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C3 IS PRO PSA MORE CANCER SPECIFIC FORM OF PROSTATE SPECIFIC ANTIGEN FOR THE EARLY DETECTION OF PROSTATE CANCER?
Poster session 1 PROSTATE CANCER I Friday, 28 October, 11.10-12.50, Poster Room 1
C1
Trends of incidence and mortality of prostate carcinoma in the region of central Serbia ten year analysis
Radosavljevic Z.1, Savic S.2, Savic N.2 1 SBIB-Mladenovac, Dept. of Urology, Belgrade, Serbia, 2KBC-Misovic, Dept. of Urology, Belgrade, Serbia Introduction & Objectives: Prostate carcinoma is recognized as one of the most important medical problems facing the male population. It is the most common solid neoplasm among mail in Europe, outnumbering lung and colorectal cancer. Monitoring annual incidence trends in population subgroups provide useful information about environmental and socioeconomic influences and help to provide better screening practice, early detection and more successful treatment. Aim of this study is to evaluate the incidence and mortality for prostate cancer in the region of Central Serbia on the basis of data collected in the studied sample from two municipalities. Material & Methods: Research was conducted in two municipalities of central Serbia, Mladenovac and Sopot which have 79425 inhabitants and 38620 are men, all referring to urology department in our hospital. We recorded all cases of prostate cancer confirmed by biopsy in the ten-year period 2001 to 2010. We also recorded all lethal outcomes caused by prostate cancer in the same period (values for 2010 estimated of data for first 10 months). Incidence and mortality rates are expressed as the number of cases and deaths in one year per 100000 mails.
Results: Incidence of prostate carcinoma in year of 2001 was 15, 53, and during ten years we have dramatic increase of new diagnosed cases to incidence rate of 59, 55 in 2010. In the same time, mortality rate decreased from 18, 12 in 2001. on 7, 67 in 2010. Conclusions: Overall, in the reporting ten-year period incidence of prostate carcinoma in observed part of central Serbia increased about four times, and mortality rate show decrease for 50% mostly because of improving monitoring and treatment of prostate carcinoma.
C2
Prostate-specific antigen levels « 4 ng/ml – there are predictive factors for prostate cancer?
Leao R.N.1, Casalta-Lopes J.2, Pereira B.J.1, Borges R.L.G.1, Grenha V.1, Coelho H.M.1, Peralta J.P.1, Godinho R.1, Sobral F.T.1, Azinhais P.M.1 1 Centro Hospitlar De Coimbra, Dept. of Urology, Coimbra, Portugal, 2Biophysics/ Biomathematics Institute, IBILI, Faculty of Medicine, University of Coimbra, Coimbra, Portugal Introduction & Objectives: Prostate Specific Antigen is a biomarker widely used in diagnosis and follow-up of prostate cancer. however urologists have a challenge concerning its lack of specificity. In clinical practice PSA level of 4 ng/mL is used as the cutoff value for the performance of a prostate biopsy, althouth the incidence of prostate cancer in patients with PSA « 4 ng/mL is approximately 15%. The authors propose to analize factors that predict prostate cancer in patienst with PSA ≤ 4 ng/ mL, with digital rectal examination (DRE) suspicious and/or abnormal transrectal ultrassonography (TRUS). Material & Methods: Retrospective study, clinical records, 102 patients with PSA ≤ 4 ng/mL - from 2951 patients underwent transrectal prostate biopsy (from January 1996 until March 2011). Biopsy was performed in patients with PSA ≤ 4 ng/mL with DRE suspicious and/or abnormal TRUS. Variables:age, tPSA, PSA density, prostate volume, urinary symtoms and pathology were evaluated.PASW statistics version 18. Results: Information from 102 patients. Age 66.6±6.47 years (varying from 50 to 84 years), prostate volume of 32.6±15.90 mL, tPSA of 2.02±1.086 ng/mL and PSAD of 0.071±0.0476 ng/mL2. 70 patients had no cancer and 32 (31,4%) patients had prostate cancer. Age in cancer group(CG) and in no-cancer group
(NCG) was not statistically different (T-student test, p=0.297). Prostate volume, we found a mean volume of 34.1±18.09 mL in NCG and 29.4±8.90 mL in CG, with no significant differences (Mann-Whitney, p=0.549). Statistical differences in tPSA between NCG (1.84±1.089 ng/mL) and CG (2.4±0.991 ng/mL) (Mann-Whitney (MW), p=0.016). PSAD was significantly different (MW, p=0.004) when comparing NCG (0.064±0.0503 ng/mL2) with CG (0.085±0.0380 ng/mL2). No statistical difference according IPSS score (MW, p=0,669). Divinding patients in two groups (PSA ≤ 2ng/mL and PSA > 2 ng/mL) obtained 51 patients in each group, with a significantly higher frequency of cancer in the second group (Chi-Square test, p=0.033,OR=2.54).Receiver operating characteristic curves were drawn using tPSA (area under curve of 0.649 [0.538;0.760]) and PSAD values (AUC of 0.679 [0.575;0.782]). tPSA, using a cut-off value of 0.985 ng/mL we obtained 90.6% sensitivity, 30.0% specificity and a negative predictive value of 87.49%. Using a cut-off value of 0.0471 ng/mL2 for PSAD we observed 90.6% sensitivity, 50.0% specificity and 92.1% negative predictive value. Conclusions: Results suggest that there are a considerable number of patients with PSA≤4 ng/mL with prostate cancer. Even without statistical significance we found differences in age and prostate volume between groups. PSAD has a higher specificity and negative predictive value than tPSA for the same sensitivity and, therefore, it should preferably be used for screening patients with PSA≤4 ng/mL. It will be important to relate these factors predictive of PCa with the degree of aggressiveness in order to avoid overtreatment.
