Yonsei Med J.  2015 Nov;56(6):1492-1496. 10.3349/ymj.2015.56.6.1492.

Can Prostate-Specific Antigen Kinetics before Prostate Biopsy Predict the Malignant Potential of Prostate Cancer?

• Kim SJ
• Jeong TY
• Yoo DS
• Park J
• Cho S
• Kang SH
• Lee SH
• Jeon SH
• Lee TY
• Park SY

• KMID: 2345874
• DOI: http://doi.org/10.3349/ymj.2015.56.6.1492

Abstract

PURPOSE
To predict the malignant potential of prostate cancer (PCa) according to prostate-specific antigen velocity (PSAV), PSA density (PSAD), free/total PSA ratio (%fPSA), and digital rectal examination (DRE).
MATERIALS AND METHODS
From January 2009 to December 2012, 548 adult male patients were diagnosed with PCa by prostate biopsy at four hospitals in Korea. We retrospectively analyzed 155 adult male patients with an initial PSA level < or =10 ng/mL and whose PSA levels had been checked more than two times at least 6 months before they had been diagnosed with PCa, with test intervals of more than 3 months. Patients with a urinary tract infection, and patients who had previously undergone cystoscopy or surgery of the prostate were excluded. We separated patients into two groups according to Gleason sum [Gleason sum < or =7 (n=134) or Gleason sum > or =8 (n=21)] and the presence of extracapsular invasion [organ confined (n=129) or extracapsular invasion (n=26)]. Differences between the groups were compared.
RESULTS
The group with a Gleason sum > or =8 or extracapsular invasion of PCa showed high PSAV and significantly lower %fPSA. There were no significant differences in PSAD and the presence of an abnormality on DRE between two groups.
CONCLUSION
In PCa patients treated with other therapies besides prostatectomy, a high PSA velocity and a low %fPSA may predict high grade PCa with a Gleason sum > or =8 or the presence of extracapsular invasion.

Keyword

Prostate-specific antigen; prostatic neoplasms; Gleason score

MeSH Terms

Adult
Aged
Biopsy, Needle
Digital Rectal Examination
Humans
Kinetics
Male
Middle Aged
Neoplasm Grading
Predictive Value of Tests
Prognosis
Prostate/*pathology
Prostate-Specific Antigen/*blood
Prostatectomy
Prostatic Neoplasms/*pathology/surgery
Republic of Korea
Retrospective Studies
Tumor Burden
Prostate-Specific Antigen

Figure

• 

  Fig. 1 The graph represents the receiver operating characteristics curve for (A) PSA velocity. (B) Free/total PSA ratio. PSA, prostate-specific antigen.

Reference

1. Rietbergen JB, Hoedemaeker RF, Kruger AE, Kirkels WJ, Schröder FH. The changing pattern of prostate cancer at the time of diagnosis: characteristics of screen detected prostate cancer in a population based screening study. J Urol. 1999; 161:1192–1198.

2. Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst. 2010; 102:605–613.

3. Klein EA. What is 'insignificant' prostate carcinoma? Cancer. 2004; 101:1923–1925.

4. Anast JW, Andriole GL, Bismar TA, Yan Y, Humphrey PA. Relating biopsy and clinical variables to radical prostatectomy findings: can insignificant and advanced prostate cancer be predicted in a screening population? Urology. 2004; 64:544–550.

5. Kim J, Ebertowski J, Janiga M, Arzola J, Gillespie G, Fountain M, et al. Many young men with prostate-specific antigen (PSA) screen-detected prostate cancers may be candidates for active surveillance. BJU Int. 2013; 111:934–940.

6. Liu D, Lehmann HP, Frick KD, Carter HB. Active surveillance versus surgery for low risk prostate cancer: a clinical decision analysis. J Urol. 2012; 187:1241–1246.

7. Eggener SE, Scardino PT, Walsh PC, Han M, Partin AW, Trock BJ, et al. Predicting 15-year prostate cancer specific mortality after radical prostatectomy. J Urol. 2011; 185:869–875.

8. Epstein JI. An update of the Gleason grading system. J Urol. 2010; 183:433–440.

9. Eifler JB, Feng Z, Lin BM, Partin MT, Humphreys EB, Han M, et al. An updated prostate cancer staging nomogram (Partin tables) based on cases from 2006 to 2011. BJU Int. 2013; 111:22–29.

