OBJECTIVE To investigate the relationship between the clinicopatho- logical stage and serum prostate specific antigen(PSA)concentration and PSAdensity(PSAD)in patients with prostate cancer. METHODS The clinicopatholog...OBJECTIVE To investigate the relationship between the clinicopatho- logical stage and serum prostate specific antigen(PSA)concentration and PSAdensity(PSAD)in patients with prostate cancer. METHODS The clinicopathological stage was determined on the basis of a pathological examination and clinical data in 65 prostate cancer patients treated by radical prostatectomy.PSA and PSAD were measured before the operation.The Spearman rank correlation was applied to evaluate the relationship between the clinicopathological stage,serum PSAconcentration and PSAD. RESULTS Patients with higher PSA and PSAD were significantly more likely to have higher clinical stages,a higher Gleason score,positive surgical margins,capsular penetration,and seminal vesicle invasion(each P<0.05). But there was no significant association between PSA and lymph node metastasis(P=0.053).The levels of serum PSA concentration and PSAD were significantly correlated with the clinical stage(P<0.05)in the prostate cancer patients. CONCLUSION The level of both PSA and PSAD were significantly correlated with the clinical stage(P<0.05)in the prostate cancer patients.But PSAD may be a more powerful predictor of clinical stage and prognosis than PSA.展开更多
This study explored a new model of Prostate Imaging Reporting and Data System(PIRADS)and adjusted prostate-specific antigen density of peripheral zone(aPSADPZ)for predicting the occurrence of prostate cancer(PCa)and c...This study explored a new model of Prostate Imaging Reporting and Data System(PIRADS)and adjusted prostate-specific antigen density of peripheral zone(aPSADPZ)for predicting the occurrence of prostate cancer(PCa)and clinically significant prostate cancer(csPCa).The demographic and clinical characteristics of 853 patients were recorded.Prostate-specific antigen(PSA),PSA density(PSAD),PSAD of peripheral zone(PSADPZ),aPSADPZ,and peripheral zone volume ratio(PZ-ratio)were calculated and subjected to receiver operating characteristic(ROC)curve analysis.The calibration and discrimination abilities of new nomograms were verified with the calibration curve and area under the ROC curve(AUC).The clinical benefits of these models were evaluated by decision curve analysis and clinical impact curves.The AUCs of PSA,PSAD,PSADPZ,aPSADPZ,and PZ-ratio were 0.669,0.762,0.659,0.812,and 0.748 for PCa diagnosis,while 0.713,0.788,0.694,0.828,and 0.735 for csPCa diagnosis,respectively.All nomograms displayed higher net benefit and better overall calibration than the scenarios for predicting the occurrence of PCa or csPCa.The new model significantly improved the diagnostic accuracy of PCa(0.945 vs 0.830,P<0.01)and csPCa(0.937 vs 0.845,P<0.01)compared with the base model.In addition,the number of patients with PCa and csPCa predicted by the new model was in good agreement with the actual number of patients with PCa and csPCa in high-risk threshold.This study demonstrates that aPSADPZ has a higher predictive accuracy for PCa diagnosis than the conventional indicators.Combining aPSADPZ with PIRADS can improve PCa diagnosis and avoid unnecessary biopsies.展开更多
