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Hsieh TF, Chen HL, Hsia YF, Lin CC, Chiang HY, Wu MY, Chen SH, Hsieh PF, Wu HC, Chang H, Kuo CC. Age-specific percentile-based prostate-specific antigen cutoff values predict the risk of prostate cancer: A single hospital observation. Biomedicine (Taipei) 2023; 13:9-24. [PMID: 37937061 PMCID: PMC10627214 DOI: 10.37796/2211-8039.1415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/18/2023] [Accepted: 06/28/2023] [Indexed: 11/09/2023] Open
Abstract
Background Testing for prostate-specific antigen (PSA) is often recommended for men with a potential risk of prostate cancer (PCa) before requiring advanced examination. However, the best PSA cutoff value remains controversial. Object We compared the predictive performance of age-specific percentile-based PSA thresholds with a conventional cutoff of >4 ng/mL for the risk of PCa. Methods We included men who received PSA measurements between 2003 and 2017 in a medical center in Taiwan. Logistic regression modeling was used to assess the association between age-specific percentile-based PSA thresholds and PCa risk in age subgroups. We further applied C-statistic and decision curve analysis to compare the predictive performance of age-specific percentile-based PSA with that of a conventional cutoff PSA. Results We identified 626 patients with PCa and 40 836 patients without PCa. The slope of PSA in patients >60-year-old was almost 3 times that of those <60-year-old (0.713 vs 0.259). The risk effect sizes of the 75th percentile PSA cutoff (<60-year-old: 2.19; 60-70-year-old: 4.36; >70-year-old: 5.84 ng/mL) were comparable to those observed based on the conventional cutoff in all age groups. However, the discrimination performance of the 75th percentile PSA cutoff was better than that of the conventional cutoff among patients aged <60-year-old (C-statistic, 0.783 vs. 0.729, p < 0.05). The 75th percentile cutoffs also correctly identified an additional 2 patients with PCa for every 100 patients with PSA screening at the threshold probability of 20%. Conclusions Our data support the use of the 75th percentile PSA cutoff to facilitate individualized risk assessment, particularly for patients aged <60-year-old.
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Affiliation(s)
- Teng-Fu Hsieh
- Division of Urology, Department of Surgery, Taichung Tzu Chi Hospital, Taichung,
Taiwan
| | - Hung-Lin Chen
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
| | - Ying-Fang Hsia
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
| | - Che-Chen Lin
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
| | - Min-Yen Wu
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
| | - Sheng-Hsuan Chen
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
| | - Po-Fan Hsieh
- Department of Urology, China Medical University Hospital, Taichung,
Taiwan
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung,
Taiwan
- Department of Urology, China Medical University Beigang Hospital, Beigang, Yunlin,
Taiwan
| | - Hsi-Chin Wu
- Department of Urology, China Medical University Hospital, Taichung,
Taiwan
- Department of Urology, China Medical University Beigang Hospital, Beigang, Yunlin,
Taiwan
| | - Han Chang
- Department of Pathology, China Medical University Hospital, Taichung,
Taiwan
| | - Chin-Chi Kuo
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
- College of Medicine, China Medical University, Taichung,
Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung,
Taiwan
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung,
Taiwan
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Crocetto F, Barone B, D’Aguanno G, Falcone A, de Vivo R, Rienzo M, Recchia L, Di Zazzo E. Vitamin D, a Regulator of Androgen Levels, Is Not Correlated to PSA Serum Levels in a Cohort of the Middle Italy Region Participating to a Prostate Cancer Screening Campaign. J Clin Med 2023; 12:1831. [PMID: 36902619 PMCID: PMC10003229 DOI: 10.3390/jcm12051831] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/11/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023] Open
Abstract
Prostate cancer (PCa) is the most common non-cutaneous malignancy in men worldwide, and it represents the fifth leading cause of death. It has long been recognized that dietary habits can impact prostate health and improve the benefits of traditional medical care. The activity of novel agents on prostate health is routinely assessed by measuring changes in serum prostate-specific antigen (PSA) levels. Recent studies hypothesized that vitamin D supplementation reduces circulating androgen levels and PSA secretion, inhibits cell growth of the hormone-sensitive PCa cell lines, counteracts neoangiogenesis and improves apoptosis. However, the results are conflicting and inconsistent. Furthermore, the use of vitamin D in PCa treatments has not achieved consistently positive results to date. In order to assess the existence of a correlation between the PSA and 25(OH)vitamin D levels as widely hypothesized in the literature, we analyzed the serum PSA and 25(OH)vitamin D concentration on a cohort of one hundred patients joining a PCa screening campaign. Additionally, we performed medical and pharmacological anamnesis and analyzed lifestyle, as sport practice and eating habits, by administering a questionnaire on family history. Although several studies suggested a protective role of vitamin D in PCa onset prevention and progression, our preliminary results revealed a clear absence of correlation between the serum vitamin D and PSA concentration levels, suggesting that vitamin D has no impact on PCa risk. Further investigations enrolling a huge number of patients are needed with particular attention to vitamin D supplementation, calcium intake, solar radiation that influences vitamin D metabolism and other potential indicators of health to confirm the absence of correlation observed in our study.
