Prostate Cancer Early Detection, Version 1.2014

Carroll, Peter R.; Parsons, J. Kellogg; Andriole, Gerald L.; Bahnson, Robert R.; Barocas, Daniel A.; Catàlona, William J.; Dahl, Douglas M.; Davis, John W.; Epstein, Jonathan I.; Etzioni, Ruth; Giri, Veda N.; Hemstreet, George P.; Kawachi, Mark H.; Lange, Paul H.; Loughlin, Kevin R.; Lowrance, William T.; Maroni, Paul; Mohler, James L.; Morgan, Todd M.; Nadler, Robert B.; Poch, Michael; Scales, Chuck; Shanefelt, Terrence M.; Vickers, Andrew; Wake, Robert; Shead, Dorothy A.; Ho, Maria M.

doi:10.6004/jnccn.2014.0120

Cited by 91 publications

(52 citation statements)

References 34 publications

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“…Again, this may be because PHI is intended for use only in patients with a negative DRE. PHI-values between 35–40 had better properties as illustrated by given example of PHI=39 (Figure 3, Table 3), also being in line with recent guidelines from the National Comprehensive Cancer Network[25]. …”

Section: Discussionsupporting

confidence: 85%

Comparison Between the Four-kallikrein Panel and Prostate Health Index for Predicting Prostate Cancer

et al. 2015

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BACKGROUND The four-kallikrein panel and the Prostate Health Index (PHI) have been shown to improve prediction of prostate cancer compared to prostate-specific antigen (PSA). No comparison between the four-kallikrein panel and PHI has been presented. OBJECTIVE To compare the four-kallikrein panel to PHI for predicting prostate cancer in an independent cohort. DESIGN, SETTING AND PARTICIPANTS Participants were from a population-based cohort of PSA-tested men in Stockholm County. We included men (n=531) with PSA 3–15 ng/ml undergoing first-time prostate biopsy during 2010–2012. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Models were fitted to case status. We computed calibration curves, the area under the receiver-operating characteristics curve (AUC), decision curves, and percent saved biopsies. RESULTS AND LIMITATIONS The four-kallikrein panel showed AUCs of 69.0 when predicting any-grade prostate cancer and 71.8 when predicting high-grade cancer (≥Gleason 7). Similar values were found for PHI: 70.4 and 71.1, respectively. Both models had higher AUC than a base model with PSA and age (p<0.0001 for both); differences between models were not significant. Sensitivity analyses including men with any PSA or a previous biopsy did not materially affect our findings. Using 10% predicted risk of high-grade prostate cancer by the four- kallikrein panel or PHI=39 as cutoff for biopsy saves 29% of performed biopsies to the cost of delayed diagnosis for 10% of the men with high-grade cancers. Both models showed limited net benefit in decision analysis. The main study limitation was lack of digital rectal examination data and biopsy decision being based on PSA information. CONCLUSIONS The four-kallikrein panel and PHI similarly improved discrimination when predicting prostate cancer and high-grade prostate cancer. Both are simple blood tests that can reduce the number of unnecessary biopsies compared to screening with total PSA, representing an important new option to reduce harm.

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Section: Discussionsupporting

confidence: 85%

Comparison Between the Four-kallikrein Panel and Prostate Health Index for Predicting Prostate Cancer

et al. 2015

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“…The NCCN guidelines for the early detection of prostate cancer recommend an initial PSA at age 45 that can then be used to stratify screening intensity. 39 …”

Section: The Way Forward: Improved Risk Stratification and Active Surmentioning

confidence: 99%

Gleason 6 Prostate Cancer: Translating Biology into Population Health

Eggener¹,

Badani²,

Barocas³

et al. 2015

Journal of Urology

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Purpose Gleason 6 (3+3) is the most commonly diagnosed prostate cancer among men with prostate specific antigen screening, the most histologically well differentiated and is associated with the most favorable prognosis. Despite its prevalence, considerable debate exists regarding the genetic features, clinical significance, natural history, metastatic potential and optimal management. Materials and Methods Members of the Young Urologic Oncologists in the Society of Urologic Oncology cooperated in a comprehensive search of the peer reviewed English medical literature on Gleason 6 prostate cancer, specifically focusing on the history of the Gleason scoring system, histological features, clinical characteristics, practice patterns and outcomes. Results The Gleason scoring system was devised in the early 1960s, widely adopted by 1987 and revised in 2005 with a more restrictive definition of Gleason 6 disease. There is near consensus that Gleason 6 meets pathological definitions of cancer, but controversy about whether it meets commonly accepted molecular and genetic criteria of cancer. Multiple clinical series suggest that the metastatic potential of contemporary Gleason 6 disease is negligible but not zero. Population based studies in the U.S. suggest that more than 90% of men newly diagnosed with prostate cancer undergo treatment and are exposed to the risk of morbidity for a cancer unlikely to cause symptoms or decrease life expectancy. Efforts have been proposed to minimize the number of men diagnosed with or treated for Gleason 6 prostate cancer. These include modifications to prostate specific antigen based screening strategies such as targeting high risk populations, decreasing the frequency of screening, recommending screening cessation, incorporating remaining life expectancy estimates, using shared decision making and novel biomarkers, and eliminating prostate specific antigen screening entirely. Large nonrandomized and randomized studies have shown that active surveillance is an effective management strategy for men with Gleason 6 disease. Active surveillance dramatically reduces the number of men undergoing treatment without apparent compromise of cancer related outcomes. Conclusions The definition and clinical relevance of Gleason 6 prostate cancer have changed substantially since its introduction nearly 50 years ago. A high proportion of screen detected cancers are Gleason 6 and the metastatic potential is negligible. Dramatically reducing the diagnosis and treatment of Gleason 6 disease is likely to have a favorable impact on the net benefit of prostate cancer screening.

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“…By contrast, the 2014 National Comprehensive Cancer Network (NCCN) guidelines suggest a cutoff value of 3 ng/ml in association with percentage free PSA (fPSA) and PSA kinetics in PB decision-making [6]. Moreover, risk calculators can be used and predictive models such as nomograms that include more variables have been developed to improve the ability to counsel patients on the need for PB [7,8].…”

Section: Indicationsmentioning

confidence: 91%

“…Moreover, risk calculators can be used and predictive models such as nomograms that include more variables have been developed to improve the ability to counsel patients on the need for PB [7,8]. Since they have not been tested in randomized controlled trials (RCTs), the cut-point for risk associated with a reduction in PCa mortality remains unknown [6].…”

Section: Indicationsmentioning

confidence: 99%