Prostate health index density predicts aggressive pathological outcomes after radical prostatectomy in Taiwanese patients
| Autor: | I-Shen Huang, Shing-Hwa Lu, Tzu-Chun Wei, Chih-Chieh Lin, Hsiao-Jen Chung, Yu-Hua Fan, Tzu-Ping Lin, Yu-Pin Huang, William J.S. Huang, Junne-Yih Kuo, Yen-Hwa Chang, Eric Yi Hsiu Huang, Alex T.L. Lin, Howard H.H. Wu, Wei-Ming Cheng |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Urology 030204 cardiovascular system & hematology 03 medical and health sciences Prostate cancer 0302 clinical medicine Prostate Humans Medicine Prospective Studies Stage (cooking) Prospective cohort study Prostatectomy Receiver operating characteristic business.industry Prostatic Neoplasms General Medicine Odds ratio Middle Aged Prostate-Specific Antigen medicine.disease Prostate-specific antigen medicine.anatomical_structure 030220 oncology & carcinogenesis business |
| Zdroj: | Journal of the Chinese Medical Association. 82:835-839 |
| ISSN: | 1726-4901 |
| DOI: | 10.1097/jcma.0000000000000169 |
| Popis: | Background There are models to predict pathological outcomes based on established clinical and prostate-specific antigen (PSA)-derived parameters; however, they are not satisfactory. p2PSA and its derived biomarkers have shown promise for the diagnosis and prognosis of prostate cancer (PCa). The aim of this study was to investigate whether p2PSA-derived biomarkers can assist in the prediction of aggressive pathological outcomes after radical prostatectomy (RP). Methods We prospectively enrolled patients who were diagnosed with PCa and treated with RP between February 2017 and December 2018. Preoperative blood samples were analyzed for tPSA, free PSA (fPSA), percentage of fPSA (%fPSA), [-2]proPSA (p2PSA), and percentage of p2PSA (%p2PSA). Prostate health index (PHI) was calculated as (p2PSA/fPSA) × √tPSA. Prostate volume was determined by transrectal ultrasound using the ellipsoid formula, and PHI density was calculated as PHI/prostate volume. The areas under the receiver operating characteristic curve were estimated for various PSA/p2PSA derivatives. Aggressive pathological outcomes measured after RP were defined as pathological T3 or a Gleason score (GS) >6 as determined in RP specimens. Results One hundred and forty-four patients were included for analysis. Postoperative GS was >6 in 86.1% of the patients, and pT stage was T3a or more in 54.2%. Among all PSA- and p2PSA-derived biomarkers, PHI density was the best biomarker to predict aggressive pathological outcomes after RP. The odds ratio of having an aggressive pathological outcome of RP was 8.796 (p = 0.001). In multivariate analysis, adding %fPSA to base model did not improve the accuracy (area under curve), but adding PHI and PHI density to base model improved the accuracy by 2% and 16%, respectively, in predicting pT3 stage or GS ≥ 7. The risk of pT3 stage or GS ≥ 7 was 20.8% for PHI density 1.125 (sensitivity: 74.6% and specificity: 88.9%). Conclusion PHI density may further aid in predicting aggressive pathological outcomes after RP. This biomarker may be useful in preoperative counseling and may have potential in decision making when choosing between definitive treatment and active surveillance of newly diagnosed PCa. |
| Databáze: | OpenAIRE |
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