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del Pino-Sedeño T, Infante-Ventura D, de Armas Castellano A, de Pablos-Rodríguez P, Rueda-Domínguez A, Serrano-Aguilar P, Trujillo-Martín MM. Molecular Biomarkers for the Detection of Clinically Significant Prostate Cancer: A Systematic Review and Meta-analysis. EUR UROL SUPPL 2022; 46:105-127. [DOI: 10.1016/j.euros.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 11/11/2022] Open
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2
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The modified prostate health index (PHI) outperforms PHI density in the detection of clinical prostate cancer within the PSA grey zone. Int Urol Nephrol 2022; 54:749-756. [PMID: 35201553 DOI: 10.1007/s11255-022-03113-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 01/10/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To compare the accuracy of several volume and diameters modified prostate health index (mPHI) models with PHI density (PHID), PHI, and other prostate-specific antigen (PSA) derivatives in detecting PSA grey zone prostate cancer (PCa). MATERIALS AND METHODS Between August 2020 and September 2021, a consecutive cohort of 214 suspected PCa patients with elevated total PSA values ranged from 4.0 to 10.0 ng/mL were prospectively recruited and received PHI detections and transrectal ultrasonography (TRUS) measurements, followed by systematic prostate biopsies confirmation. RESULTS Among the 214 patients enrolled in the project, a total of 80 were diagnosed with PCa. In univariate analysis for the training cohort, the area under curve (AUC) of mPHI-2 [Formula: see text] was 0.8310, which outperformed PHID in identifying PSA grey zone PCa (P ≤ 0.0001) and showed the best net benefit in decision curve analysis (DCA). By a threshold of 0.2835, the sensitivity and specificity in the prediction of PCa were 78.9% and 90.3%, while the positive predictive value (PPV) and negative predictive value (NPV) were 78.3% and 78.6%, respectively. CONCLUSIONS According to our present single-center experience, the mPHI-2 risk predictor outperformed PHID or other classical parameters alone in the PCa detection with a grey zone PSA level in Asian males.
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Lin X, Wu Y, Liu F, Na R, Huang D, Xu D, Gong J, Zhu Y, Dai B, Ye D, Yu H, Jiang H, Fang Z, Zheng J, Ding Q. A Germline Variant at 8q24 Contributes to the Serum p2PSA Level in a Chinese Prostate Biopsy Cohort. Front Oncol 2021; 11:753920. [PMID: 34737962 PMCID: PMC8560794 DOI: 10.3389/fonc.2021.753920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction The clinical performance of [-2]proPSA (p2PSA) and its derivatives in predicting the presence and aggressiveness of prostate cancer (PCa) has been well evaluated in prostate biopsy patients. However, no study has been performed to evaluate the common genetic determinants that affect serum level of p2PSA. Materials and Methods Here, we performed a two-stage genome-wide association study (GWAS) on the p2PSA level in Chinese men who underwent a transperineal ultrasound-guided prostate biopsy at Huashan Hospital, Shanghai Cancer Center, and Ruijin Hospital in Shanghai, China. Germline variants significantly associated with the p2PSA level in the first stage (n = 886) were replicated in the second stage (n = 1,128). Multivariate linear regression was used to assess the independent contribution of confirmed single nucleotide polymorphisms (SNPs) and known covariates, such as age, to the level of p2PSA. Results A novel non-synonymous SNP, rs72725879, in region 8q24.21 of the PRNCR1 gene was significantly associated with the serum level of p2PSA in this two-stage GWAS (p = 2.28 × 10-9). Participants with homozygous "T" alleles at rs72725879 had higher p2PSA levels compared to allele "C" carriers. This variant was also nominally associated with PCa risk (p-combined = 3.44 × 10-18). The association with serum level of p2PSA was still significant after adjusting for PCa risk and age (p = 0.017). Conclusions Our study shows that the genetic variants in the 8q24.21 region are associated with the serum level of p2PSA in a large-scale Chinese population. By taking inherited variations between individuals into account, the findings of these genetic variants may help improve the performance of p2PSA in predicting prostate cancer.
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Affiliation(s)
- Xiaoling Lin
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China.,Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yishuo Wu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China.,Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Fang Liu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China.,Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Rong Na
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Da Huang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Danfeng Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Gong
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China.,Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yao Zhu
- Department of Urology, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Bo Dai
- Department of Urology, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Dingwei Ye
- Department of Urology, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Hongjie Yu
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China
| | - Haowen Jiang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China.,Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zujun Fang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China.,Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Zheng
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China.,Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiang Ding
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China.,Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China
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Lee CU, Choi J, Sung SH, Chung JH, Song W, Kang M, Sung HH, Jeong BC, Seo SI, Jeon SS, Lee HM, Jeon HG. The Role of Prostate Combination Biopsy Consisting of Targeted and Additional Systematic Biopsy. J Clin Med 2021; 10:4804. [PMID: 34768322 PMCID: PMC8584506 DOI: 10.3390/jcm10214804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/02/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To identify the role of combination biopsy, which consists of both targeted and additional systematic cores, in the diagnosis of clinically significant prostate cancer (csPCa). METHODS We retrospectively reviewed patients with PSA levels 2.5-15 ng/mL who have a suspicious prostate lesion (with the Prostate Imaging Reporting and Data System (PI-RADS) ≥ 3) on multiparametric MRI (mpMRI) between January 2016 and December 2018. We analyzed biopsy results by PI-RADS score and biopsy methods (systematic, targeted, and combination biopsy). RESULTS Of the 711 total patients, an average of 4.0 ± 1.8 targeted and 8.6 ± 3.1 additional systematic biopsies were performed. The additional systematic biopsies were sampled outside the targeted biopsy area. The combination biopsies detected more csPCa (201 patients, 28.3%) than did the targeted (175 patients, 24.6%) or systematic (124 patients, 17.4%) biopsies alone (p < 0.001). In the initial biopsy samples, there was a 7% increase in the detection of csPCa than in targeted biopsy (62% to 69%). It increased by 11% in repeat biopsy (46% to 57%). There was no statistical significance in both groups (p = 0.3174). CONCLUSIONS Combination biopsy has the benefit of detecting csPCa in both initial and repeat biopsy when there is a suspicious lesion on mpMRI.
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Affiliation(s)
- Chung Un Lee
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Joongwon Choi
- Department of Urology, VHS Medical Center, Seoul 05368, Korea;
| | - Si Hyun Sung
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Jae Hoon Chung
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Wan Song
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Minyong Kang
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Hyun Hwan Sung
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Byong Chang Jeong
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Seong Il Seo
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Seong Soo Jeon
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Hyun Moo Lee
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Hwang Gyun Jeon
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
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Huang D, Wu YS, Ye DW, Qi J, Liu F, Helfand BT, Zheng SL, Ding Q, Xu DF, Na R, Xu JF, Sun YH. Prostate volume does not provide additional predictive value to prostate health index for prostate cancer or clinically significant prostate cancer: results from a multicenter study in China. Asian J Androl 2021; 22:539-543. [PMID: 31929198 PMCID: PMC7523603 DOI: 10.4103/aja.aja_136_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
To evaluate whether prostate volume (PV) would provide additional predictive utility to the prostate health index (phi) for predicting prostate cancer (PCa) or clinically significant prostate cancer, we designed a prospective, observational multicenter study in two prostate biopsy cohorts. Cohort 1 included 595 patients from three medical centers from 2012 to 2013, and Cohort 2 included 1025 patients from four medical centers from 2013 to 2014. Area under the receiver operating characteristic curves (AUC) and logistic regression models were used to evaluate the predictive performance of PV-based derivatives and models. Linear regression analysis showed that both total prostate-specific antigen (tPSA) and free PSA (fPSA) were significantly correlated with PV (all P < 0.05). [-2]proPSA (p2PSA) was significantly correlated with PV in Cohort 2 (P < 0.001) but not in Cohort 1 (P = 0.309), while no significant association was observed between phi and PV. When combining phi with PV, phi density (PHID) and another phi derivative (PHIV, calculated as phi/PV0.5) did not outperform phi for predicting PCa or clinically significant PCa in either Cohort 1 or Cohort 2. Logistic regression analysis also showed that phi and PV were independent predictors for both PCa and clinically significant PCa (all P < 0.05); however, PV did not provide additional predictive value to phi when combining these derivatives in a regression model (all models vs phi were not statistically significant, all P > 0.05). In conclusion, PV-based derivatives (both PHIV and PHID) and models incorporating PV did not improve the predictive abilities of phi for either PCa or clinically significant PCa.