C3
Is pro PSA more cancer specific form of prostate specific antigen for the early detection of prostate cancer?
Klecka J.1, Hora M.1, Topolcan O.2, Behounek P.1, Fuchsova R.2, Karlikova M.2, Eret V.1, Stransky P.1, Urge T.1 1 Faculty Teaching Hospital In Plzen, Dept. of Urology, Plzen, Czech Republic, 2 Faculty Teaching Hospital In Plzen, Dept. of Immunodiagnostics, Plzen, Czech Republic Introduction & Objectives: We assessed the association of quantitative clinical and pathologic information, including serum pro–prostate-specific antigen (proPSA) measurements among men with prostate cancer and benign prostate hyperplasia and we performed correlation between proPSA level and PHI (Prostate Health Index) versus diagnosis and clinical staging and grading at the patiens with prostate cancer. Material & Methods: A total of 121 patients with tPSA values between 0.8 -10.5 ng/ml (81 without prostate cancer and 40 with prostate cancer) were evaluated. Serum samples were prepared from blood drawn prior DRE. Serum samples from enrolled patiens were prepared within 3 hours of the blood drawn, than stored and frozen at -20°C or -80°C. The serum concentrations of tPSA and proPSA were measured with Beckman Coulter Access immunoassays. The Prostate Health Index was calculated using the following formula (p2PSA/tPSA)*tPSA. ROC curves were plotter to Compare the clinical performance of tPSA and % PSA prior the prostate cancer detection. The relationship with PCa Gleason score was performed as well. Results: Significant higher median values for tPSA , proPSA and PHI were observed for the patiens with PCa compared with patiens with benign prostate hyperplasia. The median value of %PSA was significantly lower in PCa patiens compared with patiens without PCa. The ROC curve analysis showed that PHI (AUC =0,70, 95% CI : 0.64-0.79) provided significantly better clinical performance to detect PCa compared to tPSA (AUC=0.51 95% CI : 0.45-0.60) and %PSA (AUC = 0.55 95% CI: 0.51-0.64). The mean and median values of tPSA ,%PSA and PHI were significantly different between the group of patiens with aggresive PCa (Gleason score more than 7) compared to the group of patiens with PCa less than Gleason score 7. Higher values were observed for tPSA and PHI for patiens with aggressive PCa while lower values for %PSA was shown for this patiens. Analysis of the PCa Gleason score detected with PHI shows that a greater proportion of aggressive PCa are detected at high PHI values. 65% of the PCa were detected with PHI more than 58. When clinical sensitivity is set at 90% (PHI cut off :30), the majority (69%) of the 10% of PCa not detected are Gleason score less than 7. Conclusions: The proPSA forms are more highly enriched in prostate tumors and are a more cancer specific marker of prostate cancer. The proPSA forms are especially useful in the 2.5–4 ng/ml PSA range, where the other PSA forms show little diagnostic utility. Our study indicate that PHI has superior clinical performance in detecting PCa in the tPSA grey zone compared to tPSA or %PSA. This PHI was the best predictor of PCa compared to tPSA and % PSA. PHI tends to preferentially detect aggressive PCa. This work was supported by financial grant MSM 0021620819.