We investigated the performance characteristics of prostate-specific antigen （PSA） and PSA density （PSAD） in Chinese men. All Chinese men who underwent transrectal ultrasound-guided prostate biopsy （TRUS-PB） fro...We investigated the performance characteristics of prostate-specific antigen （PSA） and PSA density （PSAD） in Chinese men. All Chinese men who underwent transrectal ultrasound-guided prostate biopsy （TRUS-PB） from year 2000 to 2013 were included. The receiver operating characteristic （ROC） curves for both PSA and PSAD were analyzed. The sensitivity, specificity, positive predictive value （PPV） and negative predictive value （NPV） at different cut-off levels were calculated. A total of 2606 Chinese men were included. For the ROC, the area under curve was 0.770 for PSA （P〈 0.001） and 0.823 for PSAD （P〈 0.001）. PSA of 4.5 ng ml^-1 had sensitivity of 94.4%, specificity of 14.1%, PPV of 29.5%, and NPV of 86.9%; PSAD of 0.12 ng ml^-1cc^-1 had sensitivity of 94.5%, specificity of 26.6%, PPV of 32.8%, and NPV of 92.7%. On multivariate logistic regression analyses, PSA cut-off at 4.5 ng ml^-1 （OR 1.61, 95% CI 1.05-2.45, P = 0.029） and PSAD cut-off at 0.12 ng ml^-1 cc^-1 （OR 6.22, 95% CI 4.20-9.22, P 〈 0.001） were significant predictors for prostate cancer detection on TRUS-PB. In conclusion, the performances of PSA and PSAD at different cut-off levels in Chinese men were very different from those in Caucasians. PSA of 4.5 ng ml^-1 and PSAD of O. 12 ng ml^-1 cc^-1 had near 95% sensitivity and were significant predictors of prostate cancer detection in Chinese men.展开更多
Aim： To investigate whether the measurement of serum zinc may improve the detection of prostate cancer （PCa） in men who had total prostate-specific antigen （PSA） levels higher than 4.1 ng/mL. Methods： A mass scr...Aim： To investigate whether the measurement of serum zinc may improve the detection of prostate cancer （PCa） in men who had total prostate-specific antigen （PSA） levels higher than 4.1 ng/mL. Methods： A mass screening for PCa of 3940 men over 50 years old was undertaken using total serum PSA. Of the 190 men （4.8 %） with elevated PSA, 143 （3.6 %） underwent a transrectal ultrasonography （TRUS）-guided biopsy of the prostate, and 42 men （1% of total and 29.3 % of men undergoing biopsy） were found to have cancer. The areas under the receiver operating characteristic curves （ROC-AUC） were used to compare the diagnostic power of cancer detection by means of serum zinc, and free PSA/total PSA ratio （fit）. Results： The men with levels of serum zinc that ranged from 40 ng/mL-60 ng/mL, had an age-adjusted odds ratios（OR） of 5.0. A cutoff value of 100 gg/mL for-serum zinc concentration provided a sensitivity of 90.5 % and a specificity of 32.7 % in elevated PSA range, and a sensitivity of 93.3 % and specificity of 27.1% in gray zone, respectively. In the gray zone ranges of 4.1 ng/mL-10.0 ng/mL, the ROC-AUC for zinc was 73.0 % higher than 62.7 % of f/t PSA ratio and 56.7 % of total PSA. Conclusion： PCa displays a lower serum zinc concentration. The measurement of zinc levels improves PCa detection in the gray zone compared with the f/t PSA ratio and total PSA. （Asian J Androl 2005 Sep; 7： 323-328）展开更多
Chinese men should have a higher prostate-specific antigen （PSA） ＂gray zone＂ than the traditional value of 2.5-10.0 ng ml-1 since the incidence of prostate cancer （PCa） in Chinese men is relative low. We hypothe...Chinese men should have a higher prostate-specific antigen （PSA） ＂gray zone＂ than the traditional value of 2.5-10.0 ng ml-1 since the incidence of prostate cancer （PCa） in Chinese men is relative low. We hypothesized that PSA density （PSAD） could improve the rate of PCa detection in Chinese men with a PSA higher than the traditional PSA ＂gray zone.