Age-Specific Cutoff Value for the Application of Percent Free Prostate-Specific Antigen (PSA) in Chinese Men with Serum PSA Levels of 4.0-10.0 ng/ml

68Ga-PSMA PET/CT-based multivariate model for highly accurate and noninvasive diagnosis of clinically significant prostate cancer in the PSA gray zone

BACKGROUND

The prostate-specific antigen (PSA) has been widely used in screening and early diagnosis of prostate cancer (PCa). However, in the PSA grey zone of 4-10 ng/ml, the sensitivity and specificity for diagnosing PCa are limited, resulting in considerable number of unnecessary and invasive prostate biopsies, which may lead to potential overdiagnosis and overtreatment. We aimed to predict clinically significant PCa (CSPCa) by combining the maximal standardized uptake value (SUVmax) based on 68Ga‑PSMA PET/CT and clinical indicators in men with gray zone PSA levels.

METHODS

81 patients with suspected PCa based on increased serum total PSA (TPSA) levels of 4 - 10 ng/mL who underwent transrectal ultrasound/magnetic resonance imaging (MRI)/PET fusion-guided biopsy were enrolled. Among them, patients confirmed by histopathology were divided into the CSPCa group and the non-CSPCa group, and data on PSA concentration, prostate volume (PV), PSA density (PSAD), free PSA (FPSA)/TPSA, Prostate Imaging-Reporting and Data System version 2.1 (PI-RADS v2.1) score, 68Ga-PSMA PET/CT imaging evaluation results and SUVmax were compared. Multivariate logistic regression analysis was performed to identify the independent predictors for CSPCa, thereby establishing a predictive model based on SUVmax that was evaluated by analyzing the receiver operating characteristic (ROC) curve and decision curve analysis.

RESULTS

Compared to non-CSPCa, CSPCa patients had smaller PVs (median, 31.40 mL), lower FPSA/TPSA (median, 0.12), larger PSADs (median, 0.21 ng/mL2) and higher PI-RADS scores (P < 0.05). The prediction model comprising 68Ga-PSMA PET/CT maximal standardized uptake value, PV and FPSA/TPSA had the highest AUC of 0.927 compared with that of other predictors alone (AUCs of 0.585 for PSA, 0.652 for mpMRI and 0.850 for 68Ga-PSMA PET/CT). The diagnostic sensitivity and specificity of the prediction model were 86.21% and 86.54%, respectively.

CONCLUSION

Given the low diagnostic accuracy of regular PSA tests, a new prediction model based on the 68Ga-PSMA PET/CT SUVmax, PV and FPSA/TPSA was developed and validated, and this model could provide a more satisfactory predictive accuracy for CSPCa. This study provides a noninvasive prediction model with high accuracy for the diagnosis of CSPCa in the PSA gray zone, thus may be better avoiding unnecessary biopsy procedures.

MRI-Based Radiomics Nomogram for Predicting Prostate Cancer with Gray-Zone Prostate-Specific Antigen Levels to Reduce Unnecessary Biopsies

OBJECTIVE

The aim of this study was to establish a predictive nomogram for predicting prostate cancer (PCa) in patients with gray-zone prostate-specific antigen (PSA) levels (4-10.0 ng/mL) based on radiomics and other traditional clinical parameters.

METHODS

In all, 274 patients with gray-zone PSA levels were included in this retrospective study. They were randomly divided into training and validation sets (n = 191 and 83, respectively). Data on the clinical risk factors related to PCa with gray-zone PSA levels (such as Prostate Imaging Reporting and Data System, version 2.1 [PI-RADS V2.1] category, age, prostate volume, and serum PSA level) were collected for all patients. Lesion volumes of interest (VOI) from T2-weighted imaging (T2WI) and apparent diffusion coefficient (ADC) imaging were annotated by two radiologists. The radiomics model, clinical model, and combined prediction model, which was presented on a nomogram by incorporating the radiomics signature and clinical and radiological risk factors for PCa, were developed using logistic regression. The area under the receiver operator characteristic (AUC-ROC) and decision, calibration curve were used to compare the three models for the diagnosis of PCa with gray-zone PSA levels.

RESULTS

The predictive nomogram (AUC: 0.953) incorporating the radiomics score and PI-RADS V2.1 category, age, and the radiomics model (AUC: 0.941) afforded much higher diagnostic efficacy than the clinical model (AUC: 0.866). The addition of the rad score could improve the discriminatory performance of the clinical model. The decision curve analysis indicated that the radiomics or combined model could be more beneficial compared to the clinical model for the prediction of PCa. The nomogram showed good agreement for detecting PCa with gray-zone PSA levels between prediction and histopathologic confirmation.

