Free prostate-specific antigen improves prostate cancer detection in a high-risk population of men with a normal total PSA and digitalrectal examination

Uzzo, Robert G.; Pinover, Wayne H.; Horwitz, Eric M.; Parlanti, Alicia; Mazzoni, Susan; Raysor, Susan; Mirchandani, I. L. A.; Greenberg, Richard E.; Pollack, Alan; Hanks, Gerald E.; Bruner, Deborah Watkins

doi:10.1016/s0090-4295(02)02524-4

Cited by 30 publications

(24 citation statements)

References 27 publications

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“…However, several issues remain regarding the optimal PSA level at which to recommend prostate biopsies in order to detect PCA as well as not to subject these men to unnecessary biopsies. High-risk men have been found to have PCA detected at low PSA values, even less than 2.5 ng/mL (5, 6). Determining which high-risk men should have prostate biopsies at low PSA values is crucial to early detection and avoiding unnecessary biopsies.…”

Section: Introductionmentioning

confidence: 99%

Race, Genetic West African Ancestry, and Prostate Cancer Prediction by Prostate-Specific Antigen in Prospectively Screened High-Risk Men

Giri

Egleston

Ruth

et al. 2009

Cancer Prevention Research

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Abstract"Race-specific" prostate-specific antigen (PSA) needs evaluation in men at high risk for prostate cancer for optimizing early detection. Baseline PSA and longitudinal prediction for prostate cancer were examined by self-reported race and genetic West African (WA) ancestry in the Prostate Cancer Risk Assessment Program, a prospective high-risk cohort. Eligibility criteria were age 35 to 69 years, family history of prostate cancer, African American race, or BRCA1/2 mutations. Biopsies were done at low PSA values (<4.0 ng/mL). WA ancestry was discerned by genotyping 100 ancestry informative markers. Cox proportional hazards models evaluated baseline PSA, self-reported race, and genetic WA ancestry. Cox models were used for 3-year predictions for prostate cancer. Six hundred forty-six men (63% African American) were analyzed. Individual WA ancestry estimates varied widely among self-reported African American men. Race-specific differences in baseline PSA were not found by self-reported race or genetic WA ancestry. Among men with ≥1 follow-up visit (405 total, 54% African American), 3-year prediction for prostate cancer with a PSA of 1.5 to 4.0 ng/mL was higher in African American men with age in the model (P = 0.025) compared with European American men. Hazard ratios of PSA for prostate cancer were also higher by self-reported race (1.59 for African American versus 1.32 for European American, P = 0.04). There was a trend for increasing prediction for prostate cancer with increasing genetic WA ancestry. "Race-specific" PSA may need to be redefined as higher prediction for prostate cancer at any given PSA in African American men. Large-scale studies are needed to confirm if genetic WA ancestry explains these findings to make progress in personalizing prostate cancer early detection.

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Section: Introductionmentioning

confidence: 99%

Race, Genetic West African Ancestry, and Prostate Cancer Prediction by Prostate-Specific Antigen in Prospectively Screened High-Risk Men

Giri

Egleston

Ruth

et al. 2009

Cancer Prevention Research

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“…On the global scale it is the third most common cancer in men (Grönberg, 2003). Since no effective cures are available for the advanced metastatic stage of prostate cancer, early detection of the tumors is cru-2.6 and 10 ng/ml, the ratio of free PSA to the total PSA concentration in the serum should be determined to arrive at a reliable prostate cancer diagnosis (Overmyer, 1998;Uzzo et al, 2003). The discrimination of total and free PSA concentrations is currently achieved with specific polyclonal or monoclonal antibodies labeled with an enzymatic, fluorometric, or radioactive marker (Armbruster, 1993;Cattini et al, 1993;Khosravi et al, 1995;Klee et al, 1994;Oesterling et al, 1995;Vihko et al, 1990;Yu and Diamandis, 1993).…”

Section: Introductionmentioning

confidence: 99%

Prostate-specific antigen immunosensing based on mixed self-assembled monolayers, camel antibodies and colloidal gold enhanced sandwich assays

