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Liu JX, Wang ZY, Niu SX, Sai XY, Zhang X, Zhang XP, Ma X. Transrectal versus transperineal prostate biopsy for cancer detection in patients with gray-zone prostate-specific antigen: a multicenter, real-world study. Asian J Androl 2024; 26:377-381. [PMID: 38624201 PMCID: PMC11280212 DOI: 10.4103/aja20241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/24/2024] [Indexed: 04/17/2024] Open
Abstract
Knowledge about the effect of different prostate biopsy approaches on the prostate cancer detection rate (CDR) in patients with gray-zone prostate-specific antigen (PSA) is limited. We performed this study to compare the CDR among patients who underwent different biopsy approaches and had rising PSA levels in the gray zone. Two hundred and twenty-two patients who underwent transrectal prostate biopsy (TRB) and 216 patients who underwent transperineal prostate biopsy (TPB) between June 2016 and September 2022 were reviewed in this study. In addition, 110 patients who received additional targeted biopsies following the systematic TPB were identified. Clinical parameters, including age, PSA derivative, prostate volume (PV), and needle core count, were recorded. The data were fitted via propensity score matching (PSM), adjusting for potential confounders. TPB outperformed TRB in terms of the CDR (49.6% vs 28.3%, P = 0.001). The clinically significant prostate cancer (csPCa) detection rate was not significantly different between TPB and TRB (78.6% vs 68.8%, P = 0.306). In stratified analysis, TPB outperformed TRB in CDR when the age of patients was 65-75 years (59.0% vs 22.0%, P < 0.001), when PV was 25.00-50.00 ml (63.2% vs 28.3%, P < 0.001), and when needle core count was no more than 12 (58.5% vs 31.5%, P = 0.005). The CDR ( P = 0.712) and detection rate of csPCa ( P = 0.993) did not significantly differ among the systematic, targeted, and combined biopsies. TPB outperformed TRB in CDR for patients with gray-zone PSA. Moreover, performing target biopsy after systematic TPB provided no additional benefits in CDR.
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Affiliation(s)
- Jun-Xiao Liu
- The Graduate School, Chinese PLA General Hospital, Beijing 100853, China
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Ze-Yuan Wang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Shao-Xi Niu
- Department of Urology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiao-Yong Sai
- Faculty of Epidemiology and Statistics, The Graduate School, Chinese PLA General Hospital, Beijing 100853, China
| | - Xu Zhang
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Xue-Pei Zhang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Xin Ma
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing 100853, China
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2
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Yang CH, Lin YS, Weng WC, Hsu CY, Tung MC, Ou YC. Incidental Prostate Cancer from Prostate with Benign Biopsies: A Predictive and Survival Analysis from Cohort Study. Int J Gen Med 2022; 15:2807-2816. [PMID: 35300134 PMCID: PMC8922340 DOI: 10.2147/ijgm.s357368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/25/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose This cohort was to evaluate incidental prostate cancer (iPCa) from men with preoperative benign biopsies and demonstrate their outcomes under different managements. Patients and Methods Between 2015 and 2017, we analyzed the risk factors having iPCa from surgical specimens from men provided with benign preoperative biopsies of their prostates. Furthermore, we compared the survival outcomes according to the different managements after iPCa was diagnosed. Receiver operating characteristic (ROC) curve was utilized to find the best thresholds. Univariable and multivariable nested logit regression were performed to estimate the effect size of different independent variables. Odds ratio (OR) was expressed with 95% confidence interval, and the alpha level was 5%. Results In 295 men we enrolled, there were 57 (19%) men having iPCa from surgical specimens. In univariable logit regression, we found significant variables of age, PSA, prostatic volume, PSA velocity ≥ 0.75 ng/mL/year for 3 years, taking 5α reductase inhibitors, abnormal digital rectal examination, cores of biopsy and surgical methods. In multivariable model, PSA was the strongest variable predicting iPCa (OR 3.81 [2.04–7.07]; Wald: 17.75; p < 0.001). In ROC curve, the best threshold was 9.025 ng/mL (area under curve: 0.95; sensitivity: 0.947; specificity: 0.866). In Kaplan–Meier curve of 27.89-month follow-up, robot-assisted simple prostatectomy (RASP) can provide similar PSA progression-free period as robot-assisted radical prostatectomy (RARP) following transurethral surgeries in organ-confined cancer (Log rank test, p = 0.293), and both of them were better than external-beam radiation therapy (RT) following transurethral surgeries (Log rank test, p < 0.001). Conclusion PSA was the strongest variable to predict iPCa out of prostate with preoperative benign biopsies. RASP was parallel to RARP following transurethral surgeries in organ-confined cancer in the short term.