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Affiliation(s)
- Da Huang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yi-Shuo Wu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China.,Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Ding-Wei Ye
- Department of Urology, Shanghai Cancer Center, Fudan University, Shanghai 200032, China
| | - Jun Qi
- Department of Urology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Fang Liu
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Brian T Helfand
- Division of Urology, NorthShore University Health System, Evanston, IL 60201, USA
| | - Siqun L Zheng
- Program for Personalized Cancer Care, NorthShore University Health System, Evanston, IL 60201, USA
| | - Qiang Ding
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China.,Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Dan-Feng Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Rong Na
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.,Program for Personalized Cancer Care, NorthShore University Health System, Evanston, IL 60201, USA
| | - Jian-Feng Xu
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China.,Program for Personalized Cancer Care, NorthShore University Health System, Evanston, IL 60201, USA
| | - Ying-Hao Sun
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
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6
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Anyango R, Ojwando J, Mwita C, Mugalo E. Diagnostic accuracy of [-2]proPSA versus Gleason score and Prostate Health Index versus Gleason score for the determination of aggressive prostate cancer: a systematic review. JBI Evid Synth 2021; 19:1263-1291. [PMID: 33741840 DOI: 10.11124/jbisrir-d-19-00194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this review was to determine the diagnostic accuracy of [-2]proPSA (p2PSA) and the Prostate Health Index compared to the Gleason score in determining the aggressiveness of prostate cancer. INTRODUCTION Prostate cancer is the most commonly diagnosed cancer in men. However, the utility of currently available biomarkers for determining the aggressive form of the disease remains unknown. This review sought to determine the diagnostic accuracy of two new biomarkers in determining the aggressive form of prostate cancer. INCLUSION CRITERIA Diagnostic accuracy studies that enrolled men of any age and any prostate specific antigen (PSA) level with histologically confirmed prostate cancer in which Prostate Health Index and p2PSA were assessed in comparison to Gleason score for the determination of aggressive prostate cancer were considered for inclusion. There was no time limitation on study inclusion. METHODS A three-step search strategy was utilized to identify both published and unpublished studies in the English language in the following sources: PubMed, Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, Google Scholar, MedNar, and SIGLE. Databases were searched from inception to January 2019. Study selection, critical appraisal, data extraction, and data synthesis were done according to the approach recommended by JBI. RESULTS A total of 12 studies (n = 8462) that recruited men with aggressive prostate cancer were considered in this review. The majority of included subjects had a total PSA level of 2 to 10ng/mL. The sensitivity of the Prostate Health Index ranged from 67% to 97% while specificity ranged from 6% to 64%. At a Prostate Health Index threshold of 25 and below (three studies, n = 3222), pooled sensitivity was 97% (95% confidence interval [CI], 95% to 98%) and specificity was 10% (95% CI, 6% to 16%). At a Prostate Health Index threshold of between 26 and 35 (six studies, n = 6030), pooled sensitivity was 87% (95% CI, 8% to 91%) and specificity was 45% (95% CI, 39% to 50%). At a Prostate Health Index threshold of 36 and above (five studies, n = 1476), pooled sensitivity was 72% (95% CI, 64% to 79%) and specificity was 74% (95% CI, 68% to 80%). Only one study assessed p2PSA. Sensitivity ranged from 80% to 95%, and specificity ranged from 9.9% to 27.9% with increasing threshold values from 7.9 to 10.9ng/mL. CONCLUSIONS Overall, both Prostate Health Index and p2PSA have acceptable accuracy for the determination of the likelihood of aggressive prostate cancer. However, the inverse relationship between sensitivity and specificity makes it difficult to determine an optimum cut-off value for positivity. Further research is warranted to determine their utility in the management of prostate cancer.
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Affiliation(s)
- Ruth Anyango
- Afya Research Africa (ARA): A JBI Centre of Excellence, Nairobi, Kenya.,Moi University School of Medicine, Eldoret, Kenya
| | - Joel Ojwando
- Afya Research Africa (ARA): A JBI Centre of Excellence, Nairobi, Kenya.,Moi University School of Medicine, Eldoret, Kenya
| | - Clifford Mwita
- Afya Research Africa (ARA): A JBI Centre of Excellence, Nairobi, Kenya.,Moi University School of Medicine, Eldoret, Kenya
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Maestroni U, Cavalieri D, Campobasso D, Guarino G, Ziglioli F. PSA-IgM and iXip in the diagnosis and management of prostate cancer: clinical relevance and future potential. A review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021344. [PMID: 35075069 PMCID: PMC8823593 DOI: 10.23750/abm.v92i6.12058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 01/17/2023]
Abstract
The Prostate Specific Antigen (PSA) is the first filter in the diagnosis of prostate cancer. Unfortunately, it is organ-specific but not cancer-specific. In addition, some prostate cancers are not clinically-significant and their diagnosis and treatment may lead to overdiagnosis and overtreatment. For these reasons, other markers have been proposed in the last years, such as PCA3 and PHI, but none of these are currently used in the clinical practice on large scale. In the last decade, PSA-IgM and the algorithm iXip have emerged for the diagnosis of prostate cancer and showed to perform well in decreasing the detection of clinically-insignificant prostate cancer and in reducing the number of unnecessary prostate biopsies. This review focuses on data reported in the literature on PSA-IgM and iXip as well as on the future perspectives of their usage in the clinical practice on large scale.
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Affiliation(s)
| | | | | | - Giulio Guarino
- Department of Urology, University-Hospital of Parma, Italy
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8
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Wu YS, Fu XJ, Na R, Ye DW, Qi J, Lin XL, Liu F, Gong J, Zhang N, Jiang GL, Jiang HW, Ding Q, Xu J, Sun YH. Phi-based risk calculators performed better in the prediction of prostate cancer in the Chinese population. Asian J Androl 2020; 21:592-597. [PMID: 30924451 PMCID: PMC6859657 DOI: 10.4103/aja.aja_125_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Risk prediction models including the Prostate Health Index (phi) for prostate cancer have been well established and evaluated in the Western population. The aim of this study is to build phi-based risk calculators in a prostate biopsy population and evaluate their performance in predicting prostate cancer (PCa) and high-grade PCa (Gleason score ≥7) in the Chinese population. We developed risk calculators based on 635 men who underwent initial prostate biopsy. Then, we validated the performance of prostate-specific antigen (PSA), phi, and the risk calculators in an additional observational cohort of 1045 men. We observed that the phi-based risk calculators (risk calculators 2 and 4) outperformed the PSA-based risk calculator for predicting PCa and high-grade PCa in the training cohort. In the validation study, the area under the receiver operating characteristic curve (AUC) for risk calculators 2 and 4 reached 0.91 and 0.92, respectively, for predicting PCa and high-grade PCa, respectively; the AUC values were better than those for risk calculator 1 (PSA-based model with an AUC of 0.81 and 0.82, respectively) (all P < 0.001). Such superiority was also observed in the stratified population with PSA ranging from 2.0 ng ml-1to 10.0 ng ml-1. Decision curves confirmed that a considerable proportion of unnecessary biopsies could be avoided while applying phi-based risk calculators. In this study, we showed that, compared to risk calculators without phi, phi-based risk calculators exhibited superior discrimination and calibration for PCa in the Chinese biopsy population. Applying these risk calculators also considerably reduced the number of unnecessary biopsies for PCa.
