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Using the prostate Imaging Reporting and Data System version 2 （PI-RIDS v2） to detect prostate cancer can prevent unnecessary biopsies and invasive treatment

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Asian Journal of Andrology 2018年第5期20卷 459-464页

作者： Chang Liu Shi-Liang Liu Zhi-Xian Wang Kai Yu Chun-Xiang Feng Zan Ke Liang Wang Xiao-Yong Zeng Department of Urology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430030 China Department of Radiology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430030 China

prostate cancer （PCa） is one of the most common cancers among men globally. The authors aimed to evaluate the ability of the prostate Imaging Reporting and Data System version 2 （PI-RADS v2） to classify men with PCa, clinically significant PCa （CSPCa）, or no PCa, especially among those with serum total prostate-specific antigen （tPSA） levels in the ＂gray zone＂（4-10 ng ml-1）. A total of 308 patients （355 lesions） were enrolled in this study. Diagnostic efficiency was determined. Univariate and multivariate analyses, receiver operating characteristic curve analysis, and decision curve analysis were performed to determine and compare the predictors of PCa and CSPCa. The results suggested that PI-RADS v2, tPSA, and prostate-specific antigen density （PSAD） were independent predictors of PCa and CSPCa. A PI-RADS v2 score L≥4 provided high negative predictive values （91.39% for PCa and 95.69% for CSPCa）. A model of PI-RADS combined with PSA and PSAD helped to define a high-risk group （PI-RADS score = 5 and PSAD L≥0 15 ng ml-1 cm-3, with tPSA in the gray zone, or PI-RADS score L≥4 with high tPSA level） with a detection rate of 96.1% for PCa and 93.0% for CSPCa while a low-risk group with a detection rate of 6.1% for PCa and 2.2% for CSPCa. It was concluded that the PI-RADS v2 could be used as a reliable and independent predictor of PCa and CSPCa. The combination of PI-RADS v2 score with PSA and PSAD could be helpful in the prediction and diagnosis of PCa and CSPCa and, thus, may help in preventing unnecessary invasive procedures.

关键词： diagnosis multiparametric magnetic resonance imaging prostate cancer prostate Imaging Reporting and Data Systemversion 2 prostate-specific antigen prostate-specific antigen density

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Risk stratification for disease progression in pT3 prostate cancer after robot-assisted radical prostatectomy

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Asian Journal of Andrology 2017年第6期19卷 700-706页

作者： Jeong Hee Hong Young Suk Kwon Isaac Yi Kim Section of Urologic Oncology Rutgers Cancer Institute of New Jersey Division of Urology Rutgers Robert Wood Johnson Medical School Rutgers The State University of New Jersey New Brunswick NJ 08903 USA Department of Urology Dankook University College of Medicine Cheonan 31116 South Korea.

The aim of this study is to identify optimal patients for adjuvant radiation therapy （ART） in pT3 prostate cancer. The role of ART for patients with adverse pathologic features after radical prostatectomy （RP） has been demonstrated, but over- or under-treatment remains a significant concern. Two-hundred and five patients with pT3NOMO who underwent robot-assisted RP without ART were analyzed. Multivariate Cox proportional regression analyses were used to identify predictors of biochemical recurrence （BCR） and clinical progression （CP）. The estimated 5-year BCR-free survival （BCRFS） and CP-free survival （CPFS） were 52.8% and 85.6%, respectively. Preoperative prostate-specifc antigen （PSA）：〉10 ng m1-1 （hazard ratio [HR]： 3.288-6.027; P = 0.003）, pathologic Gleason score （pGS）：〉8 （HR： 4.146; P = 0.014）, and lymphovascular invasion （LVI）（HR： 2.167; P = 0.026） were associated with BCR. Based on these factors, a risk stratification tool was developed. Patients with no risk factors （PSA 〈10 ng m1-1, pGS 6, and absent LVI） showed excellent BCRFS and CPFS at 5 years （91.9% and 100.0%, respectively）, but those with two or more risk factors （PSA ：〉10 ng ml-1, pGS ≥8, or present LVI） had poor BCRFS and CPFS （12.1% and 54.6%, respectively）. In addition, the multivariate analysis revealed that pathologic stage pT3b （HR： 5.393; P = 0.025） was the only predictor of CP. Our study demonstrated the heterogeneity of oncologic outcomes in patients with pT3 prostate cancer. The proposed risk stratification can be used to identify patients who are at risk for disease progression and may aid in identifying the best patients for ART.

