fPSA/tPSA比值优化前列腺癌早期诊断作用的研究

目的 :探讨游离前列腺特异性抗原 /总前列腺特异性抗原 (fPSA/tPSA)比值在优化tPSA早期诊断前列腺癌(PCa)中的作用。　方法 :以长春市 5 0岁以上PCa集团普查中tPSA在 4 .0～ 2 0 .0 μg/L范围、并接受前列腺活检的1 87例受检者为研究对象 ,测定tPSA、fPSA含量 ,应用SPSS 1 0 .0软件对不同区间fPSA/tPSA比值进行统计学分析。结果 :①tPSA在 4 .0～ 1 0 .0 μg/L、1 0 .0～ 2 0 .0 μg/L区间时 ,PCa检出率分别为1 8.1 %、2 2 .5 %。②ROC曲线分析显示不同区间时fPSA/tPSA比值的曲线下面积 (AUC)均大于tPSA (P <0 .0 5 )。③fPSA/tPSA比值取 0 .2 5为界值时 ,tPSA在 4 .0～ 1 0 .0 μg/L、1 0 .0～ 2 0 .0 μg/L两区间诊断PCa的敏感度分别为90 .5 %和 87.5 % ,可以分别避免 2 6 .7%和 1 1 .3%的人群进行活检。　结论 :在集团普查中 ,fPSA/tPSA比值在tPSA为 4 .0～ 2 0 .0 μg/L时可以提高检测PCa的特异性 ,减少不必要的活检。     

Medium-term Outcomes of Active Surveillance for Localised Prostate Cancer

Background

Active surveillance (AS) aims to allow men with favourable-risk, localised prostate cancer to avoid unnecessary treatment.

Objective

To describe the clinical outcomes of a prospective study of AS.

Design, setting, and participants

A single-centre, prospective cohort study. Eligibility criteria included histologically proven prostate adenocarcinoma, age 50–80 yr, stage T1/T2, prostate-specific antigen level (PSA) <15 ng/ml, Gleason score (GS) ≤3 + 3 (GS ≤3 + 4 if aged >65 yr), and percent positive biopsy cores (PPC) ≤50%.

Intervention

Patients were assessed by serum PSA level, and digital rectal examination at 3-mo intervals in year 1, 4-mo intervals in year 2, and at 6-mo intervals thereafter. Transrectal ultrasound-guided prostate biopsy was performed after 18–24 mo and every 2 yr thereafter. Treatment was recommended for PSA velocity (PSAV) >1 ng/ml per year or adverse histology, defined as GS ≥4 + 3 or PPC >50%.

Outcome measurements and statistical analysis

Outcomes described, using Kaplan-Meier methods, were rate of adverse histology on repeat biopsy, freedom from treatment, biochemical control after deferred treatment, and overall survival. Analyses using Cox regression were performed to determine predictors of deferred treatment and adverse histology.

Results and limitations

The study enrolled 471 eligible patients from 2002 to 2011. Median age was 66 yr and median initial PSA value was 6.4 ng/ml. Eighty-eight percent of patients had T1 disease and 93% had GS ≤3 + 3. At median follow-up of 5.7 yr, the 5-yr rate of adverse histology and treatment-free probability was 22% (95% confidence interval [CI], 16–29%) and 70% (95% CI, 65–75%), respectively. There were two deaths from prostate cancer. Predictors of time to adverse histology were GS 7, PSAV >1 ng/ml per year, low ratio of free PSA to total PSA, and PPC >25%. Longer follow-up is needed to confirm the safety of this strategy.

Conclusions

This study demonstrates satisfactory medium-term outcomes for AS in selected men with localised prostate cancer.     

Permanent Interstitial Low-Dose-Rate Brachytherapy for Patients with Localised Prostate Cancer: A Systematic Review of Randomised and Nonrandomised Controlled Clinical Trials

Context

Prostate cancer (PCa) is the most common cancer in men. Permanent interstitial low-dose-rate brachytherapy (LDR-BT) is a short-distance radiation therapy in which low-energy radioactive sources are implanted permanently into the prostate.