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Affiliation(s)
- Yi-Shuo Wu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China.,Urology Research Center, Fudan University, Shanghai 200040, China.,Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL 60201, USA
| | - Xiao-Jian Fu
- Department of Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Rong Na
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Ding-Wei Ye
- Department of Urology, Shanghai Cancer Center, Fudan University, Shanghai 200032, China
| | - Jun Qi
- Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Xiao-Ling Lin
- Urology Research Center, Fudan University, Shanghai 200040, China
| | - Fang Liu
- Urology Research Center, Fudan University, Shanghai 200040, China
| | - Jian Gong
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China.,Urology Research Center, Fudan University, Shanghai 200040, China
| | - Ning Zhang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China.,Urology Research Center, Fudan University, Shanghai 200040, China
| | - Guang-Liang Jiang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China.,Urology Research Center, Fudan University, Shanghai 200040, China
| | - Hao-Wen Jiang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China.,Urology Research Center, Fudan University, Shanghai 200040, China
| | - Qiang Ding
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China.,Urology Research Center, Fudan University, Shanghai 200040, China
| | - Jianfeng Xu
- Urology Research Center, Fudan University, Shanghai 200040, China.,Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL 60201, USA
| | - Ying-Hao Sun
- Department of Urology, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
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9
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Jiang CY, Shen PF, Wang C, Gui HJ, Ruan Y, Zeng H, Xia SJ, Wei Q, Zhao FJ. Comparison of diagnostic efficacy between transrectal and transperineal prostate biopsy: A propensity score-matched study. Asian J Androl 2020; 21:612-617. [PMID: 31006712 PMCID: PMC6859663 DOI: 10.4103/aja.aja_16_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This study compared the diagnostic efficacy of transrectal ultrasound (TRUS)-guided prostate biopsy (TRBx) and transperineal prostate biopsy (TPBx) in patients with suspected prostate cancer (PCa). We enrolled 2962 men who underwent transrectal (n = 1216) or transperineal (n = 1746) systematic 12-core prostate biopsy. Clinical data including age, prostate-specific antigen (PSA) level, and prostate volume (PV) were recorded. To minimize confounding, we performed propensity score-matching analysis. We measured and compared PCa detection rates between TRBx and TPBx, which were stratified by clinical characteristics and Gleason scores. The effects of clinical characteristics on PCa detection rate were assessed by logistic regression. For all patients, TPBx detected a higher proportion of clinically significant PCa (P < 0.001). Logistic regression analyses illustrated that PV had a smaller impact on PCa detection rate of TPBx compared with TRBx. Propensity score-matching analysis showed that the detection rates in TRBx were higher than those in TPBx for patients aged >- 80 years (80.4% vs 56.5%, P = 0.004) and with PSA level 20.1-100.0 ng ml-1 (80.8% vs 69.1%, P = 0.040). In conclusion, TPBx was associated with a higher detection rate of clinically significant PCa than TRBx was; however, because of the high detection rate at certain ages and PSA levels, biopsy approaches should be optimized according to patents' clinical characteristics.
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Affiliation(s)
- Chen-Yi Jiang
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Peng-Fei Shen
- Department of Urology, West China Hospital, Sichuan University, West China School of Medicine, Chengdu 610041, China
| | - Cheng Wang
- Department of Urology, Shanghai General Hospital Affiliated to Nanjing Medical University, Shanghai 200080, China
| | - Hao-Jun Gui
- Department of Urology, West China Hospital, Sichuan University, West China School of Medicine, Chengdu 610041, China
| | - Yuan Ruan
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Hao Zeng
- Department of Urology, West China Hospital, Sichuan University, West China School of Medicine, Chengdu 610041, China
| | - Shu-Jie Xia
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Qiang Wei
- Department of Urology, West China Hospital, Sichuan University, West China School of Medicine, Chengdu 610041, China
| | - Fu-Jun Zhao
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China.,Department of Urology, Shanghai General Hospital Affiliated to Nanjing Medical University, Shanghai 200080, China
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10
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A predictive model for prostate cancer incorporating PSA molecular forms and age. Sci Rep 2020; 10:2463. [PMID: 32051423 PMCID: PMC7016114 DOI: 10.1038/s41598-020-58836-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 01/16/2020] [Indexed: 12/16/2022] Open
Abstract
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.
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11
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Ziglioli F, Granelli G, Cavalieri D, Bocchialini T, Maestroni U. What chance do we have to decrease prostate cancer overdiagnosis and overtreatment? A narrative review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:423-426. [PMID: 31910165 PMCID: PMC7233784 DOI: 10.23750/abm.v90i4.9070] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 11/23/2022]
Abstract
In the era of biochemical tests and algorithms, the management of prostate cancer from prevention to treatment is still controversial. The debate is focused on clinically-significant and clinically-insignificant prostate cancer. As it is well known, the diagnostic tools available are not able to distinguish between the two, thus leading to men treated for prostate cancer even if not strictly necessary. Unfortunately, as of today, there is no test available able to predict the clinical aggressiveness of prostate cancer at the time of the diagnosis. However, some indexes, PSA derivatives, immunocomplexes, and diagnostic methods have been proposed. If properly used in the daily clinical practice, these tools may be of support in the decision making process, in the effort to reduce the overdiagnosis and the overtreatment of prostate cancer.For this reason, we believe that a clear knowledge of this tools, indexes and diagnostic methods is of the utmost importance in preventing the morbidities related to unnecessary treatment as weel as preventing the detrimental effect of missing the diagnosis of a clinically significant prostate cancer.This reviews encompasses the most studied tests and diagnostic methods to predict the aggressiveness of prostate cancer, to avoid to miss a diagnosis of clinically significant cancers and to optimize the overall pre-treatment work-up. (www.actabiomedica.it).
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12
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Wu YS, Wu XB, Zhang N, Jiang GL, Yu Y, Tong SJ, Jiang HW, Mao SH, Na R, Ding Q. Evaluation of PSA-age volume score in predicting prostate cancer in Chinese population. Asian J Androl 2019; 20:324-329. [PMID: 29405172 PMCID: PMC6038173 DOI: 10.4103/aja.aja_81_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This study was performed to evaluate prostate-specific antigen-age volume (PSA-AV) scores in predicting prostate cancer (PCa) in a Chinese biopsy population. A total of 2355 men who underwent initial prostate biopsy from January 2006 to November 2015 in Huashan Hospital were recruited in the current study. The PSA-AV scores were calculated and assessed together with PSA and PSA density (PSAD) retrospectively. Among 2133 patients included in the analysis, 947 (44.4%) were diagnosed with PCa. The mean age, PSA, and positive rates of digital rectal examination result and transrectal ultrasound result were statistically higher in men diagnosed with PCa (all P < 0.05). The values of area under the receiver operating characteristic curves (AUCs) of PSAD and PSA-AV were 0.864 and 0.851, respectively, in predicting PCa in the entire population, both performed better than PSA (AUC = 0.805; P < 0.05). The superiority of PSAD and PSA-AV was more obvious in subgroup with PSA ranging from 2.0 ng ml-1 to 20.0 ng ml-1. A PSA-AV score of 400 had a sensitivity and specificity of 93.7% and 40.0%, respectively. In conclusion, the PSA-AV score performed equally with PSAD and was better than PSA in predicting PCa. This indicated that PSA-AV score could be a useful tool for predicting PCa in Chinese population.
