BACKGROUND Prostate cancer is the second most common cancer among men worldwide,and prostate-specific antigen(PSA)is often used in clinical practice to screen for prostate cancer.Normal total PSA(tPSA)level initially ...BACKGROUND Prostate cancer is the second most common cancer among men worldwide,and prostate-specific antigen(PSA)is often used in clinical practice to screen for prostate cancer.Normal total PSA(tPSA)level initially excludes prostate cancer.Here,we report a case of prostate cancer with elevated free PSA density(fPSAD).CASE SUMMARY A patient diagnosed with benign prostatic hyperplasia underwent prostatectomy,and the postoperative pathological results showed acinar adenocarcinoma of the prostate.The patient is currently undergoing endocrine chemotherapy.CONCLUSION We provide a clinical reference for diagnosis and treatment of patients with normal tPSA but elevated fPSAD.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
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
This study aimed to assess the role of prostate-specific antigen density(PSAD)and negative multiparametric magnetic resonance imaging(mpMRI)in predicting prostate cancer for biopsy-naive men based on a large cohort of...This study aimed to assess the role of prostate-specific antigen density(PSAD)and negative multiparametric magnetic resonance imaging(mpMRI)in predicting prostate cancer for biopsy-naive men based on a large cohort of the Chinese population.From a prostate biopsy database between March 2017 and July 2021,we retrospectively identified 240 biopsy-naive patients with negative prebiopsy mpMRI(Prostate Imaging Reporting and Data System version 2[PI-RADS v2]score<3).Logistic regression analysis was performed to select the potential predictors for clinically significant prostate cancer(csPCa).Receiver operating characteristic(ROC)curve analysis and area under the ROC curve(AUC)were performed to assess the diagnostic accuracy.The negative predictive values of mpMRI in excluding any cancer and csPCa were 83.8%(201/240)and 90.8%(218/240),respectively.R0C curve analysis indicated that PSAD was the most promising predictor,with an AUC value of 0.786(95%confidence interval[CI]:0.699-0.874),and multiparametric logistic regression analysis confirmed that higher PSAD remained a significant marker for predicting csPCa(odds ratio[0R]:10.99,95%CI:2.75-44.02,P<0.001).Combining negative mpMRI and PSAD below 0.20 ng ml^(-2)obviously increased the predictive value in excluding PCa(91.0%,101/111)or csPCa(100.0%,111/111).If a PSAD below 0.20 ng ml^(-2)was set as the criterion to omit biopsy,nearly 46.3%of patients(463 per 1000)with negative mpMRI could safely avoid unnecessary biopsy,with approximately 4.2%of patients(42 per 1000)at risk of missed diagnosis of PCa and no patients with csPCa missed.A PI-RADS v2 score<3 and a PSAD<0.20 ng ml^(-2)could be potential criteria for the Chinese population to omit prompt biopsy safely.展开更多
OBJECTIVE To investigate the diagnostic value of modified prostate specific antigen(PSA)parameters in the diagnosis of prostate cancer(PCA) when the serum PSAis in a grey zone of 4~10 ng/ml. METHODS The results of ser...OBJECTIVE To investigate the diagnostic value of modified prostate specific antigen(PSA)parameters in the diagnosis of prostate cancer(PCA) when the serum PSAis in a grey zone of 4~10 ng/ml. METHODS The results of serum PSA determinations of the patients receiving a transrectal ultrasound-guided multiphase prostatic biopsy,were retrospectively analyzed.In the 88 patients with a serum PSA value of 4-10 ng/ml,the final diagnosis of PCA was made in 21,and that of benign prostate hyperplasia(BPH)in 67 patients.The percentage of the free-serum PSA([FPSA]/total-serum PSA[TPSA],F/T),PSA density(PSAD)and the sensitivity and specificity of the new PSA modified parameter(F/T)/PSAD in diagnosing PCA,within a set threshold value,was compared. RESULTS In the 88 patients with serum PSA in the grey zone of 4.0-10.0 ng/ml,there was no significant difference in comparing the TPSA between the 21 PCA patients and 67 BPH patients(P>0.05).However, there was a significant difference in the value of modified PSA parameters, such as F/T,PSAD and(F/T)/PSAD,between the PCA and the BPH groups (P<0.001).As the cut off point-value of the F/T,PSAD and(F/T)/PSAD was set at 0.16,0.15 and 0.8,the diagnostic sensitivity for PCA was 66.7%, 76.2%and 85.7%,and the specificity was 41.8%,43.3%and 68.7%,respectively.There was no significant difference in the sensitivity comparing the modified parameters for diagnosing PCA(P>0.05),whereas an overt predominance was present in the specificity of(F/T)/PSAD for PCAdiagnosis (P<0.05). CONCLUSION In the serum PSA grey zone of 4-10 ng/ml,a modified PSA parameter can improve the PCA diagnostic accuracy rate.With a considerably high sensitivity,application of the(F/T)/PSAD may effectively enhance the diagnostic specificity,which