Objective

To assess the effectiveness and safety of LDR-BT compared to treatment alternatives in men with localised PCa.

Evidence acquisition

Bibliographic databases (Medline, Embase, and the Cochrane Library) were searched from inception until June 2010 for randomised and nonrandomised controlled trials comparing LDR-BT with radical prostatectomy (RP), external-beam radiation therapy (EBRT), or no primary therapy (NPT). Primary outcome was overall survival (OS). Secondary outcomes were disease-free survival (DFS), biochemical recurrence-free survival (bRFS), physician-reported severe adverse events (SAE), and patient-reported outcomes (PRO).

Evidence synthesis

A total of 31 studies, including 1 randomised controlled trial (RCT), were identified. Risk of bias was high for all 31 studies. OS was reported in one nonrandomised controlled study; however, these data were not interpretable because of strong residual confounding. DFS was not reported. Comparison of bRFS between treatment groups is not validated; thus, results were not interpretable. Physician-reported urogenital late toxicity grade 2 to 3 was more common in the LDR-BT group when compared to the EBRT group. With respect to PRO, better scores for sexual and urinary function as well as urinary incontinence were reported for LDR-BT compared to RP. Better scores for bowel function were reported for LDR-BT compared to EBRT.

Conclusions

We found a low amount of evidence in studies that exclusively compared LDR-BT with other treatment modalities. LDR-BT may have some different physician-reported SAE and patient-reported outcomes. The current evidence is insufficient to allow a definitive conclusion about OS. Randomised trials focusing on long-term survival are needed to clarify the relevance of LDR-BT in patients with localised PCa.     

Prostate-specific antigen kinetics in clinical decision-making during active surveillance for early prostate cancer--a review

CONTEXT: The kinetics of prostate specific antigen (PSA) are generally assumed to be indicative of tumour progression and are therefore used in clinical decision-making in men on active surveillance for early prostate cancer. OBJECTIVE: This review aims to provide support for exploiting PSA kinetics in an active surveillance setting. EVIDENCE ACQUISITION: We searched the Medline database and reviewed the evidence on both the relation between PSA kinetics before radical treatment for prostate cancer and outcome, as well as the role of PSA kinetics during active surveillance. Furthermore, the benefits and setbacks of different derivatives of PSA kinetics, minimum required time interval and number of measurements, practical recommendations, and pitfalls of their use in clinical practice are discussed. EVIDENCE SYNTHESIS: The evidence concerning the prognostic value of the PSA velocity (PSA-V) and PSA doubling time (PSA-DT) is sparse, especially in active surveillance. PSA kinetics should therefore be combined with other diagnostic measures as the trigger for deferred radical treatment or repeat prostate biopsies. There seems to be consensus among several reports on the unfavourable outcome relating to a PSA-DT <3-4 yr and on the favourable prognostic value of a PSA-DT >10 yr or a decreasing PSA level. Online tools provide help with calculations and insight on disease development. The best method of calculation, number of measurements, and time interval between measurements is unknown for now. CONCLUSIONS: Despite the current deficits in our understanding of the natural behaviour of early prostate cancer and its relation to serum PSA levels, and despite several secondary factors playing a role in PSA kinetics, PSA kinetics are a practical parameter we can offer men on active surveillance to assess the status of their disease.     

A Study of Diffusion-Weighted Magnetic Resonance Imaging in Men with Untreated Localised Prostate Cancer on Active Surveillance

Background

Markers that predict the behaviour of localised prostate cancer are needed to identify patients that require treatment.

Objective

We have analysed the apparent diffusion coefficient (ADC) generated from diffusion-weighted magnetic resonance imaging (DW-MRI) with respect to repeat biopsy findings and time to radical treatment in patients in a prospective study of active surveillance.