关键词： prostatectomy prostate-specific antigen recurrence survival

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Peripheral zone PSA density:a predominant variable to improve prostate cancer detection efficiency in men with PSA higher than 4 ng ml^(-1)

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Asian Journal of Andrology 2021年第4期23卷 415-420页

作者： Cheng Wang Yue-Yang Wang Shi-Yuan Wang Ji-Xiang Ding Mao Ding Yuan Ruan Xiao-Hai Wang Yi-Feng Jing Bang-Min Han Shu-Jie Xia Chen-Yi Jiang Fu-Jun Zhao Department of Urology Jiangsu Jiangyin People's HospitalJiangyin 214400China Department of Urology Shanghai General Hospital of Nanjing Medical UniversityShanghai 200080China Department of Urology Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghai 200080China Department of Urology Kashgar Prefecture Second People's HospitalKashi 844000China

To improve the diagnostic efficiency of prostate cancer(PCa)and reduce unnecessary biopsies,we defined and analyzed the diagnostic efficiency of peripheral zone prostate-specific antigen(PSA)density(PZ-PSAD).Patients who underwent systematic 12-core prostate biopsies in Shanghai General Hospital(Shanghai,China)between January 2012 and January 2018 were retrospectively identified(n=529).Another group of patients with benign prostatic hyperplasia(n=100)were randomly preselected to obtain the PSA density of the non-PCa cohort(N-PSAD).prostate volumes and transition zone volumes were measured using multiparameter magnetic resonance imaging(mpMRI)and were combined with PSA and N-PSAD to obtain the PZ-PSAD from a specific *** operating characteristic(ROC)curve analysis was used to assess the PCa detection efficiency in patients stratified by PSA level,and the area under the ROC curve(AUC)of PZ-PSAD was higher than that of PSA,PSA density(PSAD),and transition zone PSA density(TZ-PSAD).PZ-PSAD could amend the diagnosis for more than half of the patients with inaccurate transrectal ultrasonography(TRUS)and mpMRI *** TRUS and mpMRI findings were ambiguous to predict PCa(PIRADS score≤3),PZ-PSAD could increase the positive rate of biopsy from 21.7%to 54.7%,and help 63.8%(150/235)of patients avoid unnecessary prostate *** patients whose PSA was 4.0–10.0 ng ml^(−1),10.1–20.0 ng ml^(−1),and>20.0 ng ml^(−1),the ideal PZ-PSAD cut-off value for predicting clinically significant PCa was 0.019 ng ml^(−2),0.297 ng ml^(−2),and 1.180 ng ml^(−2),respectively(sensitivity>90%).Compared with PSA,PSAD,and TZ-PSAD,the efficiency of PZ-PSAD for predicting PCa is the highest,leading to fewer missed diagnoses and unnecessary biopsies.