C4
Sonoelastographic patterns of the prostate
Bialek W.1, Jaśkiewicz M.1, Wieczorek A.P.2, Starownik R.1, Bar K.1 1 SPSK4 Hospital, Dept. of Urology, Lublin, Poland, 2DSK Hospital, Dept. of Radiology, Lublin, Poland Introduction & Objectives: The elastogram is a map of tissue stiffness derived
Eur Urol Suppl 2011;10(9):613
C1
Trends of incidence and mortality of prostate carcinoma in the region of central Serbia ten year analysis
Radosavljevic Z.1, Savic S.2, Savic N.2 1 SBIB-Mladenovac, Dept. of Urology, Belgrade, Serbia, 2KBC-Misovic, Dept. of Urology, Belgrade, Serbia Introduction & Objectives: Prostate carcinoma is recognized as one of the most important medical problems facing the male population. It is the most common solid neoplasm among mail in Europe, outnumbering lung and colorectal cancer. Monitoring annual incidence trends in population subgroups provide useful information about environmental and socioeconomic influences and help to provide better screening practice, early detection and more successful treatment. Aim of this study is to evaluate the incidence and mortality for prostate cancer in the region of Central Serbia on the basis of data collected in the studied sample from two municipalities. Material & Methods: Research was conducted in two municipalities of central Serbia, Mladenovac and Sopot which have 79425 inhabitants and 38620 are men, all referring to urology department in our hospital. We recorded all cases of prostate cancer confirmed by biopsy in the ten-year period 2001 to 2010. We also recorded all lethal outcomes caused by prostate cancer in the same period (values for 2010 estimated of data for first 10 months). Incidence and mortality rates are expressed as the number of cases and deaths in one year per 100000 mails.
Results: Incidence of prostate carcinoma in year of 2001 was 15, 53, and during ten years we have dramatic increase of new diagnosed cases to incidence rate of 59, 55 in 2010. In the same time, mortality rate decreased from 18, 12 in 2001. on 7, 67 in 2010. Conclusions: Overall, in the reporting ten-year period incidence of prostate carcinoma in observed part of central Serbia increased about four times, and mortality rate show decrease for 50% mostly because of improving monitoring and treatment of prostate carcinoma.
C2
Prostate-specific antigen levels « 4 ng/ml – there are predictive factors for prostate cancer?
Leao R.N.1, Casalta-Lopes J.2, Pereira B.J.1, Borges R.L.G.1, Grenha V.1, Coelho H.M.1, Peralta J.P.1, Godinho R.1, Sobral F.T.1, Azinhais P.M.1 1 Centro Hospitlar De Coimbra, Dept. of Urology, Coimbra, Portugal, 2Biophysics/ Biomathematics Institute, IBILI, Faculty of Medicine, University of Coimbra, Coimbra, Portugal Introduction & Objectives: Prostate Specific Antigen is a biomarker widely used in diagnosis and follow-up of prostate cancer. however urologists have a challenge concerning its lack of specificity. In clinical practice PSA level of 4 ng/mL is used as the cutoff value for the performance of a prostate biopsy, althouth the incidence of prostate cancer in patients with PSA « 4 ng/mL is approximately 15%. The authors propose to analize factors that predict prostate cancer in patienst with PSA ≤ 4 ng/ mL, with digital rectal examination (DRE) suspicious and/or abnormal transrectal ultrassonography (TRUS). Material & Methods: Retrospective study, clinical records, 102 patients with PSA ≤ 4 ng/mL - from 2951 patients underwent transrectal prostate biopsy (from January 1996 until March 2011). Biopsy was performed in patients with PSA ≤ 4 ng/mL with DRE suspicious and/or abnormal TRUS. Variables:age, tPSA, PSA density, prostate volume, urinary symtoms and pathology were evaluated.PASW statistics version 18. Results: Information from 102 patients. Age 66.6±6.47 years (varying from 50 to 84 years), prostate volume of 32.6±15.90 mL, tPSA of 2.02±1.086 ng/mL and PSAD of 0.071±0.0476 ng/mL2. 70 patients had no cancer and 32 (31,4%) patients had prostate cancer. Age in cancer group(CG) and in no-cancer group
(NCG) was not statistically different (T-student test, p=0.297). Prostate volume, we found a mean volume of 34.1±18.09 mL in NCG and 29.4±8.90 mL in CG, with no significant differences (Mann-Whitney, p=0.549). Statistical differences in tPSA between NCG (1.84±1.089 ng/mL) and CG (2.4±0.991 ng/mL) (Mann-Whitney (MW), p=0.016). PSAD was significantly different (MW, p=0.004) when comparing NCG (0.064±0.0503 ng/mL2) with CG (0.085±0.0380 ng/mL2). No statistical difference according IPSS score (MW, p=0,669). Divinding patients in two groups (PSA ≤ 2ng/mL and PSA > 2 ng/mL) obtained 51 patients in each group, with a significantly higher frequency of cancer in the second group (Chi-Square test, p=0.033,OR=2.54).Receiver operating characteristic curves were drawn using tPSA (area under curve of 0.649 [0.538;0.760]) and PSAD values (AUC of 0.679 [0.575;0.782]). tPSA, using a cut-off value of 0.985 ng/mL we obtained 90.6% sensitivity, 30.0% specificity and a negative predictive value of 87.49%. Using a cut-off value of 0.0471 ng/mL2 for PSAD we observed 90.6% sensitivity, 50.0% specificity and 92.1% negative predictive value. Conclusions: Results suggest that there are a considerable number of patients with PSA≤4 ng/mL with prostate cancer. Even without statistical significance we found differences in age and prostate volume between groups. PSAD has a higher specificity and negative predictive value than tPSA for the same sensitivity and, therefore, it should preferably be used for screening patients with PSA≤4 ng/mL. It will be important to relate these factors predictive of PCa with the degree of aggressiveness in order to avoid overtreatment.