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Affiliation(s)
- Yi-Shuo Wu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China.,Urology Research Center, Fudan University, Shanghai 200040, China
| | - Xiao-Bo Wu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China.,Urology Research Center, Fudan University, Shanghai 200040, China
| | - Ning Zhang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China.,Urology Research Center, Fudan University, Shanghai 200040, China
| | - Guang-Liang Jiang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China.,Urology Research Center, Fudan University, Shanghai 200040, China
| | - Yang Yu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Shi-Jun Tong
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China.,Urology Research Center, Fudan University, Shanghai 200040, China
| | - Hao-Wen Jiang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China.,Urology Research Center, Fudan University, Shanghai 200040, China
| | - Shan-Hua Mao
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China.,Urology Research Center, Fudan University, Shanghai 200040, China
| | - Rong Na
- Urology Research Center, Fudan University, Shanghai 200040, China.,Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Qiang Ding
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China.,Urology Research Center, Fudan University, Shanghai 200040, China
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13
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Lamy PJ, Allory Y, Gauchez AS, Asselain B, Beuzeboc P, de Cremoux P, Fontugne J, Georges A, Hennequin C, Lehmann-Che J, Massard C, Millet I, Murez T, Schlageter MH, Rouvière O, Kassab-Chahmi D, Rozet F, Descotes JL, Rébillard X. Prognostic Biomarkers Used for Localised Prostate Cancer Management: A Systematic Review. Eur Urol Focus 2018; 4:790-803. [DOI: 10.1016/j.euf.2017.02.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/08/2017] [Accepted: 02/24/2017] [Indexed: 11/28/2022]
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14
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Anyango R, Ojwando J, Mwita C, Mugalo E. Diagnostic accuracy of the [-2]Pro-PSA and Prostate Health Index versus the Gleason score for determining the aggressiveness of prostate cancer: a systematic review protocol. ACTA ACUST UNITED AC 2018; 16:2066-2071. [PMID: 30024433 DOI: 10.11124/jbisrir-2017-003385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTIONS.
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Affiliation(s)
- Ruth Anyango
- Afya Research Africa: A Joanna Briggs Institute Centre of Excellence, Nairobi, Kenya.,Moi University School of Medicine, Eldoret, Kenya
| | - Joel Ojwando
- Afya Research Africa: A Joanna Briggs Institute Centre of Excellence, Nairobi, Kenya.,Moi University School of Medicine, Eldoret, Kenya
| | - Clifford Mwita
- Afya Research Africa: A Joanna Briggs Institute Centre of Excellence, Nairobi, Kenya.,Moi University School of Medicine, Eldoret, Kenya
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15
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The application of p2PSA% and prostate health index in prostate cancer detection: A prospective cohort in a Tertiary Medical Center. J Formos Med Assoc 2018; 118:260-267. [PMID: 29779925 DOI: 10.1016/j.jfma.2018.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/27/2018] [Accepted: 05/03/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND/PURPOSE Prostate specific antigen (PSA) with low specificity that causes unnecessary prostate biopsies increases clinical morbidities, psychological stress, and medical expenses. We aimed to test the accuracy and cutoff value of Prostate Health Index (PHI) in men for prostate cancer detection. METHODS We prospectively enrolled 213 men who underwent prostate biopsy with PSA≦10 ng/ml or abnormal findings on digital rectal examination. Total PSA (tPSA), free PSA (fPSA) and p2PSA levels were measured by serum samples before prostate biopsy. PHI was calculated as (p2PSA/fPSA) × √tPSA. Multivariable logistic regression analyses were used to predict the risk of cancer and detect clinically significant prostate cancer. RESULTS 33 (27.0%) patients were confirmed with the diagnoses of prostate cancer by prostate biopsy. The levels of p2PSA, %p2PSA, and PHI showed statistically significant differences between prostate cancer patients and non-cancer patients. %p2PSA and PHI had the highest area under the receiver operating characteristic curve (AUC) of 0.723 and 0.772 (both p < 0.001), respectively, predicting cancer detection at biopsy than other predictors (tPSA, fPSA, %fPSA, and PSA density (AUC: 0.544, 0.538, 0.593, and 0.664, respectively). In multivariable logistic regression, %p2PSA had a statistical significant odds ratio 8.51 (p = 0.003) and PHI had an odds ratio with marginal significance 4.18 (p = 0.06). CONCLUSION %p2PSA and PHI increased the diagnostic accuracy with significantly greater sensitivity and specificity than tPSA. We determined an optimal cut-off value of PHI among Taiwanese population. These findings support the usefulness in the decisional process of prostate biopsy.
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16
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Tan LG, Tan YK, Tai BC, Tan KM, Gauhar V, Tiong HY, Hawkins RC, Thamboo TP, Hong FS, Chiong E. Prospective validation of %p2PSA and the Prostate Health Index, in prostate cancer detection in initial prostate biopsies of Asian men, with total PSA 4-10 ng ml-1. Asian J Androl 2018; 19:286-290. [PMID: 26908062 PMCID: PMC5427782 DOI: 10.4103/1008-682x.168687] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Despite its widespread use for prostate cancer screening, low specificity makes PSA a suboptimal biomarker, especially in the diagnostic "gray zone" of 4-10 ng ml-1 . False-positives lead to unnecessary biopsies with attendant morbidities. This is the first prospective validation study of %p2PSA and the Prostate Health Index (PHI) in Asian men presenting with a total PSA between 4.0 and 10 ng ml-1 . We studied 157 Asian men between 50 and 75 years old, with normal per rectal prostate examinations, undergoing their first prostate biopsy, using a standardized biopsy protocol, for PSA levels of 4-10 ng ml-1 . Thirty (19.1%) were found to have prostate cancer on biopsy. Statistically significant differences between patients with and without prostate cancer were found for total PSA, p2PSA, %p2PSA, and PHI. The areas under the curve of the receiver operating characteristic curve for total PSA, %fPSA, %p2PSA, and PHI were 0.479, 0.420, 0.695, and 0.794, respectively. PHI predicts prostatic biopsies results best. At a sensitivity of 90%, the specificity (95% CI) of PHI was 58.3%, more than triple the specificity of total PSA at 17.3%, potentially avoiding 77 (49%) unnecessary biopsies. Similar to studies in mainly Caucasian populations, we have prospectively shown that %p2PSA and PHI greatly outperform total and free to total PSA ratio, in the detection of prostate cancer at first biopsy. Higher PHI levels also correspond to increasing the risk of detecting GS ≥7 cancers. We have validated the use of PHI to aid decision-making regarding prostate biopsies in Asian men with serum PSA between 4 and 10 ng ml-1 .
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Affiliation(s)
- Lincoln Gl Tan
- Department of Urology, National University Hospital, National University Health System, Singapore
| | - Yung Khan Tan
- Department of Urology, Tan Tock Seng Hospital, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Karen Ml Tan
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Vineet Gauhar
- Department of Urology, Alexandra Hospital, Jurong Health, Singapore
| | - Ho Yee Tiong
- Department of Urology, National University Hospital, National University Health System, Singapore
| | - Robert Cw Hawkins
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore
| | - Thomas P Thamboo
- Department of Pathology, National University Hospital, Singapore
| | | | - Edmund Chiong
- Department of Urology, National University Hospital, National University Health System, Singapore
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17
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Sriplakich S, Lojanapiwat B, Chongruksut W, Phuriyaphan S, Kitirattakarn P, Jun-Ou J, Amantakul A. Prospective performance of the Prostate Health Index in prostate cancer detection in the first prostate biopsy of men with a total prostatic specific antigen of 4-10 ng/mL and negative digital rectal examination. Prostate Int 2018; 6:136-139. [PMID: 30505815 PMCID: PMC6251939 DOI: 10.1016/j.prnil.2018.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/02/2017] [Accepted: 02/09/2018] [Indexed: 12/20/2022] Open
Abstract
Background The disadvantage of using total serum prostatic specific antigen (PSA) test for detection of prostate cancer is that it has a low specificity. The low specificity of total PSA (tPSA) test leads to unnecessary prostate biopsies. In this prospective study, we assessed the serum tPSA, free PSA, p2PSA, and the Prostate Health Index (PHI) in the detection of prostate cancer in men with a tPSA of 4–10 ng/mL and a negative digital rectal examination (DRE). Materials and methods 101 male outpatients with a serum PSA of 4–10 ng/mL and nonsuspicious DRE for prostate cancer who underwent first transrectal ultrasound with a prostate biopsy were recruited. A blood sample to enable tPSA, free PSA, and p2PSA levels to be calculated was drawn before the prostate biopsy. The diagnosis and detection of high-grade cancer are correlated with the blood sample. Results Sixteen patients were positive for prostate cancer. All had significantly higher serum 2pPSA and PHI levels than patients with no cancer. A PHI level at 90% sensitivity (cutoff of 34.14) demonstrated a higher area under the receiver operating characteristic curve and more specificity in diagnosis and detection of high-grade prostate cancer than other tests. Conclusions The PHI in men with a PSA level of 4–10 ng/mL with negative DRE increased specificity in the detection of prostate cancer. This test is useful in discriminating between patients with or without cancer and also enables the detection of high-grade cancer avoiding unnecessary biopsies.