＂ A total of 461 men with a PSA between 2.5 and 20.0 ng ml-1, who had undergone prostatic biopsy at two Chinese centers were included in the analysis. The men were then further divided into groups with a PSA between 2.5-10.0 ng ml-1 and 10.1-20.0 ng ml-1. Receiver operating characteristic （ROC） curve was used to evaluate the efficacy of PSA and PSAD for the diagnosis of PCa. In men with a PSA of 2.5-10.0 ng ml-1 or 10.1-20.0 ng ml-z, the areas under the ROC curve were higher for PSAD than for PSA. This was consistent across both centers and the cohort overall. When the entire cohort was considered, the optimal PSAD cut-off for predicting PCa in men with a PSA of 2.5-10.0 ng m1-1 was 0.15 ng ml-2 ml-2, with a sensitivity of 64.4% and specificity of 64.6%. The optimal cut-off for PSAD in men with a PSA of 10.1-20.0 ng m1-1 was 0.33 ng ml-1 ml-1, with a sensitivity of 60.3% and specificity of 82.7%. PSAD can improve the effectiveness for PCa detection in Chinese men with a PSA of 2.5-10.0 ng ml-1 （traditional Western PSA ＂gray zone＂） and 10.1-20.0 ng ml-2 （Chinese PSA ＂gray zone＂）.展开更多
This study was designed to identify clinical predictors of favorable pathology and biochemical recurrence （BCR） in patients with intermediate-risk prostate cancer （IRPCa）. Between 2006 and 2012, clinicopathologica...This study was designed to identify clinical predictors of favorable pathology and biochemical recurrence （BCR） in patients with intermediate-risk prostate cancer （IRPCa）. Between 2006 and 2012, clinicopathological and oncological data from 203 consecutive men undergoing robot-assisted radical prostatectomy （RARP） for IRPCa were reviewed in a single-institutional retrospective study. Favorable pathology was defined as Gleason score 〈6 and organ-confined cancer as detected by surgical pathology. Logistic regression analysis was used to determine predictive variables of favorable pathology, and the Kaplan-Meier and multivariate Cox regression model were used to estimate BCR-free survival after RARP. Overall, 38 patients （18.7%） had favorable pathology after RARP. Lower quartile prostate-specific antigen density （PSAD） was associated with favorable pathology compared to the highest quartile PSAD after adjusting for preoperative PSA, clinical stage and biopsy Gleason score （odds ratio, 5.42; 95% confidence interval, 1.01-28.97; P = 0.048）. During a median 37.8 （interquartile range, 24.6-60.2） months of follow-up, 66 patients experienced BCR. There were significant differences with regard to BCR free survival by PSAD quartiles （log rank, P = 0.003）. Using a multivariable Cox proportion hazard model, PSAD was found to be an independent predictor of BCR in patients with IRPCa after RARP （hazard ratio, 4.641; 95% confidence interval, 1.109-19.417; P = 0.036）. The incorporation of the PSAD into risk assessments might provide additional prognostic information and identify some patients in whom active surveillance would be appropriate in patients with IRPCa.展开更多
To improve the diagnostic efficiency of prostate cancer(PCa)and reduce unnecessary biopsies,we defined and analyzed the diagnostic efficiency of peripheral zone prostate-specific antigen(PSA)density(PZ-PSAD).Patients ...To improve the diagnostic efficiency of prostate cancer(PCa)and reduce unnecessary biopsies,we defined and analyzed the diagnostic efficiency of peripheral zone prostate-specific antigen(PSA)density(PZ-PSAD).Patients who underwent systematic 12-core prostate biopsies in Shanghai General Hospital(Shanghai,China)between January 2012 and January 2018 were retrospectively identified(n=529).Another group of patients with benign prostatic hyperplasia(n=100)were randomly preselected to obtain the PSA density of the non-PCa cohort(N-PSAD).Prostate volumes and transition zone volumes were measured using multiparameter magnetic resonance imaging(mpMRI)and were combined with PSA and N-PSAD to obtain the PZ-PSAD from a specific algorithm.Receiver operating characteristic(ROC)curve analysis was used to assess the PCa detection efficiency in patients stratified by PSA level,and the area under the ROC curve(AUC)of PZ-PSAD was higher than that of PSA,PSA density(PSAD),and transition zone PSA density(TZ-PSAD).PZ-PSAD could amend the diagnosis for more than half of the patients with inaccurate transrectal