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Prostate Cancer: Markers (MP60): Moderated Poster 60: Monday, September 13, 2021

MP60-11 PERFORMANCE OF PROSTATIC SPECIFIC ANTIGEN DENSITY (PSAD) PREDICTING CLINICALLY SIGNIFICANT PROSTATE CANCER (csPCa) IN BIOPSY NAIVE MEN, WITH A PRIOR NEGATIVE TRUS BIOPSY, OR LOW-GRADE CANCER

Skouteris, Vassilios; Stone, Nelson; Arangua, Paul; Werahera, Priya; Maroni, Paul; La Rosa, Francisco G.; Lucia, M. Scott; Crawford, E. David

doi: 10.1097/JU.0000000000002095.11
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INTRODUCTION AND OBJECTIVE:

A PSAD ≤0.15 mg/mL2 may reduce the need to perform a prostate biopsy because csPCa is not often encountered. However, the PSAD level with the highest area under the curve (AUC) may differ for men who are biopsy naïve (BN), had a prior negative TRUS biopsy (NTB), or with a diagnosis of Gleason grade group 1 (GG1). We investigated the performance characteristics of PSAD in these groups of men who subsequently underwent transperineal mapping biopsy (TPMB).

METHODS:

371 men who were BN (n=141), had NTB (n=87) or GG1 (n=143) and a PSA < 10 ng/ml had template guided TPMB. PSAD levels of 0.1, 0.125, 0.15, 0.175 and 0.20 mg/mL2 were compared to the histopathology findings of TPMB. Area under the curves (AUC) were determined from the receiver operating characteristics. Men with Gleason grade group 2-5 (csPCa) were compared to the others (no cancer and GG1) for the 3 biopsy groups. Associations of TPMB results to PSAD levels were compared by ANOVA (with Bonferroni correction), chi-square (Pearson) and logistic regression (LR).

RESULTS:

The mean+SD age, PSA, prostate gland volume, PSAD, number of TPMB cores, and number of TPMB positive cores were 64.7+8.3 years, 5.2+2.3 ng/mL, 44.3+18.6 ml, 0.13+0.08 mg/mL2 , 57.4+22.2, and 6.2+5.5. TPMB was positive in 67.7% with 134 GG1 and 117 GG2-5. The AUCs for the different PSAD levels for BN, NTB and GG1 are shown in the table. For BN PSAD <0.125 had the greatest AUC (0.685, p<0.001), for TNB PSAD <0.15 (0.701, 0.575-0.827, p=0.003) and GG1 PSAD <0.10 (0.659, p=0.002). CsPCa was present in 71.7 vs. 17.3% for BN with a PSAD > 0.125 (OR 4.8, 95%CI 2.2-10.8, p<0.001), 61.5 vs. 17.2% for NTB with a PSDA > 0.15 (OR 5.9, 95%CI 2.2-16.1, p<0.001) and 77.3% vs. 15.6% for GG1 with a PSAD >0.1 (OR 4.1, 95%CI 1.8-9.2, p<0.001). Age (p=0.004) and PSAD 0.1 (p=0.023) were significant on LR. There was no difference in the number of specimens with csPCa in the 3 biopsy groups.

CONCLUSIONS:

Based on the results of a TPMB, the PSAD level that decreases the need to perform a biopsy should be adjusted according to the biopsy status of the patients. Men who are biopsy naïve with a PSAD < 0.125, those who had a prior negative TRUS biopsy with a PSAD ≤ 0.15 or men with GG1 and a PSAD ≤ 0.10 who forgo biopsy have a 17% chance of harboring csPCa by mapping biopsy.

Source of Funding:

None

© 2021 by American Urological Association Education and Research, Inc.