How accurate is our prediction of biopsy outcome? PCA3-based nomograms in personalized diagnosis of prostate cancer

Central European Journal of Urology 09/2012; 65(3):110-112. DOI: 10.5173/ceju.2012.03.art1
Source: PubMed


The sensitivity and specificity of prostate-specific antigen (PSA) alone to select men for prostate biopsy remain suboptimal. This review aims at presenting a review of current prostate cancer (PCa) nomograms that incorporate Prostate Cancer Gene 3 (PCA3), which was designed to outperform PSA at predicting biopsy outcome.
The PubMed database and current literature search was conducted for reports on PCA3-based nomograms and tools for examining the risk of a positive prostate biopsy in a man without a known PCa diagnosis.
The introduction of PCA3 into clinical practice has led to the development of a set of PCA3-based nomograms to predict biopsy outcome. Combining PCA3 results with established PCa risk factors has produced significant improvements over PSA alone in predicting the risk of a positive prostate biopsy for cancer.

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Available from: Jack Schalken, Apr 13, 2015
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    • "Postoperative specimens were assessed by one of two pathologists, which allows for an interobserver variability. In that time, we also did not use nomograms to predict IncPCa diagnosis and patients with previous negative TRUScoreBx did not have PCA3 test; both of which are considered to improve PCa diagnosis [19]. Finally, a small number of cases with IncPCa influenced the statistical results. "
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    ABSTRACT: Introduction In some patients submitted to transurethral resection of the prostatic (TURP) or prostatectomy (OAE) due to benign prostate hyperplasia (BPH), pathological evaluations (PE) revealed coexistence of prostate cancer (PCa) and BPH. The aim of the study is to evaluate the incidence of PCa diagnosed incidentally in prostate specimens taken during BPH surgery, to assess the need of routine PE and to define the group of patients in whom PE could be abandoned without the risk of omitting clinically significant PCa. Material and methods 968 consecutive men were subjected to surgical treatment due to BPH in Jan. 2004–Sep. 2010. Results 823 (85%) underwent TURP and 145 (15%) OAE. Incidental (Inc) PCa was diagnosed in 34(3.5%) pts. T1a and T1b stages were determined in 19 (2%) and 15 (1.5%) cases. Preoperative prostate biopsy due to abnormal prostate specific antigen (PSA) or digital rectal exam (DRE) was performed in 85 (8.8%) pts. Of PCa pts, 7 (20.58%) had undergone a cancer negative biopsy preoperatively. In BPH pts, 78 (8.35%) had undergone a prostate biopsy previously (p <0.01). Univariate and logit regression analyses had not revealed any correlations between age, Pv, serum PSA and frequency of IncPCa. The difference in rate of PCa diagnosed in patients with PSAD ≥0.15 and <0.15 was 8 pts (14.04%) and 20 pts (4.05%), respectively (p <0.001). Gls in those pts was >6 only in 4 cases. Conclusions Despite the fact of low PCa detection rate observed in our study, this condition was clinically relevant in 15 (1.5%) subjects. It is difficult to establish any cut off values of pts’ age, Pv, serum PSA level suggestive of negligible risk for prostate cancer.
    08/2014; 67(3):227-32. DOI:10.5173/ceju.2014.03.art2
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    • "Prostate cancer (PCa) is one of the most commonly diagnosed neoplasms in elderly men. In Western Europe and the USA, it is the most frequent malignant neoplasm in men and accounts for 30% of all newly diagnoses cases [1, 2]. "
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    ABSTRACT: Introduction: Prostate cancer (PCa) is one of the most commonly diagnosed neoplasms in elderly men. The precancerous lesion of PCa is considered a high-grade prostate intraepithelial neoplasm (HG-PIN), while atypical small acinar proliferation (ASAP) is commonly considered as an under-diagnosed cancer. The aim of the study was to establish the impact of ASAP and extensive HG-PIN on pre-biopsy prostate-specific antigen (PSA) levels and the risk of cancer development in subsequent biopseis. Material and methods: The 1,010 men suspected for PCa were included in the study based on elevated PSA, and/or positive rectal examination. Transrectal ultrasound (TRUS) guided 10 core biopsy was performed. In those with extensive HG-PIN or ASAP on the first biopsy, and/or elevated PSA value, a second biopsy was performed. Results: In the second biopsy, PCa was diagnosed in 6 of 19 patients (31.57%) with extensive HG-PIN, in four of 40 (10%) with BPH, and in 4 of 18 (22.22%) with ASAP. There was a statistically significant difference between the values of PSA in the group of patients with ASAP in comparison to those with benign prostate hyperplasia (BPH) (p = 0.005) as well as in patients with HG-PIN in comparison to BPH (p = 0.02). Conclusions: A precancerous lesion diagnosed upon biopsy causes a statistically significant increase in the values of PSA in relation to BPH, as well as in the case of ASAP and extensive HG-PIN. The estimate of risk of PCa diagnosis in patients with ASAP and those with extensive HG-PIN in the first biopsy is comparable, which is why there are no reasons for different treatment of patients with the above-mentioned diagnoses. Both should be subjected to urgent second biopsy in around the 4-6 weeks following the initial biopsy.
    06/2014; 67(2):136-41. DOI:10.5173/ceju.2014.02.art4
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    ABSTRACT: Historical nomograms for the prediction of cancer on prostate biopsy, developed in the sextant biopsy era are no more accurate today. The aim of this study was an independent external validation of a 10-core biopsy nomogram by Chun et al. (2007). A total of 322 patients who presented for their initial biopsy in a tertiary care center and had all the necessary data available were included in the retrospective analysis. To validate the nomogram, receiver operator characteristic (ROC) curves and calibration plots were constructed. Area under the ROC curve calculated for our data using the nomogram was 0.773, similar to that reported originally. However, the nomogram systematically overestimated prostate cancer risk, which, for our data, could be resolved by subtracting 24 points from the total number of points of the nomogram. The nomogram yielded overall good predictive accuracy as measured by the area under the ROC curve, but it systematically overestimated PC probability in individual patients. However, we showed how the nomogram could easily be adapted to our patient sample, resolving the bias issue.
    Central European Journal of Urology 08/2015; 68(2):148-52. DOI:10.5173/ceju.2015.610