Introduction & Objectives: PSA ratio (PSAr) and PSA density (PSAd) are derivates of PSA which have been introduced to improve sensibility and specifity of total PSA for values between 4 and 10 ng/ml. In this work we analyzed the predictive accuracy of PSAr and PSAd for different ranges of PSA, and we assessed the corresponding values of their cut offs. Material & Methods: A cohort of 1658 of not selected patients (pts) underwent transrectal prostatic biopsy; we performed a sextant scheme biopsy plus 2/3 further cores laterally on each lobe; in high volume prostates, number of cores was increased according to Vienna nomogram; moreover in case of re-biopsy at least 2 cores were added in the transition zone. Pts were stratified in 3 groups: PSA ≤4 ng/ml (group 1, n= 183), PSA 4 - 10 ng/ml (group 2, n= 1043), PSA >10 ng/ml (group 3, n= 432). Indications for biopsy were: in group 1 familiarity for prostate cancer, a suspicious clinical lesion (digital rectal exploration and/or hypoechoic lesion on ultrasound) or PSA velocity > 0.75 ng/ml/year ; in group 2, a suspicious clinical lesion (digital rectal exploration and/or hypoechoic lesion on ultrasound) or a PSAr < 20%; in group 3 the value of total PSA for itself was considered sufficient for biopsy. Differences of means of prostate volumes were valuated with ANOVA test. A univariate analysis was constructed for correlating PSAr and PSAd with the outcome of biopsy; receiving operating curve (ROC) was used to test the predictive accuracy of derivates of PSA and to identify the optimal cut offs. Results: The detection rates were 31.5%, 31% and 40% respectively in group 1, 2 and 3. Mean prostate volume on ultrasound was significantly different among the 3 groups (40cc vs 53cc vs 64cc; p:0.001). At univariate analysis PSAd was significantly associated to a positive biopsy among all the groups (respectively in group 1,2 and 3: p: 0.005, 0.001 and 0.001); PSAr was significantly associated to a positive biopsy in group 2 and 3 (p: 0.001 e 0.006), but not in group 1 (p: 0.335). Area Under ROC (AUC) of PSAd was higher than that of PSAr on all the 3 groups (respectively AUC: 0.70 vs 0.57; 0,71 vs 0.60; 0.78 vs 0.64); cut off values of PSAd were 0.10, 0.14 and 0.33 ng/ml/gr, and of PSAr were 14%, 13% e 10%, respectively in group 1,2 and 3. Sensibility rates at the different cut off values of PSAd were higher than that of PSAr (group 1: 70 vs 52%; group 2: 74 vs 51%; group 3: 66 vs 53%), whereas specificity rates were similar (68 vs 75%; 62 vs 68%; 80 vs 77%) Conclusions: PSAd has a higher sensibility than PSAr; PSAd could be more useful than PSAr to give indications for biopsy, above all using different cut off values according to total PSA ranges: this clinical approach could be recommended for pts with PSA ≤4 ng/ml, where, for the smaller volume gland of these pts, variability of PSAd is more sensitive in case of cancer. A value of PASd >0.10 ng/ml/gr may be used to select patient for prostate biopsy.

Sanguedolce F., Bertaccini A., Manferrari F., Schiavina R., Franceschelli A., Cicchetti G., et al. (2007). SHOULD WE USE DIFFERENT CUT OFF VALUES OF PSA DERIVATES FOR DIFFERENT RANGES OF PSA?. EUROPEAN UROLOGY, 6, 224-224 [10.1016/S1569-9056(07)60803-3].

SHOULD WE USE DIFFERENT CUT OFF VALUES OF PSA DERIVATES FOR DIFFERENT RANGES OF PSA?

