Negative influence of changing biopsy practice patterns on the predictive value of prostate‐specific antigen for cancer detection on prostate biopsy

Schwartz, Michael; Hwang, David H.; Hung, Andrew J.; Han, Jialin; McClain, Justin W.; Shemtov, M. Mendel; Te, Alexis E.; Sosa, R. Ernest; Vaughan, E. Darracott; Scherr, Douglas S.

doi:10.1002/cncr.23353

Cited by 7 publications

(5 citation statements)

References 24 publications

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“…For example, Schwartz and colleagues analyzed data from biopsies “performed at our institution”, a hospital in the US, and concluded that, in recent years, there was essentially no correlation between PSA and biopsy outcome in DRE negative men with a PSA above 2 ng/mL19. Such a conclusion is well in keeping with our findings for cohorts with recent screening, but not our findings for cohorts consisting of men without a recent PSA test.…”

Section: Discussionsupporting

confidence: 68%

The Relationship between Prostate-Specific Antigen and Prostate Cancer Risk: The Prostate Biopsy Collaborative Group

Vickers

Cronin

Roobol

et al. 2010

Clinical Cancer Research

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Purpose: The relationship between prostate-specific antigen (PSA) level and prostate cancer risk remains subject to fundamental disagreements. We hypothesized that the risk of prostate cancer on biopsy for a given PSA level is affected by identifiable characteristics of the cohort under study.Experimental Design: We used data from five European and three U.S. cohorts of men undergoing biopsy for prostate cancer; six were population-based studies and two were clinical cohorts. The association between PSA and prostate cancer was calculated separately for each cohort using locally weighted scatterplot smoothing.Results: The final data set included 25,772 biopsies and 8,503 cancers. There were gross disparities between cohorts with respect to both the prostate cancer risk at a given PSA level and the shape of the risk curve. These disparities were associated with identifiable differences between cohorts: for a given PSA level, a greater number of biopsy cores increased the risk of cancer (odds ratio for >6-versus 6-core biopsy, 1.35; 95% confidence interval, 1.18-1.54; P < 0.0005); recent screening led to a smaller increase in risk per unit change in PSA (P = 0.001 for interaction term) and U.S. cohorts had higher risk than the European cohorts (2.14; 95% confidence interval, 1.99-2.30; P < 0.0005).Conclusions: Our results suggest that the relationship between PSA and risk of a positive prostate biopsy varies, both in terms of the probability of prostate cancer at a given PSA value and the shape of the risk curve. This poses challenges to the use of PSA-driven algorithms to determine whether biopsy is indicated. Clin Cancer Res; 16(17); 4374-81. ©2010 AACR.

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Section: Discussionsupporting

confidence: 68%

The Relationship between Prostate-Specific Antigen and Prostate Cancer Risk: The Prostate Biopsy Collaborative Group

Vickers

Cronin

Roobol

et al. 2010

Clinical Cancer Research

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“…One the other hand, there are a few studies that used single institute cohorts including New York Presbyterian Hospital (Weill Medical College of Cornell University, New York, NY), Cleveland Clinic (Cleveland Clinic, Cleveland, OH, USA) and Durham VA (Durham VA Medical Center, Durham, NC, USA). The detection rates from those studies were 31%, 39% and 47% respectively, which were more comparable to ours [4]–[7]. The positive rate of prostate biopsy has decreased over the years at our institute.…”

Section: Discussionsupporting

confidence: 81%

Outcomes and Trends of Prostate Biopsy for Prostate Cancer in Chinese Men from 2003 to 2011

