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Thread: (C) Screening – Diagnosis – PSA – Imaging – Biopsies

  1. #1

    (C) Screening – Diagnosis – PSA – Imaging – Biopsies

    Table of Contents
    A title in all caps does not reflect any emphasis; it is simply how it appeared on the page I copied from.
    Studies in red are new additions.

    [#1] Developing new age-specific prostate-specific antigen thresholds for testing for prostate cancer [2018]

    [#2] Clinical and Genomic Characterization of Low-Prostate-specific Antigen, High-grade Prostate Cancer [2018]

    [#3] Diagnostic accuracy of mpMRI and fusion-guided targeted biopsy evaluated by transperineal template saturation prostate biopsy for the detection and characterization of prostate cancer [2018]

    [#4] MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis [2018]

    [#5] Imaging the High-Risk Prostate Cancer Patient: Current and Future Approaches to Staging [2018]

    [#6] Head-to-head comparison of prostate cancer risk calculators predicting biopsy outcome [2018]

    [#7] Prostate cancer screening—when to start and how to screen? [2018]

    [#7] What is an acceptable false negative rate in the detection of prostate cancer? [2018]

    [#7] Prostate cancer screening: what can we learn from randomised trials? [2018]

    [#8] Value of free/total prostate-specific antigen (f/t PSA) ratios for prostate cancer detection in patients with total serum prostate-specific antigen between 4 and 10  ng/mL: A meta-analysis [2018]

    Performance of free prostate-specific antigen ratio in differentiating between prostatic cancer and benign prostatic lesions at a referral hospital in South Africa [2018]

    [#9] MRI in early prostate cancer detection: how to manage indeterminate or equivocal PI-RADS 3 lesions? [2018]


    [#10] Review of Gallium-68 PSMA PET/CT Imaging in the Management of Prostate Cancer [2018]

    [#11] An Initial Negative Round of Targeted Biopsies In Men With Highly Suspicious Multiparametric MR Findings Does Not Exclude Clinically Significant Prostate Cancer – Preliminary Experience [2018]

    [#12] Screening for prostate cancer: are organized screening programs necessary? [2018]

    [#13] Quality of life among men with low-risk prostate cancer during the first year following diagnosis: the PREPARE prospective cohort study [2018]


    [#15] Prostate cancer–specific PET radiotracers: A review on the clinical utility in recurrent disease [2018]

    [#16] Prostate cancer bone metastases on staging prostate MRI: prevalence and clinical features associated with their diagnosis [2017]


    [#18] Prostate‐specific antigen screening impacts on biochemical recurrence in patients with clinically localized prostate cancer [2018]

    [#19] Incidence of metastasis and prostate-specific antigen levels at diagnosis in Gleason 3+4 versus 4+3 prostate cancer [2018]

    [#20] The effect of digital rectal exam on the 4Kscore for aggressive prostate cancer [2018]

    [#21] Results of Targeted Biopsy in Men with Magnetic Resonance Imaging Lesions Classified Equivocal, Likely or Highly Likely to Be Clinically Significant Prostate Cancer [2018]

    [#22] Shear-Wave Elastography for Detection of Prostate Cancer: A Systematic Review and Diagnostic Meta-Analysis [2018]

    WFUMB Guidelines and Recommendations on the Clinical Use of Ultrasound Elastography: Part 5. Prostate [2017]

    Seeing prostate cancer in a new light [2018]



    Why does multiparametric magnetic resonance imaging miss clinically significant prostate cancer? A systematic review of the literature [2017]

    [#25] Is Prostate Imaging Reporting and Data System Version 2 Sufficiently Discovering Clinically Significant Prostate Cancer? Per-Lesion Radiology-Pathology Correlation Study [2018]

    [#26] PSA-density does not improve bi-parametric prostate MR detection of prostate cancer in a biopsy na๏ve patient population [2018]

    [#27] Clinical utility of the Prostate Health Index (phi) for biopsy decision management in a large group urology practice setting [2017]

    [#28] Detection of extraprostatic disease and seminal vesicle invasion in patients undergoing magnetic resonance imaging-targeted prostate biopsies [2018]