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Affiliation(s)
- Che Hsueh Yang
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung, 435, Taiwan
| | - Yi Sheng Lin
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung, 435, Taiwan
| | - Wei Chun Weng
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung, 435, Taiwan
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, 356, Taiwan
| | - Chao Yu Hsu
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung, 435, Taiwan
- PhD Program in Translational Medicine, Rong Hsing Research Center for Transitional Medicine, National Chung Hsing University, Taichung, 402, Taiwan
| | - Min Che Tung
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung, 435, Taiwan
| | - Yen Chuan Ou
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung, 435, Taiwan
- Correspondence: Yen Chuan Ou; Yi Sheng Lin, Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, No. 699, Sec. 8, Taiwan Blvd, Wuqi District, Taichung, 435403, Taiwan, Tel +886-9-38762129; +886-926284779, Fax +886-4-26569868, Email ;
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3
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Deng W, Liu X, Liu W, Zhang C, Zhou X, Chen L, Guo J, Wang G, Fu B. Functional and Oncological Outcomes Following Robot-Assisted and Laparoscopic Radical Prostatectomy for Localized Prostate Cancer With a Large Prostate Volume: A Retrospective Analysis With Minimum 2-Year Follow-Ups. Front Oncol 2021; 11:714680. [PMID: 34631541 PMCID: PMC8495117 DOI: 10.3389/fonc.2021.714680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/02/2021] [Indexed: 01/09/2023] Open
Abstract
Objective We aimed to analyze the perioperative, functional, and oncologic outcomes following robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) for patients with localized prostate cancer (PCa) characterized by a large prostate volume (PV; ≥50 ml) over a minimum of 2 years follow-up. Materials and Methods Patients undergoing RARP and LRP for localized PCa with a large PV were included in the final analysis. The perioperative, functional, and oncologic outcomes were analyzed between the two groups. Results All operations were successfully completed without open conversion in both groups. The mean operative time and estimated blood loss in the RARP group were significantly decreased compared to those in the LRP group (139.4 vs. 159.0 min, p = 0.001, and 124.2 vs. 157.3 ml, p = 0.003, respectively). Patients in the RARP arm had significantly lower proportions of grade II or lower and of higher than grade II postoperative complications compared with those in the LRP group (7.9% vs. 17.1%, p = 0.033, and 1.6% vs. 6.7%, p = 0.047, respectively). No significant differences in terms of the rates of pT3 disease, positive surgical margin, and positive lymph node were noted between the two groups. Moreover, no significant difference in the median specimen Gleason score was observed between the RARP and LRP groups (6 vs. 7, p = 0.984). RARP vs. LRP resulted in higher proportions of urinary continence upon catheter removal (48.4% vs. 33.3%, p = 0.021) and at 3 (65.1% vs. 50.5%, p = 0.025) and 24 (90.5% vs. 81.0%, p = 0.037) months post-operation. The median erectile function scores at 6 and 24 months post-operation in the RARP arm were also significantly higher than those in the LRP arm (15 vs. 15, p = 0.042, and 15 vs. 13, p = 0.026, respectively). Kaplan–Meier analyses indicated that the biochemical recurrence-free survival and accumulative proportion of continence were statistically comparable between the two groups (p = 0.315 and p = 0.020, respectively). Conclusions For surgically managing localized PCa with a large prostate (≥50 ml), RARP had a tendency toward a lower risk of postoperative complications and better functional preservation without cancer control being compromised when compared to LRP.