C3
Is pro PSA more cancer specific form of prostate specific antigen for the early detection of prostate cancer?
Klecka J.1, Hora M.1, Topolcan O.2, Behounek P.1, Fuchsova R.2, Karlikova M.2, Eret V.1, Stransky P.1, Urge T.1 1 Faculty Teaching Hospital In Plzen, Dept. of Urology, Plzen, Czech Republic, 2 Faculty Teaching Hospital In Plzen, Dept. of Immunodiagnostics, Plzen, Czech Republic Introduction & Objectives: We assessed the association of quantitative clinical and pathologic information, including serum pro–prostate-specific antigen (proPSA) measurements among men with prostate cancer and benign prostate hyperplasia and we performed correlation between proPSA level and PHI (Prostate Health Index) versus diagnosis and clinical staging and grading at the patiens with prostate cancer. Material & Methods: A total of 121 patients with tPSA values between 0.8 -10.5 ng/ml (81 without prostate cancer and 40 with prostate cancer) were evaluated. Serum samples were prepared from blood drawn prior DRE. Serum samples from enrolled patiens were prepared within 3 hours of the blood drawn, than stored and frozen at -20°C or -80°C. The serum concentrations of tPSA and proPSA were measured with Beckman Coulter Access immunoassays. The Prostate Health Index was calculated using the following formula (p2PSA/tPSA)*tPSA. ROC curves were plotter to Compare the clinical performance of tPSA and % PSA prior the prostate cancer detection. The relationship with PCa Gleason score was performed as well. Results: Significant higher median values for tPSA , proPSA and PHI were observed for the patiens with PCa compared with patiens with benign prostate hyperplasia. The median value of %PSA was significantly lower in PCa patiens compared with patiens without PCa. The ROC curve analysis showed that PHI (AUC =0,70, 95% CI : 0.64-0.79) provided significantly better clinical performance to detect PCa compared to tPSA (AUC=0.51 95% CI : 0.45-0.60) and %PSA (AUC = 0.55 95% CI: 0.51-0.64). The mean and median values of tPSA ,%PSA and PHI were significantly different between the group of patiens with aggresive PCa (Gleason score more than 7) compared to the group of patiens with PCa less than Gleason score 7. Higher values were observed for tPSA and PHI for patiens with aggressive PCa while lower values for %PSA was shown for this patiens. Analysis of the PCa Gleason score detected with PHI shows that a greater proportion of aggressive PCa are detected at high PHI values. 65% of the PCa were detected with PHI more than 58. When clinical sensitivity is set at 90% (PHI cut off :30), the majority (69%) of the 10% of PCa not detected are Gleason score less than 7. Conclusions: The proPSA forms are more highly enriched in prostate tumors and are a more cancer specific marker of prostate cancer. The proPSA forms are especially useful in the 2.5–4 ng/ml PSA range, where the other PSA forms show little diagnostic utility. Our study indicate that PHI has superior clinical performance in detecting PCa in the tPSA grey zone compared to tPSA or %PSA. This PHI was the best predictor of PCa compared to tPSA and % PSA. PHI tends to preferentially detect aggressive PCa. This work was supported by financial grant MSM 0021620819.
C4
Sonoelastographic patterns of the prostate
Bialek W.1, Jaśkiewicz M.1, Wieczorek A.P.2, Starownik R.1, Bar K.1 1 SPSK4 Hospital, Dept. of Urology, Lublin, Poland, 2DSK Hospital, Dept. of Radiology, Lublin, Poland Introduction & Objectives: The elastogram is a map of tissue stiffness derived
Eur Urol Suppl 2011;10(9):613