    [#29] USPTF Prostate Cancer Screening Recommendations—A Step in the Right Direction [2018]

    [#30] Prostate Cancer Screening—A New Recommendation for Meaningful Physician-Patient Conversations [2018]

    [#31] Implications of the New USPSTF Prostate Cancer Screening Recommendation—Attaining Equipoise [2018]

    [#32] Prostate-Specific Antigen–Based Screening for Prostate Cancer: Evidence Report and Systematic Review for the US Preventive Services Task Force [2018]

    Prostate-Specific Antigen-Based Screening for Prostate Cancer: A Systematic Evidence Review for the U.S. Preventive Services Task Force [2018, Complete Report, Full Text]

    [#33] Evaluation of an Aggressive Prostate Biopsy Strategy in Men Younger than 50 years of Age [2018]

    [#34] Prostate-specific antigen density as a predictor of clinically significant prostate cancer when the PSA level is in the diagnostic “grey-zone”: Defining the optimum cut-point stratified by race and body mass [2018]

    [#35] Prostate Cancer Screening in African-American Men [2018]

    [#36] Fusion prostate biopsy outperforms 12-core systematic prostate biopsy in patients with prior negative systematic biopsy: A multi-institutional analysis [2018]

    [#37] One-year experience with 68Ga-PSMA PET/CT: applications and results in biochemical recurrence of prostate cancer [2018]

    [#38] The diagnostic accuracy of multiparametric MRI prior to biopsy in the detection of prostate cancer [2018]

    [#39] Editorial Comment: Advances in MRI and PET of the prostate: concurrence or complementarity? [2018]

    [#40] Do additional cores from cancer-suspicious lesions on transrectal ultrasound improve prostate cancer detection including index tumors over 12-core systematic biopsy? [2018]

    [#41] Magnetic Resonance Imaging–Based Prostate Cancer Screening: Is High-Value Care Achieved or Does the Holy Grail Remain Elusive? [2018]

    [#42] The diagnostic test accuracy of rectal examination for prostate cancer diagnosis in symptomatic patients: a systematic review [2018]

    [#43] Incorporating biomarkers into the primary prostate biopsy setting: a cost-effectiveness analysis [2018]

    [#44] Prostate Cancer Screening (PDQฎ): Health Professional Version [2019]

    [#45] Comparison of the accuracy of multiparametric magnetic resonance imaging (mpMRI) results with the final pathology findings for radical prostatectomy specimens in the detection of prostate cancer [2018]

    [#46] Studies on anesthesia for prostate biopsies

    [#47] The inverse relationship between prostate-specific antigen (PSA) and obesity [2018]

    [#48] Negative Multiparametric Magnetic Resonance Imaging for Prostate Cancer: What's Next? [2018]

    [#49] Targets missed: predictors of MRI-targeted biopsy failing to accurately localize prostate cancer found on systematic biopsy [2018]

    [#50] Extraprostatic Extension in Core Biopsies Epitomizes High-risk but Locally Treatable Prostate Cancer [2018]

    [#51] Impact of 68Ga-PSMA PET on the Management of Patients with Prostate Cancer: A Systematic Review and Meta-analysis [2018]

    [#52] Unintended consequences of decreased PSA-based prostate cancer screening [2018]

    [#53] Contribution of prostate-specific antigen density in the prediction of prostate cancer: Does prostate volume matter? [2018]

    [#54] MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis [2018]

    [#55] Should reporting of peri-neural invasion and extra prostatic extension be mandatory in prostate cancer biopsies? correlation with outcome in biopsy cases treated conservatively [2018]

    [#56] 68GaPSMA PET/CT Replacing Bone Scan in the Initial Staging of Skeletal Metastasis in Prostate Cancer: A Fait Accompli? [2018]

    [#57] Molecular Imaging and Prostate Cancer [2018]

    [#58] The natural history of prostate cancer on MRI: lessons from an active surveillance cohort [2018]

    [#59] Contemporary Incidence and Outcomes of Prostate Cancer Lymph Node Metastases [2018]

    TOC Continues Below
    Last edited by DjinTonic; 10-24-2019 at 12:22 PM.