关键词： benign prostate hyperplasia detection efficiency peripheral zone prostate-specific antigen density prostate biopsy prostate-specific antigen prostatic neoplasm

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PSA density in the diagnosis of prostate cancer in the Chinese population: results from the Chinese prostate Cancer Consortium

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Asian Journal of Andrology 2021年第3期23卷 300-305页

作者： Zi-Jian Song Jin-Ke Qian Yue Yang Han-Xiao Wu Mao-Yu Wang Si-Yuan Jiang Fu-Bo Wang Wei Zhang Rui Chen Chinese prostate Cancer Consortium Department of Urology Shanghai Changhai HospitalThe Second Military Medical UniversityShanghai 200433China Department of Urology Binhai People's HospitalYancheng 224500China 不详

We performed this study to investigate the diagnostic performance of prostate-specific antigen density(PSAD)in a multicenter cohort of the Chinese prostate Cancer *** with prostate-specific antigen(PSA)levels≥4.0 ng ml^(-1) regardless of digital rectal examination(DRE)results or PSA levelsspecificity for the diagnosis of prostate cancer(PCa)and high-grade prostate cancer(HGPCa)at different cutoff values were evaluated.A total of 5220 patients were included in the study,and 2014(38.6%)of them were diagnosed with *** patients with PSA levels ranging from 4.0 to 10.0 ng ml^(-1),PSAD was associated with PCa and HGPCa in both univariate(odds ratio[OR]=45.15,P<0.0001 and OR=25.38,P<0.0001,respectively)and multivariate analyses(OR=52.55,P<0.0001 and OR=26.05,P<0.0001,respectively).The areas under the receiver operating characteristic curves(AUCs)of PSAD in predicting PCa and HGPCa were 0.627 and 0.630,*** the PSAD cutoff of 0.10 ng ml^(-2),we obtained a sensitivity of 88.7%for PCa,and nearly all(89.9%)HGPCa cases could be detected and biopsies could be avoided in 20.2%of the patients(359/1776 cases).Among these patients who avoided biopsies,only 30 cases had *** recommend 0.10 ng ml^(-2) as the proper cutoff value of PSAD,which will obtain a sensitivity of nearly 90%for both PCa and *** results of this study should be validated in prospective,population-based multicenter studies.

关键词： Chinese early detection of cancer prostate cancer prostate-specific antigen prostate-specific antigen density

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Long-term effectiveness of luteinizing hormone-releasing hormone agonist or antiandrogen monotherapy in elderly men with localizect prostate cancer （T1-2）： a retrospective study

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Asian Journal of Andrology 2007年第2期9卷 253-258页

作者： Rupesh Raina Geetu Pahalajani Ashok Agarwal Craig Zippe Department of Medicine and Pediatrics Metrohealth Medical Center （Case School of Medicine） Cleveland Ohio 44109 USA Glickman Urological Institute Cleveland Clinic Foundation at Mary Mount Cleveland Clinic Foundation Ohio 44125 USA

Aim： To evaluate the long-term effectiveness, side effects and compliance rates of two types of drugs （luteinizing hormone-releasing hormone [LHRH] agonist and antiandrogen） that were used individually to treat patients with localized prostate cancer （T1-2） at our institution. Methods： Ninety-seven patients who were diagnosed in the period from April 1997 to January 2000 as having clinically localized prostate cancer （T1-2） received either LHRH agonist （leuprolide acetate 7.5 mg/month） monotherapy （group 1, n = 62） or antiandrogen monotherapy （group 2, n = 35; 18 received bicalutamide 50 mg q.d., 13 received nilutamide 150 mg t.i.d, and 4 received flutamide 250 mg t.i.d.）. The mean age in both groups was 76 years. Results： The mean follow-up time was （50.8 ±8.5） months in group 1 and （43.1 ± 2.2） months in group 2. prostate-specific antigen （PSA） levels rose in only 1 of the 62 patients （1.6%） in group 1, and in 20 of the 35 patients （57.1%） in group 2. In group 2, 10 of the 20 patients （50 %） with increasing PSA levels were treated with LHRH salvage therapy, and eight （80%） responded. Hot flashes （54.8%） and lethargy （41.9%） were the most common side effects in group 1. In contrast, nipple-tenderness （40%） and light-dark adaptation （17.1%） were more often seen in group 2. Only 1 of the 62 patients （1.6%） in group 1 switched to another medication because of adverse side effects; whereas 8 of the 35 patients （22.9%） in group 2 did so. Conclusion： Unlike antiandrogen monotherapy, LHRH agonist monotherapy provided long-term durable control of localized prostate cancer （T1-2）. It can also be an effective treatment option for patients whose disease failed to respond to antiandrogen monotherapy. The limitations of our study are the lack of health outcomes analysis and a small sample size.

