Re-examining Prostate-specific Antigen (PSA) Density: Defining the Optimal PSA Range and Patients for Using PSA Density to Predict Prostate Cancer Using Extended Template Biopsy

Joshua S. Jue, Marcelo Panizzutti Barboza, Nachiketh S. Prakash, Vivek Venkatramani, Varsha R. Sinha, Nicola Pavan, Bruno Nahar, Pratik Kanabur, Michael Ahdoot, Yan Dong, Ramgopal Satyanarayana, Dipen J Parekh, Sanoj Punnen

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11 Citations (Scopus)

Abstract

Objective To compare the predictive accuracy of prostate-specific antigen (PSA) density vs PSA across different PSA ranges and by prior biopsy status in a prospective cohort undergoing prostate biopsy. Materials and Methods Men from a prospective trial underwent an extended template biopsy to evaluate for prostate cancer at 26 sites throughout the United States. The area under the receiver operating curve assessed the predictive accuracy of PSA density vs PSA across 3 PSA ranges (<4 ng/mL, 4-10 ng/mL, >10 ng/mL). We also investigated the effect of varying the PSA density cutoffs on the detection of cancer and assessed the performance of PSA density vs PSA in men with or without a prior negative biopsy. Results Among 1290 patients, 585 (45%) and 284 (22%) men had prostate cancer and significant prostate cancer, respectively. PSA density performed better than PSA in detecting any prostate cancer within a PSA of 4-10 ng/mL (area under the receiver operating characteristic curve [AUC]: 0.70 vs 0.53, P <.0001) and within a PSA >10 mg/mL (AUC: 0.84 vs 0.65, P <.0001). PSA density was significantly more predictive than PSA in detecting any prostate cancer in men without (AUC: 0.73 vs 0.67, P <.0001) and with (AUC: 0.69 vs 0.55, P <.0001) a previous biopsy; however, the incremental difference in AUC was higher among men with a previous negative biopsy. Similar inferences were seen for significant cancer across all analyses. Conclusion As PSA increases, PSA density becomes a better marker for predicting prostate cancer compared with PSA alone. Additionally, PSA density performed better than PSA in men with a prior negative biopsy.

Original languageEnglish (US)
Pages (from-to)123-128
Number of pages6
JournalUrology
Volume105
DOIs
StatePublished - Jul 1 2017

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Prostate-Specific Antigen
Prostatic Neoplasms
Biopsy
Area Under Curve

ASJC Scopus subject areas

  • Urology

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Re-examining Prostate-specific Antigen (PSA) Density : Defining the Optimal PSA Range and Patients for Using PSA Density to Predict Prostate Cancer Using Extended Template Biopsy. / Jue, Joshua S.; Barboza, Marcelo Panizzutti; Prakash, Nachiketh S.; Venkatramani, Vivek; Sinha, Varsha R.; Pavan, Nicola; Nahar, Bruno; Kanabur, Pratik; Ahdoot, Michael; Dong, Yan; Satyanarayana, Ramgopal; Parekh, Dipen J; Punnen, Sanoj.

In: Urology, Vol. 105, 01.07.2017, p. 123-128.

Research output: Contribution to journalArticle

Jue, Joshua S. ; Barboza, Marcelo Panizzutti ; Prakash, Nachiketh S. ; Venkatramani, Vivek ; Sinha, Varsha R. ; Pavan, Nicola ; Nahar, Bruno ; Kanabur, Pratik ; Ahdoot, Michael ; Dong, Yan ; Satyanarayana, Ramgopal ; Parekh, Dipen J ; Punnen, Sanoj. / Re-examining Prostate-specific Antigen (PSA) Density : Defining the Optimal PSA Range and Patients for Using PSA Density to Predict Prostate Cancer Using Extended Template Biopsy. In: Urology. 2017 ; Vol. 105. pp. 123-128.
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title = "Re-examining Prostate-specific Antigen (PSA) Density: Defining the Optimal PSA Range and Patients for Using PSA Density to Predict Prostate Cancer Using Extended Template Biopsy",
abstract = "Objective To compare the predictive accuracy of prostate-specific antigen (PSA) density vs PSA across different PSA ranges and by prior biopsy status in a prospective cohort undergoing prostate biopsy. Materials and Methods Men from a prospective trial underwent an extended template biopsy to evaluate for prostate cancer at 26 sites throughout the United States. The area under the receiver operating curve assessed the predictive accuracy of PSA density vs PSA across 3 PSA ranges (<4 ng/mL, 4-10 ng/mL, >10 ng/mL). We also investigated the effect of varying the PSA density cutoffs on the detection of cancer and assessed the performance of PSA density vs PSA in men with or without a prior negative biopsy. Results Among 1290 patients, 585 (45{\%}) and 284 (22{\%}) men had prostate cancer and significant prostate cancer, respectively. PSA density performed better than PSA in detecting any prostate cancer within a PSA of 4-10 ng/mL (area under the receiver operating characteristic curve [AUC]: 0.70 vs 0.53, P <.0001) and within a PSA >10 mg/mL (AUC: 0.84 vs 0.65, P <.0001). PSA density was significantly more predictive than PSA in detecting any prostate cancer in men without (AUC: 0.73 vs 0.67, P <.0001) and with (AUC: 0.69 vs 0.55, P <.0001) a previous biopsy; however, the incremental difference in AUC was higher among men with a previous negative biopsy. Similar inferences were seen for significant cancer across all analyses. Conclusion As PSA increases, PSA density becomes a better marker for predicting prostate cancer compared with PSA alone. Additionally, PSA density performed better than PSA in men with a prior negative biopsy.",
author = "Jue, {Joshua S.} and Barboza, {Marcelo Panizzutti} and Prakash, {Nachiketh S.} and Vivek Venkatramani and Sinha, {Varsha R.} and Nicola Pavan and Bruno Nahar and Pratik Kanabur and Michael Ahdoot and Yan Dong and Ramgopal Satyanarayana and Parekh, {Dipen J} and Sanoj Punnen",
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T1 - Re-examining Prostate-specific Antigen (PSA) Density