  2. #2

    Table of Contents

    [#60] Tradeoffs in Refining the Diagnosis of Prostate Cancer [2018]

    [#61] Which scores need a core? An evaluation of MR-targeted biopsy yield by PIRADS score across different biopsy indications [2018]

    [#62] Magnetic resonance imaging of the prostate and targeted biopsy, Comparison of PIRADS and Gleason grading [2018]

    [#63] Comparison of cancer detection between 18- and 12-core prostate biopsy in Asian patients with prostate-specific antigen levels of 4-20 ng/mL [2018]

    [#64] Positron‐emission tomography imaging in urological oncology: Current aspects and developments [2018]

    [#65] MRI in prostate cancer diagnosis: do we need to add standard sampling? A review of the last 5 years [2018]

    [#66] PSMA Imaging and Theranostics: Future Impact to Patient Management [2018, Video]

    [#67] Radiologist as a Leader in the Diagnostic Process in Patients with Prostate Cancer [2017]

    [#68] Prostate-specific antigen 10–20 ng/mL: A predictor of degree of upgrading to ≥8 among patients with biopsy Gleason score 6 [2017]

    [#69] Can single positive core prostate cancer at biopsy be considered a low-risk disease? [2018]

    [#70] Changes in the outcome of prostate biopsies after preventive task force recommendation against prostate-specific antigen screening [2018]

    [#71] The Stockholm3 blood-test predicts clinically-significant cancer on biopsy: independent validation in a multi-center community cohort [2018]

    [#72] How many cores are needed to detect clinically significant prostate cancer on targeted MRI-ultrasound fusion biopsy? [2018]

    MRI/US fusion-guided prostate biopsy allows for equivalent cancer detection with significantly fewer needle cores in biopsy-naive men [2018

    [#73] How many cores are needed to detect clinically significant prostate cancer on targeted MRI-ultrasound fusion biopsy? [2018]

    [#74] Pain during Transrectal Ultrasound-Guided Prostate Biopsy and the Role of Periprostatic Nerve Block: What Radiologists Should Know [2014]

    [#75] The U Shape of Prostate-specific Antigen and Prostate Cancer-specific Mortality in High-grade Metastatic Prostate Adenocarcinoma [2018]

    [#76] National Private Payer Coverage of Prostate MRI [2018]

    [#77] Contemporary Epstein Criteria with Biopsy-Na๏ve Multiparametric Magnetic Resonance Imaging to Prevent Incorrect Assignment to Active Surveillance in the PI-RADS Version 2.0 Era [2018]

    [#78] Prostate cancer risk assessment in men with an initial P.S.A. below 3 ng/mL: results from the G๖teborg randomized population-based prostate cancer screening trial [2018]

    [#79] Towards Next-generation Urine-based Prostate Cancer Risk Stratification [2018]

    [#80] Prostate Cancer Screening Among High-Risk Black Men [2018]

    [#81] Prostate specific antigen levels and proportion of biopsy positive cores are independent predictors of upgrading patterns in low risk prostate cancer [2018]

    [#82] Comparison of Gleason upgrading rates in transrectal ultrasound systematic random biopsies versus US-MRI fusion biopsies for prostate cancer [2018]

    [#83] Entering an era of radiogenomics in prostate cancer risk stratification [2018]

    [#84] How Many Cores Does Systematic Prostate Biopsy Need?: A Large‐Sample Retrospective Analysis [2018]

    [#85] Clinical significance and predictors of oncologic outcome after radical prostatectomy for invisible prostate cancer on multiparametric MRI [2018]

    [#86] Prostate Cancer Screening Guidelines for African American Veterans: A New Perspective [2018]

    [#87] Upgrading in familial prostate cancer [2018]

    [#88] Detection of Individual Prostate Cancer Foci via Multiparametric Magnetic Resonance Imaging [2018]

    [#89] Diagnostic Imaging and Therapeutic Aspect of PSMA in Prostate Cancer [2018]

    [#90] Who Benefits from Multiparametric Magnetic Resonance Imaging After Suspicion of Prostate Cancer? [2018]

