1580: PSA-Velocity as a Tool to Identify Organ Confined Prostate Cancers in a Screening Population
Year: 2006
Type: conference-abstract
Abstract: INTRODUCTION AND OBJECTIVE: Prostate specific antigen density (PSAD) has been identified as an independent predictor of adverse pathology and biochemical failure in some but not all studies.The inability to replicate RESULTS: may be due the use of pathologic radical prostatectomy weight (PW) in some studies and preoperative ultrasound (US) values in others.Herein, we determined if US PSAD or PW PSAD were independent predictor of adverse pathology or biochemical free survival (BFS).METHODS: The clinical and pathologic data of radical prostatectomy patients from 1990 and 2003, was examined.US PSAD was calculated by dividing the preoperative PSA in ng/ml by the US measured prostate volume in cm 3 .PW PSA density was calculated by dividing the PSA value by the measured PW of the prostatectomy specimen in gm.Logistic regression analysis was performed to determine whether US PSA or PW PSA density was more accurate than PSA, Gleason Sum or stage in predicting adverse pathology (positive margins, extracapsular extension or positive seminal vesicles) or biochemical failure (PSA > 0.2ng/mL).Cox regression analysis was used to determine the effect of PSAD on BFS.Results: 1327 patients were identified for study.Multivariant analysis demonstrated that US PSAD was an independent predictor of positive margins (OR 5.0, 95%CI: 2.6-9.5),extracapsular disease (OR 1 0.9, 95%CI: 5.3-22.3),seminal vesical invasion (OR 6.1, 95%CI: 3.0-12.4)and biochemical failure (OR 3.3, 95% Cl 2.4-4.6).PW PSAD was an independent predictor of positive margins (OR 29.8, 95% Cl: 10.2-87.0),extracapsular disease (OR 126.6, 95%CI: 38.0-422.1 ), seminal vesical invasion (OR 33.7, 95% Cl: 9.8-116.2) and biochemical failure (OR 8.7, 95% Cl 5.2-14.5).Both US and PW PSAD were more strongly associated with adverse pathology and biochemical failure than grade, stage and PSA.Patients with US PSAD of less than 0.3 ng/ml/cc, 0.3-0.6 ng/ml/cc and more than 0.6 ng/ml/cc had 61.40%, 47.36%, and 32.31% BFS at 8 years (p-< 0.0001 ).Patients with PW PSA of less than 0.3 ng/ml/gm, 0.3-0.6 ng/ml/gm and greater than 0.6 ng/ml/gm had 61.10%, 39.36%, and 15.90% BFS at 8 years (p-< 0.0001 ).CONCLUSIONS: US and PW PSAD are strong predictors of advanced pathology and biochemical failure after radical prostatectomy.Incorporation of US PSAD into preoperative risk assessment and PW PSAD into postoperative risk assessment will provide additional prognostic THE JOURNAL OF UROLOGv<' 509 information beyond grade, stage and PSA and the inclusion of PSAD into nomograms should be considered.
Source: The Journal of Urology
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2791507660