Pd06-04 Rate of Discordant Psa Testing Among Varied Guidelines, Identifying Targetable Inefficiencies in Our Health System
Year: 2018
Type: article
Abstract: OBJECTIVES: PROPHET is a prospective study in order to clarify a diagnostic impact of laboratory-based and prostate volume-adjusted [-2] proPSA (p2PSA)-related indices on prostate cancer (PC) and a clinically significant PC with more than 2 positive biopsy cores or high Gleason Grade Group in the PSA below 10 ng/mL (Clinical trial No. UMIN000016934).METHODS: Between April 2015 and March 2017, 421 men aged 50 to 79 who conducted 12 to 20-core prostate biopsy in the PSA range above age-specific cut-offs (3.0ng/ml, 3.5 ng/ml and 4.0 ng/ml, respectively, for age 50-64, 65-69 and 70-79) and below 10 ng/ml were registered in the PROPHET.Among those participants, 398 eligible men were investigated a diagnostic impact of PSA density (PSAD), PSAD adjusted by transition zone volume (PSATZD) and various p2PSA-related total and transition zone prostate volume (PV)-adjusted indices on any grade, high volume and high Gleason grade group PC.RESULTS: Among 398 men, 179 (45%), 141 (35%) and 80 (20%) were diagnosed with prostate cancer, Gleason grade group !2 and !3 prostate cancer, respectively.Total AUC-ROC, partial AUC-ROC above 90% sensitivity (J Urol.2005; 173: 425-428) and false positive rate (FPR) at 90% sensitivity for PSA, PSAD, PSATZD, p2PSArelated indices adjusted by PV are shown in Table 1.Impacts of those various PV-adjusted indices on distinguishing non PC vs PC, Grade Group 1/ positive biopsy cores 0-2 vs remaining higher grade/ volume PC and Grade Group 1-2/ positive biopsy cores 0-2 vs remaining higher grade/ volume PC are indicated in Table 1.The total/ partial AUC-ROC above 90% sensitivity and FPR at 90% sensitivity in PV-adjusted p2PSA-related indices were superior to those in conventional PVadjusted indices, especially for detecting high grade and volume cancer.p2PSA/%f-PSA adjusted by transition zone PV would avoid unnecessary biopsy in 63% of men in the setting for detecting Grade Group 3-5 cancer with positive biopsy cores >2.CONCLUSIONS: PV-adjusted p2PSA-related indices would avoid in 47 to 63% of prostate biopsy in the setting not only for detecting any grade/ volume PC, but also especially for detecting clinically significant PC.
Source: The Journal of Urology
Authors: Christopher Martin, Brock O'Neil, Ashley Kapron, Kensaku Kawamoto, William Lowrance, Michael Flynn, Kathleen Cooney
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2795685363