    [#91] Intra‐ and interreader reproducibility of PI‐RADSv2: A multireader study [2018]

    [#92] A critical comparison of techniques for MRI-targeted biopsy of the prostate [2017]

    [#93] Cancer Core Length from Targeted Biopsy: An Index of Prostate Cancer Volume and Pathologic Stage [2019]

    [#94] MRI-targeted biopsies: What’s next? [2019]

    [#95] Defining Prostate Cancer at Favorable Intermediate Risk: the Potential Utility Of Magnetic Resonance Imaging And Genomic Tests [2019]

    [#96] Comparison of Prostate Biopsy with or without Prebiopsy Multiparametric Magnetic Resonance Imaging for Prostate Cancer Detection: An Observational Cohort Study [2019]

    [#97] Long-term Outcomes for Men in a Prostate Screening Trial with an Initial Benign Prostate Biopsy: A Population-based Cohort [2019]

    [#98] Ga-PSMA PET/CT Staging of Newly Diagnosed Intermediate- and High-Risk Prostate Cancer [2019]

    [#99] The predictive value of DRE in the modern era of prostate cancer diagnostics [2019]

    [#100] Prostate cancer detection rate according to lesion visibility using ultrasound and MRI [2019]

    [#101] Multivariate risk prediction tools including MRI for individualized biopsy decision in prostate cancer diagnosis: current status and future directions [2019]

    [#102] Transperineal Prostate Biopsies Using Local Anesthesia: Experience in 1,287 Patients. Prostate Cancer Detection Rate, Complications and Patient Tolerability [2019]

    [#103] There Is No Way to Avoid Systematic Prostate Biopsies in Addition to Multiparametric Magnetic Resonance Imaging Targeted Biopsies [2019]

    [#104] Risk of Upgrading and Upstaging Among 10 000 Patients with Gleasinon 3 + 4 Favorable Intermediate-risk Prostate Cancer [2019]

    [#105] Extraprostatic Extension in Core Biopsies Epitomizes High-risk but Locally Treatable Prostate Cancer [2019]

    [#106] Genomic Evaluation of Multiparametric Magnetic Resonance Imaging-visible and -nonvisible Lesions in Clinically Localised Prostate Cancer [2019]

    [#107] Is Extraprostatic Extension of Cancer Predictable? A Review of Predictive Tools and an External Validation based on a Large and a Single Center Cohort of Prostate Cancer Patients [2019]

    [#108] 68Ga-PSMA-11 PET/CT in newly diagnosed prostate cancer: diagnostic sensitivity and interobserver agreement [2019]

    [#109] Prediction Medicine: Biomarkers, Risk Calculators and Magnetic Resonance Imaging as Risk Stratification Tools in Prostate Cancer Diagnosis [2019]

    [#110] Comparison of preoperative locoregional Ga-68 PSMA-11 PET-CT and mp-MRI results with postoperative histopathology of prostate cancer [2019]

    [#111] Extracapsular extension on MRI indicates a more aggressive cell cycle progression genotype of prostate cancer [2019]

    [#112] Early Second Round Targeted Biopsy of PI-RADS Score 3 or 4 in 256 Men With Persistent Suspicion of Prostate Cancer [2019]

    [#113] Prostate MRI, with or without MRI‐targeted biopsy, and systematic biopsy for detecting prostate cancer [2019]

    [#114] Liquid biopsy: Where did it come from, what is it, and where is it going? [2019]

    [#115] Observed racial disparity in the negative predictive value of multi-parametric MRI for the diagnosis for prostate cancer [2019]

    [#116] Prostate cancer upgrading or downgrading of biopsy Gleason scores at radical prostatectomy: prediction of "regression to the mean" using routine clinical features with correlating biochemical relapse rates [2019]

    [#117] Early detection of prostate cancer using prostate-specific antigen testing: an empirical evaluation among general practitioners and urologists

    TOC Continues Below
    Last edited by DjinTonic; 06-17-2019 at 11:59 AM.

