The importance of PSA-Density in active surveillance for prostate cancer

Abstract

Objective: In this study, we aimed to determine the predictive factor for additional treatment requirement in active surveillance (AS) for patients with low or very low-risk prostate cancer (PCa) and we investigated the effect of tumor burden by total core involvement rate in biopsy to predict of need for additional treatment.Material and methods: 107 patients with PCa in AS between 2005 and 2018 have been evaluated retrospectively. Groups were divided into two groups according to the need for additional treatment. Group 1 received additional treatment, group 2 did not receive additional treatments and active surveillance was continued. Patient’s total prostate-specific antigen (tPSA), prostate-specific antigen density (PSA-D), total core involvement count, quantity and rate at biopsy pathology results and follow-up period were recorded and compared in the two groups. Results: The current cohort includes 107 patients. Mean age at diagnosis was 63.01years. Mean tPSA values at diagnosis were 6.09 ng/mL and 5.2 ng/mL in the group 1 and group 2, respectively. Mean follow-up period was 38.1 months (range, 12 to 134 months). Only PSA-D measurement significantly predicted need for additional treatment (p = 0.017). ROC analysis showed that the optimal threshold was 0.13 ng/mL/cc (sensitivity: 70.8%; specificity: 57.1%). Additional treatment requirement was not detected in patients with PSA-D cut-off level less than 0.07 ng/mL/cc. Conclusions: Total tumor burden of less than 5% is safe for patients with low or very low-risk PCa in AS. A 0.13 ng/mL/cc cut-off level of PSA-D can predict to need for additional treatment in patients managed by AS.

The Impact of Prostate Volume on Prostate Cancer Detection: Comparing Magnetic Resonance Imaging with Transrectal Ultrasound in Biopsy-naïve Men

“…Currently, AS has become a standard option of care management for patients diagnosed with low-risk PCa as approximately 50% of eligible low-risk PCa patients in the USA received AS strategy at the time of initial diagnosis [25] , [34] . PSAD is often used as a key criterion in determining patients’ eligibility for AS and necessity for additional treatments [35] , [36] , [37] . Our findings proposed that the difference between PVs estimated by TRUS and mpMRI was statistically significant, whereas the difference between PSAD values was not clinically significant.…”

Confirmatory transperineal saturation prostate biopsy combined with mpMRI decrease the reclassification rate in men enrolled in Active Surveillance: Our experience in 100 men submitted to eight-years scheduled biopsy

“…In this respect, the number of systematic and/or targeted biopsy cores is an independent predictor for selection of patients with unfavourable characteristics for AS (31)(32)(33)(34)(35). On the other hand, a relevant critical point remain the adherence of patients to scheduled AS follow up; in fact, the estimated drop out to the execution of repeated prostate biopsy at 1 vs. 4 vs. 7 years from initial diagnosis is equal to 11 vs. 30 vs. 29%, respectively (3); therefore, the European Association of Urology (EAU) guidelines strongly recommend to perform repeat biopsy in the presence of clinical suspicion of PCa progression (i,e., PSAD evaluation, progression on mpMRI) instead to repeat biopsies at scheduled times that, anyway, are suggested every three years (36,37). Finally, pathologic parameters play a critical role in identifying appropriate candidates for AS; these findings need to be reproducible and consistently reported by pathologists (38)(39)(40).…”

Delta radiomic patterns on serial bi-parametric MRI are associated with pathologic upgrading in prostate cancer patients on active surveillance: preliminary findings

“…Confirmatory systematic and targeted biopsies are still required to monitor patients on AS, despite the use of serial MRI. Clinical factors including PSA density have been studied and demonstrated to identify candidates for AS ( 17 ). PSA density in conjunction with MRI has been explored as a dynamic risk prediction strategy to monitor patients on AS ( 18 ).…”