Huang

Reekmans

Saerens

et al. 2005

Biosensors and Bioelectronics

207

113

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“…3 Another study of men at higher risk for prostate cancer (African American or a first-degree relative with prostate cancer) found that 32% of men with a normal DRE and a total PSA value between 2 and 4 ng/mL with percent free PSA values <27% had prostate cancer. 12 These studies suggest that free PSA may be useful even when total PSA is outside the range of 4 to 10 ng/mL.…”

Section: Discussionmentioning

confidence: 94%

“…7 Other studies have suggested different optimal total PSA ranges for which free PSA should be used, as well as different optimal percent free PSA cutoffs. 2,4,5,6,7,12 At the University Health Network in Toronto, a total PSA in the range of 4 to 10 ng/mL prompts a reflexive free PSA measurement.…”

Section: Discussionmentioning

confidence: 99%

Does the reflexive measurement of free PSA have a role in a tertiary cancer centre?

Allard

Yip

Blasutig

et al. 2013

CUAJ

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Purpose: The percent free prostate-specific antigen (PSA) may complement total PSA for prostate cancer screening, but is of no benefit for monitoring patients with previous prostate cancer diagnoses. At the Princess Margaret Hospital, a tertiary cancer centre in Toronto, Ontario, Canada, PSA values in the range 4 to 10 ng/mL prompt reflexive measurements of free PSA. We hypothesize that reflexive free PSA testing at tertiary cancer centres generates unnecessary costs as the test is often conducted on patients with previous diagnoses of prostate cancer. Materials and Methods:We reviewed all reflexive free PSA measurements conducted on a random sample of 250 men in a 10-year period at our institution. We determined the clinical indications for the PSA tests which triggered reflexive free PSA measurements to estimate the proportion of free PSA tests that are not clinically indicated. Results:We reviewed the 1099 reflexive free PSA measurements for the 250 subjects. Of these tests, 562 (51%) were triggered by PSA tests ordered for screening/early detection, and 537 (49%) for monitoring. Conclusions: Of all reflexive free PSA tests, 49% were unnecessary. We conducted 3022 free PSA tests, at a cost of $5.84 per test (Can$); the tests were performed in 2009 at this institution for a total cost of $17 648.48, about 49% of which ($8647.76) likely represents unnecessary annual costs. We suggest a trial of userselectable order sets allowing physicians to choose whether to include reflexive free PSA measurements on a case-by-case basis. This policy might improve the cost-effectiveness of the PSA test at tertiary cancer centres.Can Urol Assoc J 2010;4(5):317-320 RésuméObjectif : Le pourcentage d'antigène prostatique spécifique (APS) libre peut compléter la mesure de l'APS total dans le dépistage du cancer de la prostate, mais il n'est d'aucune utilité pour la surveillance de patients ayant déjà reçu un diagnostic de cancer de la prostate. À l'hôpital Princess Margaret, un centre de soins oncologiques tertiaires de Toronto, en Ontario (Canada), un taux d'APS se situant entre 4 et 10 ng/mL entraîne systématiquement une évaluation des taux d'APS libre. Nous avançons l'hypothèse que la mesure de l'APS libre dans les centres de soins oncologiques tertiaires entraîne des dépenses inutiles car ce test est souvent mené chez des patients ayant déjà reçu un diagnostic de cancer de la prostate.

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Free prostate-specific antigen improves prostate cancer detection in a high-risk population of men with a normal total PSA and digitalrectal examination

Cited by 30 publications

References 27 publications

Race, Genetic West African Ancestry, and Prostate Cancer Prediction by Prostate-Specific Antigen in Prospectively Screened High-Risk Men

Race, Genetic West African Ancestry, and Prostate Cancer Prediction by Prostate-Specific Antigen in Prospectively Screened High-Risk Men

Prostate-specific antigen immunosensing based on mixed self-assembled monolayers, camel antibodies and colloidal gold enhanced sandwich assays

Does the reflexive measurement of free PSA have a role in a tertiary cancer centre?

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