  3. #3

    Table of Contents

    [#118] No added value of 18F-sodium fluoride PET/CT for the detection of bone metastases in patients with newly diagnosed prostate cancer with normal bone scintigraphy [2019]

    [#119] Prostate Cancer Biopsy: Strategies [2018]

    [#120] Screening for prostate cancer: History, evidence, controversies and future perspectives toward individualized screening [2019]

    [#121] PI-RADS Steering Committee: The PI-RADS Multiparametric MRI and MRI-directed Biopsy Pathway [2019]

    [#122] Performance of systematic, MRI-targeted biopsies alone or in combination for the prediction of unfavourable disease in MRI-positive low-risk prostate cancer patients eligible for active surveillance [2019]

    [#123] Comparison of Magnetic Resonance Imaging-stratified Clinical Pathways and Systematic Transrectal Ultrasound-guided Biopsy Pathway for the Detection of Clinically Significant Prostate Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials [2019]

    [#124] 68Ga-PSMA PET/CT: Does it predict adverse pathology findings at radical prostatectomy? [2019]

    [#125] Current status of liquid biopsies for the detection and management of prostate cancer [2019]

    [#126] Prostate Imaging Reporting and Data System 3 Category Cases at Multiparametric Magnetic Resonance for Prostate Cancer: A Systematic Review and Meta-analysis [2019] (PIRADS 3 lesions)

    [#127] Comparison between "In-bore" MRI guided prostate biopsy and standard ultrasound guided biopsy in the patient with suspicious prostate cancer: Preliminary results [2019]

    [#128] A Prospective Head-to-Head Comparison of 18F-Fluciclovine With 68Ga-PSMA-11 in Biochemical Recurrence of Prostate Cancer in PET/CT [2019]

    [#129] Digital Rectal Examination Remains a Key Prognostic Tool for Prostate Cancer: A National Cancer Database Review [2019]

    [#130] Accuracy of standard clinical 3T prostate MRI for pelvic lymph node staging: Comparison to 68Ga-PSMA PET-CT [2019]


    [#132] Preoperative PI-RADS Version 2 scores helps improve accuracy of clinical nomograms for predicting pelvic lymph node metastasis at radical prostatectomy [2019]

    [#133] Impact of biopsy perineural invasion on the outcomes of patients who underwent radical prostatectomy: a systematic review and meta-analysis [2019]

    [#134] Research landscape of liquid biopsies in prostate cancer [2019]

    [#135] Prostate Volume Index Is Able to Differentiate between Prostatic Chronic Inflammation and Prostate Cancer in Patients with Normal Digital Rectal Examination and Prostate-Specific Antigen Values <10 ng/mL: Results of 564 Biopsy Na๏ve Cases [2019]

    Since September:

    [#136] A review of optimal prostate biopsy: indications and techniques [2019]

    [#137] The prognostic impact of downgrading and upgrading from biopsy to radical prostatectomy among men with Gleason score 7 prostate cancer. [2019]

    [#138] Liquid Biopsy in Oligometastatic Prostate Cancer—A Biologist's Point of View [2019]

    [#139] Diagnostic Accuracy of Multiparametric MRI versus 68Ga-PSMA-11 PET/MRI for Extracapsular Extension and Seminal Vesicle Invasion in Patients with Prostate Cancer [2019]

    [#140] Optimising the number of cores for magnetic resonance imaging‐guided targeted and systematic transperineal prostate biopsy [2019]

    [#141] Targeted biopsy of the prostate: does this result in improvement in detection of high‐grade cancer or the occurrence of the Will Rogers phenomenon? [2019]

    The Will Rogers phenomenon in urological oncology [2019]

    [#142] ‘Feelings, and feelings, and feelings. Let me try thinking instead’: Screening for distress and referral to psychosocial care for men with prostate cancer [2019]

    [#143] Genomic Assessment of a High Grade Low PSA Prostate Cancer Cohort [2019]

    [#144] Genetic correlates of prostate cancer visibility (and invisibility) on mpMRI: It’s time to take stock [2019]

    [#145] Use of 68Ga-PSMA PET for detecting lymph node metastases in primary and recurrent prostate cancer and location of recurrence after radical prostatectomy: an overview of the current literature

    Last edited by DjinTonic; 11-07-2019 at 02:23 PM.

