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Performance of the prostate Health Index in predicting prostate biopsy outcomes among men with a negative digital rectal examination and transrectal ultrasonography

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Asian Journal of Andrology 2016年第4期18卷 633-638页

作者： Guo-Peng Yu Rong Na Ding-Wei Ye Jun Qi Fang Liu Hai-Tao Chen Yi-Shuo Wu Gui-Ming Zhang Jie-Lin Sun Yao Zhu Li-Qun Huang Shan-Cheng Ren De-Ke Jiang S Lilly Zheng Hao-WenJiang Ying-Hao Sun Qiang Ding Jianfeng Xu Fudan Institute of Urology Huashan Hospital Fudan University Shanghai China Department of Urology Huashan Hospital Fudan University Shanghai China Department of Urology Fudan University Shanghai Cancer Center and Department of Oncology Shanghai Medical College Fudan University Shanghai China Department of Urology Xinhua Hospital School of Medicine Shanghai Jiao Tong University Shanghai China State Key Laboratory of Genetic Engineering School of Life Salience Fudan University Shanghai China Center for Cancer Genomics Wake Forest School of Medicine Winston-Salem North Carolina USA Department of Urology Shanghai Changhai Hospital Second Military Medical University Shanghai China Program for Personalized Cancer Care NorthShore University HealthSystem Evanston IL USA.

The [-2]proPSA （p2PSA） and its derivatives, the p2PSA-to-free PSA ratio （%p2PSA）, and the prostate Health Index （PHI） have greatly improved discrimination between men with and without prostate cancer （PCa） in prostate biopsies. However, little is known about their performance in cases where a digital rectal examination （DRE） and transrectal ultrasonography （TRUS） are negative. A prospective cohort of 261 consecutive patients in China with negative DRE and TRUS were recruited and underwent prostate biopsies. A serum sample had collected before the biopsy was used to measure various PSA derivatives, including total prostate-specific antigen （tPSA）, free PSA, and p2PSA. For each patient, the free-to-total PSA ratio （%fPSA）, PSA density （PSAD）, p2PSA-to-free PSA ratio （%p2PSA）, and PHI were calculated. Discriminative performance was assessed using the area under the receiver operating characteristic curve （AUC） and the biopsy rate at 91% sensitivity. The AUC scores within the entire cohort with respect to age, tPSA, %fPSA, PSAD, p2PSA, %p2PSA, and PHI were 0.598, 0.751, 0.646, 0.789, 0.814, 0.808, and 0.853, respectively. PHI was the best predictor of prostate biopsy results, especially in patients with a tPSA of 10.1-20 ng ml-1. Compared with other markers, at a sensitivity of 91%, PHI was the most useful for determining which men did not need to undergo biopsy, thereby avoiding unnecessary procedures. The use of PHI could improve the accuracy of PCa detection by predicting prostate biopsy outcomes among men with a negative DRE and TRUS in China.

关键词： [-2]proPSA prostate cancer prostate Health Index prostate-specific antigen receiver operating curve

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

Testosterone therapy in men with prostate cancer： literature review, clinical experience, and recommendations

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Asian Journal of Andrology 2015年第2期17卷 206-211,I0007页

作者： Abraham Morgentaler William P Conners III Men's Health Boston 200 Boylston St Suite A309 Chestnut Hill MA 02467 USA.

For several decades any diagnosis of prostate cancer （PCa） has been considered an absolute contraindication to the use of testosterone （T） therapy in men. Yet this prohibition against T therapy has undergone recent re-examination with refinement of our understanding of the biology of androgens and PCa, and increased appreciation of the benefits of T therapy. A reassuringly low rate of negative outcomes has been reported with T therapy after radical prostatectomy （RP）, radiation treatments, and in men on active surveillance. Although the number of these published reports are few and the total number of treated men is low, these experiences do provide a basis for consideration of T therapy in selected men with PCa. For clinicians considering offering this treatment, we recommend first selecting patients with low grade cancers and undetectable prostate-specific antigen following RP. Further research is required to define the safety of T therapy in men with PCa. However, many patients symptomatic from T deficiency are willing to accept the potential risk of PCa progression or recurrence in return for the opportunity to live a fuller and happier life with T therapy.

关键词： androgen deprivation androgens hypogonadism prostate cancer prostate-specific antigen testosterone testosterone therapy

Can we omit systematic biopsies in patients undergoing MRI fusion-targeted prostate biopsies?

