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Utility of PSA Density in Predicting Upgraded Gleason Score in Men on Active Surveillance With Negative MRI.

Authors :
Press, Benjamin H
Khajir, Ghazal
Ghabili, Kamyar
Leung, Cynthia
Fan, Richard E.
Wang, Nancy N.
Leapman, Michael S.
Sonn, Geoffrey A.
Sprenkle, Preston C.
Source :
Urology. Sep2021, Vol. 155, p96-100. 5p.
Publication Year :
2021

Abstract

<bold>Objectives: </bold>To determine whether PSA density (PSAD), can sub-stratify risk of biopsy upgrade among men on active surveillance (AS) with normal baseline MRI.<bold>Methods: </bold>We identified a cohort of patients with low and favorable intermediate-risk prostate cancer on AS at two large academic centers from February 2013 - December 2017. Analysis was restricted to patients with GG1 cancer on initial biopsy and a negative baseline or surveillance mpMRI, defined by the absence of PI-RADS 2 or greater lesions. We assessed ability of PSA, prostate volume and PSAD to predict upgrading on confirmatory biopsy.<bold>Results: </bold>We identified 98 patients on AS with negative baseline or surveillance mpMRI. Median PSA at diagnosis was 5.8 ng/mL and median PSAD was 0.08 ng/mL/mL. Fourteen men (14.3%) experienced Gleason upgrade at confirmatory biopsy. Patients who were upgraded had higher PSA (7.9 vs 5.4 ng/mL, P = .04), PSAD (0.20 vs 0.07 ng/mL/mL, P < .001), and lower prostate volumes (42.5 vs 65.8 mL, P = .01). On multivariate analysis, PSAD was associated with pathologic upgrade (OR 2.23 per 0.1-increase, P = .007). A PSAD cutoff at 0.08 generated a NPV of 98% for detection of pathologic upgrade.<bold>Conclusion: </bold>PSAD reliably discriminated the risk of Gleason upgrade at confirmatory biopsy among men with low-grade prostate cancer with negative MRI. PSAD could be clinically implemented to reduce the intensity of surveillance for a subset of patients. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
00904295
Volume :
155
Database :
Academic Search Index
Journal :
Urology
Publication Type :
Academic Journal
Accession number :
152249306
Full Text :
https://doi.org/10.1016/j.urology.2021.05.035