Korean J Urol.  2008 May;49(5):398-403. 10.4111/kju.2008.49.5.398.

The Diagnostic Value of Predictive Factors for Clinically Insignificant Prostate Cancer

• Lee HW
• Kwak KW
• Lee HM
• Choi HY

• KMID: 1204519
• DOI: http://doi.org/10.4111/kju.2008.49.5.398

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 < or=0.5cc, a Gleason score (GS)< or=6, a T stage< or=2c and no positive surgical margin. We found the statistically significant factors after comparing of preoperative clinico- pathological 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< or=95%confidence interval(CI)< or=5.692), PSA density(PSAD)(p=0.01, OR=6.6, 2.115< or=95%CI< or=278.826), biopsy GS(p=0.03, OR=4.6, 1.114< or=95%CI< or=12.568) and volume of the largest cancer(p=0.02, OR=5.6, 2.471< or=95%CI< or=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< or=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.

Keyword

Prostate cancer; Prostatectomy; Insignificant; Predictive

MeSH Terms

Predictive Value of Tests
Biopsy

Figure

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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.

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