is superior to the F/T and PSAD, and can be expected to be one of the new indices derived from the 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 performed this study to investigate the diagnostic performance of prostate-specific antigen density(PSAD)in a multicenter cohort of the Chinese Prostate Cancer Consortium.Outpatients with prostate-specific antigen(...We performed this study to investigate the diagnostic performance of prostate-specific antigen density(PSAD)in a multicenter cohort of the Chinese Prostate Cancer Consortium.Outpatients with prostate-specific antigen(PSA)levels≥4.0 ng ml^(-1) regardless of digital rectal examination(DRE)results or PSA levels<4.0 ng ml^(-1)and abnormal DRE results were included from 18 large referral hospitals in China.The diagnostic performance of PSAD and the sensitivity and specificity for the diagnosis of prostate cancer(PCa)and high-grade prostate cancer(HGPCa)at different cutoff values were evaluated.A total of 5220 patients were included in the study,and 2014(38.6%)of them were diagnosed with PCa.In patients with PSA levels ranging from 4.0 to 10.0 ng ml^(-1),PSAD was associated with PCa and HGPCa in both univariate(odds ratio[OR]=45.15,P<0.0001 and OR=25.38,P<0.0001,respectively)and multivariate analyses(OR=52.55,P<0.0001 and OR=26.05,P<0.0001,respectively).The areas under the receiver operating characteristic curves(AUCs)of PSAD in predicting PCa and HGPCa were 0.627 and 0.630,respectively.With the PSAD cutoff of 0.10 ng ml^(-2),we obtained a sensitivity of 88.7%for PCa,and nearly all(89.9%)HGPCa cases could be detected and biopsies could be avoided in 20.2%of the patients(359/1776 cases).Among these patients who avoided biopsies,only 30 cases had HGPCa.We recommend 0.10 ng ml^(-2) as the proper cutoff value of PSAD,which will obtain a sensitivity of nearly 90%for both PCa and HGPCa.The results of this study should be validated in prospective,population-based multicenter studies.展开更多
文摘BACKGROUND Prostate cancer is the second most common cancer among men worldwide,and prostate-specific antigen(PSA)is often used in clinical practice to screen for prostate cancer.Normal total PSA(tPSA)level initially excludes prostate cancer.Here,we report a case of prostate cancer with elevated free PSA density(fPSAD).CASE SUMMARY A patient diagnosed with benign prostatic hyperplasia underwent prostatectomy,and the postoperative pathological results showed acinar adenocarcinoma of the prostate.The patient is currently undergoing endocrine chemotherapy.CONCLUSION We provide a clinical reference for diagnosis and treatment of patients with normal tPSA but elevated fPSAD.
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supported by the National Natural Science Foundation of China(grant No.81974099,82170785,81974098,82170784)programs from Science and Technology Department of Sichuan Province(grant No.21GJHZ0246)+2 种基金Young Investigator Award of Sichuan University 2017(grant No.2017SCU04A17)Technology Innovation Research and Development Project of Chengdu Science and Technology Bureau(No.2019-YF05-00296-SN)Sichuan University-Panzhihua science and technology cooperation special fund(No.2020CDPZH-4).
文摘This study aimed to assess the role of prostate-specific antigen density(PSAD)and negative multiparametric magnetic resonance imaging(mpMRI)in predicting prostate cancer for biopsy-naive men based on a large cohort of the Chinese population.From a prostate biopsy database between March 2017 and July 2021,we retrospectively identified 240 biopsy-naive patients with negative prebiopsy mpMRI(Prostate Imaging Reporting and Data System version 2[PI-RADS v2]score<3).Logistic regression analysis was performed to select the potential predictors for clinically significant prostate cancer(csPCa).Receiver operating characteristic(ROC)curve analysis and area under the ROC curve(AUC)were performed to assess the diagnostic accuracy.The negative predictive values of mpMRI in excluding any cancer and csPCa were 83.8%(201/240)and 90.8%(218/240),respectively.R0C curve analysis indicated that PSAD was the most promising predictor,with an AUC value of 0.786(95%confidence interval[CI]:0.699-0.874),and multiparametric logistic regression analysis confirmed that higher PSAD remained a significant marker for predicting csPCa(odds ratio[0R]:10.99,95%CI:2.75-44.02,P<0.001).Combining negative mpMRI and PSAD below 0.20 ng ml^(-2)obviously increased the predictive value in excluding PCa(91.0%,101/111)or csPCa(100.0%,111/111).If a PSAD below 0.20 ng ml^(-2)was set as the criterion to omit biopsy,nearly 46.3%of patients(463 per 1000)with negative mpMRI could safely avoid unnecessary biopsy,with approximately 4.2%of patients(42 per 1000)at risk of missed diagnosis of PCa and no patients with csPCa missed.A PI-RADS v2 score<3 and a PSAD<0.20 ng ml^(-2)could be potential criteria for the Chinese population to omit prompt biopsy safely.
