Risk assessment models to evaluate the necessity of prostate biopsies in North Chinese patients with 4-50 ng/mL PSA

Abstract

BackgroundProstate-specific antigen (PSA) is widely used for prostate cancer screening, but low specificity results in high false positive rates of prostate biopsies.ObjectiveTo develop new risk assessment models to overcome the diagnostic limitation of PSA and reduce unnecessary prostate biopsies in North Chinese patients with 4–50 ng/mL PSA.MethodsA total of 702 patients in seven hospitals with 4–10 and 10–50 ng/mL PSA, respectively, who had undergone transrectal ultrasound-guided prostate biopsies, were assessed. Analysis-modeling stage for several clinical indexes related to prostate cancer and renal function was carried out. Multiple logistic regression analyses were used to develop new risk assessment models of prostate cancer for both PSA level ranges 4-10 and 10-50 ng/mL. External validation stage of the new models was performed to assess the necessity of biopsy.ResultsThe new models for both PSA ranges performed significantly better than PSA for detecting prostate cancers. Both models showed higher areas under the curves (0.937 and 0.873, respectively) compared with PSA alone (0.624 and 0.595), at pre-determined cut-off values of 0.1067 and 0.6183, respectively. Patients above the cut-off values were recommended for immediate biopsy, while the others were actively observed. External validation of the models showed significantly increased detection rates for prostate cancer (4-10 ng/mL group, 39.29% vs 17.79%, p=0.006; 10-50 ng/mL group, 71.83% vs 50.0%, p=0.015).ConclusionsWe developed risk assessment models for North Chinese patients with 4–50 ng/mL PSA to reduce unnecessary prostate biopsies and increase the detection rate of prostate cancer.

Improving the diagnosis of prostate cancer by telomerase-positive circulating tumor cells: A prospective pilot study

“…Interestingly, TBCD could strike a balance with diagnostic efficiency, showing a sensitivity of 79.31% and specificity of 81.58% in the validation set. A Chinese cohort study showed that prostate biopsy had lower positive diagnostic rates at PSA levels of <50 ng/ml [23]. Thus, we further evaluated the diagnostic ability in three PSA range subgroups, 4-10, 4-20, and 4-50 ng/ml, and showed that the sensitivity and specificity were both higher than 80%.…”

A Comparative Study: Has MRI-guided Fusion Prostate Biopsy Changed the Prostate-specific Antigen Gray-zone Range?

“…The most commonly used marker in the diagnosis of prostate cancer is PSA [2]. The upper limit for gray-zone PSA has been determined as 10 ng/ml in numerous studies [6][7][8]15,[17][18]. Some other studies, though few in number, suggest that the upper limit for gray-zone PSA may show ethnic variation and propose that this limit is likely to be higher in countries where PCa is less common, particularly in Far Eastern countries [9,19].…”

“…Some other studies, though few in number, suggest that the upper limit for gray-zone PSA may show ethnic variation and propose that this limit is likely to be higher in countries where PCa is less common, particularly in Far Eastern countries [9,19]. Zhao et al [6] determined the gray-zone PSA range as 4-10 ng/ml. Based on this range, the authors detected PCa in 17% of the patients that underwent SPB and in 50% of the patients with a gray-zone PSA level of 10-50 ng/ml.…”

“…The same situation is valid for the definition of gray-zone PSA. Although some studies suggest that the gray-zone PSA range may show regional and ethnic variation, some other studies have proposed an upper limit of 10 ng/ml for gray-zone PSA [6][7][8][9].…”