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Affiliation(s)
- Wen Deng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Xiaoqiang Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Weipeng Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Cheng Zhang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaochen Zhou
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Luyao Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ju Guo
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Gongxian Wang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
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Yamashiro JR, de Riese WTW. Any Correlation Between Prostate Volume and Incidence of Prostate Cancer: A Review of Reported Data for the Last Thirty Years. Res Rep Urol 2021; 13:749-757. [PMID: 34676178 PMCID: PMC8518471 DOI: 10.2147/rru.s331506] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/30/2021] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Prostate cancer (PCa) is the most common non-skin cancer in men worldwide and more than 80% of men with PCa also have histo-anatomical findings of benign prostate hyperplasia (BPH). It is well documented that BPH develops in the transition zone (TZ), whereas 80-85% of PCa originates in the peripheral zone (PZ) of the prostate. Possible causal links between both disease entities are controversially discussed in the current literature. Some studies have reported that larger prostates have a decreased incidence of PCa compared to smaller prostates. The purpose of this systematic review is to comprehensively summarize studies analyzing any association between prostate gland volume and incidence of PCa. METHODS A thorough literature review was performed between 01.01.1990 through 02.28.2020 using PubMed and applying the "PRISMA" guidelines. Inclusion and exclusion criteria were defined. RESULTS Our systematic review found 41 articles reporting an inverse (negative) relationship between prostate gland volume and incidence of prostate cancer. Sample sizes ranged from 114 to 6692 patients in these single institutional and multi-institutional studies. Thirty-nine (95%) of the 41 articles showed a statistically significant inverse relationship. In our search, no study was found showing a positive correlation between BPH size and the incidence of PCa. CONCLUSION To our knowledge, this is the first systematic review on the important clinical question of interaction between prostate size and the incidence of PCa. The results are demonstrating an inverse relationship, and therefore reveal strong evidence that large prostates may be protective of PCa when compared to smaller prostates.
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Affiliation(s)
- Justine R Yamashiro
- Department of Urology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Werner T W de Riese
- Department of Urology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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5
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Liu J, Dong B, Qu W, Wang J, Xu Y, Yu S, Zhang X. Using clinical parameters to predict prostate cancer and reduce the unnecessary biopsy among patients with PSA in the gray zone. Sci Rep 2020; 10:5157. [PMID: 32198373 PMCID: PMC7083895 DOI: 10.1038/s41598-020-62015-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/06/2020] [Indexed: 01/10/2023] Open
Abstract
The gold standard for prostate cancer (PCa) diagnosis is prostate biopsy. However, it remines controversial as an invasive mean for patients with PSA levels in the gray zone (4–10 ng/mL). This study aimed to develop strategy to reduce the unnecessary prostate biopsy. We retrospectively identified 235 patients with serum total PSA testing in the gray zone before prostate biopsy between 2014 and 2018. Age, PSA derivates, prostate volume and multiparametric magnetic imaging (mpMRI) examination were assessed as predictors for PCa and clinically significant PCa with Gleason score ≥ 7 (CSPCa). Univariate analysis showed that prostate volume, PSAD, and mpMRI examination were significant predictors of PCa and CSPCa (P < 0.05). The differences of diagnostic accuracy between mpMRI examination (AUC = 0.69) and other clinical parameters in diagnostic accuracy for PCa were not statistically significant. However, mpMRI examination (AUC = 0.79) outperformed prostate volume and PSAD in diagnosis of CSPCa. The multivariate models (AUC = 0.79 and 0.84 for PCa and CSPCa) performed significantly better than mpMRI examination for detection of PCa (P = 0.003) and CSPCa (P = 0.036) among patients with PSA level in the gray zone. At the same level of sensitivity as the mpMRI examination to diagnose PCa, applying the multivariate models could reduce the number of biopsies by 5% compared with mpMRI examination. Overall, our results supported the view that the multivariate model could reduce unnecessary biopsies without compromising the ability to diagnose PCa and CSPCa. Further prospective validation is required.