CONCLUSION

The nomogram, which combined the radiomics score and PI-RADS V2.1 category and age, is an effective and non-invasive method for predicting PCa. Furthermore, as well as good calibration and is clinically useful, which could reduce unnecessary prostate biopsies in patients having PCa with gray-zone PSA levels.

Prediction of disease progression indicators in prostate cancer patients receiving HDR-brachytherapy using Raman spectroscopy and semi-supervised learning: a pilot study

This work combines Raman spectroscopy (RS) with supervised learning methods-group and basis restricted non-negative matrix factorisation (GBR-NMF) and linear discriminant analysis (LDA)-to aid in the prediction of clinical indicators of disease progression in a cohort of 9 patients receiving high dose rate brachytherapy (HDR-BT) as the primary treatment for intermediate risk (D'Amico) prostate adenocarcinoma. The combination of Raman spectroscopy and GBR-NMF-sparseLDA modelling allowed for the prediction of the following clinical information; Gleason score, cancer of the prostate risk assessment (CAPRA) score of pre-treatment biopsies and a Ki67 score of < 3.5% or > 3.5% in post treatment biopsies. The three clinical indicators of disease progression investigated in this study were predicted using a single set of Raman spectral data acquired from each individual biopsy, obtained pre HDR-BT treatment. This work highlights the potential of RS, combined with supervised learning, as a tool for the prediction of multiple types of clinically relevant information to be acquired simultaneously using pre-treatment biopsies, therefore opening up the potential for avoiding the need for multiple immunohistochemistry (IHC) staining procedures (H&E, Ki67) and blood sample analysis (PSA) to aid in CAPRA scoring.

Improving the diagnosis of prostate cancer by telomerase-positive circulating tumor cells: A prospective pilot study

BACKGROUND

Prostate-specific antigen (PSA) testing is limited in identifying prostate cancer (PCa) with modestly elevated PSA levels. Therefore, a robust method for the diagnosis of PCa is urgently needed.

METHODS

A total of 203 men with a PSA level of ≥4 ng/ml were eligible for enrollment in this study from July 2018 to May 2021, and randomly divided into a training set (n=78) and a validation set (n=125). Circulating tumor cells (CTCs) were detected using telomerase-based CTC detection (TBCD), and the diagnostic ability was evaluated using receiver operating characteristic (ROC) and logistic regression analyses.

FINDINGS

In the training set, the area under the curve (AUC) of CTCs was 0.842 with a sensitivity of 80.33% and specificity of 82.35%. In the validation set, the AUC of CTCs was 0.789, with a sensitivity of 79.31% and specificity of 81.58%. There was no significant difference between CTCs (AUC=0.793) and PSA (AUC=0.697) in the range of 4-50 ng/ml. In the ranges of 4-20 ng/ml and 4-10 ng/ml, the AUC of CTCs were 0.811 and 0.825, respectively, which were superior to the AUC of PSA (0.588 and 0.541). The sensitivity and specificity of CTCs in the three PSA groups were higher than 80%. Moreover, we further established a CTC+PSA combined model, which could significantly improve the diagnostic ability of a PSA level of '4-10 ng/ml'.

INTERPRETATION

TBCD could be a valuable method for distinguishing PCa and benign prostatic disease, especially in the PSA diagnostic gray area of '4-10 ng/ml'.

Asian Race and Risk of Prostate Cancer: Results from the REDUCE Study

BACKGROUND

Global prostate cancer incidence rates are lower in Asian men than Caucasian men. Whether this is the result of less screening in Asian men remains to be determined. We examined whether Asian race was associated with prostate cancer diagnosis in the Reduction by Dutasteride of Cancer Events (REDUCE) study.

METHODS

REDUCE was a 4-year, multicenter, randomized trial of dutasteride versus placebo for prostate cancer prevention among men who underwent prostate-specific antigen (PSA)-independent biopsies at 2 and 4 years. Eligible men were ages 50 to 75 years, had PSA between 2.5 and 10 ng/mL, and a negative prestudy prostate biopsy. We tested the association between Asian and Caucasian race and prostate cancer diagnosis using logistic regression.