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Affiliation(s)
- Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy
| | - Biagio Barone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy
| | - Giulio D’Aguanno
- Emergency Medicine Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Alfonso Falcone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy
| | - Rosamaria de Vivo
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Monica Rienzo
- Department of Environmental, Biological, and Pharmaceutical Sciences and Technologies, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Laura Recchia
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy
- UOC Laboratorio Analisi, Ospedale “A. Cardarelli”, 86100 Campobasso, Italy
| | - Erika Di Zazzo
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy
- UOC Laboratorio Analisi, Ospedale “A. Cardarelli”, 86100 Campobasso, Italy
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3
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Coskun A, Sandberg S, Unsal I, Serteser M, Aarsand AK. Personalized reference intervals: from theory to practice. Crit Rev Clin Lab Sci 2022; 59:501-516. [PMID: 35579539 DOI: 10.1080/10408363.2022.2070905] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Using laboratory test results for diagnosis and monitoring requires a reliable reference to which the results can be compared. Currently, most reference data is derived from the population, and patients in this context are considered members of a population group rather than individuals. However, such reference data has limitations when used as the reference for an individual. A patient's test results preferably should be compared with their own, individualized reference intervals (RI), i.e. a personalized RI (prRI).The prRI is based on the homeostatic model and can be calculated using an individual's previous test results obtained in a steady-state situation and estimates of analytical (CVA) and biological variation (BV). BV used to calculate the prRI can be obtained from the population (within-subject biological variation, CVI) or an individual's own data (within-person biological variation, CVP). Statistically, the prediction interval provides a useful tool to calculate the interval (i.e. prRI) for future observation based on previous measurements. With the development of information technology, the data of millions of patients is stored and processed in medical laboratories, allowing the implementation of personalized laboratory medicine. PrRI for each individual should be made available as part of the laboratory information system and should be continually updated as new test results become available.In this review, we summarize the limitations of population-based RI for the diagnosis and monitoring of disease, provide an outline of the prRI concept and different approaches to its determination, including statistical considerations for deriving prRI, and discuss aspects which must be further investigated prior to implementation of prRI in clinical practice.
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Affiliation(s)
- Abdurrahman Coskun
- Acibadem Labmed Clinical Laboratories, Istanbul, Turkey.,Department of Medical Biochemistry, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Sverre Sandberg
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway.,Norwegian Porphyria Centre and Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway.,Department of Global Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Ibrahim Unsal
- Acibadem Labmed Clinical Laboratories, Istanbul, Turkey
| | - Mustafa Serteser
- Acibadem Labmed Clinical Laboratories, Istanbul, Turkey.,Department of Medical Biochemistry, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Aasne K Aarsand
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway.,Norwegian Porphyria Centre and Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
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Aisuodionoe-Shadrach OI, Eniola SB, Nwegbu MM, Kolade-Yunusa HO, Okereke OO, Yunusa T. Determination of Serum Prostate Specific Antigen Levels Amongst Apparently Healthy Nigerian Males in a University and University Hospital Community in the Federal Capital Territory. Cancer Control 2022; 29:10732748221081366. [PMID: 35180003 PMCID: PMC8859665 DOI: 10.1177/10732748221081366] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Prostate cancer is the commonest cancer among men worldwide and serum prostate specific antigen (PSA) has remained the most commonly applied screening test for the disease till date. Current PSA test results guidelines in our population are informed by reference intervals derived from studies from Caucasians and other racial groups. With scanty data on PSA reference values from our local population, this study evaluated the serum PSA levels of apparently healthy Nigerian male subjects in whom prostate cancer and urinary tract infection have been excluded. METHOD This study had participants aged 40 to 70 years, with no lower urinary tract symptoms or other symptoms suggestive of prostate disease recruited from the male staff population of the University of Abuja and University of Abuja Teaching Hospital and the adjoining local community. They were physically examined, had prostate ultrasonography, urine analysis, and blood sample collected for PSA testing. Data collected was analyzed using Statistical Package for Social Science (SPSS) version 24. RESULT Of a total of 210 men who participated in the study, 191 eventually met the inclusion criteria. The average age was 52.9 years, ninety seven percent of them had heard of prostate cancer before now. The mean total PSA was 1.46 ng/mL (SD +/-1.55), while the reference interval was .23-5.60 ng/mL. The average prostate size was 41.8 mL (SD+/-20.11), and there was a positive correlation between the PSA and the prostate size (.418) as well as the age of the subjects (.446). There was no significant difference in the mean PSA value for those with or without family history of prostate cancer (P=.979). CONCLUSION The reference range of PSA in Nigeria is higher than in other races, hence utilizing a local value in decision making would help to reduce unnecessary invasive procedures.
