Can one blood draw replace transrectal ultrasonography‐estimated prostate volume to predict prostate cancer risk?

Abstract

OBJECTIVE To explore whether a panel of kallikrein markers in blood: total, free and intact prostate-specific antigen (PSA) and kallikrein-related peptidase 2, could be used as a non-invasive alternative for predicting prostate cancer on biopsy in a screening setting. SUBJECTS AND METHODS The study cohort comprised previously unscreened men who underwent sextant biopsy owing to elevated PSA (≥ 3ng/mL) in two different centres of the European Randomized Study of Screening for Prostate Cancer, Rotterdam (n=2914) and Göteborg (n=740). A statistical model, based on kallikrein markers, was compared with one based on established clinical factors for the prediction of biopsy outcome. RESULTS The clinical tests were found to be no better than blood markers, with an area under the curve in favour of the blood measurements of 0.766 vs. 0.763 in Rotterdam and 0.809 vs. 0.774 in Göteborg. Adding digital rectal examination (DRE) or DRE plus transrectal ultrasonography (TRUS) volume to the markers improved discrimination, although the increases were small. Results were similar for predicting high grade cancer. There was a strong correlation between the blood measurements and TRUS-estimated prostate volume (Spearman’s correlation 0.60 in Rotterdam and 0.57 in Göteborg). CONCLUSIONS In previously unscreened men, each with indication for biopsy, a statistical model based on kallikrein levels was similar to a clinical model in predicting prostate cancer in a screening setting, outside the day-to-day clinical practice. Whether a clinical approach can be replaced by laboratory analyses or used in combination with decision models (nomograms) is a clinical judgment that may vary from clinician to clinician depending on how they weigh the different advantages and disadvantages (harms, costs, time, invasiveness) of both approaches.

Evaluation of Prostate-Specific Antigen Isoform p2PSA and Its Derivates, %p2PSA, Prostate Health Index and Prostate Dimension-Adjusted Related Index in the Detection of Prostate Cancer at First Biopsy: An Exploratory, Prospective Study

“…Serum PSA level increases with the size of the prostate and with age; thus, serum PSA level is strongly related to volume in men with BPH and no evidence of PCa. At first evaluation of a patient, besides PSA and DRE, PV has an influence in PSA values and in the prediction of PCa [20,21], and therefore PV-adjusted PSA-related indices to predict the probability of PCa may be useful to distinguish between men with and without cancer. At univariate analysis, PV was statistically different between patients with PCa versus patients without PCa; it positively correlated with %fPSA and negatively with %p2PSA and PHI, i.e.…”

Prostate Cancer Detection and Prognosis: From Prostate Specific Antigen (PSA) to Exosomal Biomarkers

“…However, according to results published by Carlsson et al [33], prostate volume is not affecting the performance of a 4-kallicrein panel in PCa detection. This group studied these biomarkers in two cohorts of 2914 and 740 patients with PSA ≥3 μg/L.…”

Digital rectal examination can detect early prostate cancer

“…To measure the size of the prostate a TRUS is recommended, but as this is an invasive procedure it is not available at GP practices. Therefore, it is suggested to use additional biomarkers 5. A rough estimate of prostate volume during DRE can also increase predictive capability considerably 6.…”