  4. #4
    [Table of Contents p.4]

  5. #5
    [Table of Contents p.5]

  6. #6
    Developing new age-specific prostate-specific antigen thresholds for testing for prostate cancer [2018, UK Study, Full Text]



    To examine whether age-related reference ranges for "normal" prostate-specific antigen (PSA) change (determined in men without prostate cancer) can be used to identify men at high risk of having prostate cancer.

    Subjects were men aged 50-69 years with PSA < 10 ng/mL from the UK-based Prostate Testing for cancer and Treatment (ProtecT) study. Men with prostate cancer were categorized as high or low risk of progression (Low risk: Gleason score ≤ 6 and stage T1-T2a; High risk: Gleason score 7-10 or stage T2C). Men without prostate cancer were those with no histological confirmation of prostate cancer. Previously developed longitudinal reference ranges for normal age-related PSA change were used to calculate an age-specific PSA threshold. We compared the ability of our age-specific PSA threshold to discriminate between high- and no/low-risk prostate cancer with that of two existing thresholds: (i) threshold of PSA = 3 ng/ml for all ages; (ii) National Institute of Clinical Excellence (NICE) guidelines dependent on age-group thresholds (age 50-59: PSA = 3 ng/mL; age 60-70: PSA = 4 ng/mL; age ≥ 70: PSA = 5 ng/mL).

    We included 823 men with high-risk prostate cancer and 80,721 men with no/low-risk prostate cancer. A threshold of PSA = 3 ng/ml for all ages identified more high-risk prostate cancers, recommending biopsy in 9.8% of men, of which 10.3% (n = 823) had high-risk prostate cancer. Using the NICE guidelines as the threshold for biopsy, 6.9% men were recommended for biopsy, of which 11.9% (n = 668 ) had high-risk prostate cancer. Using the new age-specific threshold for biopsy, 2.3% men were recommended for biopsy, of which 15.2% (n = 290) had high-risk prostate cancer. The age-specific threshold identified fewer high-risk prostate cancers, but fewer men received unnecessary biopsy.

    There is no benefit to using reference ranges for "normal" PSA that change with age nor the age-specific thresholds suggested by the NICE guidelines. While the age-varying thresholds are more discriminatory, too many high-risk cancers are missed.
    [Emphasis mine]

    From the Full Text:


    In this cohort of UK men aged 50–69 years, there is no evidence of benefit from using reference ranges for “normal” PSA change with age nor the age-specific thresholds suggested by the NICE guidelines (age 50–59: PSA = 3 ng/mL; age 60–70: PSA = 4 ng/mL; age ≥ 70: PSA = 5 ng/mL). A threshold of PSA = 3 ng/mL for all ages identified more clinically relevant prostate cancers at high risk of progression than either of the other two thresholds, resulting in fewer missed prostate cancers, but at the cost of more men receiving an unnecessary prostate biopsy. While the age-varying thresholds are more discriminatory, too many high-risk cancers are missed.
    First Forum post: https://www.cancerforums.net/threads/54411-Developing-new-age-specific-prostate-specific-antigen-thresholds-for-testing-for-PCa

  7. #7
    Clinical and Genomic Characterization of Low-Prostate-specific Antigen, High-grade Prostate Cancer [2018, Full Text]

    http://www.europeanurology.com/article/S0302-2838(18 )30098-8/fulltext
    Emoticon interference: delete the space after the 18

    There have been a few papers on this aspect of PCa deaths and PSA level: it is linear for G ≤7 but has a U-shaped curve for G8-10: PSA < 2.5 and > 20. So in the low arm of the curve, the mortality increases as the PSA at diagnosis decreases!


    The consequences of low prostate-specific antigen (PSA) in high-grade (Gleason 8-10) prostate cancer are unknown.


    To evaluate the clinical implications and genomic features of low-PSA, high-grade disease.

    This was a retrospective study of clinical data for 494 793 patients from the National Cancer Data Base and 136 113 patients from the Surveillance, Epidemiology, and End Results program with cT1-4N0M0 prostate cancer (median follow-up 48.9 and 25.0 mo, respectively), and genomic data for 4960 patients from the Decipher Genomic Resource Information Database. Data were collected for 2004-2017.