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Affiliation(s)
- Supon Sriplakich
- Division of Urology, Department of Surgery, Chiang Mai University, Chaing Mai, Thailand
| | - Bannakij Lojanapiwat
- Division of Urology, Department of Surgery, Chiang Mai University, Chaing Mai, Thailand
| | - Wilaiwan Chongruksut
- Division of Urology, Department of Surgery, Chiang Mai University, Chaing Mai, Thailand
| | - Siwat Phuriyaphan
- Division of Urology, Department of Surgery, Chiang Mai University, Chaing Mai, Thailand
| | - Pruit Kitirattakarn
- Division of Urology, Department of Surgery, Chiang Mai University, Chaing Mai, Thailand
| | - Jakrit Jun-Ou
- Division of Urology, Department of Surgery, Chiang Mai University, Chaing Mai, Thailand
| | - Akara Amantakul
- Division of Urology, Department of Surgery, Chiang Mai University, Chaing Mai, Thailand
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18
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Chistiakov DA, Myasoedova VA, Grechko AV, Melnichenko AA, Orekhov AN. New biomarkers for diagnosis and prognosis of localized prostate cancer. Semin Cancer Biol 2018; 52:9-16. [PMID: 29360504 DOI: 10.1016/j.semcancer.2018.01.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 01/18/2018] [Indexed: 11/28/2022]
Abstract
The diagnostics and management of localized prostate cancer is complicated because of cancer heterogeneity and differentiated progression in various subgroups of patients. As a prostate cancer biomarker, FDA-approved detection assay for serum prostate specific antigen (PSA) and its derivatives are not potent enough to diagnose prostate cancer, especially high-grade disease (Gleason ≥7). To date, a collection of new biomarkers was developed. Some of these markers are superior for primary screening while others are particularly helpful for cancer risk stratification, detection of high-grade cancer, and prediction of adverse events. Two of those markers such as proPSA (a part of the Prostate Health Index (PHI)) and prostate specific antigen 3 (PCA3) (a part of the PCA3 Progensa test) were recently approved by FDA for clinical use. Other markers are not PDA-approved yet but are available from Clinical Laboratory Improvement Amendment (CLIA)-certified clinical laboratories. In this review, we characterize diagnostic performance of these markers and their diagnostic and prognostic utility for prostate cancer.
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Affiliation(s)
- Dimitry A Chistiakov
- Department of Basic and Applied Neurobiology, Serbsky Federal Medical Research Center for Psychiatry and Narcology, 119991, Moscow, Russia.
| | - Veronika A Myasoedova
- Laboratory of Angiopathology, Institute of General Pathology and Pathophysiology, Russian Academy of Medical Sciences, 125315, Moscow, Russia
| | - Andrey V Grechko
- Federal Scientific Clinical Center for Resuscitation and Rehabilitation, 109240, Moscow, Russia
| | - Alexandra A Melnichenko
- Laboratory of Angiopathology, Institute of General Pathology and Pathophysiology, Russian Academy of Medical Sciences, 125315, Moscow, Russia
| | - Alexander N Orekhov
- Laboratory of Angiopathology, Institute of General Pathology and Pathophysiology, Russian Academy of Medical Sciences, 125315, Moscow, Russia; Institute for Atherosclerosis Research, Skolkovo Innovative Center, 121609, Moscow, Russia.
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19
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Preoperative prostate health index predicts poor pathologic outcomes of radical prostatectomy in patients with biopsy-detected low-risk patients prostate cancer: results from a Chinese prospective cohort. Prostate Cancer Prostatic Dis 2017; 21:64-70. [PMID: 29213105 DOI: 10.1038/s41391-017-0002-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/04/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the performance of the prostate health index (PHI) in predicting pathologic outcomes of radical prostatectomy (RP) in Chinese patients with low-risk prostate cancer (PCa). METHODS Of all consecutive patients who underwent RP in one tertiary center from September 2013 to January 2017, we prospectively examined the data of 140 patients with low-risk PCa based on the Prostate Cancer Research International: Active Surveillance (PRIAS) criteria. All patients were eligible for active surveillance, but underwent RP. Clinical and pathological data were collected. Logistic regression was used to evaluate the associations between the PHI and outcome of RP. The area under the receiver operating curve (AUC) was used to evaluate the accuracy of different models. Decision curve analysis was used to evaluate the potential clinical usefulness of making model-based decisions. RESULTS Only 44 (31.4%) patients were finally confirmed to have organ-confined Gleason ≤6 PCa. A low PHI was significantly predictive of organ-confined Gleason ≤6 PCa (p = 0.001), while tPSA and f/tPSA were not associated with final pathology. In the multivariate analyses, addition of the PHI significantly increased the predictive accuracy (AUC = 0.767, 95% Cl 0.685-0.849, p < 0.001). CONCLUSION The PRIAS criteria for active surveillance may not suitable for Chinese patients with PCa. Addition of the PHI to the PRIAS models improved the prognostic performance. If confirmed in future larger and multicenter studies, PHI may help us to identify patients eligible for AS in China.
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20
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Na R, Ye D, Qi J, Liu F, Helfand BT, Brendler CB, Conran CA, Packiam V, Gong J, Wu Y, Zheng SL, Mo Z, Ding Q, Sun Y, Xu J. Prostate health index significantly reduced unnecessary prostate biopsies in patients with PSA 2-10 ng/mL and PSA >10 ng/mL: Results from a Multicenter Study in China. Prostate 2017; 77:1221-1229. [PMID: 28664580 DOI: 10.1002/pros.23382] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/07/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND The performance of prostate health index (phi) in predicting prostate biopsy outcomes has been well established for patients with prostate-specific antigen (PSA) values between 2 and 10 ng/mL. However, the performance of phi remains unknown in patients with PSA >10 ng/mL, the vast majority in Chinese biopsy patients. We aimed to assess the ability of phi to predict prostate cancer (PCa) and high-grade disease (Gleason Score ≥7) on biopsy in a Chinese population. METHODS This is a prospective, observational, multi-center study of consecutive patients who underwent a transrectal ultrasound guided prostate biopsy at four hospitals in Shanghai, China from August 2013 to December 2014. RESULTS In the cohort of 1538 patients, the detection rate of PCa was 40.2%. phi had a significantly better predictive performance for PCa than total PSA (tPSA). The areas under the receiver operating characteristic curve (AUC) were 0.90 and 0.79 for phi and tPSA, respectively, P < 0.0001. A considerable proportion of patients in the cohort had PSAs >10 ng/mL (N = 838, 54.5%). The detection rates of PCa were 35.9% and 57.7% in patients with tPSA 10.1-20 and 20.1-50 ng/mL, respectively. The AUCs of phi (0.79 and 0.89, for these two groups, respectively) were also significantly higher than tPSA (0.57 and 0.63, respectively), both P < 0.0001. If a phi ≤35 was used as the cutoff, 599/1538 (39%) biopsies could have been avoided at a cost of missing small numbers of PCa patients: 49 (7.93%) PCa patients, including 18 (3.69%) high-grade tumors. CONCLUSIONS Results from this study suggest that phi can be used to predict PCa and high-grade disease in Chinese men with high PSA levels (>10 ng/mL).
