Tsang Chiu-Fung, Lai Terence C T, Lam Wayne, Ho Brian S H, Ng Ada T L, Ma Wai-Kit, Yiu Ming-Kwong, Tsu James H L
Division of Urology, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
Prostate Int. 2019 Jun;7(2):73-77. doi: 10.1016/j.prnil.2018.03.002. Epub 2018 Mar 12.
To investigate the role of Prostate Specific Antigen density (PSAD) in selecting prostate cancer patients for active surveillance (AS) and to determine a cutoff PSAD in identifying adverse pathological outcomes.
Data from 287 patients who underwent radical prostatectomy for prostate cancer were retrospectively reviewed. Six different AS protocols, the University of Toronto; Royal Marsden; John Hopkins; University of California San Francisco (UCSF); Memorial Sloan Kettering Cancer Center (MSKCC) and Prostate Cancer Research International: Active Surveillance (PRIAS), were applied to the cohort. Pre-operative demographics and pathological outcomes were analysed. Statistical analyses on the predictive factors of adverse pathological outcomes and significance of PSAD were performed. A cutoff PSAD with best balance between sensitivity and specificity in identifying adverse pathological outcome was determined.
PSAD predicted adverse pathological outcomes better than Prostate Specific Antigen (PSA) level alone. The PSAD was significantly lower (0.12-0.13 ng/dl/ml) in protocols including PSAD (the John Hopkins and PRIAS) compared with the other four protocols not including PSAD as a selection criteria (0.21-0.25 ng/dl/dl, = 0.00). PSAD predicted adverse pathological outcomes in all protocols not incorporating PSAD as an inclusion criteria ( = 0.00-0.02). By the receiver operator characteristics curve analysis, it was found that a PSAD level of 0.19 ng/ml/ml had the best balance between sensitivity and specificity in predicting pathological adverse disease (Area under curve = 0.63, = 0.004).
PSAD is necessary in selecting prostate cancer patients for active surveillance. It predicts adverse pathological outcomes in patients eligible for active surveillance better than PSA level alone. A PSAD cutoff at 0.19 ng/ml/ml has the best balance between sensitivity and specificity in predicting pathological adverse disease. We recommend using AS protocol incorporating PSAD as a selection criteria (in particular the PRIAS protocol with a cutoff PSAD at 0.2 ng/ml/ml) when recruiting prostate cancer patients for AS.
探讨前列腺特异性抗原密度（PSAD）在选择前列腺癌患者进行主动监测（AS）中的作用，并确定用于识别不良病理结果的PSAD临界值。
回顾性分析287例接受前列腺癌根治术患者的数据。将六种不同的AS方案，即多伦多大学、皇家马斯登医院、约翰霍普金斯大学、加利福尼亚大学旧金山分校（UCSF）、纪念斯隆凯特琳癌症中心（MSKCC）以及国际前列腺癌研究：主动监测（PRIAS），应用于该队列。分析术前人口统计学数据和病理结果。对不良病理结果的预测因素及PSAD的意义进行统计分析。确定在识别不良病理结果时灵敏度和特异性之间具有最佳平衡的PSAD临界值。
PSAD比单独的前列腺特异性抗原（PSA）水平能更好地预测不良病理结果。与其他四个不将PSAD作为选择标准的方案（0.21 - 0.25 ng/dl/dl，P = 0.00）相比，包括PSAD的方案（约翰霍普金斯大学和PRIAS）中的PSAD显著更低（0.12 - 0.13 ng/dl/ml）。在所有不将PSAD作为纳入标准的方案中，PSAD均能预测不良病理结果（P = 0.00 - 0.02）。通过受试者操作特征曲线分析发现，PSAD水平为0.19 ng/ml/ml在预测病理不良疾病时灵敏度和特异性之间具有最佳平衡（曲线下面积 = 0.63，P = 0.004）。
PSAD对于选择前列腺癌患者进行主动监测是必要的。它比单独的PSA水平能更好地预测符合主动监测条件患者的不良病理结果。PSAD临界值为0.19 ng/ml/ml在预测病理不良疾病时灵敏度和特异性之间具有最佳平衡。我们建议在招募前列腺癌患者进行主动监测时，使用将PSAD作为选择标准的AS方案（特别是PSAD临界值为0.2 ng/ml/ml的PRIAS方案）。
