Prevalence and Clinical Significance of Prostate Cancer among 12,682 Men with Normal Digital Rectal Examination, Low PSA Levels (≤4 ng/ml) and Percent Free PSA Cutoff Values of 15 and 20%

Pepe, Pietro; Panella, P; Savoca, Francesco; Cacciola, Antonio; D’Arrigo, Letterio; Dibenedetto, Giuseppe; Pennisi, Michele; Aragona, Francesco

doi:10.1159/000100833

Cited by 15 publications

(11 citation statements)

References 74 publications

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“…In our series and in others, between 11 and 27% of PCAs with a PSA value between 2.5 and 4 ng/ml are high grade (Gleason score 6 7) [13][14][15] . Therefore, there is no PSA threshold able to differentiate between clinically significant and insignificant PCAs with both high sensitivity and high specificity [11,13,15] .…”

Section: Discussionsupporting

confidence: 69%

Lowering the PSA Threshold for Prostate Biopsy from 4 to 2.5 ng/ml: Influence on Cancer Characteristics and Number of Men Needed to Biopt

Müntener¹,

Kunz²,

Eichler

et al. 2010

Urol Int

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Objective: In 1999 we lowered the prostate-specific antigen (PSA) threshold for prostate biopsy at our institution from 4 to 2.5 ng/ml. The aim of this study was to compare the differences in tumor characteristics of the detected prostate cancers (PCAs) and the detection rate for the two different PSA thresholds and to evaluate if lowering the threshold was justified by any of the detected differences. Patients and Methods: We retrospectively analyzed the records of all patients who underwent an 8-core prostate biopsy between January 1999 and December 2004 and had a PSA between 2.5 and 10 ng/ml. Patients with a PSA between 2.5 and 4 ng/ml (group 1, n = 214, mean age 62.0 years) were compared to patients whose PSA was between 4 and 10 ng/ml (group 2, n = 292, mean age 63.2 years). Patients who were older than 75 years or had a suspicious rectal examination were excluded from this study. Results: Overall, we detected 120 can-cers in 506 patients (cancer yield 23.7%). The cancer yield in group 1 was significantly lower than in group 2 (17 vs. 28%, p < 0.01). In group 1 significantly less Gleason score ≧7 (p = 0.04) and significantly more potentially insignificant cancers (p = 0.03) were identified. In 80 patients who subsequently underwent radical prostatectomy, final pathology revealed no significant differences between the two PSA groups with regard to high pT stages, Gleason score ≧7 PCA or positive surgical margins, respectively. The difference in the absolute risk of being diagnosed with high-grade PCA between a PSA threshold of 2.5 ng/ml and a PSA threshold of 4 ng/ml was 1%. Conclusion: Lowering the PSA threshold for prostate biopsy from 4 to 2.5 ng/ml results in a substantial increase in the number of men who undergo biopsy and may result in an increased detection of potentially insignificant cancers. If total PSA alone is used to determine the need for prostate biopsy, the disadvantages of this lower threshold probably outweigh its potential benefits.

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Section: Discussionsupporting

confidence: 69%

Lowering the PSA Threshold for Prostate Biopsy from 4 to 2.5 ng/ml: Influence on Cancer Characteristics and Number of Men Needed to Biopt

Müntener¹,

Kunz²,

Eichler

et al. 2010

Urol Int

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“…Hence, the use of PI-RADS with multiparametric MR imaging may enable detection of clinically significant prostate cancer that could otherwise be underestimated with biopsy results. Furthermore, in a substantial number of patients with clinically significant cancer, the serum PSA level stays in the gray zone (ie, 4-10 ng/mL) or even lower (31,32). This could explain why a PI-RADS score of 4 or greater was the only significant parameter for clinically significant cancer in multivariate analysis, although all of the preoperative clinical parameters were significant in univariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Prostate Cancer: PI-RADS Version 2 Helps Preoperatively Predict Clinically Significant Cancers