Design, setting, and participants

Some 86 men recruited between 2002 and 2006 were followed for a median of 29 mo. Patients had clinical stage T1/T2a N0/Nx M0/Mx adenocarcinoma of the prostate, prostate-specific antigen (PSA) level <15 ng/ml, Gleason score ≤7, primary Gleason grade ≤3, and positive biopsy cores (pbc) ≤50%.

Measurements

All patients had DW-MRI in addition to standard MRI sequences. Tumour regions of interest (ROIs) were identified using T2-weighted fast-spin echo images as focal areas of restricted diffusion. Univariate analyses including all clinical variables and tumour ADC data were performed with respect to repeat biopsy findings and time to radical treatment. Receiver operating curves (ROC) compared predictive variables.

Results and limitations

Patients in the study had a median age of 66 yr and a median initial PSA level of 6.7 ng/ml. Some 39 patients (45%) received deferred radical treatment, and 34 patients (40%) had adverse histology on repeat biopsy. According to univariate analysis, tumour ADC was a significant predictor of both adverse repeat biopsy findings (p < 0.0001; hazard ratio [HR]: 1.3; 95% confidence interval [CI]: 1.1–1.6), and time to radical treatment (p < 0.0001; HR: 1.5; 95% CI: 1.2–1.8). ROC curves for ADC showed an area under the curve (AUC) of 0.7 for prediction of adverse repeat biopsy findings and an AUC of 0.83 for prediction of radical treatment.

Conclusions

In patients with low-risk, localised disease, tumour ADC on DW-MRI may be a useful marker of prostate cancer progression and may help to identify patients who stand to benefit from radical treatment. This possibility warrants further study.     

Relationship between Prostate-Specific Antigen, Clinical Stage, and Degree of Bone Metastasis in Patients with Prostate Cancer: Comparison with Prostatic Acid Phosphatase and Alkaline Phosphatase

Background:
The study was designed to examine the relation of the levels of prostate-specific antigen (PSA), prostatic acid phosphatase (PAP), and alkaline phosphatase (ALP) to clinical stage and bone metastasis in prostate cancer patients.
Methods:
Serum PSA, PAP, and ALP levels were evaluated in 272 patients with prostate cancer. The relation of the level of PSA, PAP, and ALP to clinical stage and to degree of bone metastasis were examined by a multiple comparison method using ranks. The superiority of a marker in the rate of detection of bone metastasis was evaluated with receiver operating characteristic (ROC) curves. The correlation coefficients of the order of the extent of bone metastasis with PSA, PAP, and ALP were examined with Spearman's rank order correlation coefficient test.
Results:
The levels of PSA showed significant differences among 8 pairs of clinical stages, in contrast, the levels of PAP showed significant differences among 6 pairs, and the levels of ALP showed significant differences among only 4 pairs. The area under the ROC curves of PSA, PAP, and ALP for revealing bone metastasis was 84.9%, 81.4%, and 77.3%, respectively. The correlation coefficients of the order of extent of disease (EOD) with log (PSA), log (PAP), and log (ALP) were 0.346, 0.394, and 0.618, respectively, and the levels of ALP showed the most significant differences regarding the extent of bone metastasis.
Conclusion:
PSA was the best marker for differentiating clinical stages, but showed limited reliability for stratifying the extent of bone metastasis.     

Serum Prostate-Specific Antigen Values for the Prediction of Clinical Stage and Prognosis in Patients with Prostate Cancer: An Analysis of 749 Cases