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Affiliation(s)
- Rong Na
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, PR China
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, PR China
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois
- Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, Illinois
- Fudan Universtiy Shanghai Medical College, Shanghai, PR China
| | - Dingwei Ye
- Department of Urology, Shanghai Cancer Center, Fudan University, Shanghai, PR China
| | - Jun Qi
- Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Fang Liu
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Brian T Helfand
- Division of Urology, NorthShore University HealthSystem, Evanston, Illinois
| | - Charles B Brendler
- Division of Urology, NorthShore University HealthSystem, Evanston, Illinois
| | - Carly A Conran
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois
| | - Vignesh Packiam
- Division of Urology, NorthShore University HealthSystem, Evanston, Illinois
| | - Jian Gong
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Yishuo Wu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, PR China
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Siqun L Zheng
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois
| | - Zengnan Mo
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, PR China
| | - Qiang Ding
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, PR China
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Yinghao Sun
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai, PR China
| | - Jianfeng Xu
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, PR China
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois
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21
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Vukovic I, Djordjevic D, Bojanic N, Babic U, Soldatovic I. Predictive value of [-2]propsa (p2psa) and its derivatives for the prostate cancer detection in the 2.0 to 10.0ng/mL PSA range. Int Braz J Urol 2017; 43:48-56. [PMID: 28124526 PMCID: PMC5293383 DOI: 10.1590/s1677-5538.ibju.2016.0256] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/17/2016] [Indexed: 11/29/2022] Open
Abstract
Introduction To assess predictive value of new tumor markers, precursor of prostate specific antigen (p2PSA) and its derivates-%p2PSA and prostate health index (PHI) in detection of patients with indolent and aggressive prostate cancer (PC) in a subcohort of man whose total PSA ranged from 2 to 10ng/mL. Materials and Methods This cross-sectional study included 129 consecutive male patients aged over 50 years, with no previous history of PC and with normal digital rectal examination findings, but with serum PSA in interval between 2 and 10ng/mL. All patients underwent standard transrectal ultrasonography guided prostate biopsy for the first time. For all patients, serum PSA, free PSA (fPSA) and p2PSA were measured and PHI and %p2PSA were calculated. Results PHI and %p2PSA levels were significanlty higher in patients with PC compared to those without this malignancy. The same findings have been observed in group of patients with Gleason score ≥7 compared to those with Gleason score <7. ROC analysis reveled the highest area under the curve with these two markers. Multivariate logistic regression showed significant improvement in PC detection and its agressive form (assumed as Gleason score ≥7). Conclusions New markers, derivates of p2PSA (especially %p2PSA and PHI), represente potentially very important clinical tool for predicting presence of PC, and even more important, to discriminate patients with Gleason score <7 from those with Gleason score ≥7 with total PSA in range from 2 to 10ng/mL.
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Affiliation(s)
- I Vukovic
- Clinic of Urology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia
| | - D Djordjevic
- Clinic of Urology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia
| | - N Bojanic
- Clinic of Urology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia
| | - U Babic
- Clinic of Urology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia
| | - I Soldatovic
- Institute of Medical Statistics and Informatics, Belgrade, Serbia
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22
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Zhang K, Bangma CH, Roobol MJ. Prostate cancer screening in Europe and Asia. Asian J Urol 2017; 4:86-95. [PMID: 29264211 PMCID: PMC5717985 DOI: 10.1016/j.ajur.2016.08.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/16/2016] [Accepted: 08/16/2016] [Indexed: 12/19/2022] Open
Abstract
Prostate cancer (PCa) is the second most common cancer among men worldwide and even ranks first in Europe. Although Asia is known as the region with the lowest PCa incidence, it has been rising rapidly over the last 20 years mostly due to the introduction of prostate-specific antigen (PSA) testing. Randomized PCa screening studies in Europe show a mortality reduction in favor of PSA-based screening but coincide with high proportions of unnecessary biopsies, overdiagnosis and subsequent overtreatment. Conclusive data on the value of PSA-based screening and hence the balance between harms and benefits in Asia is still lacking. Because of known racial variations, Asian countries should not directly apply the European screening models. Like in the western world also in Asia, new predictive markers, tools and risk stratification strategies hold great potential to improve the early detection of PCa and to reduce the worldwide existing negative aspects of PSA-based PCa screening.
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Affiliation(s)
| | | | - Monique J. Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Yu GP, Na R, Ye DW, Qi J, Liu F, Chen HT, Wu YS, Zhang GM, Sun JL, Zhu Y, Huang LQ, Ren SC, Jiang DK, Zheng SL, Jiang HW, Sun YH, Ding Q, Xu J. Performance of the Prostate Health Index in predicting prostate biopsy outcomes among men with a negative digital rectal examination and transrectal ultrasonography. Asian J Androl 2017; 18:633-8. [PMID: 26975483 PMCID: PMC4955192 DOI: 10.4103/1008-682x.172823] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The [-2]proPSA (p2PSA) and its derivatives, the p2PSA-to-free PSA ratio (%p2PSA), and the Prostate Health Index (PHI) have greatly improved discrimination between men with and without prostate cancer (PCa) in prostate biopsies. However, little is known about their performance in cases where a digital rectal examination (DRE) and transrectal ultrasonography (TRUS) are negative. A prospective cohort of 261 consecutive patients in China with negative DRE and TRUS were recruited and underwent prostate biopsies. A serum sample had collected before the biopsy was used to measure various PSA derivatives, including total prostate-specific antigen (tPSA), free PSA, and p2PSA. For each patient, the free-to-total PSA ratio (%fPSA), PSA density (PSAD), p2PSA-to-free PSA ratio (%p2PSA), and PHI were calculated. Discriminative performance was assessed using the area under the receiver operating characteristic curve (AUC) and the biopsy rate at 91% sensitivity. The AUC scores within the entire cohort with respect to age, tPSA, %fPSA, PSAD, p2PSA, %p2PSA, and PHI were 0.598, 0.751, 0.646, 0.789, 0.814, 0.808, and 0.853, respectively. PHI was the best predictor of prostate biopsy results, especially in patients with a tPSA of 10.1-20 ng ml-1 . Compared with other markers, at a sensitivity of 91%, PHI was the most useful for determining which men did not need to undergo biopsy, thereby avoiding unnecessary procedures. The use of PHI could improve the accuracy of PCa detection by predicting prostate biopsy outcomes among men with a negative DRE and TRUS in China.
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Affiliation(s)
- Guo-Peng Yu
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai; Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Rong Na
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai; Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ding-Wei Ye
- Department of Urology, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jun Qi
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fang Liu
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Science, Fudan University, Shanghai, China; Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA,
| | - Hai-Tao Chen
- State Key Laboratory of Genetic Engineering, School of Life Science, Fudan University, Shanghai, China
| | - Yi-Shuo Wu
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai; Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Gui-Ming Zhang
- Department of Urology, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jie-Lin Sun
- Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Yao Zhu
- Department of Urology, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Li-Qun Huang
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shan-Cheng Ren
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - De-Ke Jiang
- State Key Laboratory of Genetic Engineering, School of Life Science, Fudan University, Shanghai, China; Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA,
| | - S Lilly Zheng
- Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina; Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
| | - Hao-Wen Jiang
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai; Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying-Hao Sun
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qiang Ding
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai; Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianfeng Xu
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China; Department of Urology, Huashan Hospital, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Science, Fudan University, Shanghai, China; Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA,
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Wang FB, Chen R, Ren SC, Shi XL, Zhu YS, Zhang W, Jing TL, Zhang C, Gao X, Hou JG, Xu CL, Sun YH. Prostate cancer antigen 3 moderately improves diagnostic accuracy in Chinese patients undergoing first prostate biopsy. Asian J Androl 2017; 19:238-243. [PMID: 26780868 PMCID: PMC5312226 DOI: 10.4103/1008-682x.167715] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Prostate cancer antigen 3 (PCA3) is a biomarker for diagnosing prostate cancer (PCa) identified in the Caucasian population. We evaluated the effectiveness of urinary PCA3 in predicting the biopsy result in 500 men undergoing initial prostate biopsy. The predictive power of the PCA3 score was evaluated by the area under receiver operating characteristic (ROC) curve (AUC) and by decision curve analysis. PCA3 score sufficed to discriminate positive from negative prostate biopsy results but was not correlated with the aggressiveness of PCa. The ROC analysis showed a higher AUC for the PCA3 score than %fPSA (0.750 vs 0.622, P = 0.046) in patients with a PSA of 4.0–10.0 ng ml−1, but the PCA3-based model is not significantly better than the base model. Decision curve analysis indicates the PCA3-based model was superior to the base model with a higher net benefit for almost all threshold probabilities, especially the threshold probabilities of 25%–40% in patients with a PSA of 4.0–10.0 ng ml−1. However, the AUC of the PCA3 score (0.712) is not superior to %fPSA (0.698) or PSAD (0.773) in patients with a PSA >10.0 ng ml−1. Our results confirmed that the RT-PCR-based PCA3 test moderately improved diagnostic accuracy in Chinese patients undergoing first prostate biopsy with a PSA of 4.0–10.0 ng ml−1.
