The global uptake of prostate cancer (PCa) active surveillance (AS) is steadily increasing. While prostate-specific antigen density (PSAD) is an important baseline predictor of PCa progression on AS, there is a scarcity of recommendations on its use in follow-up. In particular, the best way of measuring PSAD is unclear. One approach would be to use the baseline gland volume (BGV) as a denominator in all calculations throughout AS (nonadaptive PSAD, PSADNA), while another would be to remeasure gland volume at each new magnetic resonance imaging scan (adaptive PSAD, PSADA). In addition, little is known about the predictive value of serial PSAD in comparison to PSA. We applied a long short-term memory recurrent neural network to an AS cohort of 332 patients and found that serial PSADNA significantly outperformed both PSADA and PSA for follow-up prediction of PCa progression because of its high sensitivity. Importantly, while PSADNA was superior in patients with smaller glands (BGV ≤55 ml), serial PSA was better in men with larger prostates of >55 ml.
Repeat measurements of prostate-specific antigen (PSA) and PSA density (PSAD) are the mainstay of active surveillance in prostate cancer. Our study suggests that in patients with a prostate gland of 55 ml or smaller, PSAD measurements are a better predictor of tumour progression, whereas men with a larger gland may benefit more from PSA monitoring.
European urology open science. 2023 Apr 29*** epublish ***
Nikita Sushentsev, Luis Abrego, Anna Colarieti, Nimalan Sanmugalingam, Arnaldo Stanzione, Jeries Paolo Zawaideh, Iztok Caglic, Alexey Zaikin, Oleg Blyuss, Tristan Barrett
Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK., Department of Women's Cancer, Institute for Women's Health, University College London, London, UK., Wolfson Institute of Population Health, Queen Mary University of London, London, UK.