关键词： localized prostate cancer antiandrogen prostate-specific antigen luteinizing hormone-releasing hormone agonist androgen ablation monotherapy

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Hormone naive prostate cancer： predicting and maximizing response intervals

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Asian Journal of Andrology 2015年第6期17卷 929-935,I0007,I0008页

作者： Judd W Moul Division of Urology Department of Urology Duke Cancer Institute Duke South Duke University Medical Center Durham NC 27710 USA.

Hormone naive advanced prostate cancer is subdivided into two disease states： biochemical recurrence and traditional M 1 （metastatic） prostate cancer and characterized by no prior hormonal therapy or androgen deprivation therapy （ADT）. In biochemical recurrence/ prostate-specific antigen （PSA） recurrence, men should be risk-stratified based on their PSA doubling time, the Gleason score and the timing of the recurrence. In general, only men who are at high risk should be considered for early/immediate ADT although this is best done using shared decision with the patient. The type of ADT to be used in biochemical recurrence ranging from oral-only peripheral blockade （peripheral androgen deprivation） to complete hormonal therapy （combined androgen blockade [CAB]） remains in debate owing to lack of randomized controlled trials （RCT）. However, there is good RCT support for use of intermittent hormonal therapy （IHT）. There is also limited research on biomarker response （PSA and testosterone decline） to predict prognosis. On the other hand, in the setting of M1 hormone naive prostate cancer, there are many more RCT＇s to inform our decisions. CAB and gonadotrophin-releasing hormone antagonists perhaps provide a slight efficacy advantage while IHT may be slightly inferior with minimal M1 disease. The PSA nadir at 7 months after starting ADT is a powerful prognostic tool for M1 patients. There is growing recognition that serum testosterone （T） control while on ADT is linked to the development of castrate-resistant prostate cancer. Especially for a M 1 patient, maintaining a serum T below 20-30 ng d1-1 prolongs the response to ADT. Novel oral agents （abiraterone and enzalutamide） may soon find use in hormone naive disease and may alter the treatment landscape. Despite over 75 years of experience with ADT, many questions remain, and the field continues to evolve.

关键词： androgen deprivation therapy cancer gonadotrophin-releasing hormone antagonists hormonal therapy luteinizing hormone-releasing hormone agonists prostate prostate-specific antigen testosterone

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Evaluation of PSA-age volume score in predicting prostate cancer in Chinese population

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Asian Journal of Andrology 2018年第4期20卷 324-329页

作者： Yi-Shuo Wu Xiao-Bo Wu Ning Zhang Guang-Liang Jiang Yang Yu Shi-Jun Tong Hao-Wen Jiang Shan-Hua Mao Rong Na Qiang Ding Department of Urology Huashan Hospital Fudan University Shanghai 200040 China Urology Research Center Fudan University Shanghai 200040 China Department of Urology Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200025 China