Background: The clinical significance of pretreatment serum prostate-specific antigen (PSA) values was studied to determine the ability to predict clinical stage and prognosis using a relatively large number of patients with prostate cancer.
Methods: Serum PSA values at diagnosis were analyzed from 749 patients with newly-diagnosed prostate cancer and registered in the Tokai Urological Cancer Registry. Correlations between the PSA value, the clinical stage and prognosis of the patients were evaluated.
Results: Serum PSA values at each stage of diagnosis showed positivity (≥ 3.6 ng/mL) in 23% (stage A1) to 91.2% (stage D2) of patients, and it was possible to obtain statistical differences between the stages, even between A1 and A2. Based on a cumulative study of PSA distribution, stages greater than A2 could be diagnosed using a cut-off of 7.2 ng/mL, with a 99.2% positive predictive value (PPV), and a 16.2% negative predictive value (NPV). At a PSA level of 1 0.8 ng/mL, stages greater than B2 could be predicted with a PPV of 95.3% but an NPV of 40.3%. Pretreatment PSA values were a significant prognostic indicator in stage D2 patients using 100 to 150ng/mL as the cut-off values. These differences were primarily found in the poorly differentiated group, which showed a statistical difference using cut-off PSA values from 75 to 150 ng/mL.
Conclusions: Serum PSA levels from a large number of patients can be used to predict the stage and prognosis of prostate cancer patients.     

Current Applications for Prostate-Specific Antigen Doubling Time

OBJECTIVE: To review the current status of prostate-specific antigen doubling time (PSADT) as it pertains to the evolution of prostate cancer (PCa), specifically assessing its role in the following four stages: before diagnosis, prior to definitive treatment, following treatment including salvage therapy after recurrence, and lastly, after onset of androgen-insensitive PCa. METHODS: We searched PubMed literature for current articles on PSADT using the key words listed for this review and, where possible, selected those with significant levels of evidence that were deemed relevant, seminal, or controversial. We summarized the data regarding PSADT as a marker for diagnosis and disease characterization, as well as a predictor of progression, response to treatment, and mortality. RESULTS: PSADT may offer an advantage in providing a more dynamic picture of tumor behavior, providing clues regarding the relative aggressiveness of the underlying pathology. Evidence points toward a role for PSADT in the management of PCa, specifically in active surveillance, disease recurrence after treatment, and in androgen-independent PCa. PSADT is an important prognostic factor that may serve as an auxiliary end point for cancer-specific survival; however, optimal cut-off points denoting risk remain debatable. CONCLUSIONS: PCa management requires risk stratification with a combination of variables, PSADT being one of the most reliable predictors. It is now a parameter included in many predictive nomograms and in treatment guidelines for expectant management and salvage therapy.     

Longitudinal PSA changes in men with and without prostate cancer: assessment of prostate cancer risk

BACKGROUND: To determine longitudinal PSA changes over a period of 10 years in patients with and without prostate cancer. METHODS: Serial PSA measurements performed over 10 years were evaluated in 353 men who eventually developed prostate cancer and in 2.462 participants of a screening program without prostatic malignancy. RESULTS: In men with cancer, mean tPSA increased from 2.28 ng/ml at 10 years before diagnosis to 6.37 ng/ml at the time of postive biopsy (PSA velocity: 0.409 ng/ml/year). PSA velocity was significantly associated with Gleason scores and pathologic stage. In the benign group (n=2.462), mean tPSA increased from 1.18 to 1.49 ng/ml over a period of 10 years (PSA velocity of 0.03 ng/ml/year). Of the subjects with tPSA levels of 2 ng/ml or less, 2 years prior to cancer diagnosis, 11.4% had tPSA values of more than 4 ng/ml at the time of biopsy. Of the 972 men with tPSA below 1 ng/ml 2 years before the most recent measurement was obtained, 966 (99.4%) had no evidence of prostate cancer 2 years later, while six were found to have malignancies (0.6%). CONCLUSIONS: Longitudinal PSA changes in men with and without prostate cancer are significantly different. Annual testing may not be required in men with baseline tPSA levels of 1 ng/ml or below, whereas in patients with levels higher than 1 ng/ml, it seems to be indicated because of the significant percentage of men presenting with tPSA levels of more than 4 ng/ml two years later.     

Prostate-Specific Antigen Kinetics and Outcomes in Patients with Bone Metastases from Castration-Resistant Prostate Cancer Treated with or Without Zoledronic Acid

Background

Zoledronic acid (ZOL) is a standard therapy for the prevention of skeletal-related events (SREs) in patients with castration-resistant prostate cancer (CRPC). Although prostate-specific antigen (PSA) is an established marker for monitoring prostate cancer patients, correlations between PSA and disease outcomes during ZOL therapy are unclear.

