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Model predicts aggressive prostate cancer
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A predictive model that incorporated a variety of factors such as age, family history and PSA density was better than PSA alone to predict aggressive prostate cancer, according to a study published in Cancer.
Researchers from Beth Israel Deaconess Medical Center in Boston, Harvard Medical School, the University of Texas Health Science Center at San Antonio and others developed the Early Detection Research Network Prediction Model to reduce unnecessary prostate biopsies. The model uses age, family history, obesity, PSA density and digital rectal examination results.
“The ability to discern aggressive from indolent prostate cancer is a centerpiece of current efforts under way to refine prostate cancer detection,” the researchers wrote.
The model was tested in a prospective cohort of men enrolled in a multicenter study of the NCI Early Detection Research Network. The cohort included 635 men undergoing first prostate biopsy. Results of the biopsies identified 361 men with no cancer, 88 men with indolent cancer and 186 men with aggressive cancer.
In a multivariate analysis, age, BMI, family history of prostate cancer, abnormal digital rectal examination and PSA density were associated with aggressive cancer (P<.001). Compared to PSA alone, with a sensitivity of 90%, the model improved specificity from 32% to 42%.
To assess the model’s ability to identify men with aggressive prostate cancer in the general population, the model was applied to the control arm of the Prostate Cancer Prevention Trial study. Among the 3,833 patients on this study, 324 had aggressive cancer on biopsy, 333 had indolent cancer and the remainder had no cancer. The model accurately identified men at low risk for aggressive cancer, who could have avoided biopsy.
The researchers conclude that men who meet the following criteria can avoid a prostate biopsy: normal digital rectal exam, no family history of prostate cancer, a PSA density of <0.1mg/mL/cc and a BMI of <25 kg/m2.
Disclosure: The researchers report no relevant disclosures.
For more information:
- Williams SB. Cancer. 2011;doi:10.1002/cncr.26396
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This is a very interesting study, and it comes at a perfect time. The US Preventive Services Task Force has just released its analysis of the utility of conventional PSA screening approaches in unselected populations and has reported that PSA is not useful in saving lives overall, despite some reduction in deaths from prostate cancer per se. While the task force is probably correct in its analysis of current PSA screening approaches, it is unfortunate that it has again unilaterally released its thoughts, independent of input from experts in the field, creating anxiety and consternation among patients and physicians, which might have been ameliorated by some modification of framing and specific advice for subsets of the population. The analysis on selective detection potentially answers some of the concerns about the weaknesses of conventional PSA testing, with the potential to identify the more dangerous types of prostate cancer and improve the efficacy of the process. As noted by the authors, the arbitrary classification into Caucasian and non-Caucasian is unfortunate, as the non-Caucasian group is likely to have been heterogeneous to the point of vitiating the impact of African-American race. It is also disappointing that this important study selected so heavily against men of color for inclusion. Although this report is quite promising, this approach will need to be validated further, but it points the way to a better model for screening asymptomatic men for prostate cancer which might put them at risk.
– Derek Raghavan, MD
HemOnc Today Editorial Board member
Disclosure: Dr. Raghavan reports no relevant financial disclosures.