Pathological outcome for Chinese patients with low-risk prostate cancer eligible for active surveillance and undergoing radical prostatectomy: comparison of six different active surveillance protocols

Tsang, Chi‐Ching; Tsu, James Hok‐Leung; Lai, Terence Ct; Wong, Kai Pun; Ho, Brian; Ng, Ada Tl; Ma, WK; Yiu, MK

doi:10.12809/hkmj166194

“…A cutoff PSAD at 0.19 ng/ml/ml with the best balance between sensitivity and specificity in identifying adverse pathological outcome was derived by the coordination points of the receiver operator characteristic curve. A PSAD of 0.085 ng/ml/ml was proposed by Ha et al 24 . This level is much lower than a PSAD of 0.15 ng/ml/ml and 0.2 ng/ml/ml used in the John Hopkins and PRIAS criteria, respectively.…”

Section: Discussionmentioning

confidence: 70%

“…Altogether, these suggested that despite the same aim to select low-risk patients for AS, there is a large variation in stringency between different protocols. It was reported that the John Hopkins and PRIAS criteria (the only protocols that take PSAD into account in their selection criteria) have the lowest incidence of adverse pathological outcome among different AS protocols 24 . Such results provided clues that PSAD may have an implication in identifying low-risk prostate cancer in AS.…”

Section: Discussionmentioning

confidence: 95%

Is prostate specific antigen (PSA) density necessary in selecting prostate cancer patients for active surveillance and what should be the cutoff in the Asian population?

Tsang

¹

,

Lai

²

,

Lam

³

et al. 2019

Prostate International

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Background To investigate the role of Prostate Specific Antigen density (PSAD) in selecting prostate cancer patients for active surveillance (AS) and to determine a cutoff PSAD in identifying adverse pathological outcomes. Methods Data from 287 patients who underwent radical prostatectomy for prostate cancer were retrospectively reviewed. Six different AS protocols, the University of Toronto; Royal Marsden; John Hopkins; University of California San Francisco (UCSF); Memorial Sloan Kettering Cancer Center (MSKCC) and Prostate Cancer Research International: Active Surveillance (PRIAS), were applied to the cohort. Pre-operative demographics and pathological outcomes were analysed. Statistical analyses on the predictive factors of adverse pathological outcomes and significance of PSAD were performed. A cutoff PSAD with best balance between sensitivity and specificity in identifying adverse pathological outcome was determined. Results PSAD predicted adverse pathological outcomes better than Prostate Specific Antigen (PSA) level alone. The PSAD was significantly lower (0.12–0.13 ng/dl/ml) in protocols including PSAD (the John Hopkins and PRIAS) compared with the other four protocols not including PSAD as a selection criteria (0.21–0.25 ng/dl/dl, P = 0.00). PSAD predicted adverse pathological outcomes in all protocols not incorporating PSAD as an inclusion criteria ( P = 0.00–0.02). By the receiver operator characteristics curve analysis, it was found that a PSAD level of 0.19 ng/ml/ml had the best balance between sensitivity and specificity in predicting pathological adverse disease (Area under curve = 0.63, P = 0.004). Conclusion PSAD is necessary in selecting prostate cancer patients for active surveillance. It predicts adverse pathological outcomes in patients eligible for active surveillance better than PSA level alone. A PSAD cutoff at 0.19 ng/ml/ml has the best balance between sensitivity and specificity in predicting pathological adverse disease. We recommend using AS protocol incorporating PSAD as a selection criteria (in particular the PRIAS protocol with a cutoff PSAD at 0.2 ng/ml/ml) when recruiting prostate cancer patients for AS.

