At 90 and 95 % sensitivity, laboratory-based indices containing p2PSA, particularly phi, showed significantly greater specificity for prostate cancer as compared with %f-PSA. The diagnostic accuracy of prostate volume-adjusted p2PSA-related indices could be excellent, particularly the transition zone volume-adjusted indices at fixed sensitivities of 95 and 90%.

BACKGROUND:In the era when various treatment agents for advanced-stage prostate cancer are available, it is important to investigate overall survival for metastatic prostate cancer treated with step-up hormonal treatment as a reference against new treatment regimens, including antitumor agents and/or new hormonal derivatives, and it is desirable to explore pretreatment, biopsy-related and post-treatment prognostic factors to establish tailor-made treatment strategies. METHODS:Between 1992 and 2002, 94 patients were diagnosed with prostate cancer with distant metastases in our facility. Various pretreatment clinical findings including serum PSA, testosterone, alkaline phosphatase (ALP), digital rectal examination (DRE) and extension of disease score were investigated for predicting outcomes in step-up hormonal treatment. We also investigated the impact of pathological findings including Gleason grading, tumor volume indices, various Gleason grade 5 volume indices in biopsy specimens, and post-treatment PSA nadir following step-up hormonal treatment on overall survival. RESULTS:The 3-and 5-year overall survival was 72.4% and 62.5%, respectively. According to univariate analyses, patients with PSA p100 ng ml -1 , ALP o440 IU l -1 , T1c to T3 on DRE, extension of disease (EOD) score 0-3, no Gleason grade 5 cancer in biopsy specimens or less such cancer and good response at any stage of hormonal therapy had significantly better overall survival than did patients with alternative status. A multivariate Cox proportional hazard model revealed that PSA nadir after first-line hormonal treatment, PSA nadir after second-line treatment and Gleason grade 5 volume index were independent prognostic factors.CONCLUSIONS: Even in very advanced prostate cancer, local pathological indices, a Gleason grade 5 volume index in particular, could differentiate patients with better prognosis from worse prognosis.Step-up hormonal therapy including luteinizing hormone-releasing hormone agonist, estrogen derivatives and steroid hormones may be valuable in patients with metastatic prostate cancer, especially in good responders at any stage of hormonal therapy.

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Objective: To investigate the clinical significance of prostate-specific antigen (PSA)-related markers, including the precursor form of PSA, using the full-range area under the curve of receiver operating characteristics (AUC-ROC), partial AUC-ROC (pAUC-ROC) and multiple logistic regression analyses. Methods: Participants consisted of 257 consecutive men (PSA range 4.1-20 ng/mL) undergoing transrectal ultrasonography-guided ageadjusted and prostate volume-adjusted multiple-core prostate biopsy at Gunma University Hospital between January 2003 and May 2005. Sensitivity, specificity, AUC-ROC and pAUC-ROC of the ratio of free PSA to total PSA (free/total PSA), PSA density (PSAD) and PSAD adjusted by transition zone volume, the ratio of [-7/-5] precursor forms of PSA (proPSA) to free PSA (pro/free PSA), the ratio of pro to total PSA and the ratio of pro to free/total PSA (pro/f/t ratio) were investigated. Multiple logistic regression analyses were also carried out to investigate the independency of selected clinical parameters. Results: According to pAUC-ROC analyses, pro/free PSA and the pro/f/t ratio were the two best PSA-related parameters in terms of maintaining high sensitivity and avoiding unnecessary biopsy. Multiple regression analyses revealed that not only pro/free PSA, but also age, findings on digital rectal examination and PSAD were independent parameters for predicting biopsy outcomes. Conclusion: Pro/free PSA and pro/f/t ratio may be excellent predictive markers for prostate cancer, allowing unnecessary biopsy to be avoided while maintaining high sensitivity at 90% or 95%, in the PSA range 4-20 ng/mL.

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The lead time of screen detected cancer in our screening system is not as long as previously thought. This new methodology for lead time estimation may be useful for evaluating treatment outcomes of screen detected prostate cancer in individual screening systems done in various regions worldwide.

BACKGROUND:We previously reported the diagnostic efficacy of the age-and prostate volume-adjusted prostate biopsy method (the adjusted biopsy method). Here, we developed a new nomogram for predicting cancer probability at initial biopsy using the adjusted method. METHODS:Between 2002 and 2010, 1059 Japanese men with PSA levels between 1.1 and 40 ng ml À1 and biopsied for the first time using the adjusted method at Gunma University Hospital were enrolled. All subjects underwent digital rectal examination (DRE) and transrectal ultrasonography (TRUS). Data from the initial 849 subjects were used for development of the nomogram and those from the final 210 subjects were used for internal validation. External validation was conducted using data from two affiliated hospitals where the same adjusted biopsy method was used. The nomogram was developed through logistic regression analysis, and predictive accuracy and performance characteristics were assessed using the area under the curve (AUC) of the receiver operating characteristics and calibration plots. Furthermore, we compared the predictive accuracy of the newly developed nomogram with the 'Prostate Risk Indicator' using the development data set, as well as the two external data sets. RESULTS:The AUC of the logistic regression-based nomogram was significantly higher than those of any single clinical parameter. External validation showed significant correlations with the present model. The AUC-receiver operating characteristic of the 'Prostate Risk Indicator' was the second largest following the new nomogram using the development data set and one external data set and almost equal to the new nomogram using the other external data set.CONCLUSIONS: Nevertheless the present model does not include somewhat subjective findings on TRUS abnormality, which is necessary for the estimation by 'Prostate Risk Indicator', the predictive accuracy of the present simple nomogram could be excellent enough to contribute to accurate shared decision-making between doctors and men who are candidates for the adjusted biopsy scheme.