Developing a follow-up strategy for patients with PSA ranging from 4 to 10 ng/ml via a new model to reduce unnecessary prostate biopsies

Multivariate model for predicting semen cryopreservation outcomes in a human sperm bank

Semen cryopreservation is widely used in assisted reproductive technologies, but it reduces sperm quality dramatically. The aim of this study was to develop a model using basal semen quality to predict the outcome of postthaw semen parameters and improve the efficiency of cryopreservation in a human sperm bank. Basal semen parameters of 180 samples were evaluated in the first stage, and a multiple logistic regression analysis involving a backward elimination selection procedure was applied to select independent predictors. After a comprehensive analysis of all results, we developed a new model to assess the freezability of sperm. Progressive motility (PR), straight-line velocity (VSL) and average path velocity (VAP) were included in our model. A greater area under the receiver operating characteristic curve was obtained in our model when compared with other indicators. In the second stage of our study, samples that satisfied the new model were selected to undergo freeze–thawing. Compared with the first stage, the rate of good freezability was increased significantly (94% vs 67%, P = 0.003). By determining basal semen quality, we have developed a new model to improve the efficiency of cryopreservation in a human sperm bank.

Integrated predictive model for prostatic cancer using clinical, laboratory and ultrasound data

OBJECTIVE

to develop a predictive model to estimate the probability of prostate cancer prior to biopsy.

METHODS

from September 2009 to January 2014, 445 men underwent prostate biopsy in a radiology service. We excluded from the study patients with diseases that could compromise the data analysis, who had undergone prostatic resection or used 5-alpha-reductase inhibitors. Thus, we selected 412 patients. Variables included in the model were age, prostate specific antigen (PSA), digital rectal examination, prostate volume and abnormal sonographic findings. We constructed Receiver Operating Characteristic (ROC) curves and calculated the areas under the curve, as well as the model's Positive Predictive Value (PPV) .

RESULTS

of the 412 men, 155 (37.62%) had prostate cancer (PC). The mean age was 63.8 years and the median PSA was 7.22ng/ml. In addition, 21.6% and 20.6% of patients had abnormalities on digital rectal examination and image suggestive of cancer by ultrasound, respectively. The median prostate volume and PSA density were 45.15cm3 and 0.15ng/ml/cm3, respectively. Univariate and multivariate analyses showed that only five studied risk factors are predictors of PC in the study (p<0.05). The PSA density was excluded from the model (p=0.314). The area under the ROC curve for PC prediction was 0.86. The PPV was 48.08% for 95%sensitivity and 52.37% for 90% sensitivity.

CONCLUSION

the results indicate that clinical, laboratory and ultrasound data, besides easily obtained, can better stratify the risk of patients undergoing prostate biopsy.

Developing a model for forecasting Gleason score ≥7 in potential prostate cancer patients to reduce unnecessary prostate biopsies

PURPOSE

The diagnosis of Gleason score (GS) ≥7 with distinction from GS < 7 remains a difficult problem instructing clinical decisions. Moreover, the present wide application of prostate biopsy to increase prostate cancer detection rate might cause unnecessary and excessive examination or treatment. Therefore, a risk assessment model for forecasting GS ≥ 7 in potential prostate cancer patients was established to reduce unnecessary prostate biopsies.

METHODS

Patients (n = 981; September 2009 to January 2013) who underwent trans-rectal ultrasound (TRUS)-guided core prostate biopsy were retrospectively evaluated in the first stage of the study. Age, prostate-specific antigen (PSA), free PSA (fPSA), the free/total PSA ratio (f/t), prostate volume (PV), PSA density (PSAD), digital rectal examination (DRE) findings (texture, nodules) and B-ultrasound detection results (normal or abnormal, presence of hypoechoic mass or microcalcification) were considered as potential predictive factors. After multiple logistic regression analysis, independent variables used to build a nomogram were selected using a backward elimination selection procedure. Then, a model to forecast GS ≥ 7 was designed for potential prostate cancer patients. In the second stage of the study, 410 cases (January 2013 to March 2015) were subsequently evaluated using our model for prostate biopsies, and the outcomes of biopsies were compared between the two stages.