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Affiliation(s)
- Junxiao Liu
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Biao Dong
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wugong Qu
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiange Wang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yue Xu
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuanbao Yu
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xuepei Zhang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China. .,Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China.
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6
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Detection of Prostate Cancer Antigen 3 and Prostate Cancer Susceptibility Candidate in Non-DRE Urine Improves Diagnosis of Prostate Cancer in Chinese Population. Prostate Cancer 2020; 2020:3964615. [PMID: 32099679 PMCID: PMC7013283 DOI: 10.1155/2020/3964615] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/13/2019] [Accepted: 01/03/2020] [Indexed: 12/24/2022] Open
Abstract
Although prostate biopsy is the gold standard for the diagnosis of prostate cancer, it also leads to high incidence of negative biopsies and the diagnosis of clinically low-risk prostate cancer and the subsequent overtreatment. It remains an unmet need to discover new biomarkers in order to defer the unnecessary biopsies in clinical practice. In this study, we described a new method, LBXexo score, to measure the urine exosomal PCA3/PRAC expression from non-DRE urine as a noninvasive diagnosis to improve the detection rate in Chinese population with a low serum PSA level. First-voided urine samples were collected to isolate exosomes, and exosomal RNAs of PCA3 and PRAC were measured by quantitative reverse transcription PCR. A significant increase in exoPCA3/PRAC was observed in both any-grade and high-grade prostate cancer groups when compared with the biopsy-negative group. Receiver-operating characteristic curve analyses showed that the LBXexo score significantly improved diagnostic performance in predicting biopsy results, with AUCs of 0.723 (p=0.017) and 0.736 (p=0.038) for any-grade and high-grade (GS ≥ 7) prostate cancer, respectively. For high-grade cancer, LBXexo had the negative and positive predictive values of 100% and 27.59%, respectively, and could potentially avoid unnecessary biopsy. This is the first report in Chinese population that demonstrates the predictive value of the exosomal expression of PCA3 and PRAC derived from non-DRE urine in predicting prostate biopsy outcomes. It could be used in clinical practice to make a better informed biopsy decision and avoid unnecessary biopsies in Chinese population.
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7
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Smailova DS, Fabbro E, Ibrayev SE, Brusati L, Semenova YM, Samarova US, Rakhimzhanova FS, Zhussupov SM, Khismetova ZA, Hosseini H. Epidemiological and Economic Evaluation of a Pilot Prostate Cancer Screening Program. Prostate Cancer 2020; 2020:6140623. [PMID: 32411478 PMCID: PMC7204116 DOI: 10.1155/2020/6140623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/04/2019] [Accepted: 11/05/2019] [Indexed: 11/18/2022] Open
Abstract
Background. Prostate cancer (PCa) is the second most commonly diagnosed cancer, and the sixth most common killer among men worldwide (Aubry et al., 2013). This research was motivated by the fact that PCa screening continues to be a controversial topic in the Kazakh medical community. This study aimed at description of how newly diagnosed PCa patients are managed in Pavlodar region of the Kazakhstan Republic and at presentation of a budget impact analysis (BIA) for PCa screening program. Also, we aimed to provide a comparative analysis of pricing system on medical services applied in both private and public healthcare sectors of the Kazakhstan Republic. Methods. New cases of PCa have been retrospectively analyzed for the period from January 2013 to December 2017 based on the information obtained from information system "Policlinic" maintained by the Pavlodar regional branch of the Republican Center for Electronic Health and from Cancer Registry of Pavlodar Regional Oncology Center. All data were analyzed with the help of SPSS 20.0 software. Results. The mean age of PCa patients was 68.34 years (SD = 8.559). The government of Kazakhstan invested 20,437,000 KZT (Kazakhstani tenge) in 2017 equivalently 61,188 USD-to fund a pilot study for examination of 9638 men. From 2013 to 2017, out of 49,334 men residing in Pavlodar region of Kazakhstan 1,248 men were diagnosed with prostate diseases, including 130 PCa cases. The PCa detection rate was equal to two cases per month. Only 22.8% of all PCa cases identified in the region within specified time period were revealed as a result of the government-funded PCa screening program. The average prostate cancer detection rate among the target group of Pavlodar region within the period of 5 years was equal to 0.23%. Conclusion. Based on the fact that the PCa screening program failed to enable adequate detection of new PCa cases, we would not recommend to continue this type of screening unless it is undergone careful revision and replanning.
