Journal List > Korean J Urol > v.49(5) > 1005103

Lee, Kwak, Lee, and Choi: The Diagnostic Value of Predictive Factors for Clinically Insignificant Prostate Cancer

Abstract

Purpose

In the present study, we identified the pre-operative predictive factors of insignificant prostate cancer and we analyzed their diagnostic accuracy.

Material and Methods

Of a total 343 patients who had undergone radical prostatectomy, 33 patients (9.6%) were diagnosed with insignificant cancer that was characterized by a total cancer volume ≤0.5cc, a Gleason score (GS)≤6, a T stage≤2c and no positive surgical margin. We found the statistically significant factors after comparing of preoperative clinicopathological findings between two groups and determined the diagnostic accuracy of the identified predictors.

Results

Of several factors, prostate-specific antigen (PSA) level (p=0.04, odds ratio (OR)=4.3 3.589≤95%confidence interval (CI)≤5.692), PSA density (PSAD) (p=0.01, OR=6.6, 2.115≤95%CI≤278.826), biopsy GS (p=0.03, OR=4.6, 1.114≤95%CI≤12.568) and volume of the largest cancer (p=0.02, OR=5.6, 2.471≤95%CI≤9.725) were analyzed as independent predictors of insignificant cancer. The volume of the largest cancer was the most precise predictor (AUC=0.791), followed by the PSAD (AUC=0.748) and the PSA level (AUC=0.677) in the ROC (receiver operating characteristic) curve analysis. The sensitivity, specificity and positive predictive value for predicting insignificant cancer were 10.3%, 63.7% and 12.8% at a PSA level of 10ng/ml, and 44.8%, 16.8% and 26.3% at a PSAD of 0.15ng/ml/ml, and 13.8%, 53.8% and 14.2% at a volume of the largest cancer of 50%, respectively. Even with using a combination of these three factors as well as a biopsy GS≤6, only 53% of insignificant prostate cancer could be predicted preoperatively.

Conclusions

In our study, PSA level, PSAD, biopsy GS and volume of the largest cancer were identified as predictors of insignificant cancer in spite of their unsatisfactory diagnostic accuracy.

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Fig. 1.
The ROC curve analysis of the PSA, PSAD and the volume of the largest cancer for predicting insignificant prostate cancer is shown below. Area under curve: volume of the largest cancer; 0.791 PSAD; 0.748 PSA; 0.677. ROC: receiver operating characteristic, PSA: prostate-specific antigen, PSAD: prostate-specific antigen density, PPV: positive predictive value.
kju-49-398-f1.tif
Table 1.
Comparison of clinical tumor characteristics of the 343 patients and who are stratified by the pathological insignificance of their cancer
Tumor characteristics Insignificant prostate cancer (n=33) Significant prostate cancer (n=310) p-value
Mean age±SD 61.3±5.6 63.9±6.0 0.011
Mean PSA±SD (ng/ml) 7.3±6.0 11.6±6.0 <0.001
Mean PSA density±SD (ng/ml/ml) 0.26±0.48 0.40±0.45 <0.001
No. of clinical stage (%): ≤T2c vs >T2c 0.041
≤T1c 15 (45.5%) 73 (23.9%)
T2a/b/c 12 (36%) 122 (39.4%)
≥T3 6 (18.5%) 115 (37.1%)
No. of biopsy Gleason score (%): <0.001
≤6 vs >6
≤6 29 (87.9%) 144 (46.5%)
7 4 (12.1%) 104 (33.5%)
≥8 0 62 (20%)
Mean percentage of cancer per biopsy set±SD (%) 18.8±16.0 35.1±22.1 <0.001
Mean tumor volume of largest cancer±SD (%) 16.2±20.4 43.6±30.1 <0.001

PSA: prostate-specific antigen

Table 2.
The univariate and multivariate analyses of the pre-operative parameters for insignificant prostate cancer
Pre-operative parameter Univariate Multivariate
p-value OR 95% CI p-value
PSA <0.001 4.252 3.589-5.692 0.039
PSAD <0.001 6.561 2.115-278.826 0.010
Percentage of cancer per biopsy set 0.008 0.871 0.946-1.020 0.351
Tumor volume of largest cancer <0.001 5.643 2.471-9.725 0.018
Biopsy GS (≤6 vs ≥7) <0.001 4.558 1.114-12.568 0.033
Clinical staging 0.654 0.036 0.773-1.237 0.850

PSA: prostate-specific antigen, PSAD: prostate-specific antigen density, GS: Gleason score, OR: odds ratio, CI: confidence interval

Table 3.
The sensitivity, specificity and PPV of each parameter for predicting insignificant prostate cancer
Preoperative parameter Sensitivity (%) Specificity (%) PPV(%) AUC
PSA (ng/ml) 0.677
5 55.2 18.8 22.3
10 10.3 63.7 12.8
20 6.9 87.7 10.0
PSAD (ng/ml/ml) 0.748
0.10 72.4 6.2 30.3
0.15 44.8 16.8 26.3
0.20 27.6 28.4 19.2
Tumor volume of the largest cancer (%) 0.791
10 41.4 13.7 26.6
25 20.7 33.9 18.8
50 13.8 53.8 14.2

PSA: prostate-specific antigen, PSAD: prostate-specific antigen density, PPV: positive predictive value, AUC: area under curve

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