文摘OBJECTIVE To investigate the diagnostic value of modified prostate specific antigen(PSA)parameters in the diagnosis of prostate cancer(PCA) when the serum PSAis in a grey zone of 4~10 ng/ml. METHODS The results of serum PSA determinations of the patients receiving a transrectal ultrasound-guided multiphase prostatic biopsy,were retrospectively analyzed.In the 88 patients with a serum PSA value of 4-10 ng/ml,the final diagnosis of PCA was made in 21,and that of benign prostate hyperplasia(BPH)in 67 patients.The percentage of the free-serum PSA([FPSA]/total-serum PSA[TPSA],F/T),PSA density(PSAD)and the sensitivity and specificity of the new PSA modified parameter(F/T)/PSAD in diagnosing PCA,within a set threshold value,was compared. RESULTS In the 88 patients with serum PSA in the grey zone of 4.0-10.0 ng/ml,there was no significant difference in comparing the TPSA between the 21 PCA patients and 67 BPH patients(P>0.05).However, there was a significant difference in the value of modified PSA parameters, such as F/T,PSAD and(F/T)/PSAD,between the PCA and the BPH groups (P<0.001).As the cut off point-value of the F/T,PSAD and(F/T)/PSAD was set at 0.16,0.15 and 0.8,the diagnostic sensitivity for PCA was 66.7%, 76.2%and 85.7%,and the specificity was 41.8%,43.3%and 68.7%,respectively.There was no significant difference in the sensitivity comparing the modified parameters for diagnosing PCA(P>0.05),whereas an overt predominance was present in the specificity of(F/T)/PSAD for PCAdiagnosis (P<0.05). CONCLUSION In the serum PSA grey zone of 4-10 ng/ml,a modified PSA parameter can improve the PCA diagnostic accuracy rate.With a considerably high sensitivity,application of the(F/T)/PSAD may effectively enhance the diagnostic specificity,which is superior to the F/T and PSAD, and can be expected to be one of the new indices derived from the 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.
基金for National Natural Science Foundation Youth Project(No.81702514 to RC).
文摘We performed this study to investigate the diagnostic performance of prostate-specific antigen density(PSAD)in a multicenter cohort of the Chinese Prostate Cancer Consortium.Outpatients with prostate-specific antigen(PSA)levels≥4.0 ng ml^(-1) regardless of digital rectal examination(DRE)results or PSA levels<4.0 ng ml^(-1)and abnormal DRE results were included from 18 large referral hospitals in China.The diagnostic performance of PSAD and the sensitivity and specificity for the diagnosis of prostate cancer(PCa)and high-grade prostate cancer(HGPCa)at different cutoff values were evaluated.A total of 5220 patients were included in the study,and 2014(38.6%)of them were diagnosed with PCa.In patients with PSA levels ranging from 4.0 to 10.0 ng ml^(-1),PSAD was associated with PCa and HGPCa in both univariate(odds ratio[OR]=45.15,P<0.0001 and OR=25.38,P<0.0001,respectively)and multivariate analyses(OR=52.55,P<0.0001 and OR=26.05,P<0.0001,respectively).The areas under the receiver operating characteristic curves(AUCs)of PSAD in predicting PCa and HGPCa were 0.627 and 0.630,respectively.With the PSAD cutoff of 0.10 ng ml^(-2),we obtained a sensitivity of 88.7%for PCa,and nearly all(89.9%)HGPCa cases could be detected and biopsies could be avoided in 20.2%of the patients(359/1776 cases).Among these patients who avoided biopsies,only 30 cases had HGPCa.We recommend 0.10 ng ml^(-2) as the proper cutoff value of PSAD,which will obtain a sensitivity of nearly 90%for both PCa and HGPCa.The results of this study should be validated in prospective,population-based multicenter studies.