SANGUEDOLCE, FRANCESCO;BERTACCINI, ALESSANDRO;MANFERRARI, FABIO;SCHIAVINA, RICCARDO;FRANCESCHELLI, ALESSANDRO;CICCHETTI, GIACOMO;GAROFALO, MARCO;MARTORANA, GIUSEPPE
2007

Abstract

Introduction & Objectives: PSA ratio (PSAr) and PSA density (PSAd) are derivates of PSA which have been introduced to improve sensibility and specifity of total PSA for values between 4 and 10 ng/ml. In this work we analyzed the predictive accuracy of PSAr and PSAd for different ranges of PSA, and we assessed the corresponding values of their cut offs. Material & Methods: A cohort of 1658 of not selected patients (pts) underwent transrectal prostatic biopsy; we performed a sextant scheme biopsy plus 2/3 further cores laterally on each lobe; in high volume prostates, number of cores was increased according to Vienna nomogram; moreover in case of re-biopsy at least 2 cores were added in the transition zone. Pts were stratified in 3 groups: PSA ≤4 ng/ml (group 1, n= 183), PSA 4 - 10 ng/ml (group 2, n= 1043), PSA >10 ng/ml (group 3, n= 432). Indications for biopsy were: in group 1 familiarity for prostate cancer, a suspicious clinical lesion (digital rectal exploration and/or hypoechoic lesion on ultrasound) or PSA velocity > 0.75 ng/ml/year ; in group 2, a suspicious clinical lesion (digital rectal exploration and/or hypoechoic lesion on ultrasound) or a PSAr < 20%; in group 3 the value of total PSA for itself was considered sufficient for biopsy. Differences of means of prostate volumes were valuated with ANOVA test. A univariate analysis was constructed for correlating PSAr and PSAd with the outcome of biopsy; receiving operating curve (ROC) was used to test the predictive accuracy of derivates of PSA and to identify the optimal cut offs. Results: The detection rates were 31.5%, 31% and 40% respectively in group 1, 2 and 3. Mean prostate volume on ultrasound was significantly different among the 3 groups (40cc vs 53cc vs 64cc; p:0.001). At univariate analysis PSAd was significantly associated to a positive biopsy among all the groups (respectively in group 1,2 and 3: p: 0.005, 0.001 and 0.001); PSAr was significantly associated to a positive biopsy in group 2 and 3 (p: 0.001 e 0.006), but not in group 1 (p: 0.335). Area Under ROC (AUC) of PSAd was higher than that of PSAr on all the 3 groups (respectively AUC: 0.70 vs 0.57; 0,71 vs 0.60; 0.78 vs 0.64); cut off values of PSAd were 0.10, 0.14 and 0.33 ng/ml/gr, and of PSAr were 14%, 13% e 10%, respectively in group 1,2 and 3. Sensibility rates at the different cut off values of PSAd were higher than that of PSAr (group 1: 70 vs 52%; group 2: 74 vs 51%; group 3: 66 vs 53%), whereas specificity rates were similar (68 vs 75%; 62 vs 68%; 80 vs 77%) Conclusions: PSAd has a higher sensibility than PSAr; PSAd could be more useful than PSAr to give indications for biopsy, above all using different cut off values according to total PSA ranges: this clinical approach could be recommended for pts with PSA ≤4 ng/ml, where, for the smaller volume gland of these pts, variability of PSAd is more sensitive in case of cancer. A value of PASd >0.10 ng/ml/gr may be used to select patient for prostate biopsy.
2007
Sanguedolce F., Bertaccini A., Manferrari F., Schiavina R., Franceschelli A., Cicchetti G., et al. (2007). SHOULD WE USE DIFFERENT CUT OFF VALUES OF PSA DERIVATES FOR DIFFERENT RANGES OF PSA?. EUROPEAN UROLOGY, 6, 224-224 [10.1016/S1569-9056(07)60803-3].
Sanguedolce F.; Bertaccini A.; Manferrari F.; Schiavina R.; Franceschelli A.; Cicchetti G.; Garofalo M.; Martorana G.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/45729
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