ultrasonography(TRUS)and mpMRI results.When TRUS and mpMRI findings were ambiguous to predict PCa(PIRADS score≤3),PZ-PSAD could increase the positive rate of biopsy from 21.7%to 54.7%,and help 63.8%(150/235)of patients avoid unnecessary prostate biopsy.In patients whose PSA was 4.0–10.0 ng ml^(−1),10.1–20.0 ng ml^(−1),and>20.0 ng ml^(−1),the ideal PZ-PSAD cut-off value for predicting clinically significant PCa was 0.019 ng ml^(−2),0.297 ng ml^(−2),and 1.180 ng ml^(−2),respectively(sensitivity>90%).Compared with PSA,PSAD,and TZ-PSAD,the efficiency of PZ-PSAD for predicting PCa is the highest,leading to fewer missed diagnoses and unnecessary biopsies.展开更多
文摘OBJECTIVE To investigate the relationship between the clinicopatho- logical stage and serum prostate specific antigen(PSA)concentration and PSAdensity(PSAD)in patients with prostate cancer. METHODS The clinicopathological stage was determined on the basis of a pathological examination and clinical data in 65 prostate cancer patients treated by radical prostatectomy.PSA and PSAD were measured before the operation.The Spearman rank correlation was applied to evaluate the relationship between the clinicopathological stage,serum PSAconcentration and PSAD. RESULTS Patients with higher PSA and PSAD were significantly more likely to have higher clinical stages,a higher Gleason score,positive surgical margins,capsular penetration,and seminal vesicle invasion(each P<0.05). But there was no significant association between PSA and lymph node metastasis(P=0.053).The levels of serum PSA concentration and PSAD were significantly correlated with the clinical stage(P<0.05)in the prostate cancer patients. CONCLUSION The level of both PSA and PSAD were significantly correlated with the clinical stage(P<0.05)in the prostate cancer patients.But PSAD may be a more powerful predictor of clinical stage and prognosis than PSA.
基金supported by two grants from the Key Research and Development Program of jiangsu Province (No.BE2020654 and No.BE2020655)a grant from the General Program of Jiangsu Health Commission (No.H2019040)a grant from National Key R&D Program of China (No.2017YFC0114303).
文摘This study explored a new model of Prostate Imaging Reporting and Data System(PIRADS)and adjusted prostate-specific antigen density of peripheral zone(aPSADPZ)for predicting the occurrence of prostate cancer(PCa)and clinically significant prostate cancer(csPCa).The demographic and clinical characteristics of 853 patients were recorded.Prostate-specific antigen(PSA),PSA density(PSAD),PSAD of peripheral zone(PSADPZ),aPSADPZ,and peripheral zone volume ratio(PZ-ratio)were calculated and subjected to receiver operating characteristic(ROC)curve analysis.The calibration and discrimination abilities of new nomograms were verified with the calibration curve and area under the ROC curve(AUC).The clinical benefits of these models were evaluated by decision curve analysis and clinical impact curves.The AUCs of PSA,PSAD,PSADPZ,aPSADPZ,and PZ-ratio were 0.669,0.762,0.659,0.812,and 0.748 for PCa diagnosis,while 0.713,0.788,0.694,0.828,and 0.735 for csPCa diagnosis,respectively.All nomograms displayed higher net benefit and better overall calibration than the scenarios for predicting the occurrence of PCa or csPCa.The new model significantly improved the diagnostic accuracy of PCa(0.945 vs 0.830,P<0.01)and csPCa(0.937 vs 0.845,P<0.01)compared with the base model.In addition,the number of patients with PCa and csPCa predicted by the new model was in good agreement with the actual number of patients with PCa and csPCa in high-risk threshold.This study demonstrates that aPSADPZ has a higher predictive accuracy for PCa diagnosis than the conventional indicators.Combining aPSADPZ with PIRADS can improve PCa diagnosis and avoid unnecessary biopsies.