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Asian Journal of Andrology 2023年第1期25卷 43-49页

作者： Jeffrey J Leow Soon Hock Koh Marcus WL Chow Wayren Loke Rolando Salada Seok Kwan Hong Yuyi Yeow Chau Hung Lee Cher Heng Tan Teck Wei Tan Department of Urology Tan Tock Seng HospitalSingapore 308433Singapore Lee Kong Chian School of Medicine Nanyang Technological UniversitySingapore 308232Singapore Department of Diagnostic Radiology Tan Tock Seng HospitalSingapore 308433Singapore

Magnetic resonance imaging(MRI)-targeted prostate biopsy is the recommended investigation in men with suspicious lesion(s)on *** role of concurrent systematic in addition to targeted biopsies is currently *** our prospectively maintained database,we identified men with at least one prostate Imaging-Reporting and Data System(PI-RADS)≥3 lesion who underwent targeted and/or systematic biopsies from May 2016 to May *** significant prostate cancer(csPCa)was defined as any Gleason grade group≥2 *** 545 patients who underwent MRI fusion-targeted biopsy,222(40.7%)were biopsy naïve,247(45.3%)had previous prostate biopsy(s),and 76(13.9%)had known prostate cancer undergoing active *** cancer was more commonly found in biopsy-naïve men(63.5%)and those on active surveillance(68.4%)compared to those who had previous biopsies(35.2%;both Pprostate-specific antigen(PSA)density≥0.15 ng ml^(−2)(OR=3.24,Pprostate health index(PHI)≥35(OR=2.43,P=0.006),higher PI-RADS score(vs PI-RADS 3;OR=4.59 for PI-RADS 4,and OR=9.91 for PI-RADS 5;both Pprostate volume ratio≥0.10(OR=5.26,P=0.013)were significantly associated with csPCa detection on targeted *** conclusion,for men undergoing MRI fusion-targeted prostate biopsies,systematic biopsies should not be omitted given its incremental value to targeted biopsies *** factors such as PSA density≥0.15 ng ml^(−2),PHI≥35,higher PI-RADS score,and target lesion volume-to-prostate volume ratio≥0.10 can help identify men at higher risk of csPCa.

关键词： prostate biopsy prostate cancer prostate health index prostate-specific antigen software fusion Uronav

Pathological findings following radical prostatectomy in patients who are candidates for active surveillance： impact of varying PSA levels

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Asian Journal of Andrology 2011年第6期13卷 838-841页

作者： Dong Il Kang Thomas L. Jang Jeongyun Jeong Eun Young Choi Kelly Johnson Dong Hyeon Lee Wun-Jae Kim Isaac Yi Kim Section of Urologic Oncology and Dean and Betty Gallo prostate Cancer The Cancer Institute of New Jersey Robert Wood Johnson Medical School New Brunswick NJ 08903 USA Department of Urology Inje University Medical School Busan 614-735 Korea Department of Urology Ewha Womans University Seoul 158-710 Korea Department of Urology Chungbuk National University College of Medicine Cheongju 361-711 Korea

Active surveillance is an acceptable treatment option in men with a low-risk prostate cancer. In the present study, we have retrospectively reviewed the outcomes of 509 men who fit the criteria for active surveillance but selected radical prostatectomy. Then, the impact of varying prostate-specific antigen （PSA） levels on the risk of upstaging and upgrading in these patients was assessed. Pathological characteristics of patients who fulfilled the inclusion criteria under three active surveillance criteria--those of the University of California-San Francisco, the National Cancer Institute and the European Association of Urology--were examined. The proportion of men who were deemed candidates for active surveillance but were subsequently upstaged or upgraded was determined. Of 509 patients, 186 （36.5%）, 132 （25.9%） and 88 （17.3%） men fulfilled the active surveillance criteria, respectively. Upgrading （Gleason scores 7-10） ranged from 32.8% to 38.6%, while upstaging （≥ pT3） ranged from 10.2% to 12.5%, depending on the three active surveillance criteria. After a median follow-up of 24 months, three patients developed a biochemical recurrence. When the impact of varying PSA levels was examined using a test for trend analysis in the context of PSA for each protocol, rates of upstaging were lower in men with PSA 〈4 ng m1-1. However, there was no impact of varying PSA levels on upgrading. In conclusion, commonly used active surveillance protocols carry the risks of upgrading and upstaging. More reliable and accurate markers are needed to better stratify the risks of men who are appropriate candidates for active surveillance.