10. D'Amico AV, Whittington R, Malkowicz SB, Cote K, Loffredo M, Schultz D, et al. Biochemical outcome after radical prostatectomy or external beam radiation therapy for patients with clinically localized prostate carcinoma in the prostate specific antigen era. Cancer. 2002; 95:281–286.

11. Penney KL, Stampfer MJ, Jahn JL, Sinnott JA, Flavin R, Rider JR, et al. Gleason grade progression is uncommon. Cancer Res. 2013; 73:5163–5168.

12. Suardi N, Briganti A, Gallina A, Salonia A, Karakiewicz PI, Capitanio U, et al. Testing the most stringent criteria for selection of candidates for active surveillance in patients with low-risk prostate cancer. BJU Int. 2010; 105:1548–1552.

13. Conti SL, Dall'era M, Fradet V, Cowan JE, Simko J, Carroll PR. Pathological outcomes of candidates for active surveillance of prostate cancer. J Urol. 2009; 181:1628–1633.

14. Smaldone MC, Cowan JE, Carroll PR, Davies BJ. Eligibility for active surveillance and pathological outcomes for men undergoing radical prostatectomy in a large, community based cohort. J Urol. 2010; 183:138–143.

15. Montironi R, Mazzucchelli R, Scarpelli M, Lopez-Beltran A, Mikuz G, Algaba F, et al. Prostate carcinoma II: prognostic factors in prostate needle biopsies. BJU Int. 2006; 97:492–497.

16. Bul M, van den Bergh RC, Rannikko A, Valdagni R, Pickles T, Bangma CH, et al. Predictors of unfavourable repeat biopsy results in men participating in a prospective active surveillance program. Eur Urol. 2012; 61:370–377.

17. Sfoungaristos S, Perimenis P. Implications of PSA kinetics for an adverse pathology after radical prostatectomy. Asian Pac J Cancer Prev. 2011; 12:1765–1769.

18. van As NJ, Norman AR, Thomas K, Khoo VS, Thompson A, Huddart RA, et al. Predicting the probability of deferred radical treatment for localised prostate cancer managed by active surveillance. Eur Urol. 2008; 54:1297–1305.

19. Epstein JI, Walsh PC, Carmichael M, Brendler CB. Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. JAMA. 1994; 271:368–374.

20. Thompson IM, Ankerst DP, Chi C, Goodman PJ, Tangen CM, Lucia MS, et al. Assessing prostate cancer risk: results from the Prostate Cancer Prevention Trial. J Natl Cancer Inst. 2006; 98:529–534.

21. D'Amico AV, Chen MH, Roehl KA, Catalona WJ. Preoperative PSA velocity and the risk of death from prostate cancer after radical prostatectomy. N Engl J Med. 2004; 351:125–135.

22. Catalona WJ, Partin AW, Slawin KM, Brawer MK, Flanigan RC, Patel A, et al. Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial. JAMA. 1998; 279:1542–1547.

23. Nam RK, Toi A, Klotz LH, Trachtenberg J, Jewett MA, Appu S, et al. Assessing individual risk for prostate cancer. J Clin Oncol. 2007; 25:3582–3588.

24. Brawer MK, Aramburu EA, Chen GL, Preston SD, Ellis WJ. The inability of prostate specific antigen index to enhance the predictive the value of prostate specific antigen in the diagnosis of prostatic carcinoma. J Urol. 1993; 150(2 Pt 1):369–373.

25. Kassouf W, Nakanishi H, Ochiai A, Babaian KN, Troncoso P, Babaian RJ. Effect of prostate volume on tumor grade in patients undergoing radical prostatectomy in the era of extended prostatic biopsies. J Urol. 2007; 178:111–114.

26. Thompson IM, Goodman PJ, Tangen CM, Lucia MS, Miller GJ, Ford LG, et al. The influence of finasteride on the development of prostate cancer. N Engl J Med. 2003; 349:215–224.

27. McKenney JK, Simko J, Bonham M, True LD, Troyer D, Hawley S, et al. The potential impact of reproducibility of Gleason grading in men with early stage prostate cancer managed by active surveillance: a multi-institutional study. J Urol. 2011; 186:465–469.

28. Djavan B, Remzi M, Schulman CC, Marberger M, Zlotta AR. Repeat prostate biopsy: who, how and when?. a review. Eur Urol. 2002; 42:93–103.