Mp57-20 delineation of prostate cancer from bph by excess psa relative to predicted: a study in men undergoing mri-targeted biopsy

You have accessJournal of UrologyProstate Cancer: Detection & Screening V1 Apr 2018MP57-20 DELINEATION OF PROSTATE CANCER FROM BPH BY EXCESS PSA RELATIVE TO PREDICTED: A STUDY IN MEN UNDERGOING MRI-TARGETED BIOPSY Nabeel Shakir, Niccolo Passoni, Daniel Wong, Samuel Gold, Graham Hale, Kareem Rayn, Joseph Baiocco, Jonathan Bloom, Vladimir Valero, Maria Merino, Baris Turkbey, Peter Choyke, Bradford Wood, Peter Pinto, Daniel Costa, and Claus Roehrborn Nabeel ShakirNabeel Shakir More articles by this author , Niccolo PassoniNiccolo Passoni More articles by this author , Daniel WongDaniel Wong More articles by this author , Samuel GoldSamuel Gold More articles by this author , Graham HaleGraham Hale More articles by this author , Kareem RaynKareem Rayn More articles by this author , Joseph BaioccoJoseph Baiocco More articles by this author , Jonathan BloomJonathan Bloom More articles by this author , Vladimir ValeroVladimir Valero More articles by this author , Maria MerinoMaria Merino More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , Peter ChoykePeter Choyke More articles by this author , Bradford WoodBradford Wood More articles by this author , Peter PintoPeter Pinto More articles by this author , Daniel CostaDaniel Costa More articles by this author , and Claus RoehrbornClaus Roehrborn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1832AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The contribution of benign prostatic hyperplasia (BPH) versus prostate cancer (PCa) to elevation in serum prostate-specific antigen (PSA) is difficult to ascertain, particularly in men with enlarged prostates, and may confound diagnosis and treatment planning. With increasing adoption of prostate multiparametric magnetic resonance imaging (MP-MRI), improved determination of prostate volume and anatomy is feasible. We assessed the difference between actual PSA and that predicted by readily available pre-biopsy parameters and association with presence of PCa. METHODS A total of 1791 men undergoing first-time MP-MRI followed by MRI-fusion and standard template transrectal ultrasound guided prostate biopsy at two institutions were reviewed. PSA was modeled as a function of age and prostate volume by MRI in 621 men who had no cancer by either fusion or standard biopsy. This model was used to predict PSA in the remaining 1170 men diagnosed with PCa. "Excess PSA", or predicted subtracted from actual PSA, was determined for all patients and stratified by highest biopsy grade group (GG). RESULTS Median age and prostate volume were 64 years (IQR 58-68) and 50 mL (IQR 36-69) respectively. Populations did not differ significantly between centers by age or PSA. For men without PCa, median actual PSA was 6.7 ng/mL and was correlated with both age and prostate volume (Spearman's rho 0.52, p<0.0001), while median excess PSA was -0.97 ng/mL. For men with PCa, increasing excess PSA was correlated with greater GG (Figure 1). Specifically, men with GG1 and 2 did not differ by median excess PSA from men without PCa (p=0.5 and 0.1 respectively) whereas men with GG3 or greater did (p<0.0001). When adjusting for potential confounders in a multivariable model predicting ≥GG3 PCa on biopsy, excess PSA remained significantly associated (p<0.0001). CONCLUSIONS Increasing excess PSA as calculated from age and MRI prostate volume may correlate with higher grade PCa, and is close to zero in men with BPH or lower grade PCa (GG1-2). © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e772 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Nabeel Shakir More articles by this author Niccolo Passoni More articles by this author Daniel Wong More articles by this author Samuel Gold More articles by this author Graham Hale More articles by this author Kareem Rayn More articles by this author Joseph Baiocco More articles by this author Jonathan Bloom More articles by this author Vladimir Valero More articles by this author Maria Merino More articles by this author Baris Turkbey More articles by this author Peter Choyke More articles by this author Bradford Wood More articles by this author Peter Pinto More articles by this author Daniel Costa More articles by this author Claus Roehrborn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...