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01-02-2012 | Original Article

PSA density lower cutoff value as a tool to exclude pathologic upstaging in initially diagnosed unilateral prostate cancer: impact on hemiablative focal therapy

Authors: Thomas Hofner, Jesco Pfitzenmaier, Adel Alrabadi, Sascha Pahernik, Boris Hadaschik, Nina Wagener, Nenad Djakovic, Axel Haferkamp, Markus Hohenfellner

Published in: World Journal of Urology | Issue 1/2012

Abstract

Purpose

To investigate prostate-specific antigen density as a predictor for pathologic upstaging in patients initially thought to have unilateral prostate cancer.

Methods

We analyzed 438 patients with unilateral prostate cancer in prostate biopsy samples that were treated with radical prostatectomy. Bilateral or extracapsular growth in the final surgical specimens was defined as upstaging. Using Kaplan–Meier curves and a multivariate Cox proportional hazard model, we evaluated the oncologic effect of pathologic upstaging on biochemical recurrence-free survival. Prostate-specific antigen density was evaluated as a diagnostic tool to predict upstaging using ROC-curve analysis.

Results

Of the patients, 30.8% had bilateral prostate cancer or extracapsular extension in the surgical specimen. Prostate-specific antigen density was a diagnostic predictor for pathologic upstaging in patients initially thought to have unilateral prostate cancer (AUC 0.62, P < 0.001). Using a lower cutoff value of PSA density <0.056 ng/ml/cm³, upstaging could be excluded in patients with a sensitivity of >98%.

Conclusions

A considerable amount of patients that are initially diagnosed with unilateral prostate cancer on biopsy are underdiagnosed and are upstaged in the radical prostatectomy specimen. In general, AUC of PSA density is too low to use PSA density as diagnostic tool to predict pathologic upstaging in all patients. Nonetheless, PSA density could be used for hemiablative focal therapy decision making using a lower cutoff value of <0.056 ng/ml/cm³.

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Title: PSA density lower cutoff value as a tool to exclude pathologic upstaging in initially diagnosed unilateral prostate cancer: impact on hemiablative focal therapy
Authors: Thomas Hofner
Jesco Pfitzenmaier
Adel Alrabadi
Sascha Pahernik
Boris Hadaschik
Nina Wagener
Nenad Djakovic
Axel Haferkamp
Markus Hohenfellner
Publication date: 01-02-2012
Publisher: Springer-Verlag
Published in: World Journal of Urology / Issue 1/2012
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-010-0631-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

PSA density lower cutoff value as a tool to exclude pathologic upstaging in initially diagnosed unilateral prostate cancer: impact on hemiablative focal therapy

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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