Prevalence of Prostate Cancer among Men with a Prostate-Specific Antigen Level ≤4.0 ng per Milliliter

Thompson, Ian M.; Pauler, Donna K.; Goodman, Phyllis J.; Tangen, Catherine M.; Lucia, M. Scott; Parnes, Howard L.; Minasian, Lori M.; Ford, Leslie G.; Lippman, Scott M.; Crawford, E. David; Crowley, John; Coltman, Charles A.

doi:10.1056/nejmoa031918

Cited by 2,167 publications

(1,353 citation statements)

References 29 publications

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“…However, Kundu et al did not compare the relative accuracy of PSAD and PSA in predicting these pathological and clinical findings. 13 Jones et al recently reported that PSAD was significantly associated with patient age, prostate weight, cancer volume, Gleason score, and positive SM rates. Furthermore, PSAD was also found to be an independent predictor of biochemical recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…The fact that our results demonstrate a very small increase in the predictive accuracy of PSAD among patients with biopsy Gleason score ≤ 6 is consistent with knowledge that patients with lower grade prostate cancer generally exhibit lower PSA levels, thus reducing the predictive value of PSA in this subgroup. 13 Kundu et al recently demonstrated that measurement of PSAD was useful for determining the aggressiveness of prostate cancer. Specifically, PSAD was associated with positive SM rates, prostatectomy Gleason score, cancer volume, PSA velocity in the year prior to diagnosis, and biochemical recurrence.…”

Section: Discussionmentioning

confidence: 99%

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Prostate Specific Antigen Versus Prostate Specific Antigen Density as a Prognosticator of Pathological Characteristics and Biochemical Recurrence Following Radical Prostatectomy

Magheli¹,

Rais‐Bahrami²,

Trock³

et al. 2008

Journal of Urology

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Purpose-The utility of PSAD for predicting pathological stage and biochemical recurrence after radical prostatectomy (RP) has not been well defined. The goal of this study was to investigate whether PSAD yielded an advantage over total PSA in predicting adverse pathologic characteristics and disease recurrence following RP.Materials and methods-A total of 13,434 men who underwent radical prostatectomy for clinically localized prostate cancer between 1984 and 2006 were included in this study. The study population was stratified by Gleason score (≤ 6, 7, and ≥ 8) and clinical and pathological characteristics of each group were compared. We constructed receiver operating characteristic (ROC) curves and determined the areas under the receiver operating curves (AUC) and c-index to specifically investigate the accuracy of PSA and PSAD for the prediction of pathological stage and biochemical recurrence.Results-PSAD was better than PSA in predicting EPE (p<0.001) and BCR (p<0.001) in patients with a biopsy Gleason score ≤ 6. In patients with biopsy Gleason scores of 7, PSA was more predictive than PSAD for SV involvement (p<0.001), LN involvement (p=0.017), and BCR (p<0.001). For men with biopsy Gleason scores ≥ 8, there was no statistical difference between PSA and PSAD in prognostic value for pathological or clinical outcomes.Conclusions-PSAD is highly associated with pathological stage and biochemical free survival following RP. In lower grade prostate cancers, PSAD is significantly more accurate in predicting EPE and BCR compared to total PSA and should be considered when counseling patients on outcomes following RP.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prostate Specific Antigen Versus Prostate Specific Antigen Density as a Prognosticator of Pathological Characteristics and Biochemical Recurrence Following Radical Prostatectomy

Magheli¹,

Rais‐Bahrami²,

Trock³

et al. 2008

Journal of Urology

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“…PSA testing is very sensitive, but two-thirds of PSA elevations are caused by non-malignant prostate disorders [1] and widespread PSA screening resulted in the detection of clinically insignificant PCA [2]. On the other hand, a number of high grade PCA are overlooked because patients' PSA levels are within normal range [3].…”