RESULTS

PSA, DRE texture, DRE nodules and B-ultrasound results were finally brought into our nomogram; a obviously greater area under the receiver operating characteristic (ROC) curve was obtained for the model than utilizing PSA, fPSA or PSAD alone (0.831 vs. 0.803, 0.770, 0.780 separately). We thereafter sought the best cutoff value in the ROC curve at 0.87, which provided sensitivity as high as 90%. Meanwhile, the specificity was 45.8%, which was much higher than the specificity of PSA, fPSA and PSAD at the same sensitivity level (37.7, 24.6 and 35.2%, respectively). In the first stage, the detection rate of GS ≥ 7 in the high-risk group was significantly higher than in the low-risk group (80.3 vs. 35.0%, p < 0.001). Furthermore, in the second stage, with the application of the new model associated with our former models, the rate of GS ≥ 7 was improved from 71.0 (697/981) to 79.2% (267/337) (p = 0.003).

CONCLUSIONS

The model for forecasting GS ≥ 7 is effective, which could reduce unnecessary prostate biopsies without delaying patients' diagnoses and treatments.

Cancer screening through a multi-analyte serum biomarker panel during health check-up examinations: Results from a 12-year experience

BACKGROUND

The use of blood-based tumor biomarkers for screening malignancies at early stages has significant advantages, including being convenient, automated, quantitative, objective, and relatively inexpensive compared with histology, endoscopy, and imaging.

METHODS

We describe our 12-year experience on the diagnostic usefulness of a biomarker panel consisting of eight molecules (i.e., α-fetoprotein, carcinoembryonic antigen, prostate-specific antigen, CA 19-9, CA125, CA 15-3, squamous cell specific antigen, and cytokeratin 19 fragment) for cancer screening in Taiwanese subjects who underwent a health check-up examination at their own expenses.

RESULTS

The sensitivity of the panel for the detection of specific cancers was higher than that of isolated cancer-specific markers. Specifically, the sensitivity of the panel for identifying the four most commonly diagnosed malignancies (i.e., liver cancer, lung cancer, prostate cancer, and colorectal cancer) was 90.9%, 75.0%, 100%, and 76.9%, respectively. The ability of the panel to detect early-stage (stage 1) hepatocellular carcinoma (HCC) or prostate cancer was similar to that observed for advanced malignancies.

CONCLUSIONS

The multi-analyte biomarker panel is clinically useful during health check-up examinations for the screening of different tumors (especially for the early detection of HCC and prostate malignancies).

Association of serum EPCA-2 level with prostate cancer in Chinese Han population

BACKGROUND

Early prostate cancer antigen 2 (EPCA-2), a kind of nuclear matrix protein, may relate to prostate cancer. However, the association of EPCA-2 level in serum with prostate diseases has not been clarified in Chinese Han population.

METHODS

EPCA-2 and prostate-specific antigen (PSA) levels in serum were detected by enzyme linked immunosorbent assay in 116 patients with prostate cancer (PCa), 342 patients with benign prostatic hyperplasia (BPH), and 174 healthy controls (Control) in Chinese population. Associations of serum EPCA-2 and PSA level with prostate diseases were analyzed by ANOVA. Comparison of diagnostic effect for prostate cancer between EPCA-2 and PSA was evaluated by Receiver Operator Curve, Chi-square test, and others.

RESULTS

Serum EPCA-2 and PSA levels in PCa group were significantly higher than BPH and Control group (EPCA-2: F=200.05, P<0.01; PSA: F=210.65, P<0.01). However, EPCA-2 levels in the prostate cancers with different pathological grade were no significant difference. Furthermore, for detection of prostate cancer, EPCA-2 had a sensitivity of 81.9% and a specificity of 87.6%.

CONCLUSIONS

Serum EPCA-2 could be used as a potential serological marker to diagnose prostate cancer in Chinese Han population, which was more specific than PSA and did not associate with pathological grades of prostate cancer.