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Affiliation(s)
| | - Elisa Fabbro
- Department of Medicine, Udine University, Udine, Italy
| | - Serik E. Ibrayev
- Public Health Department, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Luca Brusati
- Department of Economics and Statistics, Udine University, Udine, Italy
| | | | | | | | | | | | - Hengameh Hosseini
- Department of Health Administration, University of Scranton, Scranton, PL, USA
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8
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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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9
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Chang Y, Chen R, Yang Q, Gao X, Xu C, Lu J, Sun Y. Peripheral zone volume ratio (PZ-ratio) is relevant with biopsy results and can increase the accuracy of current diagnostic modality. Oncotarget 2018; 8:34836-34843. [PMID: 28422738 PMCID: PMC5471015 DOI: 10.18632/oncotarget.16753] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 03/21/2017] [Indexed: 01/03/2023] Open
Abstract
The current diagnostic modality of prostate cancer based on prostate specific antigen (PSA) and systematic biopsy is far from ideal in terms of over-diagnosing indolent prostate cancer and missing significant ones. Thus we integrated the peripheral zone volume ratio (PZ-ratio) for diagnostic refinement. This retrospective study included 247 consecutive patients who underwent initial transrectal ultrasound-guided systematic prostate biopsy from April 2014 to November 2015. Prostate volume was determined by semi-automatic contour on axial T2 weighted magnetic resonance imaging (MRI). PZ-ratio was inversely correlated with age (r = −0.36, p <0.0001). Adding PZ-ratio and MRI findings to the current predictive model (age, PSA density, percent-free PSA) significantly increased diagnostic accuracy in all patients (AUC: 0.871 vs. 0.812, p = 0.0059), but not in patient subgroup with PSA 4–10 ng/ml (AUC: 0.863 vs. 0.803, p = 0.12). The new model also significantly reduced the number of unnecessary biopsies while missing less significant cancers at a probability threshold of 25%. PZ-ratio is a potential tool in predicting biopsy results, and when added alone or in combination with MRI findings, the diagnostic accuracy can be further enhanced.
