Serum prostate-specific antigen concentration is a powerful predictor of acute urinary retention and need for surgery in men with clinical benign prostatic hyperplasia

Roehrborn, Claus G.; McConnell, John D.; Lieber, Michael M.; Kaplan, Steven A.; Geller, Jack; Malek, Gholam H.; Castellanos, Ronald; Coffield, Scott; Saltzman, Brian; Resnick, Martin I.; Cook, Thomas J.; Waldstreicher, Joanne

doi:10.1016/s0090-4295(98)00654-2

Cited by 283 publications

(183 citation statements)

References 11 publications

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“…Evidence from several clinical studies demonstrates that the risk of clinical progression in BPH is greatest in men with a prostate volume 30 ml and a PSA level of 1.5 ng/ml [18,19]. Our community data confirm that in men with a PSA < 1.5 the probability of an enlarged prostate (>30 cc) was low.…”

Section: Discussionsupporting

confidence: 80%

Serum Prostate-Specific Antigen as a Predictor of Prostate Volume in the Community: The Krimpen Study

2007

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e u r o p e a n u r o l o g y 5 1 ( 2 0 0 7 ) 1 6 4 5 -1 6 5 3 a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o m Article info AbstractObjectives: Serum prostate-specific antigen (PSA) is considered a proxy for prostate volume (PV). This study investigates which range of PSA values has the best utility in the determination of PV (<30 cc, at 30, 40, and 50 cc), and whether PSA performs better than digital rectal examination (DRE) when estimating PV. Methods: In a population-based follow-up study of 1688 men in Krimpen aan den IJssel, The Netherlands, at baseline we estimated PV by DRE and by transrectal planimetric ultrasound (TRUS), in addition to measuring PSA. Men who tested positive for prostate cancer (PCa) at baseline and at 2 and 4 yr of follow-up were excluded from the analyses (n = 142). Of the men without PCa, PSA and PV data were available in 1524 participants. Results: Of all 1524 men analysed, 76.7% had a PSA of 0-2.0, 15.0% had a PSA of 2.1-4.0, and 8.3% a PSA > 4. Low PSA ranges (0-2 and 2.1-4.0) discriminate better for a PV of 30 cc (eg, in men with a PSA range of 2.1-2.5 ng/ml there was a 72% chance of having a PV > 30 cc). Higher ranges of PSA (>4.0) discriminate better for a PV > 40 or 50 cc. (eg, in men with a PSA in the range of 4.1-7.0 ng/ml there was a 69% chance of having a PV > 40 cc and in men with a PSA > 10 ng/ml there was a 75% chance of a PV > 50 cc). The receiver operating curve (ROC) for the performance of PSA in estimating a PV > 30 cc shows an area under the curve (AUC) of 0.79, denoting reasonable discrimination, and AUCs of 0.86 and 0.92, denoting good discrimination of PVs > 40 cc and >50 cc, respectively. PSA performed significantly better than DRE at estimating PV. Multiple regression analysis shows that both DRE and an interaction term for age and PSA provided minimal additional information beyond PSA in the prediction of PV; however, their contribution is numerically minimal/not clinically meaningful. Conclusions: In men for whom a diagnosis of PCa has been ruled out, PSA can be used to detect an enlarged prostate (>30 cc and with more accuracy PV > 40 or 50 cc). More precision in estimating PV can be obtained when using a formula that contains PSA, age, DRE, and an interaction term between age and PSA; however, the clinical advantage of the formula over PSA alone is only modest as shown by the ROC curves. Thus, for clinicians looking for an easy and fast way to identify patients with an enlarged prostate, PSA is a good approximation for men without PCa.

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Section: Discussionsupporting

confidence: 80%

Serum Prostate-Specific Antigen as a Predictor of Prostate Volume in the Community: The Krimpen Study

2007

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“…Although several epidemiological and clinical studies have substantially increased our knowledge about the risk of disease progression in patients with LUTS/BPH, [1][2][3][4][5][6][7] their results are of limited usefulness for daily clinical practice. Most studies focused on the impact of single risk factors but practising doctors are faced with patients The regression results show the impact of each factor in comparison to a reference patient, having no unfavourable conditions (total I-PSS 0-7, prostate volume o30 ml, PSAo1.4 ng/ml, Qmax 415 ml/s, PVR o50 ml).…”

Section: Discussionmentioning

confidence: 99%

“…Community-based studies and randomised controlled trials (RCTs) have identified several clinical parameters that are associated with the risk of symptom deterioration, serious complications such as acute urinary retention (AUR) and/or the need for invasive therapy. [1][2][3][4][5][6][7] These include age, prostate volume, prostate-specific antigen (PSA), symptom severity, maximum flow rate (Q max ), and postvoid residual (PVR). [1][2][3][4][5][6][7] The relevance of identifying patients at different risk of disease progression has become manifest since recent studies have shown that long-term treatment with a 1 -adrenoceptor (AR) antagonists, 5a-reductase inhibitors (RIs) and their combination reduce the risk of clinical progression, AUR, and the need for invasive therapy.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7] These include age, prostate volume, prostate-specific antigen (PSA), symptom severity, maximum flow rate (Q max ), and postvoid residual (PVR). [1][2][3][4][5][6][7] The relevance of identifying patients at different risk of disease progression has become manifest since recent studies have shown that long-term treatment with a 1 -adrenoceptor (AR) antagonists, 5a-reductase inhibitors (RIs) and their combination reduce the risk of clinical progression, AUR, and the need for invasive therapy. 6 However, the a 1 -AR antagonist doxazosin only reduced the occurrence of AUR compared to placebo in patients with a low-to-intermediate PSA, whereas combination therapy of the a 1 -AR antagonist with the 5a-RI finasteride provided the largest benefit with regard to reducing the development of AUR and need of invasive therapy, in particular in high-risk patients such as those with a high PSA/large prostate volume.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for disease progression in patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH): a systematic analysis of expert opinion

Lowe

Batista

Berges

et al. 2005

Prostate Cancer Prostatic Dis

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Disease progression has become an important issue for the management of lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH). Although several risk factors have been identified, no specific patient risk profiles have been established that can be useful in the day-to-day management of LUTS/BPH. In this study, an international panel of urologists developed a risk classification based on the attribution of a risk score to 243 unique patient profiles. From the perspective of clinical decision making, it was concluded that postvoid residual, symptom severity and maximum flow rate are the most relevant determinants of the risk of disease progression.

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“…Subjects in the highest volume group also showed higher rates of symptom progression and worsening flow rates. 45 The poor correlation between prostate size and symptoms occurs because multiple other factors influence the development of LUTS such as age, medications, comorbid conditions, diet and bladder physiology. 46 A more useful way to predict symptoms, flow rates and high detrusor pressure is by using the TZ volume instead of using the total volume, because prostatic hyperplasia only occurs in the TZ and periurethral glands.…”

Section: Best Predictors Of Progressionmentioning

confidence: 99%

Voiding dysfunction in men: pathophysiology and risk factors

Scofield

Kaplan

2008

Int J Impot Res

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Serum prostate-specific antigen concentration is a powerful predictor of acute urinary retention and need for surgery in men with clinical benign prostatic hyperplasia

Cited by 283 publications

References 11 publications

Serum Prostate-Specific Antigen as a Predictor of Prostate Volume in the Community: The Krimpen Study

Serum Prostate-Specific Antigen as a Predictor of Prostate Volume in the Community: The Krimpen Study

Risk factors for disease progression in patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH): a systematic analysis of expert opinion

Voiding dysfunction in men: pathophysiology and risk factors

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