Objective

To evaluate the relationships among PSA kinetics, bone-directed therapy with ZOL, and clinical outcomes in men with bone metastases from CRPC using a ZOL phase 3 trial database.

Design, setting, and participants

Exploratory analyses from a phase 3 trial in men with bone metastases from CRPC (n = 643) randomized to ZOL or placebo every 3 wk.

Outcome measurements and statistical analysis

PSA levels during the first 3 mo of the study were evaluated in linear and logarithmic (log) models stratified using prognostic factors established in a ZOL phase 3 trial and a CRPC nomogram. Relative risks of SREs, bone disease progression (BDP), and death were calculated per 1 log (nanograms per milliliter) PSA increase. Baseline PSA models used the study median (PSA: 77.3 ng/ml) as the high/low cut-off point.

Results and limitations

A total of 202 placebo- and 434 ZOL-treated patients were assessable. In both groups, PSA increases correlated with significantly increased risks of death, BDP, and first SRE. In the placebo and ZOL groups, associated increases in risk per 1 log (nanograms per milliliter) PSA increase were 29% (p < 0.0001) and 10% (p < 0.0074), respectively, for BDP, and 24% (p = 0.0010) and 13% (p = 0.0079), respectively, for first SRE. Limitations include the retrospective nature of these analyses and the potential confounding effects of concurrent antineoplastic therapies.

Conclusions

PSA is an important prognostic tool for survival in patients with bone metastases from CRPC, and these analyses show that PSA is also prognostic for BDP and SREs regardless of bone-targeted therapy.     

An examination of the dynamic changes in prostate-specific antigen occurring in a population-based cohort of men over time

Study Type – Diagnosis (exploratory cohort) Level of Evidence 2b What's known on the subject? and What does the study add? A single serum PSA measurement is commonly used as a screening test to identify men with prostate cancer. A rise in PSA over time may identify men at increased risk of prostate cancer. Dynamic measures of PSA change (ex: PSA velocity, PSA doubling time) are frequently used to justify prostate biopsy in men. We demonstrate that the current serum PSA is the best predictor of future prostate cancer risk among commonly available clinical variables. We show that dynamic measures of PSA change do not improve upon PSA's ability to predict future prostate cancer. Our study suggests that dynamic measures of PSA change may not be useful in screening for prostate cancer.

OBJECTIVE

• ? To determine whether prostate‐specific antigen velocity (PSA‐V), PSA doubling time (PSA‐DT), or PSA percentage change (PSA‐PC) add incremental information to PSA alone for community‐based men undergoing prostate cancer (PCa) screening.

PARTICIPANTS AND METHODS

• ? A population‐based cohort of 11 872 men from Olmsted County, MN undergoing PSA screening for PCa from 1993 to 2005 was analysed for PSA, PSA‐DT, PSA‐PC and PSA‐V and subsequent PCa.
• ? Receiver‐operating characteristics curves and logistic regression were used to calculate the area under the curve (AUC) and Aikaike's information criterion.
• ? Reclassification analysis was performed and the net reclassification improvement and integrated discrimination improvement were measured.
• ? The method of Begg and Greenes was used to adjust for verification bias.

RESULTS

• ? The single best predictor of future PCa was PSA (AUC = 0.773) with PSA‐V (AUC = 0.729) and PSA‐DT/PSA‐PC (AUC = 0.689) performing worse.
• ? After age adjustment, combining PSA with PSA‐V (AUC = 0.773) or PSA‐DT/PSA‐PC (AUC = 0.773) resulted in no better predictions than PSA alone.
• ? Reclassification analysis showed that adding PSA‐V or PSA‐DT/PSA‐PC to PSA did not result in a meaningful amount of reclassification.