    Multivariable Fine-Gray and Cox regressions were used to analyze prostate cancer-specific mortality (PCSM) and all-cause mortality, respectively.


    For Gleason 8-10 disease, using PSA 4.1-10.0ng/ml (n=38 719) as referent, the distribution of PCSM by PSA was U-shaped, with an adjusted hazard ratio (AHR) of 2.70 for PSA ≤2.5ng/ml (n=3862, p<0.001) versus 1.97, 1.36, and 2.56 for PSA of 2.6-4.0 (n=4199), 10.1-20.0 (n=17 372), and >20.0ng/ml (n=16 114), respectively. By contrast, the distribution of PCSM by PSA was linear for Gleason ≤7 (using PSA 4.1-10.0ng/ml as the referent, n=359 898 ), with an AHR of 0.41 (p=0.13) for PSA ≤2.5ng/ml (n=37 812) versus 1.38, 2.28, and 4.61 for PSA of 2.6-4.0 (n=54 152), 10.1-20.0 (n=63 319), and >20.0ng/ml (n=35 459), respectively (pinteraction<0.001). Gleason 8-10, PSA ≤2.5ng/ml disease had a significantly higher PCSM than standard high-risk/very high-risk disease with PSA >2.5ng/ml (AHR 2.15, p=0.002; 47-mo PCSM 14% vs 4.9%). Among Gleason 8-10 patients treated with radiotherapy, androgen deprivation therapy was associated with a survival benefit for PSA >2.5ng/ml (AHR 0.87; p<0.001) but not ≤2.5ng/ml (AHR 1.36; p=0.084; pinteraction=0.021). For Gleason 8-10 tumors, PSA ≤2.5ng/ml was associated with higher expression of neuroendocrine/small-cell markers compared to >2.5ng/ml (p=0.046), with no such relationship for Gleason ≤7 disease.


    Low-PSA, high-grade prostate cancer has very high risk for PCSM, potentially responds poorly to androgen deprivation therapy, and is associated with neuroendocrine genomic features.


    In this study, we found that low-prostate-specific antigen, high-grade prostate cancer has a very high risk for prostate cancer death, may not respond well to androgen deprivation therapy, and is associated with neuroendocrine genomic features. These findings suggest that current nomograms and treatment paradigms may need modification.
    [Emphasis mine]

    From the interesting Full-Text Discussion:

    In this large, contemporary study of patients from three national cohorts, we found that low-PSA, high-grade prostate cancer appears to be a unique and aggressive entity among men with prostate cancer, with poor clinical outcomes and genomic features of neuroendocrine dedifferentiation. Characterization of this disease as a unique entity distinguishable by expression profiling from other high-grade prostate adenocarcinomas has not been reported in the literature, and the implications of these findings are highly clinically significant.
    First Forum post: https://www.cancerforums.net/threads/54403-Clinical-amp-Genomic-Characterization-of-Low-PSA-High-grade-PCa

  8. #8
    Diagnostic accuracy of mpMRI and fusion-guided targeted biopsy evaluated by transperineal template saturation prostate biopsy for the detection and characterization of prostate cancer [2018, Abstract]


    To evaluate the diagnostic accuracy of mpMRI and mpMRI / transrectal ultrasound (TRUS) fusion-guided targeted biopsy (FTB) against transperineal template saturation prostate biopsy (TTSPB) for the detection of prostate cancer (PCa).

    Retrospective analysis of 415 men consecutively presenting for prostate biopsy between 11/2014 and 9/2016 at our tertiary care centre. MpMRI (3-Tesla, without endorectal coil) was performed followed by TTSPB with the BiopSeeฎ fusion system. Additional FTB was carried out in men with a suspicious lesion on mpMRI (Likert score 3-5). Any Gleason pattern 4 was defined as clinically significant PCa (csPCa). Detection rates of mpMRI and FTB were compared with the detection rate of TTSPB using the McNemar test.

