Incidence of insignificant prostate cancer using free/total PSA: results of a case-finding protocol on 14 453 patients

Abstract

To evaluate prostate cancer (PCa) detection and incidence of pathologically insignificant PCa (pIPCa) tumour using percent-free PSA (%f-PSA) in patients with total PSA p10 ng ml À1 . From February 2002 to October 2009, 14 453 patients (median 60.5 years) were enrolled in a case-finding protocol for the early diagnosis of PCa. Indications to biopsy were suspicious digital rectal examination; PSA 410 ng ml À1 ; PSAp2.5 ng ml À1 , included between 2.6-4 and 4.1-10 ng ml À1 with %f-PSA o15, o20 and o25%, respectively. A median of 18 and 26 cores in case of primary and repeated biopsy were determined; 2123 men underwent prostate biopsy, of whom 1589 (74.8%) had a PSA p10 ng ml À1 . A PCa was found in 777 (36.6%) and in 35 (23.3%) patients at primary and repeated biopsy: 459 and 26 men had PSA p10 ng ml À1 and 419 and 26 patients underwent surgery, respectively, 244 (58.3%) and 18 (69.2%) had an organ-confined PCa with a pIPCa incidence equal to 1.4 and 7.7%, respectively. Cancer detection rate of 28.8% in patients with PSA p10 ng ml À1 associated with a low incidence of pIPCa should induce to introduce %f-PSA in screening programmes to reduce the risk of overdiagnosis.

Morbidity After Transperineal Prostate Biopsy in 3000 Patients Undergoing 12 vs 18 vs More Than 24 Needle Cores

“…The patients underwent digital rectal examination (DRE), and a blood sample was taken for total and free prostate-specific antigen (PSA) assay (Roche Diagnostics, Indianapolis, IN) and measurement of the PSA free-to-total (F/T) ratio. The indications for biopsy were 11 1). Prostate biopsy was performed as initial an initial procedure in 2180 patients (72.6%) and as a repeat procedure in 820 (27.4%).…”

PCA3 score and prostate cancer diagnosis at repeated saturation biopsy. Which cut-off: 20 or 35?

“…Gleason score (GS) was 6 in 26 cases (81.2%), 7 in 4 (12.5%) and 8 in 2 (6.3%). Median positive cores were 2 (range: [1][2][3][4][5][6][7][8][9][10][11][12][13][14] with the presence of either only one positive Diagnostic accuracy, sensitivity, specificity, PPV and NPV of PCA3 score cut-off of 20 vs 35 are listed in Table-1. ROC analysis demonstrated an AUC for PCA3 ≥ 20 vs PCA3 ≥ 35 of 0.678 and 0.634, respectively.…”

“…The 118 patients were selected from a case-finding protocol for PCa detection (12) and had one single previous negative biopsy. The indications for repeated biopsy were: persistently high or increasing PSA values; PSA > 10 ng/mL, PSA values between 4.1-10 or 2.6-4 ng/mL with free/total PSA ≤ 25% and ≤ 20%, respectively.…”

Detection Rate of Anterior Prostate Cancer in 226 Patients Submitted to Initial and Repeat Transperineal Biopsy

“…From January 2013 to August 2013, 226 consecutive patients, all of Caucasian origin and aged 47-75 years (median 64 years), underwent initial (144 cases) and repeat (82 cases) prostate biopsy; all of the men had negative digital rectal examination and the indications for biopsy were [9]: PSA >10 ng/ml, PSA 4.1-10.0 or 2.6- 4.0 ng/ml with free/total PSA ≤25% and ≤20%, respectively. In case of initial extended biopsy and repeat saturation biopsy, a median of 22 (range 21-23) and 32 (range 26-40) cores were performed: 9 (extended biopsy) versus 12 cores (saturation biopsy) in the peripheral zone (PZ) of each lobe (apex, median zone and base of the gland), beginning parasagittally to reach the outer edges of the gland (lateral margins); in addition, 4 cores of the AZ and 4 cores of the AZ plus 2 cores of the transition zone (TZ) were performed at initial and repeat biopsy, respectively (fig.…”