Jiang

Kim

et al. 2012

PLoS ONE

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BackgroundProstate-specific antigen (PSA) screening is growing in popularity in China, but its impact on biopsy characteristics and outcomes are poorly understood.ObjectiveOur objective was to characterize prostate biopsy outcomes and trends in Chinese men over a 10-year period, since the increasing use of PSA tests.MethodsAll men (n = 1,650) who underwent prostate biopsy for PCa at Huashan Hospital, Shanghai, China from 2003–2011 were evaluated. Demographic and clinical information was collected for each patient, including age, digital rectal examination (DRE), transrectal ultrasound (prostate volume and nodule), total prostate-specific antigen (tPSA) levels and free PSA ratio (fPSA/tPSA) prior to biopsy. Prostate biopsy was performed using six cores before October 2007 or ten cores thereafter. Logistic regression and multivariate analysis were used to evaluate our data.ResultsThe overall positive rate of prostate biopsy for PCa was 47% and the rate decreased significantly over the years from 74% in 2003 to 33% in 2011 (P-trend = 0.004) . Age at diagnosis was slightly increased (P-trend = 0.04) while fPSA/tPSA was significantly decreased (P-trend = 1.11×10-5). A statistically significant trend was not observed for tPSA levels, prostate volume, or proportion of positive nodule. The model including multiple demographic and clinical variables (i.e., age, DRE, tPSA, fPSA/tPSA and transrectal ultrasound results) (AUC = 0.93) statistically outperformed models that included only PSA (AUC = 0.85) or fPSA/tPSA (AUC = 0.66) to predict PCa risks (P<0.05). Similar results were observed in a subgroup of men whose tPSA levels were lower than 20 ng/mL (AUC = 0.87, vs. AUC of tPSA = 0.62, P<0.05).ConclusionsDetection rates of PCa and high-grade PCa among men that underwent prostate biopsy at the institution has decreased significantly in the past 10 years, likely due to increasing use of PSA tests. Predictive performance of demographic and clinical variables of PCa was excellent. These variables should be used in clinics to determine the need for prostate biopsy.

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“…As a result, measuring serum PSA in men older than 50 years was suggested by the American Urological Association and the American Cancer Society as the best means to screen for the disease 2. Despite the success of PSA monitoring to detect earlier stage ACa in the last 2 decades this test leads to a significant number of false-positive findings because PSA is produced by malignant and benign processes 3,4. Alternative PSA based biomarkers, including PSA velocity, free-to-bound PSA ratio, age adjusted PSA, pro-PSA and PSA density, are being investigated in terms of sensitivity and specificity to a significant cancer presence but no concise clinical standard has been adopted 5.…”

mentioning

confidence: 99%

Electrical Properties of Prostatic Tissues: I. Single Frequency Admittivity Properties

et al. 2009

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Purpose Electrical properties of the prostate may provide sufficient contrast for distinguishing malignant and benign formations in the gland. We evaluated how well these electrical properties discriminate cancer from noncancer tissues in the prostate. Materials and Methods Electrical admittivity (conductivity and permittivity) was recorded at 31 discrete frequencies of 0.1 to 100 kHz from each of 50 ex vivo human prostates. A specifically designed admittivity probe was used to gauge these electrical properties from sectioned prostate specimens. The specific tissue area probed was marked to provide precise colocalization between tissue histological assessment and recorded admittivity spectra. Results Adenocarcinoma, benign prostatic hyperplasia, nonhyperplastic glandular tissue and stromal tissue were the primary tissue types probed. Mean cancer conductivity was significantly less than that of glandular and stromal tissues at all frequencies (p <0.05), while mean cancer permittivity was significantly greater than that of all benign tissues at 100 kHz (p <0.0001). ROC curves showed that permittivity at 100 kHz was optimal for discriminating cancer from all benign tissues. This parameter had 77% specificity at 70% sensitivity and an ROC AUC of 0.798. Conclusions The contrast in electrical admittivity properties of different prostate tissues shows promise for distinguishing cancer from benign tissues. Sensitivity and specificity exceed those reported for current prostate specific antigen screening practices at low prostate specific antigen, making this an attractive addition to the clinical armamentarium for identifying prostate cancer.

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Negative influence of changing biopsy practice patterns on the predictive value of prostate‐specific antigen for cancer detection on prostate biopsy

Cited by 7 publications

References 24 publications

The Relationship between Prostate-Specific Antigen and Prostate Cancer Risk: The Prostate Biopsy Collaborative Group

The Relationship between Prostate-Specific Antigen and Prostate Cancer Risk: The Prostate Biopsy Collaborative Group

Outcomes and Trends of Prostate Biopsy for Prostate Cancer in Chinese Men from 2003 to 2011

Electrical Properties of Prostatic Tissues: I. Single Frequency Admittivity Properties

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