml also also exceeded those for PHIand %>fPSA. The negative predictive valuefor PCA3score in this group ofmen was 100 %. The sensitivity ofdetection ofthe TMPRSS2:ERG fusion transcript in urine was 37.14 %, specificity 86.96 %, and the positive predictive value was 81.25 %. Conclusion. The use ofthe PCA3 score in combination with the detection of TMPRSS2:ERG fusion will improve the assessment of PCa risk in men with PSA levels between 2 and 10ng/ml (the “grey zone”).

EFFECT OF PRUNING HEIGHT ON THE PRODUCTION OF ORTOTROPIC BUDS OR BRANCHES IN VIVERO CONDITIONS

Prostate-specific antigen (PSA) is a glycoprotein secreted by the epithelial cells of the prostate, total PSA is usually found at levels below 4ng / ml, however, higher levels are detected in benign prostatic hyperplasia, prostatitis, prostate cancer, therefore, a periodic control of the total PSA is indispensable. On the other hand, the research was observational in a descriptive manner whose objective was to determine the PSA values through the micro ELISA technique in adults aged 40 to 49 who belong to the 15 urban parishes of the city of Cuenca. In this context, it was possible to determine that 5% of the studied inhabitants have values higher than 4ng / ml, while the remaining 95% do not present major problems. Statistically, the ratio of prostate-specific antigen (PSA) values obtained from the inhabitants with the body mass index (BMI) and family history of prostate disease was demonstrated, given that the values obtained (p = 0.000) are within the range of allowed acceptance of statistical significance (p <0.05).

Efficacy and Safety of Androgen-Deprivation Therapy Combined with Docetaxel Plus Prednisone in High-Burden Metastatic Hormone-Sensitive Prostate Cancer.

PurposeThe aim of this study was to evaluate the efficacy and safety of hormonal and synchronous docetaxel plus prednisone (DocP) in metastatic hormone-sensitive prostate cancer (mHSPC).MethodsOne hundred fifty-one cases with high-burden mHSPC diagnosed at 1 single center from January 2014 to August 2018 were analyzed retrospectively. Among them, 85 cases received androgen-deprivation therapy (ADT) within 3 months, along with 6 cycles of docetaxel + prednisone (treatment group), whereas 66 received ADT alone (control group). The primary end point was the median overall survival (OS), while the secondary outcomes included prostate-specific antigen (PSA) progression-free survival (PFS), radiographic PFS, and the proportion of PSA falling to 0.2 ng/mL.ResultsA total of 151 patients were included and followed up for a median of 34 months in this study. The median OS time in the treatment group was unavailable, but it was remarkably longer than that of the control group (P<0.001). In addition, the PFS of PSA in the treatment group and control group was 17.9 months and 9.2 months, respectively (P<0.001). Meanwhile, the radiographic PFS was 43 months in the treatment group and 19.8 months in the control group, respectively (P<0.001). The proportions of PSA falling to 0.2 ng/mL were 53.7% and 23.3%, respectively (P<0.001). However, there was no significant difference in the incidence of ≥3 toxic side effects between these 2 groups (P=0. 21).ConclusionADT combined with 6 cycles of docetaxel + prednisone chemotherapy benefits patients diagnosed with high-burden mHSPC in terms of the OS, PFS of PSA and radiographic, and the ratio of PSA falling to 0.2 ng/mL.

Guidelines for Reporting of Figures and Tables for Clinical Research in Urology.

In an effort to improve the presentation of and information within tables and figures in clinical urology research, we propose a set of appropriate guidelines. We introduce six principles: (1) include graphs only if they improve the reader's ability to understand the study findings; (2) think through how a graph might best convey information, do not just select a graph from preselected options on statistical software; (3) do not use graphs to replace reporting key numbers in the text of a paper; (4) graphs should give an immediate visual impression of the data; (5) make it beautiful; and (6) make the labels and legend clear and complete. We present a list of quick "dos and don'ts" for both tables and figures. Investigators should feel free to break any of the guidelines if it would result in a beautiful figure or a clear table that communicates data effectively. That said, we believe that the quality of tables and figures in the medical literature would improve if these guidelines were to be followed. Patient summary: A set of guidelines were developed for presenting figures and tables in urology research. The guidelines were developed by a broad group of statistical experts with special interest in urology.