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Affiliation(s)
- Oseremen I Aisuodionoe-Shadrach
- Department of Surgery, College of Health Sciences, 99399University of Abuja, Abuja, Nigeria.,Division of Urology, Department of Surgery, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - Sefiu B Eniola
- Division of Urology, Department of Surgery, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - Maxwell M Nwegbu
- Department of Chemical Pathology, College of Health Sciences, 99399University of Abuja/ University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - Hadijat O Kolade-Yunusa
- Department of Radiology, 291366University of Abuja/University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - Oriaku O Okereke
- University Health Services, 99399University of Abuja, Abuja, Nigeria
| | - Thairu Yunusa
- Department of Microbiology, 291366University of Abuja/University of Abuja Teaching Hospital, Gwagwalada, Nigeria
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5
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Mohamed Mokhtar K. Establishment of age-related prostate-specific antigen (PSA) reference limits in the Algerian population: A comparison of four indirect methods. Clin Chim Acta 2020; 507:149-155. [DOI: 10.1016/j.cca.2020.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 11/24/2022]
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6
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Borai A, Ichihara K, Masaud A, Tamimi W, Bahijri S, Armbuster D, Kawano R, Baarmah Z, Joatar F, Almohammadi M. Establishment of reference intervals for immunoassay analytes of adult population in Saudi Arabia. ACTA ACUST UNITED AC 2020; 58:1302-1313. [DOI: 10.1515/cclm-2019-1049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/17/2020] [Indexed: 11/15/2022]
Abstract
Abstract
Background
This is a second part of report on the IFCC global multicenter study conducted in Saudi Arabia to derive reference intervals (RIs) for 20 immunoassay analytes including five tumor makers, five reproductive, seven other hormones and three vitamins.
Methods
A total of 826 apparently healthy individuals aged ≥18 years were recruited in three clinical laboratories located in western, central and eastern Saudi Arabia using the protocol specified for the global study. All serum specimens were measured using Abbott, Architect analyzers. Multiple regression analysis (MRA) was performed to explore sources of variation of each analyte: age, body mass index (BMI), physical exercise and smoking. The magnitude of variation of reference values (RVs) attributable to sex, age and region was calculated by ANOVA as a standard deviation ratio (SDR). RIs were derived by the parametric (P) method.
Results
MRA revealed that region, smoking and exercise were not relevant sources of variation for any analyte. Based on SDR and actual between-sex differences in upper limits (ULs), we chose to partition RIs by sex for all analytes except for α-fetoprotein and parathyroid hormone (PTH). Age-specific RIs were required in females for ferritin, estradiol, progesterone, testosterone, follitropin, luteotropin and prolactin (PRL). With prominent BMI-related increase, RIs for insulin and C-peptide were derived after excluding individuals with BMI > 32 kg/m2. Individuals taking vitamin D supplements were excluded in deriving RIs for vitamin D and PTH.
Conclusions
RIs of major immunoassay analytes specific for Saudi Arabians were established in careful consideration of various biological sources of variation.
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Affiliation(s)
- Anwar Borai
- King Abdullah International Medical Research Center , King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City , Jeddah , Saudi Arabia
| | - Kiyoshi Ichihara
- Faculty of Health Sciences , Yamaguchi University Graduate School of Medicine , Ube , Japan
| | - Abdulaziz Masaud
- King Abdullah International Medical Research Center , King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City , Jeddah , Saudi Arabia
| | - Waleed Tamimi
- King Abdullah International Medical Research Center , King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City , Jeddah , Saudi Arabia
| | - Suhad Bahijri
- Faculty of Medicine, Department of Clinical Biochemistry , King Abdulaziz University , Jeddah , Saudi Arabia
| | - David Armbuster
- Global Scientific Affairs, Abbott Diagnostics , Chicago, IL , USA
| | - Reo Kawano
- Faculty of Health Sciences , Yamaguchi University Graduate School of Medicine , Ube , Japan
| | - Ziad Baarmah
- King Abdullah International Medical Research Center , King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City , Jeddah , Saudi Arabia
| | - Faris Joatar
- King Abdullah International Medical Research Center , King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City , Jeddah , Saudi Arabia
| | - Mohammed Almohammadi
- King Abdullah International Medical Research Center , King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City , Jeddah , Saudi Arabia
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