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Reducing Unnecessary Biopsy During Prostate Cancer Screening Using a Four-Kallikrein Panel: An Independent Replication.

Vickers, Andrew; Cronin, Angel; Roobol, Monique; Savage, Caroline; Peltola, Mari; Pettersson, Kim; Scardino, Peter T; Schröder, Fritz and Lilja, Hans LU (2010) In Journal of Clinical Oncology May 4. p.2493-2498
Abstract
PURPOSE: We previously reported that a panel of four kallikrein forms in blood-total, free, and intact prostate-specific antigen (PSA) and kallikrein-related peptidase 2 (hK2)-can reduce unnecessary biopsy in previously unscreened men with elevated total PSA. We aimed to replicate our findings in a large, independent, representative, population-based cohort. PATIENTS AND METHODS: The study cohort included 2,914 previously unscreened men undergoing biopsy as a result of elevated PSA (>/= 3 ng/mL) in the European Randomized Study of Screening for Prostate Cancer, Rotterdam, with 807 prostate cancers (28%) detected. The cohort was randomly divided 1:3 into a training and validation set. Levels of kallikrein markers were compared with... (More)
PURPOSE: We previously reported that a panel of four kallikrein forms in blood-total, free, and intact prostate-specific antigen (PSA) and kallikrein-related peptidase 2 (hK2)-can reduce unnecessary biopsy in previously unscreened men with elevated total PSA. We aimed to replicate our findings in a large, independent, representative, population-based cohort. PATIENTS AND METHODS: The study cohort included 2,914 previously unscreened men undergoing biopsy as a result of elevated PSA (>/= 3 ng/mL) in the European Randomized Study of Screening for Prostate Cancer, Rotterdam, with 807 prostate cancers (28%) detected. The cohort was randomly divided 1:3 into a training and validation set. Levels of kallikrein markers were compared with biopsy outcome. RESULTS: Addition of free PSA, intact PSA, and hK2 to a model containing total PSA and age improved the area under the curve from 0.64 to 0.76 and 0.70 to 0.78 for models without and with digital rectal examination results, respectively (P < .001 for both). Application of the panel to 1,000 men with elevated PSA would reduce the number of biopsies by 513 and miss 54 of 177 low-grade cancers and 12 of 100 high-grade cancers. Findings were robust to sensitivity analysis. CONCLUSION: We have replicated our previously published finding that a panel of four kallikreins can predict the result of biopsy for prostate cancer in men with elevated PSA. Use of this panel would dramatically reduce biopsy rates. A small number of men with cancer would be advised against immediate biopsy, but these men would have predominately low-stage, low-grade disease. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Clinical Oncology
volume
May 4
pages
2493 - 2498
publisher
American Society of Clinical Oncology
external identifiers
  • wos:000277832400002
  • pmid:20421547
  • scopus:77953688557
ISSN
1527-7755
DOI
10.1200/JCO.2009.24.1968
language
English
LU publication?
yes
id
e87188ed-31e4-4583-8859-61d825f9ea5b (old id 1594774)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/20421547?dopt=Abstract
date added to LUP
2010-05-04 22:51:34
date last changed
2018-05-29 09:18:49
@article{e87188ed-31e4-4583-8859-61d825f9ea5b,
  abstract     = {PURPOSE: We previously reported that a panel of four kallikrein forms in blood-total, free, and intact prostate-specific antigen (PSA) and kallikrein-related peptidase 2 (hK2)-can reduce unnecessary biopsy in previously unscreened men with elevated total PSA. We aimed to replicate our findings in a large, independent, representative, population-based cohort. PATIENTS AND METHODS: The study cohort included 2,914 previously unscreened men undergoing biopsy as a result of elevated PSA (&gt;/= 3 ng/mL) in the European Randomized Study of Screening for Prostate Cancer, Rotterdam, with 807 prostate cancers (28%) detected. The cohort was randomly divided 1:3 into a training and validation set. Levels of kallikrein markers were compared with biopsy outcome. RESULTS: Addition of free PSA, intact PSA, and hK2 to a model containing total PSA and age improved the area under the curve from 0.64 to 0.76 and 0.70 to 0.78 for models without and with digital rectal examination results, respectively (P &lt; .001 for both). Application of the panel to 1,000 men with elevated PSA would reduce the number of biopsies by 513 and miss 54 of 177 low-grade cancers and 12 of 100 high-grade cancers. Findings were robust to sensitivity analysis. CONCLUSION: We have replicated our previously published finding that a panel of four kallikreins can predict the result of biopsy for prostate cancer in men with elevated PSA. Use of this panel would dramatically reduce biopsy rates. A small number of men with cancer would be advised against immediate biopsy, but these men would have predominately low-stage, low-grade disease.},
  author       = {Vickers, Andrew and Cronin, Angel and Roobol, Monique and Savage, Caroline and Peltola, Mari and Pettersson, Kim and Scardino, Peter T and Schröder, Fritz and Lilja, Hans},
  issn         = {1527-7755},
  language     = {eng},
  pages        = {2493--2498},
  publisher    = {American Society of Clinical Oncology},
  series       = {Journal of Clinical Oncology},
  title        = {Reducing Unnecessary Biopsy During Prostate Cancer Screening Using a Four-Kallikrein Panel: An Independent Replication.},
  url          = {http://dx.doi.org/10.1200/JCO.2009.24.1968},
  volume       = {May 4},
  year         = {2010},
}