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Affiliation(s)
- Yifan Chang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Rui Chen
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Qingsong Yang
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Xu Gao
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Chuanliang Xu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Yinghao Sun
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
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10
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Zhang J, Ma M, Nan X, Sheng B. Obesity inversely correlates with prostate-specific antigen levels in a population with normal screening results of prostate cancer in northwestern China. ACTA ACUST UNITED AC 2017; 49:S0100-879X2016000800704. [PMID: 27409334 PMCID: PMC4954736 DOI: 10.1590/1414-431x20165272] [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] [Received: 01/18/2016] [Accepted: 04/13/2016] [Indexed: 01/21/2023]
Abstract
Serum prostate-specific antigen (PSA) is a diagnostic biomarker of prostate cancer and is possibly associated with obesity. This study aimed to explore the relationships between obesity indicators [body mass index (BMI) and waist circumference (WC)] with PSA in Chinese men. A cross-sectional study of men aged 30-85 years undergoing prostate cancer screening was conducted from August 2008 to July 2013 in Xi'an, China. Data were obtained from clinical reports, condition was recorded based on self-report including demographics, weight, height, and WC (>90 cm=obese). Fasting blood glucose (FBG) and prostate volume (PV) were assessed clinically. Patients were grouped by BMI (normal=22.9, overweight=23-27.4, obese≥27.5 kg/m2). PSA parameters of density (PSAD), PSA serum level, and PSA increasing rate per year (PSAR) were calculated per BMI and age groups (30-40, 41-59, 60-85 years). Obesity indicators (BMI and WC) and PSA parameter relationships were modeled by age-stratified linear regression. Of 35,632 Chinese men surveyed, 13,084 were analyzed, including 13.44% obese, 57.44% overweight, and 29.12% normal weight, according to BMI; 25.84% were centrally (abdominally) obese according to WC. BMI and WC were negatively associated with all PSA parameters, except PSAD and PSAR [P<0.05, BMI: β=-0.081 (95%CI=-0.055 to -0.036), WC: β=-0.101 (-0.021 to -0.015)], and independent of FBG and PV (P<0.05) in an age-adjusted model. In conclusion, obesity was associated with lower PSA in Chinese men. Therefore, an individual's BMI and WC should be considered when PSA is used to screen for prostate cancer.
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Affiliation(s)
- J Zhang
- Nutrition Department, The First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, China
| | - M Ma
- Geriatric Surgery Department, The First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, China
| | - X Nan
- Urology Institute, The First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, China
| | - B Sheng
- Geriatric Surgery Department, The First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, China
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Nnabugwu II, Udeh EI, Ugwumba FO, Ozoemena FO. Predicting Gleason score using the initial serum total prostate-specific antigen in Black men with symptomatic prostate adenocarcinoma in Nigeria. Clin Interv Aging 2016; 11:961-6. [PMID: 27486316 PMCID: PMC4957636 DOI: 10.2147/cia.s98232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Men of Black African descent are known to have the highest incidence of prostate cancer. The disease is also more aggressive in this group possibly due to biologically more aggressive tumor or late presentation. Currently, serum prostate-specific antigen (PSA) assay plays a significant role in making the diagnosis of prostate cancer. However, the obtained value of serum PSA may not directly relate with the Gleason score (GS), a measure of tumor aggression in prostate cancer. This study explores the relationship between serum total PSA at presentation (iPSA) and GS. Patients and methods The iPSA of patients with histologically confirmed prostate cancer was compared with the obtained GS of the prostate biopsy specimens. The age of the patients at presentation and the prostate volumes were also analyzed with respect to the iPSA and GS. The data were analyzed retrospectively using IBM SPSS Version 20. Pearson correlation was used for numeric variables, whereas Fisher’s exact test was used for categorical variables. Significance was set at P≤0.05. Results There were 205 patients from January 2010 to November 2013 who satisfied the inclusion criteria. iPSA as well as age at presentation and prostate volume were not found to significantly correlate with the primary Gleason grade, the secondary Gleason grade, or the GS. However, the presence of distant metastasis was identified to significantly correlate positively with GS. Conclusion GS may not be confidently predicted by the iPSA. Higher iPSA does not correlate with higher GS and vice versa.
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Affiliation(s)
- Ikenna I Nnabugwu
- Urology Unit, Department of Surgery, College of Medicine, Enugu Campus, University of Nigeria, Enugu, Nigeria
| | - Emeka I Udeh
- Urology Unit, Department of Surgery, College of Medicine, Enugu Campus, University of Nigeria, Enugu, Nigeria
| | - Fredrick O Ugwumba
- Urology Unit, Department of Surgery, College of Medicine, Enugu Campus, University of Nigeria, Enugu, Nigeria
| | - Francis O Ozoemena
- Urology Unit, Department of Surgery, College of Medicine, Enugu Campus, University of Nigeria, Enugu, Nigeria
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