文摘We investigated the performance characteristics of prostate-specific antigen （PSA） and PSA density （PSAD） in Chinese men. All Chinese men who underwent transrectal ultrasound-guided prostate biopsy （TRUS-PB） from year 2000 to 2013 were included. The receiver operating characteristic （ROC） curves for both PSA and PSAD were analyzed. The sensitivity, specificity, positive predictive value （PPV） and negative predictive value （NPV） at different cut-off levels were calculated. A total of 2606 Chinese men were included. For the ROC, the area under curve was 0.770 for PSA （P〈 0.001） and 0.823 for PSAD （P〈 0.001）. PSA of 4.5 ng ml^-1 had sensitivity of 94.4%, specificity of 14.1%, PPV of 29.5%, and NPV of 86.9%; PSAD of 0.12 ng ml^-1cc^-1 had sensitivity of 94.5%, specificity of 26.6%, PPV of 32.8%, and NPV of 92.7%. On multivariate logistic regression analyses, PSA cut-off at 4.5 ng ml^-1 （OR 1.61, 95% CI 1.05-2.45, P = 0.029） and PSAD cut-off at 0.12 ng ml^-1 cc^-1 （OR 6.22, 95% CI 4.20-9.22, P 〈 0.001） were significant predictors for prostate cancer detection on TRUS-PB. In conclusion, the performances of PSA and PSAD at different cut-off levels in Chinese men were very different from those in Caucasians. PSA of 4.5 ng ml^-1 and PSAD of O. 12 ng ml^-1 cc^-1 had near 95% sensitivity and were significant predictors of prostate cancer detection in Chinese men.
文摘Aim： To investigate whether the measurement of serum zinc may improve the detection of prostate cancer （PCa） in men who had total prostate-specific antigen （PSA） levels higher than 4.1 ng/mL. Methods： A mass screening for PCa of 3940 men over 50 years old was undertaken using total serum PSA. Of the 190 men （4.8 %） with elevated PSA, 143 （3.6 %） underwent a transrectal ultrasonography （TRUS）-guided biopsy of the prostate, and 42 men （1% of total and 29.3 % of men undergoing biopsy） were found to have cancer. The areas under the receiver operating characteristic curves （ROC-AUC） were used to compare the diagnostic power of cancer detection by means of serum zinc, and free PSA/total PSA ratio （fit）. Results： The men with levels of serum zinc that ranged from 40 ng/mL-60 ng/mL, had an age-adjusted odds ratios（OR） of 5.0. A cutoff value of 100 gg/mL for-serum zinc concentration provided a sensitivity of 90.5 % and a specificity of 32.7 % in elevated PSA range, and a sensitivity of 93.3 % and specificity of 27.1% in gray zone, respectively. In the gray zone ranges of 4.1 ng/mL-10.0 ng/mL, the ROC-AUC for zinc was 73.0 % higher than 62.7 % of f/t PSA ratio and 56.7 % of total PSA. Conclusion： PCa displays a lower serum zinc concentration. The measurement of zinc levels improves PCa detection in the gray zone compared with the f/t PSA ratio and total PSA. （Asian J Androl 2005 Sep; 7： 323-328）
文摘Chinese men should have a higher prostate-specific antigen （PSA） ＂gray zone＂ than the traditional value of 2.5-10.0 ng ml-1 since the incidence of prostate cancer （PCa） in Chinese men is relative low. We hypothesized that PSA density （PSAD） could improve the rate of PCa detection in Chinese men with a PSA higher than the traditional PSA ＂gray zone.＂ A total of 461 men with a PSA between 2.5 and 20.0 ng ml-1, who had undergone prostatic biopsy at two Chinese centers were included in the analysis. The men were then further divided into groups with a PSA between 2.5-10.0 ng ml-1 and 10.1-20.0 ng ml-1. Receiver operating characteristic （ROC） curve was used to evaluate the efficacy of PSA and PSAD for the diagnosis of PCa. In men with a PSA of 2.5-10.0 ng ml-1 or 10.1-20.0 ng ml-z, the areas under the ROC curve were higher for PSAD than for PSA. This was consistent across both centers and the cohort overall. When the entire cohort was considered, the optimal PSAD cut-off for predicting PCa in men with a PSA of 2.5-10.0 ng m1-1 was 0.15 ng ml-2 ml-2, with a sensitivity of 64.4% and specificity of 64.6%. The optimal cut-off for PSAD in men with a PSA of 10.1-20.0 ng m1-1 was 0.33 ng ml-1 ml-1, with a sensitivity of 60.3% and specificity of 82.7%. PSAD can improve the effectiveness for PCa detection in Chinese men with a PSA of 2.5-10.0 ng ml-1 （traditional Western PSA ＂gray zone＂） and 10.1-20.0 ng ml-2 （Chinese PSA ＂gray zone＂）.