RESULTS

Of 8,122 men in REDUCE, 5,755 (71%) were Caucasian and 105 (1.8%) were Asian. Asians had lower body mass index (24.8 vs. 26.9 kg/m², P < 0.001), had smaller prostate volume (35.0 vs. 43.5 cc, P < 0.001), and were less likely to have abnormal digital rectal exams (P = 0.048), but were similar in baseline age, PSA, family history of prostate cancer, and smoking status compared with Caucasian men (all P ≥ 0.164). Asian men were equally likely to receive any on-study biopsy compared with Caucasian men (P = 0.634). After adjusting for potential confounders, Asian men were less likely to be diagnosed with prostate cancer during the 4-year study (OR = 0.49; 95% confidence interval, 0.28-0.88; P = 0.016), compared with Caucasian men.

CONCLUSIONS

In REDUCE, where all men underwent biopsies largely independent of PSA, Asian race was associated with lower prostate cancer diagnosis.

IMPACT

These findings suggest that lower prostate cancer risk in Asian men may be due to biological, genetic, and/or lifestyle factors.

Comparison of diagnostic efficacy between transrectal and transperineal prostate biopsy: A propensity score-matched study

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.

Association between lactate dehydrogenase levels and oncologic outcomes in metastatic prostate cancer: A meta-analysis

Purpose

Previous studies have provided evidence of the high expression of lactate dehydrogenase (LDH) in multiple solid tumors; however, its prognostic relationship with metastatic prostate cancer (mPCa) remains controversial. We performed a meta‐analysis to better understand the prognostic potential of LDH in mPCa.

Methods

In our investigation, we included PubMed, Embase, Web of Science, and Cochrane Library as web‐based resources, as well as studies published before January 2020 on the predictive value of LDH in mPCa. We independently screened the studies according to the inclusion and exclusion criteria, evaluated the quality of the literature, extracted the data, and used RevMan 5.3 and STATA12.0 software for analysis.

Result

From the 38 published studies, the records of 9813 patients with mPCa were included in this meta‐analysis. We observed that higher levels of LDH in patients with mPCa were significantly associated with poorer overall survival (OS) (HR = 2.17, 95% CI: 1.91‐2.47, P < .00001) and progression‐free survival (PFS) (HR = 1.60, 95% CI: 1.20‐2.13, P = .001). The subgroup analyses indicated that the negative prognostic impact of higher levels of LDH on the oncologic outcomes of mPCa was significant regardless of ethnicity, publication year, sample size, analysis type, treatment type, age, and disease state.

Conclusion

Our analysis suggested the association between a higher level of LDH and poorer OS and PFS in patients with mPCa. As a parameter that can be conveniently evaluated, the LDH levels should be included as a valuable biomarker in the management of mPCa.

The reference intervals for CA125, CA15-3, CA19-9, CA72-4, AFP, CEA, NSE and CYFRA21-1

Tumor markers are noninvasive diagnostic tools for cancer. Their abnormal expression often occurs earlier than clinical symptoms or other detection signals. Appropriate reference intervals (RIs) of tumor markers are important for health evaluation, cancer diagnosis, therapy monitoring and prognosis assessment. In this study, we aimed to establish the RIs of cancer antigen 125 (CA125), CA15-3, CA19-9, CA72-4, alpha fetoprotein (AFP), carcino-embryonic antigen (CEA), neuron-specific enolase (NSE) and cytokeratin 19 fragment antigen 21-1 (CYFRA21-1) in apparently healthy Henan population. A total of 1705 apparently healthy participants (21-89 years) were recruited from five representative geographical regions in Henan province. Nonparametric 95th percentile intervals were used to define the RIs of CA125, CA15-3, CA19-9, CA72-4, AFP, CEA, NSE and CYFRA21-1. The test results of CA125, CA15-3, CA19-9, CA72-4, AFP, CEA, NSE and CYFRA21-1 can traceable to reference measurement procedures. The age- and gender-specific RIs of the tumor markers were established. We established age- and gender-specific RIs for CA125, CA15-3, CA19-9, CA72-4, AFP, CEA, NSE and CYFRA21-1. The newly established RIs should be more suitable for Henan population. It will be valuable for clinicians to make a medical diagnosis, therapeutic management decision and other physiological assessment.

Are prostate biopsies necessary for all patients 75years and older?

PURPOSE

To develop nomograms predicting prostate cancer (PCa) and high-grade PCa (HGPCa) in the elderly population.