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Affiliation(s)
- Fu-Bo Wang
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Rui Chen
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Shan-Cheng Ren
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xiao-Lei Shi
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ya-Sheng Zhu
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Wei Zhang
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Tai-Le Jing
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Chao Zhang
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xu Gao
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jian-Guo Hou
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Chuan-Liang Xu
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ying-Hao Sun
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
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25
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Chiu PKF, Teoh JYC, Lee WM, Yee CH, Chan ESY, Hou SM, Ng CF. Extended use of Prostate Health Index and percentage of [-2]pro-prostate-specific antigen in Chinese men with prostate specific antigen 10-20 ng/mL and normal digital rectal examination. Investig Clin Urol 2016; 57:336-42. [PMID: 27617315 PMCID: PMC5017555 DOI: 10.4111/icu.2016.57.5.336] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/21/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE We investigated the extended use of Prostate Health Index (PHI) and percentage of [-2]pro-prostate-specific antigen (%p2PSA) in Chinese men with prostate-specific antigen (PSA) 10-20 ng/mL and normal digital rectal examination (DRE). MATERIALS AND METHODS All consecutive Chinese men with PSA 10-20 ng/mL and normal DRE who agreed for transrectal ultrasound (TRUS)-guided 10-core prostate biopsy were recruited. Blood samples were taken immediately before TRUS-guided prostate biopsy. The performances of total PSA (tPSA), %free-to-total PSA (%fPSA), %p2PSA, and PHI were compared using logistic regression, receiver operating characteristic, and decision curve analyses (DCA). RESULTS From 2008 to 2015, 312 consecutive Chinese men were included. Among them, 53 out of 312 (17.0%) men were diagnosed to have prostate cancer on biopsy. The proportions of men with positive biopsies were 6.7% in PHI<35, 22.8% in PHI 35-55, and 54.5% in PHI>55 (chi-square test, p<0.001). The area under curves (AUC) of the base model including age, tPSA and status of initial/repeated biopsy was 0.64. Adding %p2PSA and PHI to the base model improved the AUC to 0.79 (p<0.001) and 0.78 (p<0.001), respectively, and provided net clinical benefit in DCA. The positive biopsy rates of Gleason 7 or above prostate cancers were 2.2% for PHI<35, 7.9% for PHI 35-55, and 36.4% for PHI>55 (chi-square test, p<0.001). By utilizing the PHI cutoff of 35 to men with PSA 10-20 ng/mL and normal DRE, 57.1% (178 of 312) biopsies could be avoided. CONCLUSIONS Both PHI and %p2PSA performed well in predicting prostate cancer and high grade prostate cancer. The use of PHI and %p2PSA should be extended to Chinese men with PSA 10-20 ng/mL and normal DRE.
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Affiliation(s)
- Peter Ka-Fung Chiu
- Department of Surgery, Division of Urology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, Division of Urology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wai-Man Lee
- Department of Surgery, Division of Urology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chi-Hang Yee
- Department of Surgery, Division of Urology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eddie Shu-Yin Chan
- Department of Surgery, Division of Urology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - See-Ming Hou
- Department of Surgery, Division of Urology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chi-Fai Ng
- Department of Surgery, Division of Urology, The Chinese University of Hong Kong, Hong Kong SAR, China.; Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong SAR, China
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Sun WG, Liang CZ, Zheng QC, Hu XW, Li ZZ, Wu P. Influence of age on seven putative prostate tumor markers: a cohort study in Chinese men. Asian J Androl 2016; 19:463-467. [PMID: 27048780 PMCID: PMC5507094 DOI: 10.4103/1008-682x.175787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The accuracy and sensitivity of prostate-specific antigen (PSA) for prostate cancer diagnosis is often poor; however, the reasons for its inaccuracy have rarely been investigated, especially with respect to age. In this study, 476 healthy males, aged 10-89 years, were stratified into eight age groups, and levels of seven markers were determined: total PSA (tPSA), free PSA (fPSA), %fPSA, isoform [-2]proPSA (p2PSA), p2PSA/tPSA, %p2PSA, and the prostate health index (PHI). Both tPSA and fPSA levels increased with age. The tPSA level was highest (1.39 ng ml-1) at 70-79 years; %fPSA was highest (0.57 ng ml-1) at 10-19 years; and %p2PSA was lowest (18.33 ng ml-1) at 40-49 years. Both p2PSA and p2PSA/tPSA had relatively flat curves and showed no correlation with age (P = 0.222). PHI was a sensitive age-associated marker (P < 0.05), with two peaks and one trough. The coverage rates and radiance graphs of PHI and %p2PSA were more distinctive than those of tPSA and the other markers. In subjects older than 69 years, PHI and %p2PSA both began to decrease, approximately 10 years earlier than the decrease in tPSA. Our results suggest that the clinical diagnosis of prostate cancer using PSA should be investigated more comprehensively based on patient age. Moreover, %p2PSA and PHI could be considered as earlier markers that may be more suitable than PSA alone.
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Affiliation(s)
- Wei-Gui Sun
- Research Institute of Urology, Ma'anshan People's Hospital, Affiliated to Anhui Medical University, Ma'anshan 243000, China
| | - Chao-Zhao Liang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, China
| | - Qi-Chuan Zheng
- Research Institute of Urology, Ma'anshan People's Hospital, Affiliated to Anhui Medical University, Ma'anshan 243000, China
| | - Xiao-Wu Hu
- The Center of Clinical Molecular Biology Laboratory, Ma'anshan 243000, China
| | - Zhi-Zhen Li
- The Center of Clinical Molecular Biology Laboratory, Ma'anshan 243000, China
| | - Ping Wu
- The Center of Clinical Molecular Biology Laboratory, Ma'anshan 243000, China
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27
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Effect of body mass index on the performance characteristics of PSA-related markers to detect prostate cancer. Sci Rep 2016; 6:19034. [PMID: 26754552 PMCID: PMC4709513 DOI: 10.1038/srep19034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 12/02/2015] [Indexed: 12/29/2022] Open
Abstract
To examine whether the predictive performance of prostate-specific antigen (PSA) and PSA-related markers for prostate cancer (PCa) is modified by body mass index (BMI). Patients with a PSA 2-10 ng/mL who underwent multicore prostate biopsies were recruited from three tertiary centers. Serum markers measured included total PSA (tPSA), free-to-total PSA (f/tPSA), p2PSA, percentage of p2PSA (%p2PSA), and prostate health index (PHI). The association between serum markers and PCa risk was assessed by logistic regression. Predictive performance for each marker was quantified using the area under the receiver operator curves (AUC). Among 516 men, 18.2% had PCa at biopsy. For all tested markers, their predictive value on PCa risk was lower in obese patients compared to normal weight patients. We found statistically significant interactions between BMI and tPSA (P = 0.0026) and p2PSA (P = 0.038). PHI achieved an AUC of 0.872 in normal weight patients and 0.745 in obese patients, which outperformed the other predictors regardless of BMI category. In conclusion, PHI achieved the best predictive performance for detecting PCa and was not influenced by BMI.