关键词： prostatectomy prostate-specific antigen prostatic neoplasm risk

The Huashan risk calculators performed better in prediction of prostate cancer in Chinese population： a training study followed by a validation study

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Asian Journal of Andrology 2016年第6期18卷 925-929页

作者： Yi-Shuo Wu Ning Zhang Sheng-Hua Liu Jian-Feng Xu Shi-Jun Tong Ye-Hua Cai Li-Min Zhang Pei-De Bai Meng-Bo HU Hao-Wen Jiang Rong Na Qiang Ding Ying-Hao Sun Department of Urology Huashan Hospital Fudan University Shanghai China Urology Research Center Fudan University Shanghai China Department of Ultrasonic Huashan Hospital Fudan University Shanghai China NorthShore University HeatthSystem Evanston IL USA Department of Urology Changhai Hospital The Second Military Medical University Shanghai China

The performances of the prostate Cancer Prevention Trial （PCPT） risk calculator and other risk calculators for prostate cancer （PCa） prediction in Chinese populations were poorly understood. We performed this study to build risk calculators （Huashan risk calculators） based on Chinese population and validated the performance of prostate-specific antigen （PSA）, PCPT risk calculator, and Huashan risk calculators in a validation cohort. We built Huashan risk calculators based on data from 1059 men who underwent initial prostate biopsy from January 2006 to December 2010 in a training cohort. Then, we validated the performance of PSA, PCPT risk calculator, and Huashan risk calculators in an observational validation study from January 2011 to December 2014. All necessary clinical information were collected before the biopsy. The results showed that Huashan risk calculators 1 and 2 outperformed the PCPT risk calculator for predicting PCa in both entire training cohort and stratified population （with PSA from 2.0 ng ml^-1 to 20.0 ng ml^-1）. In the validation study, Huashan risk calculator 1 still outperformed the PCPT risk calculator in the entire validation cohort （0.849 vs 0.779 in area under the receiver operating characteristic curve [AUC]） and stratified population. A considerable reduction of unnecessary biopsies （approximately 30%） was also observed when the Huashan risk calculators were used. Thus, we believe that the Huashan risk calculators （especially Huashan risk calculator 1） may have added value for predicting PCa in Chinese population. However, these results still needed further evaluation in larger populations.

关键词： biopsy China prostate cancer prostate-specific antigen risk calculator

PSA time to nadir as a prognostic factor of first-line docetaxel treatment in castration-resistant prostate cancer： evidence from patients in Northwestern China

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Asian Journal of Andrology 2018年第2期20卷 173-177页

作者： Kai-Jie Wu Xin-Qi Pei Ge Tian Da-Peng Wu Jin-Hai Fan Yu-Mei Jiang Da-Lin He Department of Urology The First Affiliated Hospital of Xi'an Jiaotong University Xi'an 710061 China

Docetaxel-based chemotherapy remains the first-line treatment for patients with metastatic castration-resistant prostate cancer （mCRPC） in China; however, the prognostic factors associated with effects in these patients are still controversial. In this study, we retrospectively reviewed the data from 71 eligible Chinese patients who received docetaxel chemotherapy from 2009 to 2016 in our hospital and experienced a reduction of prostate-specific antigen （PSA） level 〉50% during the treatment and investigated the potential role of time to nadir （TTN） of PSA. TTN was defined as the time from start of chemotherapy to the nadir of PSA level during the treatment. Multivariable Cox regression models and Kaplan-Meier analysis were used to predict overall survival （OS）. In these patients, the median of TTN was 17 weeks. Patients with TTN ≥17 weeks had a longer response time to chemotherapy compared to TTN 〈17 weeks （42.83 vs 21.50 weeks, P 〈 0.001）. The time to PSA progression in patients with TTN ：〉17 weeks was 11.44 weeks compared to 5.63 weeks when TTN was 〈17 weeks. We found several factors to be associated with OS, including TTN （hazard ratio [HR]. 3.937, 95% confidence interval [CI]： 1.502-10.309, P = 0.005）, PSA level at the diagnosis of cancer （HR： 4,337, 95% CI： 1.616-11.645, P= 0.004）, duration of initial androgen deprivation therapy （HR： 2.982, 95% CI： 1.104-8.045, P= 0.031）, neutrophil-to-lymphocyte ratio （HR： 3.963, 95% CI： 1.380-11.384, P = 0.011）, and total PSA response （Class 1 [〈0 response] compared to Class 2 [0-50% response], HR： 3.978, 95% CI： 1.278-12.387, P = 0.017）. In conclusion, TTN of PSA remains an important prognostic marker in predicting therapeutic outcome in Chinese population who receive chemotherapy for mCRPC and have 〉50% PSA remission.

