Clinical association between pre-treatment levels of plasma fibrinogen and bone metastatic burden in newly diagnosed prostate cancer patients

Background:Due to the different treatments for low-volume metastatic prostate cancer(PCa)as well as high-volume evaluation of bone metastatic status is clinically significant.In this study,we evaluated the correlation between pre-treatment plasma fibrinogen and the burden of bone metastasis in newly diagnosed PCa patients.Methods:A single-center retrospective analysis,focusing on prostate biopsies of newly diagnosed PCa patients,was performed.A total of 261 patients were enrolled in this study in a 4-year period.All subjects were submitted to single-photon emission computerized tomography-computed tomography to confirm the status of bone metastasis and,if present,the number of metastatic lesions would then be calculated.Clinical information such as age,prostate-specific antigen(PSA),fibrinogen,clinical T stage,and Gleason score were collected.Patients were divided into three groups:(i)a non-metastatic group,(ii)a high volume disease(HVD)group(>3 metastases with at least one lesion outside the spine),and(iii)a low volume disease(LVD)group(metastatic patients excluding HVD ones).The main statistical methods included non-parametric Mann-Whitney test,Spearman correlation,receiver operating characteristic(ROC)curves,and logistic regression.Results:Fibrinogen positively correlated with Gleason score(r=0.180,P=0.003),PSA levels(r=0.216,P<0.001),and number of metastatic lesions(r=0.296,P<0.001).Compared with the non-metastatic and LVD groups,the HVD group showed the highest PSA(104.98 ng/mL,median)and fibrinogen levels(3.39 g/L,median),as well as the largest proportion of Gleason score>7(86.8%).Both univariate(odds ratio[OR]=2.16,95%confidential interval[CI]:1.536-3.038,P<0.001)and multivariate(OR=1.726,95%CI:1.206-2.472,P=0.003)logistic regressions showed that fibrinogen was independently associated with HVD.The ROC curve suggested that fibrinogen acts as a predictor of HVD patients,yielding a cut-off of 3.08 g/L,with a sensitivity of 0.684 and a specificity of 0.760(area under the curve=0.739,95%CI:0.644-0.833,P<0.001).Conclusions:Pre-treatment plasma fibrinogen is positively associated with bone metastatic burden in PCa patients.Our results indicate that fibrinogen might be a potential predictor of HVD.

Prostate-specific Antigen Density Variation Rate as a Potential Guideline Parameter for Second Prostate Cancer Detection Biopsy

Background： The diagnostic value of current prostate-specific antigen （PSA） tests is challenged by the poor detection rate of prostate cancer （PCa） in repeat prostate biopsy. In this study, we proposed a novel PSA-related parameter named PSA density variation rate （PSADVR） and designed a clinical trial to evaluate its potential diagnostic value for detecting PCa on a second prostate biopsy. Methods： Data from 184 males who underwent second ultrasound-guided prostate biopsy 6 months after the first biopsy were included in the study. The subjects were divided into PCa and non-PCa groups according to the second biopsy pathological results. Prostate volume, PSA density （PSAD）, free-total PSA ratio, and PSADVR were calculated according to corresponding formulas at the second biopsy. These parameters were compared using t-test or Mann-Whitney U-test between PCa and non-PCa groups, and receiver operating characteristic analysis were used to evaluate their predictability on PCa detection. Results： PCa was detected in 24 patients on the second biopsy. Mean values of PSA, PSAD, and PSADVR were greater in the PCa group than in the non-PCa group （8.39 μg/L vs. 7.16 μg/L, 0.20 vs. 0.16, 14.15% vs. 1.36%, respectively）. PSADVR had the largest area trader the curve, with 0.667 sensitivity and 0.824 specificity when the cutoff was 10%. The PCa detection rate was significantly greater in subjects with PSADVR 〉10% than PSADVR _〈10% （28.6% vs. 6.5%, P 〈 0.001 ）. In addition, PSADVR was the only parameter in this study that showed a significant correlation with mid-to-high-risk PCa （r = 0.63, P = 0.03）. Conclusions： Our results demonstrated that PSADVR improved the PCa detection rate on second biopsies, especially for mid-to-high-risk cancers requiring prompt treatment.