CONCLUSIONS

• ? PSA is a better predictor of future PCa than PSA‐V, PSA‐DT, or PSA‐PC.
• ? Adding PSA‐V, PSA‐DT, or PSA‐PC to PSA does not result in clinically relevant improvements in the ability to predict future PCa.

     

Novel Tools to Improve Patient Selection and Monitoring on Active Surveillance for Low-risk Prostate Cancer: A Systematic Review

Context

Active surveillance (AS) is an alternative to initial radical treatment of low-risk prostate cancer (PCa). Current criteria for selection and follow-up incorrectly exclude some patients eligible for AS and misclassify some who actually harbour significant disease. Better prediction of cancer behaviour at diagnosis would allow less strict monitoring and may improve acceptance of AS.

Objective

To review and critically analyse the literature on the value of novel clinical tools for patient selection and monitoring on AS.

Evidence acquisition

A comprehensive search of the PubMed database until July 10, 2013, was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis statement guidelines. Studies assessing novel markers and diagnostics for patient selection for AS and follow-up during AS were included. Studies analysing only classic clinical parameters used in current protocols (prostate-specific antigen, prostate volume, number of (positive) prostate biopsies, percentage malignant tissue, Gleason score) were excluded. This review focuses only on the AS setting and not on predicting insignificant disease in general.

Evidence synthesis

Of 787 studies on AS, 30 were included in this review: 14 on magnetic resonance imaging (MRI), 5 on serum markers, 5 on urinary markers, 4 on histopathology markers, and 2 on germline genetic markers. Several of these markers improve the prediction of tumour volume, tumour grade, or time to active treatment. MRI has a high specificity for low-risk PCa; new serum markers are associated with unfavourable disease. In none of the studies was the new marker used as the primary decision tool. Long-term outcome measures such as mortality were not assessed. The definition of indolent PCa is disputable.

Conclusions

Imaging and serum markers may improve future patient selection for AS and follow-up during AS. Prospective studies should aim to further evaluate the clinical utility of these new markers with respect to longer term outcomes of AS.

Patient summary

We searched the literature for articles reporting new ways to safely monitor low-risk prostate cancer for patients who have not had radical treatment. We found 30 articles. The most promising tools appear to be magnetic resonance imaging scans and various new blood markers. These may be used in the future within active surveillance regimens.     

Prostate-Specific Antigen Velocity for Early Detection of Prostate Cancer: Result from a Large,Representative, Population-based Cohort

Background

It has been suggested that changes in prostate-specific antigen (PSA) over time (ie, PSA velocity [PSAV]) aid prostate cancer detection. Some guidelines do incorporate PSAV cut points as an indication for biopsy.

Objective

To evaluate whether PSAV enhances prediction of biopsy outcome in a large, representative, population-based cohort.

Design, setting, and participants

There were 2742 screening-arm participants with PSA <3 ng/ml at initial screening in the European Randomized Study of Screening for Prostate Cancer in Rotterdam, Netherlands, or Göteborg, Sweden, and who were subsequently biopsied during rounds 2–6 due to elevated PSA.

Measurements

Total, free, and intact PSA and human kallikrein 2 were measured for 1–6 screening rounds at intervals of 2 or 4 yr. We created logistic regression models to predict prostate cancer based on age and PSA, with or without free-to-total PSA ratio (%fPSA). PSAV was added to each model and any enhancement in predictive accuracy assessed by area under the curve (AUC).

Results and limitations

PSAV led to small enhancements in predictive accuracy (AUC of 0.569 vs 0.531; 0.626 vs 0.609 if %fPSA was included), although not for high-grade disease. The enhancement depended on modeling a nonlinear relationship between PSAV and cancer. There was no benefit if we excluded men with higher velocities, which were associated with lower risk. These results apply to men in a screening program with elevated PSA; men with prior negative biopsy were not evaluated in this study.

