Optimal baseline prostate-specific antigen level to distinguish risk of prostate cancer in healthy men between 40 and 69 years of age

Diagnostic accuracy of prostate-specific antigen below 4 ng/mL as a cutoff for diagnosing prostate cancer in a hospital setting: A systematic review and meta-analysis

PURPOSE

A prostate-specific antigen (PSA) cutoff of 4 ng/mL has been widely used for prostate cancer screening in population-based settings. However, the accuracy of PSA below 4 ng/mL as a cutoff for diagnosing prostate cancer in a hospital setting is inconclusive. We systematically reviewed the accuracy of PSA below 4 ng/mL cutoff in a hospital setting.

MATERIALS AND METHODS

We systematically reviewed the literature by searching major databases until March 2020, and a meta-analysis and quality assessment were performed.

RESULTS

A total of 11 studies were included at the completion of the screening process. The meta-analysis showed a sensitivity of 0.92 and a specificity of 0.16 for a PSA cutoff below 4 ng/mL. The area under the hierarchical summary receiver operating characteristic curve was 0.87, the positive likelihood ratio was 1.23, the negative likelihood ratio was 0.46, and the diagnostic odds ratio was 2.64. PSA sensitivities and specificities varied according to the cutoff range: 0.94 and 0.17 for 2 to 2.99 ng/mL, and 0.92 and 0.16 for 3 to 3.99 ng/mL, respectively. No significant differences in the sensitivity and specificity of PSA cutoffs in the range of 2 to 2.99 ng/mL and 3 to 3.99 ng/mL were found.

CONCLUSIONS

Although a PSA cutoff <3 ng/mL is relatively more sensitive and specific than PSA ≥3 ng/mL, no significant differences in sensitivity and specificity were found in the diagnosis of prostate cancer. Therefore, clinicians should choose an appropriate PSA cutoff on the basis of clinical circumstances and patients' characteristics.

Prostate Cancer Screening, Diagnostic, Treatment Procedures and Costs in Sub-Saharan Africa: A Situational Analysis

PURPOSE

Prostate cancer mortality is predicted to nearly double by 2040 in Sub-Saharan Africa (SSA). The lack of prostate cancer screening in SSA contributes to late-stage diagnosis, treatment delays, and poor survival among patients. We analyzed the availability and use of prostate cancer screening, diagnostic and treatment guidelines, procedures, and costs in few SSA countries to determine factors for consideration in the development of prostate cancer screening guidelines for SSA.

METHODS

We applied mixed methods approaches to collect data through an electronic survey administered to clinicians (oncologists, urologists, pathologists, nurses, and radiation oncologists) providing prostate cancer screening, diagnosis, and treatment services in multiple sub-Saharan countries.

RESULTS

Inconsistencies in respondents' understanding of the availability and use of prostate cancer screening guidelines in their countries were noted. Prostate Specific Antigen (PSA) and Digital Rectal Examination (DRE) were the most commonly available screening modalities. Available diagnostic procedures included a combination of prostate biopsies, transrectal ultrasonography, and DRE. Our study's data suggest that PSA and DRE exams are available for early diagnosis and screening procedures. Availability of treatment modalities with curative intent and costs for prostate cancer related procedures varied between and within countries.

CONCLUSIONS

PSA and DRE are available for detecting prostate cancer and may detect aggressive cancers early, leading to improved outcomes. However, PSA screening is also associated with overdiagnosis and over-treatment. National prostate cancer policies should consider health systems, evidence-based guidelines, population characteristics and healthcare financing to ensure access to clinically relevant and safe prostate cancer related care.

Unveiling the Link between Prostatitis and Periodontitis

Background:

One of the important tumor markers having critically important applications in every aspect of treating men with prostatic illness is prostate-specific antigen (PSA), formed by prostate acini's epithelial cells. Where prostate is affected by inflammation or malignancy, the PSA levels rise to/and above 4 ng/ml. This study analyzes the interlink between different severity of periodontitis and prostatitis by assessment of PSA antigen levels and periodontal clinical parameters.

Materials and Methods:

In this study, 100 chronic prostatitis patients diagnosed to also have periodontal diseases were divided into four batches on the basis of the nature of prostatitis and levels of periodontal clinical attachment. The grouping was as: group 1A – clinical attachment level (CAL) <3 mm and mild prostatitis, Group 2A – CAL ≥3 mm and mild prostatitis, and Group 1B – CAL <3 mm and moderate-to-severe prostatitis, Group 2B – CAL ≥3 mm and moderate-to-severe prostatitis. Readings of CAL, probing pocket depth, bleeding on probing, plaque index, and gingival index (PI and GI) were recorded, followed by calculation and assessment of PSA values and correlation of periodontal parameters, respectively.

Results:

An important and affirmative correlation (r = 0.5549, P < 0.05) was seen between PSA and CAL scores at significance level of 5%, and also between PSA and probing depths (PD) scores at 5% (r = 0.5315, P < 0.05), indicating that PSA and CAL scores, as also PSA and PD scores are mutually dependent. The similar positive correlation was seen between PSA with PI (r = 0.3231, P < 0.05) and GI (r = 0.3567, P < 0.05) scores, respectively, at 5% level of significance, which shows PSA is also mutually dependent on PI and GI scores.

Conclusion:

Patients with of grades, moderate-to-severe prostatitis as well as periodontitis were found having higher PSA levels. The clinical readings of periodontal parameters were significantly higher in patients with moderate-to-severe prostatitis which shows a pathological link between the above two.

