Prostate Specific Antigen Density as a Predictor of Clinically Significant Prostate Cancer When the Prostate Specific Antigen is in the Diagnostic Gray Zone: Defining the Optimum Cutoff Point Stratified by Race and Body Mass Index

被引:60
作者
Aminsharifi, Alireza [1 ,5 ]
Howard, Lauren
Wu, Yuan [1 ,2 ]
De Hoedt, Amanda [3 ]
Bailey, Charlotte [3 ]
Freedland, Stephen J. [3 ,4 ]
Polascik, Thomas J. [1 ,3 ]
机构
[1] Duke Canc Inst, Durham, NC USA
[2] Duke Univ, Sch Med, Dept Biostat & Bioinformat, Durham, NC USA
[3] Durham Vet Affairs Med Ctr, Durham, NC USA
[4] Cedars Sinai Med Ctr, Ctr Integrated Res Canc & Lifestyle, Los Angeles, CA 90048 USA
[5] Shiraz Univ Med Sci, Dept Urol, Shiraz, Iran
关键词
prostatic neoplasms; prostate-specific antigen; biopsy; African continental ancestry group; body mass index; PSA DENSITY; ACTIVE SURVEILLANCE; RISK CALCULATOR; BIOPSY; VOLUME; MEN; ALGORITHM; CARCINOMA; RANGE;
D O I
10.1016/j.juro.2018.05.016
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose: We assessed the predictive value of prostate specific antigen density to detect clinically significant prostate cancer, defined as prostate cancer grade group 2 or greater, in a series of men undergoing prostate biopsy with prostate specific antigen 4 to 10 ng/ml. We sought to define an optimum cutoff point for prostate specific antigen density and assess how race and body mass index affects prostate specific antigen density performance. Materials and Methods: We analyzed data on 2,162 men, of whom 56% were African American, with serum prostate specific antigen 4 to 10 ng/ml who underwent prostate biopsy. We compared the AUC between prostate specific antigen and prostate specific antigen density to predict clinically significant and any prostate cancer vs no cancer. We calculated the negative predictive value of prostate specific antigen density cutoff points ranging from 0.05 to 0.15 by every 0.01 step. We a priori defined the optimal cutoff point of prostate specific antigen density as a negative predictive value of 95% and tested whether the cutoff was sensitive to body mass index and race by comparing the negative predictive value across strata. Results: Median prostate specific antigen was 5.6 ng/ml (IQR 4.8-7) and median prostate specific antigen density was 0.15 ng/ml/cc (IQR 0.1-0.22). Prostate specific antigen density improved the performance of prostate specific antigen to detect significant cancer (AUC 0.58 to 0.68) and any cancer (AUC 0.55 to 0.69, each p<0.001). We identified a prostate specific antigen density cutoff point of less than 0.08 ng/ml/cc with a 96% negative predictive value for grade group 2 or greater. This was largely unchanged among different races and body mass indexes. Conclusions: Regardless of race or body mass index men with prostate specific antigen density less than 0.08 were unlikely to harbor grade group 2 or greater disease when prostate specific antigen was 4 to 10 ng/ml. If validated, prostate specific antigen density is a simple inexpensive and available tool that can be used to identify men who can likely forego prostate biopsies, thus reducing the over detection and morbidity of unnecessary biopsies.
引用
收藏
页码:758 / 764
页数:7
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