This study was performed to evaluate prostate-specific antigen-age volume （PSA-AV） scores in predicting prostate cancer （PCa） in a Chinese biopsy population. A total of 2355 men who underwent initial prostate biopsy from January 2006 to November 2015 in Huashan Hospital were recruited in the current study. The PSA-AV scores were calculated and assessed together with PSA and PSA density （PSAD） retrospectively. Among 2133 patients included in the analysis, 947 （44.4%） were diagnosed with PCa. The mean age, PSA, and positive rates of digital rectal examination result and transrectal ultrasound result were statistically higher in men diagnosed with PCa （all P 〈 0.05）. The values of area under the receiver operating characteristic curves （AUCs） of PSAD and PSA-AV were 0.864 and 0.851, respectively, in predicting PCa in the entire population, both performed better than PSA （AUC = 0.805; P 〈 0.05）. The superiority of PSAD and PSA-AV was more obvious in subgroup with PSA ranging from 2.0 ng ml^-1 to 20.0 ng ml^-1. A PSA-AV score of 400 had a sensitivity and specificity of 93.7% and 40.0%, respectively. In conclusion, the PSA-AV score performed equally with PSAD and was better than PSA in predicting PCa. This indicated that PSA-AV score could be a useful tool for predicting PCa in Chinese population.

关键词： age China prostate cancer prostate-specific antigen volume

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The combined role of MRI prostate and prostate health index in improving detection of significant prostate cancer in a screening population of Chinese men

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Asian Journal of Andrology 2023年第6期25卷 674-679页

作者： Peter KF Chiu Thomas YT Lam Chi-Fai Ng Jeremy YC Teoh Carmen CM Cho Hiu-Yee Hung Cindy Hong Monique J Roobol Winnie CW Chu Samuel YS Wong Joseph JY Sung SH Ho Urology Centre Department of SurgeryThe Chinese University of Hong KongHong Kong SARChina The Jockey Club School of Public Health and Primary Care The Chinese University of Hong KongHong Kong SARChina Department of Imaging and Interventional Radiology The Chinese University of Hong KongHong Kong SARChina Erasmus MC Cancer Institute Erasmus Medical UniversityRotterdam 3015The Netherlands Lee Kong Chian School of Medicine Nanyang Technological UniversitySingapore 308232Singapore

Using prostate-specific antigen(PSA)for prostate cancer(PCa)screening led to overinvestigation and overdiagnosis of indolent *** aimed to investigate the value of prostate health index(PHI)and magnetic resonance imaging(MRI)prostate in an Asian PCa screening *** aged 50–75 years were prospectively recruited from a community-based PSA screening *** with PSA 4.0–10.0 ng ml^(−1) had PHI result *** prostate was offered to men with PSA 4.0–50.0 ng ml−1.A systematic prostate biopsy was offered to men with PSA 4.0–9.9 ng ml^(−1) and PHI≥35,or PSA 10.0–50.0 ng ml^(−1).Additional targeted prostate biopsy was offered if they had PI-RADS score≥*** significant PCa(csPCa)was defined as the International Society of Urological Pathology(ISUP)grade group(GG)≥2 or ISUP GG 1 with involvement of≥30%of total systematic *** total,12.8%(196/1536)men had PSA≥4.0 ng ml^(−1).Among 194 men with PSA 4.0–50.0 ng ml^(−1),187(96.4%)received MRI *** them,28.3%(53/187)had PI-RADS≥3 ***,7.0%(107/1536)men were indicated for biopsy and 94.4%(101/107)men received *** the men received biopsy,PCa,ISUP GG≥2 PCa,and csPCa was diagnosed in 42(41.6%),24(23.8%),and 34(33.7%)men,*** with PSA/PHI pathway in men with PSA 4.0–50.0 ng ml^(−1),additional MRI increased diagnoses of PCa,ISUP GG≥2 PCa,and csPCa by 21.2%(from 33 to 40),22.2%(from 18 to 22),and 18.5%(from 27 to 32),*** benefit of additional MRI was only observed in PSA 4.0–10.0 ng ml^(−1),and the number of MRI needed to diagnose one additional ISUP GG≥2 PCa was 20 in PHI≥35 and 94 in PHIprostate was mainly observed in PSA 4.0–9.9 ng ml^(−1) and PHI≥35 *** was an important risk stratification step for PCa

关键词： magnetic resonance imaging prostate prostate cancer prostate health index prostate-specific antigen screening

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When is a bone scan study appropriate in asymptomatic men diagnosed with prostate cancer？