How can we predict the active surveillance candidates meeting all Epstein criteria prior to prostate biopsy to avoid overdiagnosis?

Objective To investigate the effectiveness of PSA, prostate volume (PV) and free-to-total PSA ratio (fPSA%) in predicting patients meeting all active surveillance criteria, including Epstein criteria. Method Retrospective analysis was made of the data of 1901 men who underwent transrectal ultrasound (TRUS)-guided prostate biopsy in our clinic between January 2015 and December 2019. The active surveillance criteria were determined as Gleason score ≤6, when specified ≤2 positive cores with <50% cancer involvement in every positive core, a clinical T1c, a PSA <10ng/mL and a PSA density <0.15 ng/mL/cc. Patients who met all active surveillance criteria were included in Group 1, and other patients with prostate cancer were included in Group 2. Results The study included 336 patients with available data of age, total-free PSA levels, PV calculated by TRUS. Group 1 consisted of 82 patients and Group 2 consisted of 254 patients. PV and fPSA% were significantly higher and PSA was significantly lower in Group 1 than in Group 2. On multivariate analysis, the independent predictors were determined to be PSA and PV while fPSA% was not. Conclusion By using PSA and PV in predicting patients meeting all active surveillance criteria, unnecessary biopsies and ultimately overdiagnosis can be reduced.

18F-choline PET/computed tomography and clinical parameters in the detection of significant prostate cancer in patients with increased prostate-specific antigen levels and previous negative biopsies.

The aim of this study is to assess the value of the F-choline PET/computed tomography (CT) in predicting significant prostate cancer (sPCa) in patients with persistently increased prostate-specific antigen (PSA) levels and previous negative biopsies. To study the possible predictive added value of F-choline PET/CT to clinical variables and biomarkers derived from PSA in detecting sPCa. We evaluated patients who underwent F-choline PET/CT because of ongoing suspicion of prostate cancer (PCa) due to elevated PSA levels (4-20 ng/mL) and at least one previous negative or no conclusive prostate biopsy for PCa. Age, PSA, free PSA, free/total PSA ratio, PSA velocity, PSA doubling time, PSA density and score risk were obtained. F-choline PET/CT was classified as negative/positive (PET-categorical). Additionally, we subclassified F-choline PET/CT according to the radiotracer uptake patterns (PET-pattern). The reference standard was the histological confirmation. Accuracy of PET/CT was evaluated. Univariate and multivariate logistic regression analyses were performed for metabolic and clinical variables. A total of 78 patients were included in our study, 23 had PCa (15 with sPCa). The PET pattern showed the highest accuracy and was the most powerful predictor of sPCa. In this research, the prediction of sPCa was improved combining PET pattern and score risk. F-choline PET/CT is a potential tool for predicting sPCa in patients with persistently increased PSA levels and previous negative biopsies, and also it could improve the performance of score risk in predicting sPCa.

A PI-RADS-Based New Nomogram for Predicting Clinically Significant Prostate Cancer: A Cohort Study.

PurposeTo develop and validate a PI-RADS-based nomogram for predicting the probability of clinically significant prostate cancer (csPCa) at initial prostate biopsy.Patients and MethodsFrom February 2015 to October 2018, 573 consecutive patients made up the development cohort (DC), and another 253 patients were included as an independent validation cohort (VC). Univariate and multivariate analysis were used for determining the dependent clinical risk factors for csPCa. Prediction model1 was constructed by integrating independent clinical risk factors. Then added the PI-RADS score to model1 to develop the prediction model2 and present it in the form of a nomogram. The performance of the nomogram was assessed by receiver operating characteristic curve, net reclassification improvement analysis, calibration curve, and decision curve.ResultsAll clinical candidate factors were significantly different between csPCa and non-csPCa in both the DC and VC. Age, PSA density (PSAD), and free-to-total PSA ratio (f/t) were ultimately determined as dependent clinical risk factors for csPCa and integrated into prediction model1. Then, prediction model2 was developed and presented in a nomogram. In the DC, the nomogram (AUC=0.894) was superior to model1, PI-RADS score, or other clinical factors alone in detecting csPCa. Similar result (AUC=0.891) was obtained in the VC. NRI analysis showed that the nomogram improved the classification of patients significantly compared with model1. Furthermore, the nomogram showed favorable calibration and great clinical usefulness.ConclusionThis study developed and validated a nomogram that integrates PI-RADS score with other independent clinical risk factors to facilitate prebiopsy individualized prediction in high-risk patients with csPCa.

