Optimal predictors of prostate cancer on repeat prostate biopsy: A prospective study of 1,051 men

• Percent free PSA was the most accurate predictor of prostate cancer in repeat biopsy specimens
• Repeat biopsies are recommended in men with percent free PSA <30% or transition zone PSA density 0.26ng/ml/cc.

Although the Prostate Specific Antigen (PSA) test is an important biological marker for prostate cancer its use is limited in serum PSA range 4-10ng/ml, as there is considerable overlap of patients with prostate cancer and those with benign disease. However this can mean that a large percentage of patients will undergo unnecessary prostatic biopsy. This paper reports on a prospective study to evaluate the ability of PSA, PSA density, transition zone PSA density and percent free PSA to improve sensitivity and specificity of PSA testing compared to the use of total PSA measurements alone.

Between January 1997 and March 1999 a total of 1051 men (aged 48-77 years), who had undergone repeat prostatic biopsy after initial results were negative for prostate carcinoma, were enrolled into the study. All subject to total serum PSA value between 4-10ng/ml. Blood samples were taken for PSA measurements before any prostate manipulation. All patients underwent digital rectal examination and transrectal ultrasound guided sextant biopsy with 2 additional transition zone biopsies. In 254 patients biopsy specimens were also taken from suspicious areas identified during investigations. Subjects with negative initial biopsy results underwent repeat biopsies after 6 weeks.

In 231 subjects (22%) initial biopsy results were positive for prostate cancer, these men had significantly higher total PSA, PSA density and transitional zone PSA density. The remaining 820 men were diagnosed with benign prostate hyperplasia, and underwent repeat biopsies at 6 weeks, at which point 10% were determined to have prostate cancer. Percent free PSA and transition zone PSA density were most accurate predictors of carcinoma in this group. Assessing sensitivity and specificity it was observed that a cut-off of 30% percent free PSA and 0.26ng/ml/cc transition zone PSA density, would have detected 90% of cancers whilst avoiding 505 unnecessary repeat biopsies. Using receiver operating characteristics (ROC) analysis it was found that when initial and repeat biopsy results were combined, the area under the curve was 82.7% for transition zone PSA density and 74.2% for percent free PSA, making transistion zone PSA density a better predictor of repeat biopsy results.

In the repeat biopsy group and overall (initial plus repeat biopsy group) percent free PSA resulted in a higher rate of cancer detection. It was recommended that percent free PSA and/or transition zone PSA density should be determined in patients with total serum PSA between 4-10ng/ml.

Supported by an educational grant from AstraZeneca

Nøkkelord i denne artikkelen: Klikk på et nøkkelord for å finne mer informasjon

Publisert 01.11.2001

Aktuelt på AstraZeneca.no nå

12.04.10 Gratis e-læringskurs om Astma Lær mer om symptomer, bakgrunn og behandling av astma. Kurset gir en generell beskrivelse av lungene og forteller deretter om astma som sykdom og om hva som skjer ved astmaanfall samt hvilke tester legen kan benytte for å påvise astma. Kurset avsluttes med informasjon om hvordan du kan unngå astmautløsende faktorer og om hvilke alternativer som finnes for behandling av astma. Start kurset

28.05.10: Astma og allergi i ferietiden Som astmatiker eller allergiker er det mye man bør passe på. Dette gjelder også når man skal på ferie. Her er noen reisetips.

Aktuelle nyheter om AstraZeneca

28.05.2010 AstraZeneca flytter til nye lokaler på Helsfyr Mandag d. 31 mai vil AstraZeneca Norge være på plass i nye lokaler på Helsfyr. Besøksadressen er: Innspurten 15, 0663 Oslo. Ny post adresse er: Postboks 6050, Etterstad, 0601 OSLO 04.05.2009 AstraZeneca oppretter et nytt nordisk markedsføringsselskap - styrket kompetanse med fortsatt sterk lokal kundestøtte. AstraZeneca vil konsentrere sine markedsføringsressurser i Danmark, Finland, Norge og Sverige i ett nytt nordisk markedsføringsselskap. Det nye selskapet vil være basert i Södertälje i Sverige. Det nordiske markedsselskapet vil være ansvarlig for strategiske og administrative oppgaver, mens direkte kunderelasjoner forblir lokale. I alle nordiske land vil det være en sterk lokal kundeorganisasjon for å sikre at kundene får kontinuerlig service av høy kvalitet. Les mer.

Andre norske nettsteder fra AstraZeneca

AstraZeneca har flere nettsteder beregnet både på det generelle publikum og på spesielle faggrupper.