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Asian Journal of Andrology 2008年第6期10卷 890-895页

作者： Raj P. Pal Thivyaan Thiruudaian Masood A. Khan Department of Urology University Hospitals of Leicester NHS Trust Leicester General Hospital Leicester LE5 4WP UK

Aims： To determine when a bone scan investigation is appropriate in asymptomatic men diagnosed with prostate cancer. Methods： Between November 2005 and July 2006, 317 men with prostate cancer underwent a bone scan study; 176 men fulfilled the inclusion criteria. prostate-specific antigen （PSA） cut-offs as well as univariate and multivariate logistic regression analyses using digital rectal examination finding, biopsy Gleason scores and age were performed to determine when a bone scan study is likely to be of value. Results： Only 1/61 men （1.6%） with a serum PSA 〈 20 ng/mL had a positive bone scan. However, 2/38 men （4.7%） with a serum PSA 20.1-40.0 ng/mL, 3/20 men （15%） with a serum PSA 40.1-60.0 ng/mL, 7/19 men （36.8%） with a serum PSA 60.1-100.0 ng/mL and 19/38 men （50%） with a serum PSA 〉 100.0 ng/mL had positive bone scans. Univariate and multivariate logistic regression analyses were uninformative in these groups. Conclusion： Based on our findings, a bone scan is of limited value in asymptomatic prostate cancer patients presenting PSA 〈 20 ng/mL. Therefore, this investigation can be eliminated unless a curative treatment is contemplated. Furthermore, digital rectal examination finding, biopsy Gleason score and age are unhelpful in predicting those who might harbor bone metastasis.

关键词： prostate cancer bone scan asymptomatic prostate-specific antigen

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Measurement of serum zinc improves prostate cancer detection efficiency in patients with PSA levels between 4 ng/mL and 10 ng/mL

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Asian Journal of Andrology 2005年第3期7卷 323-328页

作者： Xiao-Meng Li Ling Zhang Jiang Li Yang Li Hong-Liang Wang Guo-Yi Ji Masaaki Kuwahara Xue-Jian Zhao Department of Pathophysiology School of Basic Medical Sciences Department of Prosthodentics Dental School Jilin University Changchun 130021 China Department of Urology Miyagi Prefecture Cancer Center Natori 981-1293 Japan

Aim： To investigate whether the measurement of serum zinc may improve the detection of prostate cancer （PCa） in men who had total prostate-specific antigen （PSA） levels higher than 4.1 ng/mL. Methods： A mass screening for PCa of 3940 men over 50 years old was undertaken using total serum PSA. Of the 190 men （4.8 %） with elevated PSA, 143 （3.6 %） underwent a transrectal ultrasonography （TRUS）-guided biopsy of the prostate, and 42 men （1% of total and 29.3 % of men undergoing biopsy） were found to have cancer. The areas under the receiver operating characteristic curves （ROC-AUC） were used to compare the diagnostic power of cancer detection by means of serum zinc, and free PSA/total PSA ratio （fit）. Results： The men with levels of serum zinc that ranged from 40 ng/mL-60 ng/mL, had an age-adjusted odds ratios（OR） of 5.0. A cutoff value of 100 gg/mL for-serum zinc concentration provided a sensitivity of 90.5 % and a specificity of 32.7 % in elevated PSA range, and a sensitivity of 93.3 % and specificity of 27.1% in gray zone, respectively. In the gray zone ranges of 4.1 ng/mL-10.0 ng/mL, the ROC-AUC for zinc was 73.0 % higher than 62.7 % of f/t PSA ratio and 56.7 % of total PSA. Conclusion： PCa displays a lower serum zinc concentration. The measurement of zinc levels improves PCa detection in the gray zone compared with the f/t PSA ratio and total PSA. （Asian J Androl 2005 Sep; 7： 323-328）

关键词： prostate cancer prostate-specific antigen zinc gray zone

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