Detection of Prostatic Inflammation From Peripheral Lymphocyte Count and Free/Total PSA Ratio in Men With LUTS/BPH.

ObjectiveIdentifying biomarkers of prostatic inflammation has been a question of great interest in the development of anti-inflammatory pharmacotherapy for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). Systemic inflammation and serum prostate-specific antigen (PSA) have been linked with prostatic inflammation. This study set out to develop a diagnostic model for prostatic inflammation using clinical and laboratory parameters.MethodsWe included LUTS/BPH patients undergoing transurethral resection of the prostate. The severity of prostatic inflammation was determined by pathological review. Clinical manifestations and preoperative laboratory test results were recorded. We used LASSO regression with 10-fold cross-validation to select variables with the most diagnostic value of prostatic inflammation. Furthermore, we used multivariable logistic regression analysis to develop the diagnostic model, presented in a nomogram. The discrimination, calibration of the post-LASSO diagnostic model, and the model supplemented with clinical parameters were assessed. Decision curve analysis was performed.ResultsA total of 164 patients were included. Of all patients, 97 (59.1%) had no or mild prostatic inflammation, and 67 (40.9%) had moderate to severe prostatic inflammation. A higher peripheral white blood cell count, higher peripheral lymphocyte count, lower free/total (f/t) PSA ratio, and acute urinary retention history were associated with a higher risk of moderate to severe prostatic inflammation. Peripheral lymphocyte count and f/t PSA ratio were selected by the LASSO method and entered into the nomogram. The post-LASSO diagnostic model had an AUC of 0.756 (95% CI: 0.684–0.829) and good calibration. The addition of clinical parameters failed to show incremental diagnostic value. The decision curve analysis demonstrated that the post-LASSO laboratory nomogram was clinically useful.ConclusionOur findings demonstrated that peripheral lymphocyte count and f/t PSA ratio appear to be reliable diagnostic markers, based on which we build a clinically useful nomogram for prostatic inflammation. This diagnostic model could facilitate the development of anti-inflammatory pharmacotherapy for LUTS/BPH. Before this model is adopted in clinical practice, future validation is needed to determine its clinical utility.

Impact of Long-Term use of Mobile Phones on the Prostate in Human users

The current study investigated some possible effects of long-term use of mobile phones on the oxidative-antioxidants balance and its effect on the prostate. Twenty-eight eligible volunteers frequently use mobile phones and from the same socioeconomic status were enrolled in the study. They were examined according to the effect of time every two years for a follow-up period with four years. A detailed personal, occupational and medical questionnaire was completed for each participant through personal interviews. Total and free Prostate-Specific Antigen (PSA) levels, in addition to the levels of malondialdehyde, Total Antioxidant Capacity (TAC) and Zinc (Zn) were determined. At the end of the study, total and free PSA and MDA levels increased significantly compared to the baseline. Compared to the two years of use, total and free PSA level, free PSA/total PSA ratio, MDA and Zn levels were significantly increased after 4 years. In conclusion, the long-term use of cell phones may cause a redox imbalance characterized by increased oxidative stress that eventually affected the prostate gland.

Association of Gleason score with PSA Values and Serum Testosterone Levels Measured Prior To Prostate Biopsy.