    The median numbers of TTSPB and FTB cores taken were 40 (range 30-55) and three (2-4), respectively. Among 124 patients (29.9%) without suspicious lesion on mpMRI, 32 (25.8%) were found to have csPCa on TTSPB. Among 291 patients (70.1%) with a Likert score 3-5 on mpMRI, FTB detected 129 (44.3%), TTSPB 176 (60.5%) and the combined approach 187 patients (64.3%) with a csPCa. Overall, 58 cases (19.9%) of csPCa would have been missed if FTB was performed exclusively. Sensitivities of mpMRI and FTB for csPCa were 84.6% and 56.7%, with a negative likelihood ratio of 0.35 and 0.46, respectively.

    MpMRI alone should not be used as a triage test due to a substantial number of false-negative cases with csPCa. Systematic biopsy outperformed FTB and will therefore remain crucial in the diagnostic pathway of PCa.
    [Emphasis mine]

    First Forum post: https://www.cancerforums.net/threads/54386-Accuracy-of-mpMRI-and-fusion-guided-targeted-biopsy-evaluated-by-saturation-biopsy

  9. #9
    MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis [2018, NEJM, Full Text]
    (Thanks to PCASpouse for first spotting this paper)



    Multiparametric magnetic resonance imaging (MRI), with or without targeted biopsy, is an alternative to standard transrectal ultrasonography–guided biopsy for prostate-cancer detection in men with a raised prostate-specific antigen level who have not undergone biopsy. However, comparative evidence is limited.

    In a multicenter, randomized, noninferiority trial, we assigned men with a clinical suspicion of prostate cancer who had not undergone biopsy previously to undergo MRI, with or without targeted biopsy, or standard transrectal ultrasonography–guided biopsy. Men in the MRI-targeted biopsy group underwent a targeted biopsy (without standard biopsy cores) if the MRI was suggestive of prostate cancer; men whose MRI results were not suggestive of prostate cancer were not offered biopsy. Standard biopsy was a 10-to-12–core, transrectal ultrasonography–guided biopsy. The primary outcome was the proportion of men who received a diagnosis of clinically significant cancer. Secondary outcomes included the proportion of men who received a diagnosis of clinically insignificant cancer.

    A total of 500 men underwent randomization. In the MRI-targeted biopsy group, 71 of 252 men (28%) had MRI results that were not suggestive of prostate cancer, so they did not undergo biopsy. Clinically significant cancer was detected in 95 men (38%) in the MRI-targeted biopsy group, as compared with 64 of 248 (26%) in the standard-biopsy group (adjusted difference, 12 percentage points; 95% confidence interval [CI], 4 to 20; P=0.005). MRI, with or without targeted biopsy, was noninferior to standard biopsy, and the 95% confidence interval indicated the superiority of this strategy over standard biopsy. Fewer men in the MRI-targeted biopsy group than in the standard-biopsy group received a diagnosis of clinically insignificant cancer (adjusted difference, −13 percentage points; 95% CI, −19 to −7; P<0.001).

    The use of risk assessment with MRI before biopsy and MRI-targeted biopsy was superior to standard transrectal ultrasonography–guided biopsy in men at clinical risk for prostate cancer who had not undergone biopsy previously. (Funded by the National Institute for Health Research and the European Association of Urology Research Foundation; PRECISION ClinicalTrials.gov number, NCT02380027.)
    [Emphasis mine]

  10. #10
    Imaging the High-Risk Prostate Cancer Patient: Current and Future Approaches to Staging



    Imaging is critically important for the diagnosis, staging, and management of men with high-risk prostate cancer. Conventional imaging modalities, including computed tomography and radionuclide bone scan have been employed for local and metastatic staging, but their performance has generally been poor. Sodium fluoride positron emission tomography is recommended when there is high suspicion for bone metastases despite a negative or indeterminate bone scan. Magnetic resonance imaging has advantages in local staging but its value depends on the extent of disease. Whole body positron emission tomography/magnetic resonance imaging could provide both local and distant staging although the technology is not yet widely disseminated. None of the existing positron emission tomography agents are recommended in practice guidelines, however, among them, prostate specific membrane antigen-based tracers seem to hold the most promise based on sensitivity and specificity.


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