Conclusions

In men with PSA of about ≥3 ng/ml, we found little justification for formal calculation of PSAV or for use of PSAV cut points to determine biopsy. Informal assessment of PSAV will likely aid clinical judgment, such as a sudden rise in PSA suggesting prostatitis, which could be further evaluated before biopsy.     

Clinical Evaluation of Serum Prostate-Specific Antigen-Alpha1 - Antichymotrypsin Complex Values in Diagnosis of Prostate Cancer: A Cooperative Study

Background We studied the clinical significance of serum prostate-specific antigen bound to α₁-antichymotrypsin (PSA-ACT) values determined with a newly developed enzyme immunoassay.
Methods Serum PSA-ACT values were determined in a total of 652 sera. Clinical utility for the diagnosis of prostate cancer was compared to that of Tandem-R PSA and y-seminoprotein (μgm- Sm). The new enzyme immunoassay is based on the use of the Stanford reference as an international standard for PSA assays.
Results Serum PSA-ACT values ranged from less than 0.10 to 1.4ng/mL in healthy males (n = 100) while values in patients with benign prostatic hyperplasia (n = 1 55) averaged 3.4 ± 3.8ng/mL (mean ± SD). In patients with prostate cancer, serum PSA-ACT values increased significantly with progression of the clinical stage and there were statistically significant differences between benign prostatic hyperplasia and each stage of prostate cancer except for stage A. Using BPH levels as controls (4.8ng/mL for PSA-ACT, 7.2ng/mL for PSA, 3.8ng/mL for y-Sm, and 2.4ng/mL for thecomplexed/free PSA ratio of PSA-ACT/μtgM-Sm), specificity was 80%. The sensitivity of prostate cancer detection was 79% for PSA-ACT, 77% for PSA, 57% for γ-Sm, and 46% for the ratio between PSA-ACT/γ-Sm.
Conclusion Although the determination of serum PSA-ACT showed essentially the same utility as that of PSA for the diagnosis of prostate cancer, PSA-ACT may allow prediction of the clinical stage. The PSA-ACT assay may therefore replace PSA in the detection of prostate cancer.     

Long-term Psychological and Quality-of-life Effects of Active Surveillance and Watchful Waiting After Diagnosis of Low-risk Localised Prostate Cancer

Background

Long-term psychological well-being and quality-of-life are important considerations when deciding whether to undergo active treatment for low-risk localised prostate cancer.

External validation of the SEARCH model for predicting aggressive recurrence after radical prostatectomy: results from the Duke Prostate Center Database

Study Type – Prognosis (retrospective cohort)
Level of Evidence 2b

OBJECTIVE

To validate a model previously developed using the Shared Equal Access Regional Cancer Hospital (SEARCH) database to predict the risk of aggressive recurrence after surgery, defined as a prostate‐specific antigen (PSA) doubling time (DT) of <9 months, incorporating pathological stage, preoperative PSA level and pathological Gleason sum, that had an area under the curve (AUC) of 0.79 using a cohort of men from the Duke Prostate Center (DPC).

PATIENTS AND METHODS

Data were included from 1989 men from the DPC database who underwent RP for node‐negative prostate cancer between 1987 and 2003. Of these men, 100 had disease recurrence, with a PSADT of <9 months, while 1889 either did not have a recurrence but had ≥36 months of follow‐up or had a recurrence with a PSADT of ≥9 months. We examined the ability of the SEARCH model to predict aggressive recurrence within the DPC cohort, and examined the correlation between the predicted risk of aggressive recurrence and the actual outcome within DPC.

RESULTS

The SEARCH model predicted aggressive recurrence within DPC with an AUC of 0.82. There was a strong and significant correlation between the predicted risk of aggressive recurrence based on the SEARCH tables and the actual outcomes within DPC (r= 0.68, P < 0.001), although the model predictions tended to be slightly higher than the actual risk.

CONCLUSIONS

The SEARCH model to predict aggressive recurrence after RP predicted aggressive recurrence in an external dataset with a high degree of accuracy. These tables, now validated, can be used to help select men for adjuvant therapy and clinical trials.