To analyse the association of prostate cancer (PCa) Gleason score evaluated upon prostate biopsy with clinical PSA values, total and free testosterone (TT and FT, respectively) levels measured prior to biopsy. A descriptive study. Department of Urology, Sultan Abdulhamid Han Education and Research Hospital, from July to December 2019. A total of 85 patients were included and classified into non-PCa (group 1) and PCa (group 2) groups according the results of prostate biopsy pathology. Age, digital rectal examination (DRE) findings; prostate volume (PV); free/total prostate specific antigen (PSA) ratio (f/tPSA); PSA density (PSA-D) and total PSA (tPSA), free PSA (fPSA), TT and FT levels of the two groups were evaluated. Associations of the ISUP grade of patients in group 2 with age, DRE findings for PCa; PV; PSA-D; f/tPSA and tPSA, fPSA, TT and FT levels were analysed. Mean patient age was 63.00 (57.50-70.00) years. Mean age, significant DRE findings for PCa, tPSA levels and PSA-D were significantly higher in group 2 (p <0.05), whereas PV was significantly higher in group 1 (p <0.05). The ISUP grade of patients in group 2 was significantly and positively correlated with age and tPSA levels (p <0.05). ISUP grade was significantly and positively correlated with significant DRE findings for PCa (p <0.05). However, ISUP grade was negatively correlated with PV and f/tPSA (p <0.05). No significant difference was observed between the two groups in terms of TT and FT levels (p >0.05). TT and FT levels evaluated before prostate biopsy did not provide any additional benefit in predicting Gleason score grade before biopsy. Key Words: Prostate biopsy, prostate cancer, ISUP grade, Gleason score, total testosterone, free testosterone.

Epidemiological study on more accurate diagnosis of prostate cancer.

The study aimed at assessing the potential benefit of prostate health index (PHI) for early detection of prostate cancer (PCa) and the use of PHI as a marker predicting the presence of PCa before performing prostate biopsy. The study comprised 55 males who underwent prostate biopsy. Before the procedure, blood samples were collected to test prostate specific antigen (PSA) and free/total PSA ratio (%fPSA) and PHI was calculated. Receiver operating characteristic (ROC) analysis was used to assess the benefit of these values for predicting the presence of PCa. Based on histological examination 31 males were diagnosed with PCa, the remaining 24 were negative. Among the PCa patients, 39% had a Gleason score of 6, 26% had a score of 7 and 35% had a score of 8-10. There were statistically significant differences in PHI and PSA between males with and without PCa. The areas under the ROC curve for %fPSA, total PSA and PHI were 0.712, 0.746 and 0.789, respectively. PHI showed the best predictive ability to estimate biopsy results. If the cut-off criterion PHI > 36.4 (77.42% sensitivity, 66.67% specificity) had been used, 41.7% of males would have avoided unnecessary biopsy. The use of PHI may considerably improve the accuracy of PCa detection in patients with elevated PSA and thus reduce the number of unnecessary biopsies.

The role of FPSA/TPSA, PSAD combined with multi-parameter magnetic resonance imaging PI-RADS score in the diagnosis of PSA gray area prostate cancer

Objective To investigate the diagnostic value of prostate specific antigen free PSA and total PSA ratio, PSA density combined with multiparametric magnetic resonance imaging PI.RADS score in PSA gray area prostate cancer. Methods Patients with prostate cancer or benign prostatic hyperplasia(BPH) diagnosed by prostate biopsy from PSA gray area in the second affiliated hospital of Kunming medical university from May 2016 to August 2018 were selected.The FPSA, TPSA, multi-parameter magnetic and resonance PI-RADS score data were measured.FPSA/TPSA, PSAD were calculated, and the differences between the two groups of patients were compared.The role of FPSA/TPSA, PSAD combined with multi-parameter magnetic resonance imaging PI-RADS score in the diagnosis of PSA gray area prostate cancer was analyzed by receiver operating characteristic(ROC). Results A total of 117 patients were enrolled, including 30 patients in the PCa group and 87 patients in the BPH group. There were no significant differences in age, FPSA, TPSA, FPSA/TPSA between the two groups(P>0.05). However, there were significant differences in PSAD and PI-RADS scores between the two groups(P<0.01). ROC analysis showed that the FPSA/TPSA, PSAD combined with PI-RADS scores for the PCA and BPH patients under the curve AUC=0.771(P<0.01). Conclusions For patients with PSA in the gray zone. PSAD and PI-RADS scores are of significant value in the diagnosis of prostate cancer.FPSA/TPSA, PSAD combined with multi-parameter magnetic resonance imaging PI-RADS score has important application value in the diagnosis of PSA gray area prostate cancer. Key words: Prostatic Neoplasms; Prostate-Specific Antigen; Magnetic Resonance Spectroscopy

Can natural killer cell activity help screen patients requiring a biopsy for the diagnosis of prostate cancer?

