Diagnostic properties of percent-free PSA as a predictor of prostate cancer in Thai men with total serum PSA level of 4-10 ng/ml
DOI:
https://doi.org/10.52786/isu.a.81Keywords:
%Free PSA, total PSA, intermediate PSA, prostate cancer, ThaiAbstract
Objective: The percent-free prostate specific antigen (%fPSA) could enhance total PSA (tPSA) with regards to early prostate cancer detection by increasing its specificity. However, due to significant physiologic differences across races, the optimal cut-off level for %fPSA may vary. We aimed to determine optimal %fPSA cut-off level for Thai men aged between 50 to 80 years whose tPSA score ranged from 4-10 ng/mL and to evaluate its corresponding diagnostic properties, specifically sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The secondary endpoint is the relationship between Gleason Grade Group and %fPSA value.
Materials and Methods: A total of 184 male patients from age 50-80 years whose tPSA was between 4-10 ng/ml were enrolled onto the study. Their %fPSA were measured before undergoing transrectal ultrasonography (TRUS) guided prostate biopsy, which procured at least 10 cores. All histologic reports were reviewed and confirmed for further analysis.
Results: Out of the 184 patients registered the final diagnoses were 31 (16.84%) were positive for prostate cancer and the other 153 (83.16%) had benign prostate hypertrophy (BPH). At %fPSA cut-off of ≤ 10%, the sensitivity would be 22.6%, specificity 95.4%, PPV 50.0% and NPV 85.9%. However, at a %fPSA cut-off of ≤ 20%, the sensitivity was 77.4%, specificity 32.7%, PPV 18.9%, and NPV 87.7%. The %fPSA value has a direct relationship with sensitivity and NPV whereas it is inversely proportional to specificity and PPV. Lower %fPSA is associated with higher risk of prostate cancer. The area under the curve (AUC) of ROC curve was 0.65. The incidence of prostate cancer among patients with Gleason Grade Groups 1, 2, 3, 4, and 5 were 41.94%, 32.26%, 16.13%, 6.45%, and 3.23% respectively. The mean %fPSA scores among those groups were 14.75%, 17.64%, 10.19% ,13.33%, and 15.65% respectively.
Conclusion: The decision to undergo prostate biopsy in Thai males with a tPSA score between 4-10 ng/ml can be guided by %fPSA, which proved to be an effective and useful predictive tool. The cut-off level of %fPSA ≤ 20% had the highest diagnostic properties in Thai men in our study which yielded a sensitivity of 77.4%, specificity of 32.7%, PPV of 18.9%, and NPV 87.7%. If %fPSA was ≥ 30%, there was no risk of prostate cancer in this cohort. In addition, with regard to disease severity, we found that %fPSA level is not associated with the Gleason Grade Grouping.
References
International Agency for Research on cancer WHO. Prostate 2022 [Internet]. [cited 2023 Feb 25]. Available from: https://gco.iarc.who.int/media/globocan/ factsheets/cancers/27-prostate-fact-sheet.pdf
Cabarkapa S, Perera M, McGrath S, Lawrentschuk N. Prostate cancer screening with prostate-specific antigen: A guide to the guidelines. Prostate Int 2016; 4:125-9.
Catalona WJ, Smith DS, Ratliff TL, Dodds KM, Coplen DE, Yuan JJ, et al. Measurement of pros- tate-specific antigen in serum as a screening test for prostate cancer. N Engl J Med 1991;324:1156-61.
SriplakichS,LojanapiwatB,ChongruksutW,Phuri- yaphan S, Kitirattakarn P, Jun-Ou J, et al. Prospective performance of the Prostate Health Index in prostate cancer detection in the first prostate biopsy of men with a total prostatic specific antigen of 4-10 ng/ml and negative digital rectal examination. Prostate Int 2018;6:136-9.
Catalona WJ, Smith DS, Wolfert RL, Wang TJ, Rittenhouse HG, Ratliff TL, et al. Evaluation of percentage of free serum prostate-specific antigen to improve specificity of prostate cancer screening. JAMA 1995;274:1214-20.
Tanaka M, Murakami S, Igarashi T, Abe T, Suzuki K, Sekita N, et al. [Free/total ratio of prostate-specific antigen (PSA) for prostate cancer detection in patients with gray zone PSA level]. Hinyokika Kiyo 1997;43:855-60.
