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Re-evaluating the diagnostic efficacy of PSA as a referral test to detect clinically significant prostate cancer in contemporary MRI-based image-guided biopsy pathways

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cam.issuedOnline2021-12-01
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cam.orpheus.successTue Feb 01 19:02:06 GMT 2022 - Embargo updated
dc.contributor.authorLophatananon, A
dc.contributor.authorLight, A
dc.contributor.authorBurns-Cox, N
dc.contributor.authorMaccormick, A
dc.contributor.authorJohn, J
dc.contributor.authorOtti, V
dc.contributor.authorMcGrath, J
dc.contributor.authorArcher, P
dc.contributor.authorAnning, J
dc.contributor.authorMcCracken, S
dc.contributor.authorPage, T
dc.contributor.authorMuir, K
dc.contributor.authorGnanapragasam, VJ
dc.contributor.orcidGnanapragasam, VJ [0000-0003-4722-4207]
dc.date.accessioned2021-11-04T00:30:56Z
dc.date.available2021-11-04T00:30:56Z
dc.date.issued2023
dc.description.abstract<jats:sec><jats:title>Introduction:</jats:title><jats:p> Modern image-guided biopsy pathways at diagnostic centres have greatly refined the investigations of men referred with suspected prostate cancer. However, the referral criteria from primary care are still based on historical prostate-specific antigen (PSA) cut-offs and age-referenced thresholds. Here, we tested whether better contemporary pathways and biopsy methods had improved the predictive utility value of PSA referral thresholds. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> PSA referral thresholds, age-referenced ranges and PSA density (PSAd) were assessed for positive predictive value (PPV) in detection of clinically significant prostate cancer (csPCa – histological ⩾ Grade Group 2). Data were analysed from men referred to three diagnostics centres who used multi-parametric magnetic resonance imaging (mpMRI)-guided prostate biopsies for disease characterisation. Findings were validated in a separate multicentre cohort. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Data from 2767 men were included in this study. The median age, PSA and PSAd were 66.4 years, 7.3 ng/mL and 0.1 ng/mL<jats:sup>2</jats:sup>, respectively. Biopsy detected csPCa was found in 38.7%. The overall area under the curve (AUC) for PSA was 0.68 which is similar to historical performance. A PSA threshold of ⩾ 3 ng/mL had a PPV of 40.3%, but this was age dependent (PPV: 24.8%, 32.7% and 56.8% in men 50–59 years, 60–69 years and ⩾ 70 years, respectively). Different PSA cut-offs and age-reference ranges failed to demonstrate better performance. PSAd demonstrated improved AUC (0.78 vs 0.68, p &lt; 0.0001) and improved PPV compared to PSA. A PSAd of ⩾ 0.10 had a PPV of 48.2% and similar negative predictive value (NPV) to PSA ⩾ 3 ng/mL and out-performed PSA age-reference ranges. This improved performance was recapitulated in a separate multi-centre cohort ( n = 541). </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> The introduction of MRI-based image-guided biopsy pathways does not appear to have altered PSA diagnostic test characteristics to positively detect csPCa. We find no added value to PSA age-referenced ranges, while PSAd offers better PPV and the potential for a single clinically useful threshold (⩾0.10) for all age groups. </jats:p></jats:sec><jats:sec><jats:title>Level of evidence:</jats:title><jats:p> IV </jats:p></jats:sec>
dc.identifier.doi10.17863/CAM.77708
dc.identifier.eissn2051-4166
dc.identifier.issn2051-4158
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/330267
dc.language.isoeng
dc.publisherSAGE Publications
dc.publisher.urlhttp://dx.doi.org/10.1177/20514158211059057
dc.rightsAll rights reserved
dc.rights.urihttp://www.rioxx.net/licenses/all-rights-reserved
dc.subjectProstate cancer
dc.subjectPSA
dc.subjectPSA density
dc.subjectMRI
dc.subjectdiagnosis
dc.subjectpredictive value
dc.titleRe-evaluating the diagnostic efficacy of PSA as a referral test to detect clinically significant prostate cancer in contemporary MRI-based image-guided biopsy pathways
dc.typeArticle
dcterms.dateAccepted2021-10-25
prism.publicationNameJournal of Clinical Urology
pubs.funder-project-idNational Institute for Health and Care Research (IS-BRC-1215-20014)
rioxxterms.licenseref.startdate2021-10-25
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.typeJournal Article/Review
rioxxterms.versionAM
rioxxterms.versionofrecord10.1177/20514158211059057

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