ABSTRACTPurpose To evaluate the usefulness of natural killer cell activity (NKA) in diagnosing prostate cancer (PC).Materials and Methods The medical records of patients who underwent transrectal prostate biopsy (TRBx) at Korea University Ansan Hospital between May 2017 and December 2017 were retrospectively reviewed. NKA levels were measured using NK Vue® Tubes (ATgen, Sungnam, Korea). All blood samples were obtained at 8 AM on the day of biopsy. Patients with other malignancies, chronic inflammatory conditions, high prostate-specific antigen (PSA) level (>20ng/mL), or history of taking 5-alpha-reductase inhibitor or testosterone replacement therapy were excluded.Results A total of 102 patients who underwent TRBx for PC diagnosis were enrolled. Among them, 50 were diagnosed with PC. Significant differences in age and NKA level were observed between the PC and no-PC groups. Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off of NKA level for the prediction of PC was 500pg/dL, with a sensitivity of 68.0% and a specificity of 73.1%. In addition, NKA level (0.630) had the greatest area under the ROC curve compared to those for the ratio of total PSA to free PSA (0.597) and PSA density (0.578).Conclusions The results of this pilot study revealed that low NKA and high PSA levels were likely to be associated with a positive TRBx outcome. NKA detection was easy and improved the diagnostic accuracy of PC.

A predictive model for prostate cancer incorporating PSA molecular forms and age

The diagnostic specificity of prostate specific antigen (PSA) is limited. We aimed to characterize eight anti-PSA monoclonal antibodies (mAbs) to assess the prostate cancer (PCa) diagnostic utility of different PSA molecular forms, total (t) and free (f) PSA and PSA complexed to α1-antichymotrypsin (complexed PSA). MAbs were obtained by immunization with PSA and characterized by competition studies, ELISAs and immunoblotting. With them, we developed sensitive and specific ELISAs for these PSA molecular forms and measured them in 301 PCa patients and 764 patients with benign prostate hyperplasia, and analyzed their effectiveness to discriminate both groups using ROC curves. The free-to-total (FPR) and the complexed-to-total PSA (CPR) ratios significantly increased the diagnostic yield of tPSA. Moreover, based on model selection, we constructed a multivariable logistic regression model to predictive PCa that includes tPSA, fPSA, and age as predictors, which reached an optimism-corrected area under the ROC curve (AUC) of 0.86. Our model outperforms the predictive ability of tPSA (AUC 0.71), used in clinical practice. In conclusion, The FPR and CPR showed better diagnostic yield than tPSA. In addition, the PCa predictive model including age, fPSA and complexed PSA, outperformed tPSA detection efficacy. Our model may avoid unnecessary biopsies, preventing harmful side effects and reducing health expenses.

Prostate cancer screening among elderly men in Brazil: should we diagnose or not?

ABSTRACTPurpose:Prostate cancer screening in the elderly is controversial. The Brazilian government and the National Cancer Institute (INCA) do not recommend systematic screening. Our purpose was to assess prevalence and aggressiveness of prostate cancer in men aged 70 years and above, on the first Latin American database to date.Materials and Methods:Cross-sectional study (n=17,571) from 231 municipalities, visited by Mobile Cancer Prevention Units of a prostate-specific antigen (PSA) based opportunistic screening program, between 2004 and 2007. The criteria for biopsy were: PSA>4.0ng/ml, or PSA 2.5-4.0ng/ml with free/total PSA ratio ≤15%, or suspicious digital rectal examination findings. The screened men were stratified in two age groups (45-69 years, and ≥70 years). These groups were compared regarding prostate cancer prevalence and aggressiveness criteria (PSA, Gleason score from biopsy and TNM staging).Results:The prevalence of prostate cancer found was 3.7%. When compared to men aged 45-69 years, individuals aged 70 years and above presented cancer prevalence about three times higher (prevalence ratio 2.9, p<0.01), and greater likelihood to present PSA level above 10.0ng/ml at diagnosis (odds ratio 2.63, p<0.01). The group of elderly men also presented prevalence of histologically aggressive disease (Gleason 8-10) 3.6 times higher (p<0.01), and 5-fold greater prevalence of metastases (PR 4.95, p<0.05).Conclusions:Prostate cancer screening in men aged over 70 may be relevant in Brazil, considering the absence of systematic screening, higher prevalence and higher probability of high-risk disease found in this age range of the population studied.