nach oben

Erschienen in:

01.04.2013 | Original Article

Diagnostic significance of [−2]pro-PSA and prostate dimension-adjusted PSA-related indices in men with total PSA in the 2.0–10.0 ng/mL range

verfasst von: Kazuto Ito, Mai Miyakubo, Yoshitaka Sekine, Hidekazu Koike, Hiroshi Matsui, Yasuhiro Shibata, Kazuhiro Suzuki

Erschienen in: World Journal of Urology | Ausgabe 2/2013

Einloggen, um Zugang zu erhalten

Abstract

Purpose

One of the most important issues to address when developing an optimal screening system for prostate cancer is investigating appropriate biopsy indications following serum prostate-specific antigen (PSA) measurements in order to maintain high sensitivity and avoid unnecessary biopsy.

Methods

Between April 2004 and December 2007, 239 consecutive men with total PSA levels of 2.0–10.0 ng/mL underwent measurements of PSA, free PSA, and [−2]pro-PSA. We assessed the significance of laboratory-based PSA-related indices including free PSA/total PSA (%f-PSA), p2PSA/free PSA (%p2PSA), p2PSA/%f-PSA, Prostate Health Index (phi, an index combining PSA, free PSA, and p2PSA), total prostate volume (TPV)-adjusted PSA-related indices, including PSA density, %p2PSA density, p2PSA/%f-PSA density, and phi density, and transition zone (TZ) prostate volume-adjusted PSA-related indices such as PSA TZ density (PSATZD), %p2PSA TZD, p2PSA/%fPSA TZD, and phi TZD.

Results

The positive biopsy rate was 22.2 %. When sensitivity was fixed at 95 %, unnecessary biopsies could be avoided in 28 % of men when phi was used as a biopsy indication. In cases where total and transition zone prostate volumes were available, the use of %p2PSA density, phi density, p2PSA/%f-PSA TZD, and phi TZD resulted in the avoidance of 48, 47, 54, and 54 % of unnecessary biopsies, respectively, while maintaining a high sensitivity of 90 %.

Conclusions

At 90 and 95 % sensitivity, laboratory-based indices containing p2PSA, particularly phi, showed significantly greater specificity for prostate cancer as compared with %f-PSA. The diagnostic accuracy of prostate volume-adjusted p2PSA-related indices could be excellent, particularly the transition zone volume-adjusted indices at fixed sensitivities of 95 and 90 %.

Catalona WJ, Smith DS, Ratliff TL et al (1991) Measurement of prostate specific antigen in serum as a screening test for prostate cancer. N Engl J Med 324:1156–1161PubMedCrossRef

Catalona WJ, Richie JP, Ahmann FR et al (1994) Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: result of a multicenter trial of 6,630 men. J Urol 151:1283–1290PubMed

Catalona WJ, Smith DS, Wolfert RL et al (1995) Evaluation of percentage of free serum prostate specific antigen to improve specificity of prostate cancer screening. JAMA 274:1214–1220PubMedCrossRef

Prestigiacomo AF, Lilja H, Pettersson K, Wolfert RL, Stamey TA (1996) A comparison of the free fraction of serum prostate specific antigen in men with benign and cancerous prostates: the best-case scenario. J Urol 156:350–354PubMedCrossRef

Partin AW, Catalona WJ, Southwick PC, Subong EN, Gasior GH, Chan DW (1996) Analysis of percent free prostate-specific antigen (PSA) for prostate cancer detection: influence of total PSA, prostate volume, and age. Urology 48:55–61PubMedCrossRef

Kikuchi E, Nakashima J, Ishibashi M et al (2000) Prostate specific antigen adjusted for transition zone volume: the most powerful method for detecting prostate carcinoma. Cancer 89:842–849PubMedCrossRef

Kumar A, Mikolajczyk SD, Goel AS, Millar LS, Saedi MS (1997) Expression of pro form of prostate specific antigen by mammalian cells and its conversion to mature, active form by human kallikrein 2. Cancer Res 57:3111–3114PubMed

Chan TY, Mikolajczyk SD, Lecksell K et al (2003) Immunohistochemical staining of prostate cancer with monoclonal antibodies to the precursor of prostate-specific antigen. Urology 62:177–181PubMedCrossRef

Stephan C, Kahrs AM, Cammann H et al (2009) A [−2]pro-PSA-based artificial neural network significantly improves differentiation between prostate cancer and benign prostatic diseases. Prostate 69:198–207PubMedCrossRef

10.

Sokoll LJ, Sanda MG, Feng Z et al (2010) A prospective, multicenter, National Cancer Institute Early Detection Research Network study of [−2]pro-PSA: improving prostate cancer detection and correlating with cancer aggressiveness. Cancer Epidemiol Biomarkers Prev 19:1193–1200PubMedCrossRef

11.

Miyakubo M, Ito K, Yamamoto T, Takechi H, Ohi M, Suzuki K (2009) Proprostate-specific antigen: its usefulness in the era of multiple-core prostate biopsy. Int J Urol 16:561–565PubMedCrossRef

12.