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“…[ 51 ] These figures suggest that the prevalence of high-risk PCa is lower in the USA, the UK, and Germany than in West Africa and Asia [ Table 2 ]. [ 3 28 29 31 36 37 40 41 52 53 54 55 56 57 58 59 60 61 ] An earlier study shows that the death risk of patients with a GS of 7 to 10 range from 29% to 43%, irrespective of age. [ 62 ] This might be due to a lower prevalence of pathogenic mutation (BRCA1/2) in GS ≤ 6 (0.6%) than in GS ≥ 7 (1.2%–3.4%).…”

Section: Gleason Score Of Prostate Cancer In West Africa and Asiamentioning

confidence: 99%

High mortality risk of prostate cancer patients in Asia and West Africa: A systematic review

Okoye

¹

2020

Avicenna J Med

3

0

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Globally, prostate cancer (PCa) is the second most preponderant cancer in men. It contributes to the high mortality-to-incidence ratio reported in West Africa and Asia largely due to low screening. The mortality risk is determined or predicted based on the prevalence of high-risk or aggressive PCa using a scoring or grading system such as Gleason score (GS), Gleason grade (GG), and prostate-specific antigen (PSA) level. In this review, peer-reviewed articles found on databases such as Google Scholar, Scopus, Web of Science, PubMed Central and, EMBASE were selected based on adherence to clinical guidelines for the classification of PCa. In West Africa and Asia, the result revealed that the frequency of high-risk PCa was 42% and 51.2% based on GS, 48.8% and 25.3% based on GG pattern, and 87.5% and 44.3% based on PSA level >10 ng/mL, respectively. Data revealed a high prevalence of high-risk PCa both in West Africa and Asia when compared with developed countries. However, the prevalence of high-risk PCa is higher in West Africa than in Asia. Studies have shown that high-risk PCas are associated with germline mutations and such mutations are prevalent in blacks and Asians than in whites. Thus, testing for germline mutations in patients with GS of ≥ 7, GG ≥ 3, high prostate density, low prostate volume, and PSA levels of >4.0 ng/mL may identify those at risk of developing lethal PCa and could reduce the mortality rates in Asia and West Africa.

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“…It also shows that BPH can be found in individuals younger <40 years of age Asia [Table 2]. [3,28,29,31,36,37,40,41,[52][53][54][55][56][57][58][59][60][61] An earlier study shows that the death risk of patients with a GS of 7 to 10 range from 29% to 43%, irrespective of age. [62] This might be due to a lower prevalence of pathogenic mutation (BRCA1/2) in GS ≤ 6 (0.6%) than in GS ≥ 7 (1.2%-3.4%).…”

Section: Gleason Score Of Prostate Cancer In West Africa and Asiamentioning

confidence: 99%

Untitled

2020

Avicenna J Med

0

View full text Add to dashboard Cite

Globally, prostate cancer (PCa) is the second most preponderant cancer in men. It contributes to the high mortality-to-incidence ratio reported in West Africa and Asia largely due to low screening. The mortality risk is determined or predicted based on the prevalence of high-risk or aggressive PCa using a scoring or grading system such as Gleason score (GS), Gleason grade (GG), and prostate-specific antigen (PSA) level. In this review, peer-reviewed articles found on databases such as Google Scholar, Scopus, Web of Science, PubMed Central and, EMBASE were selected based on adherence to clinical guidelines for the classification of PCa. In West Africa and Asia, the result revealed that the frequency of high-risk PCa was 42% and 51.2% based on GS, 48.8% and 25.3% based on GG pattern, and 87.5% and 44.3% based on PSA level >10 ng/mL, respectively. Data revealed a high prevalence of high-risk PCa both in West Africa and Asia when compared with developed countries. However, the prevalence of high-risk PCa is higher in West Africa than in Asia. Studies have shown that high-risk PCas are associated with germline mutations and such mutations are prevalent in blacks and Asians than in whites. Thus, testing for germline mutations in patients with GS of ≥ 7, GG ≥ 3, high prostate density, low prostate volume, and PSA levels of >4.0 ng/mL may identify those at risk of developing lethal PCa and could reduce the mortality rates in Asia and West Africa.

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Pathological outcome for Chinese patients with low-risk prostate cancer eligible for active surveillance and undergoing radical prostatectomy: comparison of six different active surveillance protocols

Cited by 4 publications

References 18 publications

Is prostate specific antigen (PSA) density necessary in selecting prostate cancer patients for active surveillance and what should be the cutoff in the Asian population?

Is prostate specific antigen (PSA) density necessary in selecting prostate cancer patients for active surveillance and what should be the cutoff in the Asian population?

High mortality risk of prostate cancer patients in Asia and West Africa: A systematic review

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