METHODS

We reviewed the data of patients aged 75years and older who underwent first-time prostate biopsy and multiparametric magnetic resonance imaging (mpMRI). The nomograms were developed based on multivariate analysis and evaluated. We performed the external validation and calibration of the risk calculators from the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the Prostate Cancer Prevention Trial (PCPT).

RESULTS

The present study included 302 subjects with a median age of 78years (range: 75-91years). Overall, 225 and 129 subjects were diagnosed with PCa and HGPCa (Gleason score≥4+3), respectively. The ratio of free-to-total PSA, prostate-specific antigen density (PSAD), transrectal ultrasound (TRUS), and Prostate Imaging Reporting and Data System (PI-RADS) were used to develop the PCa-predicting nomogram, and PSAD, TRUS, and PI-RADS were used to develop the HGPCa-predicting nomogram. The area under the curve (AUC) values of PCa-predicting and HGPCa-predicting nomograms were 0.90 and 0.87. The ERSPC calculator had acceptable external calibration and validation outcomes. We recommended a cut-off probability of 42% for PCa-predicting nomogram when used in healthy older men to achieve a sensitivity of 95.6%, and a cut-off probability of 73% for HGPCa-predicting nomogram when used in vulnerable older men to achieve a specificity of 98.3%.

CONCLUSIONS

The present nomograms could help discriminate patients with PCa from healthy elder adults for standard treatment, and discriminate patients with HGPCa from vulnerable elder adults for modified treatment. External validation is expected.

PSA and Prostate Health Index based prostate cancer screening in a hereditary migration complicated population: implications in precision diagnosis

Precision diagnosis requires specific markers for differential ethnic populations. Prostate-Specific Antigen (PSA) level (threshold of 4ng/ml) has been widely used to screen prostate cancer and as reference of pro-biopsy but false diagnosis frequently occurs. Prostate health Index (PHI) is a new diagnosis marker which combines PSA, free PSA and p2PSA4. Overall the PCa screening database is lacking in Kazakhstani patients. We analyzed the PSA levels and Gleason scores of 222 biopsies collected in 2015 in Almaty area, Kazakhstan approved by institutional ethics board. We found using PSA of 4ng/ml as threshold, only 25.68% of patients have cancer with Gleason score ranged 6-8 and 65.77% of patients have no character of cancer. Moreover, there is no significant correlation between PSA and cancerous (P=0.266) or Gleason grade (P=0.3046) based on pathological biopsy. In addition, PHI is not correlated to prostate cancer (P=0.4301). Our data suggest that false-positive rate is much higher than the correct-positive diagnosis when using PSA as the first screening. Thus in this cohort study, most patients can not get benefit from the PSA screening for precision PCa diagnosis. As Kazakhstani family trees are unique and complicated because of history and migration, the high rate of over diagnosis might be due to the hyperexpression of PSA via heterosis in Eurasian men. Therefore we should be cautious when using pro-biopsy in precision diagnosis for Eurasian prostate cancer patients.

The age-specific reference intervals for tPSA, fPSA, and %fPSA in healthy Han ethnic male

INTRODUCTION

Prostate cancer (PC) is one of the most common malignancies in male, and has become the fastest growing malignancy in recent years. Prostate specific antigen (PSA) is widely used as a tumor marker to screen for PC. Many studies have been performed to define the reference intervals (RIs) for total circulating PSA (tPSA). The results were different among different nations and races, even in the same race. Few researches have been performed on the RIs of free PSA (fPSA) and the ratio of free to total PSA (%fPSA). In this study, we aimed to simultaneously determine the age-specific RIs for tPSA, fPSA, and %fPSA in the healthy Han ethnic male.

METHODS

A total of 1862 apparently healthy male aged from 21 to 94 years were included in our study. Nonparametric 95th percentile intervals were used to define the RIs.

RESULTS

The reference limits in different age groups (21-50, 51-60, 61-70, 71-80, and ≥81 years) were 2.07, 3.59, 4.93, 6.83, and 7.73 ng/mL for tPSA, and 0.60, 0.76, 0.83, 1.30, and 2.41 ng/mL for fPSA. The RIs of %fPSA were ≥0.16 for 21-50 years and ≥0.13 for male over 50 years old.

CONCLUSIONS

We established age-specific RIs for tPSA, fPSA and %fPSA. The newly established RIs should be more suitable for Chinese Han ethnic male. It will be valuable for physicians to make exact medical decision and appropriate medical intervention.

Prevalence and management of prostate cancer among East Asian men: Current trends and future perspectives

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.