Is prostate specific antigen (PSA) density necessary in selecting prostate cancer patients for active surveillance and what should be the cutoff in the Asian population?
| Autor: | Tsang CF; Division of Urology, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong., Lai TCT; Division of Urology, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong., Lam W; Division of Urology, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong., Ho BSH; Division of Urology, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong., Ng ATL; Division of Urology, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong., Ma WK; Division of Urology, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong., Yiu MK; Division of Urology, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong., Tsu JHL; Division of Urology, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong. |
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| Jazyk: | angličtina |
| Zdroj: | Prostate international [Prostate Int] 2019 Jun; Vol. 7 (2), pp. 73-77. Date of Electronic Publication: 2018 Mar 12. |
| DOI: | 10.1016/j.prnil.2018.03.002 |
| Abstrakt: | Background: To investigate the role of Prostate Specific Antigen density (PSAD) in selecting prostate cancer patients for active surveillance (AS) and to determine a cutoff PSAD in identifying adverse pathological outcomes. Methods: Data from 287 patients who underwent radical prostatectomy for prostate cancer were retrospectively reviewed. Six different AS protocols, the University of Toronto; Royal Marsden; John Hopkins; University of California San Francisco (UCSF); Memorial Sloan Kettering Cancer Center (MSKCC) and Prostate Cancer Research International: Active Surveillance (PRIAS), were applied to the cohort. Pre-operative demographics and pathological outcomes were analysed. Statistical analyses on the predictive factors of adverse pathological outcomes and significance of PSAD were performed. A cutoff PSAD with best balance between sensitivity and specificity in identifying adverse pathological outcome was determined. Results: PSAD predicted adverse pathological outcomes better than Prostate Specific Antigen (PSA) level alone. The PSAD was significantly lower (0.12-0.13 ng/dl/ml) in protocols including PSAD (the John Hopkins and PRIAS) compared with the other four protocols not including PSAD as a selection criteria (0.21-0.25 ng/dl/dl, P = 0.00). PSAD predicted adverse pathological outcomes in all protocols not incorporating PSAD as an inclusion criteria ( P = 0.00-0.02). By the receiver operator characteristics curve analysis, it was found that a PSAD level of 0.19 ng/ml/ml had the best balance between sensitivity and specificity in predicting pathological adverse disease (Area under curve = 0.63, P = 0.004). Conclusion: PSAD is necessary in selecting prostate cancer patients for active surveillance. It predicts adverse pathological outcomes in patients eligible for active surveillance better than PSA level alone. A PSAD cutoff at 0.19 ng/ml/ml has the best balance between sensitivity and specificity in predicting pathological adverse disease. We recommend using AS protocol incorporating PSAD as a selection criteria (in particular the PRIAS protocol with a cutoff PSAD at 0.2 ng/ml/ml) when recruiting prostate cancer patients for AS. |
| Databáze: | MEDLINE |
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