Oesterling JE, Jacobsen SJ, Klee GG, Pettersson K, Piironen T, Abrahamsson PA, et al. Free, complexed and total serum prostate specific antigen: the establishment of appropriate reference ranges for their concentrations and ratios. J Urol 1995;154:1090-5.
Salami SS, Palapattu GS, Partin AW, Morgan TM. Prostate Cancer Biomarkers. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, editors. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia: Saunders Elsevier; 2020. p. 3478-89.
Huang M, Lin Y, Xu A, Uhlman M, Deng X, Lin X, et al. Percent free prostate-specific antigen does not improve the effectiveness of prostate cancer detection in Chinese men with a prostate-specific antigen of 2.5-20.0 ng/ml: a multicenter study. Med Oncol 2014;31:925.
Fowler JE, Jr., Sanders J, Bigler SA, Rigdon J, Kilambi NK, Land SA. Percent free prostate specific antigen and cancer detection in black and white men with total prostate specific antigen 2.5 to 9.9 ng/ml J Urol 2000;163:1467-70.
Catalona WJ, Partin AW, Slawin KM, Naughton CK, Brawer MK, Flanigan RC, et al. Percentage of free PSA in black versus white men for detection and staging of prostate cancer: a prospective multicenter clinical trial. Urology 2000;55:372-6.
Catalona WJ, Partin AW, Slawin KM, Brawer MK, Flanigan RC, Patel A, et al. Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial. JAMA 1998;279:1542-7.
Catalona WJ, Partin AW, Slawin KM, Naughton CK, Brawer MK, Flanigan RC, et al. Percentage of free PSA in black versus white men for detection and staging of prostate cancer: a prospective multicenter clinical trial. Urology 2000;55:372-6.
Catalona WJ, Partin AW, Slawin KM, Brawer MK, Flanigan RC, Patel A, et al. Use of the percentage of free prostate-specific antigen to enhance differ- entiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial. JAMA 1998;279:1542-7.
Tantiwong A, Soontrapa S, Sujijantrarat P, Vanprapar N, Sawangsak L. The prevalence of prostate cancer screening in Thai elderly. J Med Assoc Thai 2002; 85:502-8.
Matsuyama H, Baba Y, Yamakawa G, Yamamoto N, Naito K. Diagnostic value of prostate-specific antigen-related parameters in discriminating prostate cancer. Int J Urol 2000;7:409-14.
Ezenwa EV, Tijani KH, Jeje EA, Soriyan OO, Ogunjimi MA, Ojewola RW, et al. The value of percentage free prostate specific antigen (PSA) in the detection of prostate cancer among patients with intermediate levels of total PSA (4.0-10.0 ng/ml) in Nigeria. Arab J Urol 2012;10:394-400.
Tijani KH, Anunobi CC, Adeyomoye AO, Alabi TO, Lawal AO, Akanmu NO, et al. The role of the percentage free PSA in the diagnosis of prostate cancer in Blacks: Finding in indigenous West African men using TRUS guided biopsy. African J Urol 2017;23: 14-19.
Arai Y, Maeda H, Ishitoya S, Okubo K, Okada T, Aoki Y. Prospective evaluation of prostate specific antigen density and systematic biopsy for detecting prostate cancer in Japanese patients with normal rectal examinations and intermediate prostate spe- cific antigen levels. J Urol 1997;158:861-4.
Oesterling JE, Kumamoto Y, Tsukamoto T, Girman CJ, Guess HA, Masumori N, et al. Serum prostate-specific antigen in a community-based population of healthy Japanese men: lower values than for similarly aged white men. Br J Urol 1995;75:347-53.
Noldus J, Graefen M, Huland E, Busch C, Hammerer P, Huland H. The value of the ratio of free-to-total prostate specific antigen for staging purposes in previously untreated prostate cancer. J Urol 1998;159:2004-7;discussion 7-8.
Sakai I, Harada K, Hara I, Eto H, Miyake H. Limited usefulness of the free-to-total prostate-specific antigen ratio for the diagnosis and staging of prostate cancer in Japanese men. Int J Clin Onco 2004;9:64-7.
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