Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ; Department of Urology, School of Medicine, Kyungpook National University Medical Center, Daegu, Korea.
Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ; Department of Urology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
Urology. 2014 Aug;84(2):365-71. doi: 10.1016/j.urology.2014.02.038. Epub 2014 Jun 10.
To investigate the impact of prostate-specific antigen density (PSAD) on existing prostate cancer (PCa) active surveillance (AS) protocols.
Prospectively maintained database on men with PCa who underwent radical prostatectomy was reviewed retrospectively. Demographic data and pathologic characteristics of patients who fulfilled the AS inclusion criteria under the National Comprehensive Cancer Network (NCCN), Prostate Cancer Research International Active Surveillance (PRIAS), and University of California, San Francisco (UCSF) guidelines were examined.
Of 930 patients, 231, 280, and 325 fulfilled the NCCN, PRIAS, and UCSF AS criteria, respectively. The frequencies of advanced disease on surgical pathology (upstaging and/or upgrading) were 31.6% (NCCN), 35.4% (PRIAS), and 34.2% (UCSF) of the study cohorts. PSAD was significantly higher in patients with advanced disease compared with that in patients with nonadvanced disease in all 3 AS schemas. Modifying the PRIAS and UCSF criteria using the NCCN's lower PSAD cutoff of 0.15 ng/mL(2) decreased the rates of the advanced disease significantly to 33.5% and 31.4%, respectively. Using the receiver operating characteristic curve analysis, the optimal PSAD cutoff level for the prediction of advanced disease was 0.085 ng/mL(2) (sensitivity/specificity of 76.7%/50.6% in NCCN and 75.6%/49.7% in PRIAS).
Among patients with low-risk PCa who underwent radical prostatectomy, PSAD is a predictor of advanced disease at the time of surgery. Adopting a lower PSAD threshold of 0.085 ng/mL(2) decreased the risk of the advanced disease to 17.5%-21.7%. Therefore, PSAD should be part of all AS guidelines.
研究前列腺特异性抗原密度（PSAD）对现有的前列腺癌（PCa）主动监测（AS）方案的影响。
回顾性分析了接受根治性前列腺切除术的 PCa 患者的前瞻性数据库。检查了符合国家综合癌症网络（NCCN）、前列腺癌研究国际主动监测（PRIAS）和加利福尼亚大学旧金山分校（UCSF）指南 AS 纳入标准的患者的人口统计学数据和病理特征。
在 930 名患者中，分别有 231、280 和 325 名患者符合 NCCN、PRIAS 和 UCSF AS 标准。在所有 3 个 AS 方案中，手术病理上高级别疾病（升级和/或升级）的频率分别为研究队列的 31.6%（NCCN）、35.4%（PRIAS）和 34.2%（UCSF）。在所有 3 个 AS 方案中，高级别疾病患者的 PSAD 明显高于非高级别疾病患者。使用 NCCN 的较低 PSAD 截止值 0.15ng/mL(2)修改 PRIAS 和 UCSF 标准，显著降低高级别疾病的发生率，分别为 33.5%和 31.4%。使用受试者工作特征曲线分析，预测高级别疾病的最佳 PSAD 截止值为 0.085ng/mL(2)（NCCN 中的灵敏度/特异性为 76.7%/50.6%，PRIAS 为 75.6%/49.7%）。
在接受根治性前列腺切除术的低危 PCa 患者中，PSAD 是手术时发生高级别疾病的预测因子。采用较低的 PSAD 阈值 0.085ng/mL(2)可将高级别疾病的风险降低到 17.5%-21.7%。因此，PSAD 应成为所有 AS 指南的一部分。