文摘This study was designed to identify clinical predictors of favorable pathology and biochemical recurrence （BCR） in patients with intermediate-risk prostate cancer （IRPCa）. Between 2006 and 2012, clinicopathological and oncological data from 203 consecutive men undergoing robot-assisted radical prostatectomy （RARP） for IRPCa were reviewed in a single-institutional retrospective study. Favorable pathology was defined as Gleason score 〈6 and organ-confined cancer as detected by surgical pathology. Logistic regression analysis was used to determine predictive variables of favorable pathology, and the Kaplan-Meier and multivariate Cox regression model were used to estimate BCR-free survival after RARP. Overall, 38 patients （18.7%） had favorable pathology after RARP. Lower quartile prostate-specific antigen density （PSAD） was associated with favorable pathology compared to the highest quartile PSAD after adjusting for preoperative PSA, clinical stage and biopsy Gleason score （odds ratio, 5.42; 95% confidence interval, 1.01-28.97; P = 0.048）. During a median 37.8 （interquartile range, 24.6-60.2） months of follow-up, 66 patients experienced BCR. There were significant differences with regard to BCR free survival by PSAD quartiles （log rank, P = 0.003）. Using a multivariable Cox proportion hazard model, PSAD was found to be an independent predictor of BCR in patients with IRPCa after RARP （hazard ratio, 4.641; 95% confidence interval, 1.109-19.417; P = 0.036）. The incorporation of the PSAD into risk assessments might provide additional prognostic information and identify some patients in whom active surveillance would be appropriate in patients with IRPCa.
基金This study was supported by the National Natural Science Foundation of China(No.81772746,No.81870516)Natural Science Foundation of Xinjiang Province(2019D01C091).
文摘To improve the diagnostic efficiency of prostate cancer(PCa)and reduce unnecessary biopsies,we defined and analyzed the diagnostic efficiency of peripheral zone prostate-specific antigen(PSA)density(PZ-PSAD).Patients who underwent systematic 12-core prostate biopsies in Shanghai General Hospital(Shanghai,China)between January 2012 and January 2018 were retrospectively identified(n=529).Another group of patients with benign prostatic hyperplasia(n=100)were randomly preselected to obtain the PSA density of the non-PCa cohort(N-PSAD).Prostate volumes and transition zone volumes were measured using multiparameter magnetic resonance imaging(mpMRI)and were combined with PSA and N-PSAD to obtain the PZ-PSAD from a specific algorithm.Receiver operating characteristic(ROC)curve analysis was used to assess the PCa detection efficiency in patients stratified by PSA level,and the area under the ROC curve(AUC)of PZ-PSAD was higher than that of PSA,PSA density(PSAD),and transition zone PSA density(TZ-PSAD).PZ-PSAD could amend the diagnosis for more than half of the patients with inaccurate transrectal ultrasonography(TRUS)and mpMRI results.When TRUS and mpMRI findings were ambiguous to predict PCa(PIRADS score≤3),PZ-PSAD could increase the positive rate of biopsy from 21.7%to 54.7%,and help 63.8%(150/235)of patients avoid unnecessary prostate biopsy.In patients whose PSA was 4.0–10.0 ng ml^(−1),10.1–20.0 ng ml^(−1),and>20.0 ng ml^(−1),the ideal PZ-PSAD cut-off value for predicting clinically significant PCa was 0.019 ng ml^(−2),0.297 ng ml^(−2),and 1.180 ng ml^(−2),respectively(sensitivity>90%).Compared with PSA,PSAD,and TZ-PSAD,the efficiency of PZ-PSAD for predicting PCa is the highest,leading to fewer missed diagnoses and unnecessary biopsies.