Section: Introductionmentioning

confidence: 99%

CpG Island hypermethylation in cell‐free serum DNA identifies patients with localized prostate cancer

et al. 2007

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BACKGROUND.One of the earliest and most common epigenetic events in prostate carcinogenesis is DNA CpG island (CGI) hypermethylation. Our aim was to analyze the diagnostic and prognostic possibilities of multigene methylation analysis in cell-free serum DNA of prostate cancer (PCA) patients. METHODS. We analyzed serum samples from 226 consecutive patients (168 PCA; 42 benign prostatic hyperplasia (BPH); 5 incidental PCA; 11 healthy individuals). Cell-free DNA was digested with methylation-sensitive restriction endonucleases (HpaII and HinP1I). Subsequently, CGI hypermethylation at GSTP1, PTGS2, Reprimo, and TIG1 was assessed using real-time PCR. RESULTS. CGI hypermethylation at GSTP1, TIG1, PTGS2, and Reprimo was more frequent in PCA (42.3%, 9.5%, 2.4%, and 1.2%, respectively) compared to BPH (7.7%, 0%, 0%, and 0%, respectively) and healthy individuals (all 0%) with a statistical significant difference of GSTP1 (P < 0.0001) and TIG1 (P ¼ 0.038). GSTP1 hypermethylation was also detected in four patients with incidental PCA. Hypermethylation in serum DNA at GSTP1 and hypermethylation at any gene site distinguished between PCA and BPH patients in a highly specific (92%) but less sensitive (42-47%) manner. Neither CGI hypermethylation at a single gene loci nor the combination of multiple gene sites was correlated to the pathological stage, grade or biochemical recurrence following radical prostatectomy. CONCLUSIONS. The detection of aberrant hypermethylation in cell-free serum DNA allows the highly specific diagnosis of PCA. A test based on GSTP1 hypermethylation in serum samples of patients with suspected PCA may help to identify men with increased risk of harboring PCA despite negative prostate biopsy.

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“…There is no established PSA cut point for detecting prostate cancer with simultaneously high sensitivity and high specificity, but there is a continuum of prostate cancer risk at all values, with higher values of PSA having been associated with higher risk. 25,26 Of the prostate cancers diagnosed in 2010, 12.5% had PSA values 4.0 ng/ml, that is, they had values in the range usually considered "normal" (Table 6). Of these, 49.9% had a clinical interpretation of positive.…”

Section: Discussionmentioning

confidence: 99%

Prostate cancer collaborative stage data items—their definitions, quality, usage, and clinical implications: A review of SEER data for 2004‐2010

Howlader

Chen

Ries

et al. 2014

Cancer

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BACKGROUND: Version 2 of the Collaborative Stage Data Collection System (CSv2) became effective with cases diagnosed in 2010. This report focuses on the CSv2 components required to derive the American Joint Committee on Cancer (AJCC) stage for prostate cancer and on the site-specific factors for prostate cancer captured in CSv2. The report also highlights differences between the AJCC 6th and 7th editions for classifying prostate cancer stage. METHODS: Data from 18 Surveillance, Epidemiology, and End Results (SEER) Program population-based registries (SEER-18) were analyzed for the years 2004-2010, which included 400,591 prostate cancer cases. RESULTS: CSv2 provides specificity with regard to the Gleason grading system by distinguishing between clinical and pathologic patterns and scores. The AJCC 7th edition incorporates prostate-specific antigen values into staging, subdivides stage II into IIA and IIB, and reclassifies extraprostatic invasion with microscopic bladder neck invasion from T4 in the 6th edition to T3a; this latter change affected the AJCC stage of 283 cases in 2010. Of the 44,578 prostate cancer cases diagnosed in 2010 that would have been classified as stage II in the AJCC 6th edition, 32.7%, 27.5%, and 39.8% are classified as stages I, IIA, and IIB, respectively, in the 7th edition. CONCLUSIONS: CSv2 provides more information than was previously available to researchers using SEER prostate data.

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Prevalence of Prostate Cancer among Men with a Prostate-Specific Antigen Level ≤4.0 ng per Milliliter

Abstract: Biopsy-detected prostate cancer, including high-grade cancers, is not rare among men with PSA levels of 4.0 ng per milliliter or less--levels generally thought to be in the normal range.

Cited by 2,167 publications

References 29 publications

Prostate Specific Antigen Versus Prostate Specific Antigen Density as a Prognosticator of Pathological Characteristics and Biochemical Recurrence Following Radical Prostatectomy

Prostate Specific Antigen Versus Prostate Specific Antigen Density as a Prognosticator of Pathological Characteristics and Biochemical Recurrence Following Radical Prostatectomy

CpG Island hypermethylation in cell‐free serum DNA identifies patients with localized prostate cancer

Prostate cancer collaborative stage data items—their definitions, quality, usage, and clinical implications: A review of SEER data for 2004‐2010

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