Le BV, Griffin CR, Loeb S et al (2010) [−2]Proenzyme prostate specific antigen is more accurate than total and free prostate specific antigen in differentiating prostate cancer from benign disease in a prospective prostate cancer screening study. J Urol 183:1355–1359PubMedCrossRef

13.

Catalona WJ, Partin AW, Sanda MG et al (2011) A multicenter study of [−2]pro-prostate specific antigen combined with prostate specific antigen and free prostate specific antigen for prostate cancer detection in the 2.0 to 10.0 ng/ml prostate specific antigen range. J Urol 185:1650–1655PubMedCrossRef

14.

Ito K, Ohi M, Yamamoto T et al (2002) The diagnostic accuracy of the age-adjusted and prostate volume-adjusted biopsy method in males with prostate specific antigen levels of 4.1–10.0 ng/ml. Cancer 95:2112–2119PubMedCrossRef

15.

Nomura M, Ito K, Miyakubo M et al (2012) Development and external validation of a nomogram for predicting cancer probability at initial prostate biopsy using the life expectancy-adjusted and prostate volume-adjusted biopsy scheme. Prostate Cancer Prostatic Dis 15:202–209PubMedCrossRef

16.

Bangma CH, Wildhagen MF, Yurdakul G, Schröder FH, Blijenberg BG (2004) The value of (−7, −5) pro-prostate-specific antigen and human kallikrein-2 as serum markers for grading prostate cancer. BJU Int 93:720–724PubMedCrossRef

17.

Stephan C, Meyer HA, Kwiatkowski M et al (2006) A (−5, −7) pro-PSA-based artificial neural network to detect prostate cancer. Eur Urol 50:1014–1020PubMedCrossRef

18.

Lein M, Semjonow A, Graefen M et al (2005) A multicenter clinical trial on the use of (−5, −7) pro prostate specific antigen. J Urol 174:2150–2153PubMedCrossRef

19.

Catalona WJ, Bartsch G, Rittenhouse HG et al (2004) Serum pro-prostate specific antigen preferentially detects aggressive prostate cancers in men with 2 to 4 ng/mL prostate specific antigen. J Urol 171:2239–2244PubMedCrossRef

20.

Terris MK, Stamey TA (1991) Determination of prostate volume by transrectal ultrasound. J Urol 145:984–987PubMed

21.

Alkan I, Türkeri L, Biren T, Cevik I, Akdaş A (1996) Volume determinations by transrectal ultrasonography in patients with benign prostatic hyperplasia: correlation with removed prostate weight. Int Urol Nephrol 28:517–523PubMedCrossRef

22.

Rodriguez E Jr, Skarecky D, Narula N, Ahlering TE (2008) Prostate volume estimation using the ellipsoid formula consistently underestimates actual gland size. J Urol 179:501–503PubMedCrossRef

23.

Semjonow A, Köpke T, Eltze E et al (2010) Pre-analytical in vitro stability of [−2]pro-PSA in blood and serum. Clin Biochem 43:926–928PubMedCrossRef

Titel: Diagnostic significance of [−2]pro-PSA and prostate dimension-adjusted PSA-related indices in men with total PSA in the 2.0–10.0 ng/mL range
verfasst von: Kazuto Ito
Mai Miyakubo
Yoshitaka Sekine
Hidekazu Koike
Hiroshi Matsui
Yasuhiro Shibata
Kazuhiro Suzuki
Publikationsdatum: 01.04.2013
Verlag: Springer-Verlag
Erschienen in: World Journal of Urology / Ausgabe 2/2013
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-012-0927-9

Neu im Fachgebiet Urologie

Patrone im Penis bringt Urologen in Gefahr

30.05.2024 Operationen am Penis Nachrichten

In Lebensgefahr brachte ein junger Mann nicht nur sich selbst, sondern auch das urologische Team, das ihm zu Hilfe kam: Er hatte sich zur Selbstbefriedigung eine scharfe Patrone in die Harnröhre gesteckt.

15% bedauern gewählte Blasenkrebs-Therapie

29.05.2024 Urothelkarzinom Nachrichten

Ob Patienten und Patientinnen mit neu diagnostiziertem Blasenkrebs ein Jahr später Bedauern über die Therapieentscheidung empfinden, wird einer Studie aus England zufolge von der Radikalität und dem Erfolg des Eingriffs beeinflusst.

Costims – das nächste heiße Ding in der Krebstherapie?

28.05.2024 Onkologische Immuntherapie Nachrichten

„Kalte“ Tumoren werden heiß – CD28-kostimulatorische Antikörper sollen dies ermöglichen. Am besten könnten diese in Kombination mit BiTEs und Checkpointhemmern wirken. Erste klinische Studien laufen bereits.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Update Urologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Diagnostic significance of [−2]pro-PSA and prostate dimension-adjusted PSA-related indices in men with total PSA in the 2.0–10.0 ng/mL range