T2 - Defining the Optimal PSA Range and Patients for Using PSA Density to Predict Prostate Cancer Using Extended Template Biopsy

AU - Jue, Joshua S.

AU - Barboza, Marcelo Panizzutti

AU - Prakash, Nachiketh S.

AU - Venkatramani, Vivek

AU - Sinha, Varsha R.

AU - Pavan, Nicola

AU - Nahar, Bruno

AU - Kanabur, Pratik

AU - Ahdoot, Michael

AU - Dong, Yan

AU - Satyanarayana, Ramgopal

AU - Parekh, Dipen J

AU - Punnen, Sanoj

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Objective To compare the predictive accuracy of prostate-specific antigen (PSA) density vs PSA across different PSA ranges and by prior biopsy status in a prospective cohort undergoing prostate biopsy. Materials and Methods Men from a prospective trial underwent an extended template biopsy to evaluate for prostate cancer at 26 sites throughout the United States. The area under the receiver operating curve assessed the predictive accuracy of PSA density vs PSA across 3 PSA ranges (<4 ng/mL, 4-10 ng/mL, >10 ng/mL). We also investigated the effect of varying the PSA density cutoffs on the detection of cancer and assessed the performance of PSA density vs PSA in men with or without a prior negative biopsy. Results Among 1290 patients, 585 (45%) and 284 (22%) men had prostate cancer and significant prostate cancer, respectively. PSA density performed better than PSA in detecting any prostate cancer within a PSA of 4-10 ng/mL (area under the receiver operating characteristic curve [AUC]: 0.70 vs 0.53, P <.0001) and within a PSA >10 mg/mL (AUC: 0.84 vs 0.65, P <.0001). PSA density was significantly more predictive than PSA in detecting any prostate cancer in men without (AUC: 0.73 vs 0.67, P <.0001) and with (AUC: 0.69 vs 0.55, P <.0001) a previous biopsy; however, the incremental difference in AUC was higher among men with a previous negative biopsy. Similar inferences were seen for significant cancer across all analyses. Conclusion As PSA increases, PSA density becomes a better marker for predicting prostate cancer compared with PSA alone. Additionally, PSA density performed better than PSA in men with a prior negative biopsy.

AB - Objective To compare the predictive accuracy of prostate-specific antigen (PSA) density vs PSA across different PSA ranges and by prior biopsy status in a prospective cohort undergoing prostate biopsy. Materials and Methods Men from a prospective trial underwent an extended template biopsy to evaluate for prostate cancer at 26 sites throughout the United States. The area under the receiver operating curve assessed the predictive accuracy of PSA density vs PSA across 3 PSA ranges (<4 ng/mL, 4-10 ng/mL, >10 ng/mL). We also investigated the effect of varying the PSA density cutoffs on the detection of cancer and assessed the performance of PSA density vs PSA in men with or without a prior negative biopsy. Results Among 1290 patients, 585 (45%) and 284 (22%) men had prostate cancer and significant prostate cancer, respectively. PSA density performed better than PSA in detecting any prostate cancer within a PSA of 4-10 ng/mL (area under the receiver operating characteristic curve [AUC]: 0.70 vs 0.53, P <.0001) and within a PSA >10 mg/mL (AUC: 0.84 vs 0.65, P <.0001). PSA density was significantly more predictive than PSA in detecting any prostate cancer in men without (AUC: 0.73 vs 0.67, P <.0001) and with (AUC: 0.69 vs 0.55, P <.0001) a previous biopsy; however, the incremental difference in AUC was higher among men with a previous negative biopsy. Similar inferences were seen for significant cancer across all analyses. Conclusion As PSA increases, PSA density becomes a better marker for predicting prostate cancer compared with PSA alone. Additionally, PSA density performed better than PSA in men with a prior negative biopsy.

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