Can one blood draw replace transrectal ultrasonography-estimated prostate volume to predict prostate cancer risk? Journal Article

Authors: Carlsson, S. V.; Peltola, M. T.; Sjoberg, D.; Schroder, F. H.; Hugosson, J.; Pettersson, K.; Scardino, P. T.; Vickers, A. J.; Lilja, H.; Roobol, M. J.
Article Title: Can one blood draw replace transrectal ultrasonography-estimated prostate volume to predict prostate cancer risk?
Abstract: Objective To explore whether a panel of kallikrein markers in blood: total, free and intact prostate-specific antigen (PSA) and kallikrein-related peptidase 2, could be used as a non-invasive alternative for predicting prostate cancer on biopsy in a screening setting. Subjects and Methods The study cohort comprised previously unscreened men who underwent sextant biopsy owing to elevated PSA (≥3 ng/mL) in two different centres of the European Randomized Study of Screening for Prostate Cancer, Rotterdam (n = 2914) and Göteborg (n = 740). A statistical model, based on kallikrein markers, was compared with one based on established clinical factors for the prediction of biopsy outcome. Results The clinical tests were found to be no better than blood markers, with an area under the curve in favour of the blood measurements of 0.766 vs. 0.763 in Rotterdam and 0.809 vs. 0.774 in Göteborg. Adding digital rectal examination (DRE) or DRE plus transrectal ultrasonography (TRUS) volume to the markers improved discrimination, although the increases were small. Results were similar for predicting high-grade cancer. There was a strong correlation between the blood measurements and TRUS-estimated prostate volume (Spearman's correlation 0.60 in Rotterdam and 0.57 in Göteborg). Conclusions In previously unscreened men, each with indication for biopsy, a statistical model based on kallikrein levels was similar to a clinical model in predicting prostate cancer in a screening setting, outside the day-to-day clinical practice. Whether a clinical approach can be replaced by laboratory analyses or used in combination with decision models (nomograms) is a clinical judgment that may vary from clinician to clinician depending on how they weigh the different advantages and disadvantages (harms, costs, time, invasiveness) of both approaches. © 2013 BJU International.
Keywords: adult; controlled study; aged; middle aged; unclassified drug; major clinical study; cancer risk; cancer grading; prostate specific antigen; tumor markers, biological; cancer screening; age; prostate cancer; netherlands; sweden; prostate-specific antigen; prostatic neoplasms; prostate; blood analysis; prostate biopsy; kallikrein; predictive value of tests; area under curve; physical examination; organ size; statistical model; transrectal ultrasonography; early detection of cancer; non invasive measurement; kallikrein related peptidase 2; kallikreins; predictive value; receiver operating characteristic; digital rectal examination; diagnostic test accuracy study; prostate volume; ultrasound transducer; echograph
Journal Title: BJU International
Volume: 112
Issue: 5
ISSN: 1464-4096
Publisher: Wiley Blackwell  
Date Published: 2013-09-01
Start Page: 602
End Page: 609
Language: English
DOI: 10.1111/j.1464-410X.2012.11690.x
PROVIDER: scopus
PMCID: PMC3675187
PUBMED: 23448270
Notes: --- - Cited By (since 1996):1 - "Export Date: 4 September 2013" - "CODEN: BJINF" - "Source: Scopus"
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MSK Authors
  1. Peter T Scardino
    630 Scardino
  2. Hans Gosta Lilja
    295 Lilja
  3. Andrew J Vickers
    592 Vickers
  4. Daniel D. Sjoberg
    150 Sjoberg