Solitary fibrous tumors of the prostate: A case report

Increasing numbers of extrapleural solitary fibrous tumours (SFTs), including the prostate SFT, have been reported over the last 10-years. Prostate SFT is relatively uncommon, with <20 cases reported in the literature worldwide. In the present study, a prostate SFT case, which was initially misdiagnosed as benign prostatic hyperplasia, is presented. The patient was subjected to three surgeries (cystoscopy and per urethra lithocystotomy, transurethral resection of the prostate and nerve-sparing retropubic radical prostatectomy) prior to SFT diagnosis. It was demonstrated that histopathological and immunohistochemical factors (positive staining for CD34 and B cell lyphoma-2 expression) were of significant diagnostic value. Thus, nerve-sparing retropubic radical prostatectomy for total resection may be the best therapeutic strategy to treat prostate SFT, allowing the preservation of sexual function and reducing the risk of locoregional recurrence.

Comparison of pathological and biochemical outcomes after radical prostatectomy in Korean patients with serum PSA ranges

The aim of this study was to assess surgical outcome at radical prostatectomy (RP) in Korean men with a serum prostate-specific antigen (PSA) level of 2.5 to 3.0 ng/mL and compared with those of patients who had a PSA level of 3.0-4.0 and 4.0-10.0 ng/mL. We retrospectively compared clinico-pathological characteristics and biochemical recurrence (BCR) risk in patients with PSA level of 2.5-3.0 (group 1, n = 92, 5.7%), 3.0-4.0 (group 2, n = 283, 17.5%), or 4.0-10.0 ng/mL (group 3, n = 1,242, 76.8%) who underwent RP between 1995 and 2013. The pathologic characteristics including Gleason score, pathologic stage, and percentage of significant cancer in group 1 were similar to those in group 2 and group 3. Furthermore, pathological upgrading and upstaging were found in 23 (30.7%) and 10 (14.7%) in group 1, 84 (33.9%) and 19 (8.8%) in group 2, and 321 (32.8%) and 113 (12.8%) in group 3, respectively, with no significant differences among the three groups (all P > 0.05). In multivariate analysis, PSA grouping was not an independent predictor of BCR. Within the population with PSA lower than 10 ng/mL, substratification of PSA is not a significant predictor for upgrading, upstaging, or adverse prognosis.

Prevalência e fatores associados à realização de exames de rastreamento para câncer de próstata em idosos de Juiz de Fora, MG, Brasil

Pouco se conhece sobre as práticas de rastreamento para câncer de próstata em idosos brasileiros. O objetivo deste estudo foi estimar a prevalência de realização de exames de rastreamento para câncer de próstata em idosos de Juiz de Fora (MG) e analisar os fatores associados. Trata-se de estudo seccional com 2825 homens de 60 anos ou mais que participaram da campanha de vacinação contra gripe de 2006. Foram analisadas variáveis sociodemográficas e relativas a condições de saúde e ao uso de serviços de saúde. Utilizou-se a regressão de Poisson na análise multivariada para avaliar associações entre as covariáveis e as variáveis dependentes e estimou-se a prevalência de realização dos exames. A idade média da população foi de 70,0 (± 7,2) anos. A prevalência de realização de toque retal foi 61,0% e a de PSA 75,5%. As variáveis "história familiar de câncer de próstata", "tipo de serviço de saúde", "status conjugal", "uso de medicação regular" e "escolaridade" foram fatores independentes associados à realização de toque retal. As mesmas variáveis, com exceção do "status conjugal", permaneceram no modelo múltiplo para PSA. O estudo evidencia que muitos idosos têm aderido à prática do rastreamento e a necessidade de dimensionar e qualificar esse processo, tendo em vista suas possíveis repercussões na saúde pública.

Comparison of oncologic outcomes after radical prostatectomy in men diagnosed with prostate cancer with PSA levels below and above 4 ng/mL

PURPOSE

To assess whether the PSA level (threshold 4 ng/mL) is a prognostic factor in biochemical recurrence-free survival in men with prostate cancer (PCa) with an initial PSA level <10 ng/mL who underwent robotic-assisted laparoscopic radical prostatectomy (RARLP).

METHODS

We prospectively recruited data for consecutive patients treated by RARLP for PCa with an initial PSA level below 10 ng/mL between 2003 and 2011 at our institution. We divided the population into two groups: patients with a PSA level below 4 ng/mL (G1; n = 53) and patients with a PSA level between 4 and 10 ng/mL (G2; n = 371). Biochemical recurrence was defined as a single increase in PSA greater than 0.2 ng/mL after surgery. Multivariate analysis was used to assess prognostic factors of recurrence-free survival.

RESULTS

Overall, 424 patients were included, and the median age was 62 (58-67) years. The median PSA was 5.8 ng/mL (4.8-7.7 ng/mL). Overall, 6 patients from G1 and 34 patients from G2 experienced a biochemical recurrence. Overall, the 5-year recurrence-free survival rate was 86.6 %. The PSA level at diagnosis (under or over 4 ng/mL) was not significantly linked to recurrence-free survival (HR = 0.59, p = 0.25). However, positive margins and a Gleason score >7 on the specimen were significantly linked to recurrence-free survival with respective hazard ratios of 4.30 (p < 0.0001) and 6.18 (p < 0.0001), respectively.

CONCLUSION

A PSA level <4 ng/mL alone appears to be obsolete as a cut-off to define a population of men likely to have indolent disease.