et al. 2016

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Purpose To retrospectively analyze whether Prostate Imaging Reporting and Data System (PI-RADS) version 2 is helpful for the detection of clinically significant prostate cancer. Materials and Methods Institutional review board approved this retrospective study. A total of 425 patients with prostate cancer who had undergone magnetic resonance (MR) imaging and radical prostatectomy were included. Preoperative parameters such as prostate-specific antigen, biopsy Gleason score, greatest percentage of the core, percentage of the positive core number, and score at PI-RADS version 2 with MR imaging were investigated. Two independent readers performed PI-RADS scoring. Clinically significant prostate cancer was defined as follows: (a) Gleason score of 7 or greater, (b) tumor volume of 0.5 cm(3) or greater, or a (c) positive extracapsular extension or seminal vesicle invasion. The reference standard was based on review of surgical specimen. Logistic regression was conducted to determine which parameters are associated with the presence of clinically significant cancer. Interreader agreement (ie, score ≥4 or not) was investigated by using κ statistics. Results At univariate analysis, all of the preoperative parameters were significant for clinically significant prostate cancer (P < .05). However, multivariate analysis revealed that PI-RADS score was the only significant parameter for both readers (reader 1: odds ratio = 28.170, P = .002; reader 2: odds ratio = 5.474, P = .007). The interreader agreement was excellent for PI-RADS score of 4 or greater (weighted κ = 0.801; 95% confidence interval: 0.737, 0.865). Conclusion The use of PI-RADS version 2 may help preoperatively diagnose clinically significant prostate cancer. (©) RSNA, 2016.

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“…In a prevalence study and clinical significance of prostate cancer among 12682 men with normal DRE and low PSA levels Pepe et al have shown that 27.4% of men with PSA between 2.5 and 4ng/mL had prostate cancer and some of them were clinically significant (19). Another recent study published by Faria et al evaluated the detection rates, clinical and pathological findings in Brazilian men with serum PSA levels <4ng/ mL.…”

Section: Discussionmentioning

confidence: 99%

Prostate-Specific Antigen testing in men between 40 and 70 years in Brazil: database from a check-up program

et al. 2014

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ARTICLE INFO ______________________________________________________________ ______________________Objectives: To evaluate the PSA in a large population of Brazilian men undergone to check up, and correlate the PSA cutoffs with prostate size and urinary symptoms. Materials and Methods: This is a cross sectional study performed with men between 40 and 70 years undergone to check-up. All men were undergone to urological evaluation, digital rectal examination, prostate-specific antigen, and ultrasonography The exclusion criteria were men who used testosterone in the last six months, or who were using 5 alpha-reductase inhibitors.Results: A total of 5015 men with an average age of 49.0 years completed the study. Most men were white and asymptomatic. The PSA in the three different aging groups were 0.9 ± 0.7ng/dL for men between 40 and 50; 1.2 ± 0.5ng/dL for men between 50 and 60; and 1.7 ± 1.5ng/dL for men greater than 60 years (p=0.001). A total of 192 men had PSA between 2.5 and 4ng/ml. From these men 130 were undergone to prostate biopsy. The predictive positive value of biopsy was 25% (32/130). In the same way, 100 patients had PSA >4ng/mL. From these men, 80 were undergone to prostate biopsy. In this group, the predictive positive value of biopsy was 40% (32/100). The Gleason score was 6 in 19 men (60%), 7 in 10 men (31%) and 8 in 3 men (9%). Conclusions:The PSA level of Brazilian men undergone to check up was low. There was a positive correlation with aging, IPSS and prostate size.

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Prevalence and Clinical Significance of Prostate Cancer among 12,682 Men with Normal Digital Rectal Examination, Low PSA Levels (≤4 ng/ml) and Percent Free PSA Cutoff Values of 15 and 20%

Cited by 15 publications

References 74 publications

Lowering the PSA Threshold for Prostate Biopsy from 4 to 2.5 ng/ml: Influence on Cancer Characteristics and Number of Men Needed to Biopt

Lowering the PSA Threshold for Prostate Biopsy from 4 to 2.5 ng/ml: Influence on Cancer Characteristics and Number of Men Needed to Biopt

Prostate Cancer: PI-RADS Version 2 Helps Preoperatively Predict Clinically Significant Cancers

Prostate-Specific Antigen testing in men between 40 and 70 years in Brazil: database from a check-up program

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