关键词： castration-resistant prostate cancer chemotherapy docetaxel prostate-specific antigen survival time to nadir

PSA density improves the rate of prostate cancer detection in Chinese men with a PSA between 2.5-10.0 ng ml-1 and 10.1-20.0 ng ml-1： a multicenter study

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Asian Journal of Andrology 2015年第3期17卷 503-507页

作者： Yu-Rong Lin Xing-Hua Wei Matthew Uhlman Xuan-Ting Lin Si-Feng Wu Peng-Fei Diao Hai-Qing Xie Ke-Ji Xie Ping Tang Department of Urology Guangzhou First People's Hospital Guangzhou Medical University Guangzhou 510180 China Department of Urology Jieyang People's Hospital Jieyang 522000 China Department of Urology University of Iowa Iowa City IA 52242 USA

Chinese men should have a higher prostate-specific antigen （PSA）＂gray zone＂ than the traditional value of 2.5-10.0 ng ml-1 since the incidence of prostate cancer （PCa） in Chinese men is relative low. We hypothesized that PSA density （PSAD） could improve the rate of PCa detection in Chinese men with a PSA higher than the traditional PSA ＂gray zone.＂ A total of 461 men with a PSA between 2.5 and 20.0 ng ml-1, who had undergone prostatic biopsy at two Chinese centers were included in the analysis. The men were then further divided into groups with a PSA between 2.5-10.0 ng ml-1 and 10.1-20.0 ng ml-1. Receiver operating characteristic （ROC） curve was used to evaluate the efficacy of PSA and PSAD for the diagnosis of PCa. In men with a PSA of 2.5-10.0 ng ml-1 or 10.1-20.0 ng ml-z, the areas under the ROC curve were higher for PSAD than for PSA. This was consistent across both centers and the cohort overall. When the entire cohort was considered, the optimal PSAD cut-off for predicting PCa in men with a PSA of 2.5-10.0 ng m1-1 was 0.15 ng ml-2 ml-2, with a sensitivity of 64.4% and specificity of 64.6%. The optimal cut-off for PSAD in men with a PSA of 10.1-20.0 ng m1-1 was 0.33 ng ml-1 ml-1, with a sensitivity of 60.3% and specificity of 82.7%. PSAD can improve the effectiveness for PCa detection in Chinese men with a PSA of 2.5-10.0 ng ml-1 （traditional Western PSA ＂gray zone＂） and 10.1-20.0 ng ml-2 （Chinese PSA ＂gray zone＂）.

关键词： area under the receiver operating characteristic curve prostate cancer prostate-specific antigen prostate-specificantigen density

Expression of kallikrein-related peptidase 7 is decreased in prostate cancer

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Asian Journal of Andrology 2015年第1期17卷 106-110,I0010页

作者： Chong-Yu Zhang Yu Zhu Wen-Bin Rui Jun Dai Zhou-Jun Shen Department of Urology Ruijin Hospital School of Medicine Shanghai Jiaotong University Shanghai China.

Recent evidence suggests that the human kallikrein 7 （KLK7） is differentially regulated in a variety of tumors. The aim of this study was to determine the expression of kallikrein-related peptidase 7 and KLK7 in our large collection of prostate samples. Between August 2000 and December 2012, 116 patients with histologically confirmed prostate cancer （PCa） and 92 with benign prostate hyperplasia （BPH） were recruited into the study. Using immunohistochemistry, quantitative reverse transcription polymerase chain reaction （RT-PCR） and western blot, kallikrein-related peptidase 7 expression in BPH and PCa tissues was determined at the mRNA and protein levels. The relationships between kallikrein-related peptidase 7 mRNA expression and clinicopathological features were analyzed. A total of 64 of 92 （69.57%） benign cases showed positive staining for KLK7 and 23 of 116 （19.83%） malignant cases showed positive, the difference of KLK7 expression between PCa and BPH was statistically significant （P〈 0.001）. The expression level of kallikrein-related peptidase 7 mRNA was significantly decreased in PCa tissues compared with that in BPH tissues and normal prostate tissue. Kallikrein-related peptidase 7 mRNA exhibited different expression patterns in terms of localization depending on pathological category of PCa. Similarly, our western immunoblot analyses demonstrated that the protein expression levels of KLK7 was lower in PCa than in BPH tissues and normal prostate tissue. Kallikrein-related peptidase 7 and KLK7 expression are down-regulated in PCa and lower expression of kallikrein-related peptidase 7 closely correlates with higher Gleason score and higher prostate-specific antigen level.

关键词： human kallikrein 7 kallikrein-related peptidase 7 prostate cancer prostate-specific antigen