Re-evaluating the diagnostic efficacy of PSA as a referral test to detect clinically significant prostate cancer in contemporary MRI-based image-guided biopsy pathways.

Autor:	Lophatananon A; Division of Population Health, Health Services Research & Primary Care Centre, University of Manchester, UK., Light A; Division of Urology, Department of Surgery, University of Cambridge, UK.; Department of Urology, Cambridge University Hospitals NHS Foundation Trust, UK., Burns-Cox N; Department of Urology, Somerset NHS Foundation Trust, UK., Maccormick A; Department of Urology, Somerset NHS Foundation Trust, UK., John J; Department of Urology, Royal Devon and Exeter NHS Foundation Trust and University of Exeter, UK., Otti V; Department of Urology, Royal Devon and Exeter NHS Foundation Trust and University of Exeter, UK., McGrath J; Department of Urology, Royal Devon and Exeter NHS Foundation Trust and University of Exeter, UK., Archer P; Department of Urology, Southend Hospital, UK., Anning J; Department of Urology, North Bristol NHS Trust, UK., McCracken S; Department of Urology, South Tyneside and Sunderland NHS Trust, UK., Page T; Department of Urology, Newcastle Hospitals NHS Trust, UK., Muir K; Division of Population Health, Health Services Research & Primary Care Centre, University of Manchester, UK., Gnanapragasam VJ; Division of Urology, Department of Surgery, University of Cambridge, UK.; Department of Urology, Cambridge University Hospitals NHS Foundation Trust, UK.; Cambridge Urology Translational Research and Clinical Trials Office, Addenbrooke's Hospital, UK.
Jazyk:	angličtina
Zdroj:	Journal of clinical urology [J Clin Urol] 2023 Jul; Vol. 16 (4), pp. 264-273. Date of Electronic Publication: 2021 Dec 01.
DOI:	10.1177/20514158211059057
Abstrakt:	Introduction: Modern image-guided biopsy pathways at diagnostic centres have greatly refined the investigations of men referred with suspected prostate cancer. However, the referral criteria from primary care are still based on historical prostate-specific antigen (PSA) cut-offs and age-referenced thresholds. Here, we tested whether better contemporary pathways and biopsy methods had improved the predictive utility value of PSA referral thresholds. Methods: PSA referral thresholds, age-referenced ranges and PSA density (PSAd) were assessed for positive predictive value (PPV) in detection of clinically significant prostate cancer (csPCa - histological ⩾ Grade Group 2). Data were analysed from men referred to three diagnostics centres who used multi-parametric magnetic resonance imaging (mpMRI)-guided prostate biopsies for disease characterisation. Findings were validated in a separate multicentre cohort. Results: Data from 2767 men were included in this study. The median age, PSA and PSAd were 66.4 years, 7.3 ng/mL and 0.1 ng/mL 2 , respectively. Biopsy detected csPCa was found in 38.7%. The overall area under the curve (AUC) for PSA was 0.68 which is similar to historical performance. A PSA threshold of ⩾ 3 ng/mL had a PPV of 40.3%, but this was age dependent (PPV: 24.8%, 32.7% and 56.8% in men 50-59 years, 60-69 years and ⩾ 70 years, respectively). Different PSA cut-offs and age-reference ranges failed to demonstrate better performance. PSAd demonstrated improved AUC (0.78 vs 0.68, p < 0.0001) and improved PPV compared to PSA. A PSAd of ⩾ 0.10 had a PPV of 48.2% and similar negative predictive value (NPV) to PSA ⩾ 3 ng/mL and out-performed PSA age-reference ranges. This improved performance was recapitulated in a separate multi-centre cohort ( n = 541). Conclusion: The introduction of MRI-based image-guided biopsy pathways does not appear to have altered PSA diagnostic test characteristics to positively detect csPCa. We find no added value to PSA age-referenced ranges, while PSAd offers better PPV and the potential for a single clinically useful threshold (⩾0.10) for all age groups. Level of Evidence: IV. Competing Interests: Conflicting interests The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Databáze:	MEDLINE
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