BERKELEY, CA (UroToday.com) - Limited survival benefit and excess treatment due to PSA screening in randomized trials suggests a need for more restricted selection of prostate biopsy candidates by discerning risk of histologically aggressive versus indolent cancer before biopsy.
We analyzed subjects undergoing first prostate biopsy enrolled in a multi-center, prospective cohort of the NCI Early Detection Research Network (EDRN) to develop a model for predicting histologically aggressive prostate cancers. Furthermore, we then used the control arm of the Prostate Cancer Prevention Trial (PCPT) to validate our model.
Age, body mass index, family history of prostate cancer, abnormal digital rectal exam (DRE), and prostate specific antigen density (PSAD) were associated with aggressive cancer (all P<0.001). The EDRN model outperformed PSA alone in predicting aggressive cancer (AUC=0.81 vs. 0.71, P<0.01). For example, when compared with PSA alone, at a sensitivity level of 90%, the multivariable model improved specificity from 32% to 42%. In addition, model validation in the PCPT cohort accurately identified men at low (<10%) risk of aggressive cancer for whom biopsy could be averted (AUC=0.78; 95% CI .75-.80). Using our predictive model incorporating age, family history, obesity, PSAD and DRE one-quarter of prostate biopsies can be averted while retaining high sensitivity in detecting aggressive prostate cancer.
These findings represent a poignant contrast to the recent US Preventative Services Task Force (USPSTF) recommendations against the use of PSA screening for prostate cancer. Whereas the USPSTF focused criticism on short-term studies that showed limited efficacy of uniform PSA cut-offs without any consideration whatsoever of relevant risk factors such as family history, race, or obesity, our study demonstrates that individualized strategies for cancer screening that adjust for these factors may overcome shortcomings of one-size-fits-all recommendations such as those of the USPSTF.
Written by:
Stephen B. Williams, MD1 as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
1Urologist and Surgeon
Associated Urologists of Orange County
1801 N. Broadway
Santa Ana, CA 92706
UroToday.com Prostate Cancer Section