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28
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Monn MF, Tatem AJ, Cheng L. Prevalence and management of prostate cancer among East Asian men: Current trends and future perspectives. Urol Oncol 2015; 34:58.e1-9. [PMID: 26493449 DOI: 10.1016/j.urolonc.2015.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 09/08/2015] [Accepted: 09/11/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Previously East Asian men had been considered less likely to develop or die of prostate cancer. Emerging research and the onset of prostate-specific antigen screening in East Asian countries suggests that this may not be the case. We sought to analyze epidemiology and molecular genetic data and recent trends in the management of prostate cancer among East Asian men. METHODS AND MATERIALS We performed literature searches using PubMed, Embase, and Google Scholar to examine current literature on prostate cancer in East Asian men. Additionally, articles were searched for further references related to the topic. RESULTS Recent studies have reported increasing incidence of prostate cancer identified in East Asian men. Prostate cancer mortality has increased and is currently the fourth leading cause of death among men in Shanghai, China. Although prostate cancer was considered less aggressive among East Asian men, studies suggest that it is similarly aggressive to prostate cancer in Western populations. Molecular markers such as the TEMPRESS:ERG fusion gene and PTEN loss may provide novel methods of screening East Asian men for prostate cancer. National-level guidelines for prostate cancer screening and management are only available in Japan. CONCLUSIONS The prevalence of prostate cancer in East Asian men is likely similar to that in Western male populations. East Asian men present at higher stages of prostate cancer, likely because of a lack of standardized screening protocols. Urologists in Western countries should screen East Asian men for prostate cancer using the same standards as used for Western men.
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Affiliation(s)
- M Francesca Monn
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Alexander J Tatem
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Liang Cheng
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN; Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN.
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29
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Development and external validation of a prostate health index-based nomogram for predicting prostate cancer. Sci Rep 2015; 5:15341. [PMID: 26471350 PMCID: PMC4607975 DOI: 10.1038/srep15341] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 09/23/2015] [Indexed: 12/24/2022] Open
Abstract
To develop and externally validate a prostate health index (PHI)-based nomogram for predicting the presence of prostate cancer (PCa) at biopsy in Chinese men with prostate-specific antigen 4–10 ng/mL and normal digital rectal examination (DRE). 347 men were recruited from two hospitals between 2012 and 2014 to develop a PHI-based nomogram to predict PCa. To validate these results, we used a separate cohort of 230 men recruited at another center between 2008 and 2013. Receiver operator curves (ROC) were used to assess the ability to predict PCa. A nomogram was derived from the multivariable logistic regression model and its accuracy was assessed by the area under the ROC (AUC). PHI achieved the highest AUC of 0.839 in the development cohort compared to the other predictors (p < 0.001). Including age and prostate volume, a PHI-based nomogram was constructed and rendered an AUC of 0.877 (95% CI 0.813–0.938). The AUC of the nomogram in the validation cohort was 0.786 (95% CI 0.678–0.894). In clinical effectiveness analyses, the PHI-based nomogram reduced unnecessary biopsies from 42.6% to 27% using a 5% threshold risk of PCa to avoid biopsy with no increase in the number of missed cases relative to conventional biopsy decision.
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30
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Chen R, Ren S, Yiu MK, Fai NC, Cheng WS, Ian LH, Naito S, Matsuda T, Kehinde E, Kural A, Chiu JY, Umbas R, Wei Q, Shi X, Zhou L, Huang J, Huang Y, Xie L, Ma L, Yin C, Xu D, Xu K, Ye Z, Liu C, Ye D, Gao X, Fu Q, Hou J, Yuan J, He D, Pan T, Ding Q, Jin F, Shi B, Wang G, Liu X, Wang D, Shen Z, Kong X, Xu W, Deng Y, Xia H, Cohen AN, Gao X, Xu C, Sun Y. Prostate cancer in Asia: A collaborative report. Asian J Urol 2015; 1:15-29. [PMID: 29511634 PMCID: PMC5832886 DOI: 10.1016/j.ajur.2014.08.007] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/11/2014] [Accepted: 08/18/2014] [Indexed: 02/05/2023] Open
Abstract
The incidence of prostate cancer (PCa) within Asian population used to be much lower than in the Western population; however, in recent years the incidence and mortality rate of PCa in some Asian countries have grown rapidly. This collaborative report summarized the latest epidemiology information, risk factors, and racial differences in PCa diagnosis, current status and new trends in surgery management and novel agents for castration-resistant prostate cancer. We believe such information would be helpful in clinical decision making for urologists and oncologists, health-care ministries and medical researchers.
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Affiliation(s)
- Rui Chen
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Shancheng Ren
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | | | - Ming Kwong Yiu
- Division of Urology, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Ng Chi Fai
- Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Wai Sam Cheng
- Urology Centre, Singapore General Hospital, Singapore
| | - Lap Hong Ian
- Department of Urology, Centro Hospitalar Conde de São Januário (CHCSJ) Hospital, Macau, China
| | - Seiji Naito
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tadashi Matsuda
- Department of Urology and Andrology, Hirakata Hospital, Kansai Medical University, Osaka, Japan
| | | | - Ali Kural
- Department of Urology, Istanbul Acibadem University, Istanbul, Turkey
| | - Jason Yichun Chiu
- Department of Urology, Taipei City Hospital, National Yang-Ming University, Taipei, Taiwan, China
| | - Rainy Umbas
- Division of Urology, Department of Surgery, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Qiang Wei
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaolei Shi
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Jian Huang
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yiran Huang
- Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Liping Xie
- Department of Urology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Changjun Yin
- State Key Laboratory of Reproductive Medicine, Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Danfeng Xu
- Department of Urology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Kexin Xu
- Peking University People's Hospital, Beijing, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunxiao Liu
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Dingwei Ye
- Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai, China
| | - Xin Gao
- Department of Urology, 3rd Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qiang Fu
- Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jianquan Hou
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jianlin Yuan
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Dalin He
- Department of Urology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, China
| | - Tiejun Pan
- Department of Urology, Wuhan General Hospital of Guangzhou Military Command, Wuhan, China
| | - Qiang Ding
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Fengshuo Jin
- Department of Urology, Daping Hospital, Chongqing, China
| | - Benkang Shi
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Gongxian Wang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiuheng Liu
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Dongwen Wang
- Department of Urology, First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Zhoujun Shen
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiangbo Kong
- Department of Urinary Surgery, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Wanhai Xu
- Department of Urology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yaoliang Deng
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Haibo Xia
- Department of Urology, Affiliated Hospital of Chifeng College, Chifeng, China
| | - Alexa N Cohen
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA, USA
| | - Xu Gao
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Chuanliang Xu
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yinghao Sun
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
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31
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Chen R, Ren S, Yiu MK, Fai N, Cheng WS, Ian LH, Naito S, Matsuda T, Kehinde E, Kural A, Chiu JY, Umbas R, Wei Q, Shi X, Zhou L, Huang J, Huang Y, Xie L, Ma L, Yin C, Xu D, Xu K, Ye Z, Liu C, Ye D, Gao X, Fu Q, Hou J, Yuan J, He D, Pan T, Ding Q, Jin F, Shi B, Wang G, Liu X, Wang D, Shen Z, Kong X, Xu W, Deng Y, Xia H, Cohen AN, Gao X, Xu C, Sun Y. WITHDRAWN: Prostate cancer in Asia: A collaborative report. Asian J Urol 2014. [DOI: 10.1016/j.ajur.2014.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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