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A pre-specified model based on four kallikrein markers in blood improves predictions of adverse pathology and biochemical recurrence after radical prostatectomy

Haese, Alexander ; Tin, Amy L. ; Carlsson, Sigrid V. LU ; Sjoberg, Daniel D. ; Pehrke, Dirk ; Steuber, Thomas ; Huland, Hartwig ; Graefen, Markus ; Scardino, Peter T. and Schlomm, Thorsten , et al. (2020) In British Journal of Cancer 123(4). p.604-609
Abstract

Background: A pre-specified model based on four kallikrein markers in blood, commercially available as 4Kscore, predicts Gleason Grade (GG) 3 + 4 or higher prostate cancer on biopsy. However, sampling error and variation in pathology reporting may miss aggressive disease. Methods: The 4Kscore was measured in cryopreserved blood from 2330 men obtained before prostatectomy at a single institution between 2002 and 2010. Adverse surgical pathology and biochemical recurrence (BCR) were pre-specified to be assessed in all men, biopsy GG 3 + 3, and 3 + 4. Results: Adjusted for established clinical predictors, the 4Kscore was significantly associated with adverse pathology (OR 1.49; 95% CI 1.32, 1.67; p < 0.0001). Adding 4Kscore increased... (More)

Background: A pre-specified model based on four kallikrein markers in blood, commercially available as 4Kscore, predicts Gleason Grade (GG) 3 + 4 or higher prostate cancer on biopsy. However, sampling error and variation in pathology reporting may miss aggressive disease. Methods: The 4Kscore was measured in cryopreserved blood from 2330 men obtained before prostatectomy at a single institution between 2002 and 2010. Adverse surgical pathology and biochemical recurrence (BCR) were pre-specified to be assessed in all men, biopsy GG 3 + 3, and 3 + 4. Results: Adjusted for established clinical predictors, the 4Kscore was significantly associated with adverse pathology (OR 1.49; 95% CI 1.32, 1.67; p < 0.0001). Adding 4Kscore increased discrimination from (AUC) 0.672 to 0.718 and 0.644 to 0.659 within biopsy GG 3 + 3 and 3 + 4, respectively. Higher 4Kscore was associated with higher risk of BCR (HR 1.16, 95% CI 1.06, 1.26; p = 0.001). Adding 4Kscore improved the prediction of BCR (C-index 0.630–0.660) within GG 3 + 3, but not GG 3 + 4. Conclusions: The 4Kscore can help guide the clinical decision whether additional risk assessment—such as confirmatory biopsy—is needed to decide between active surveillance versus curative therapy. Evidence that the panel could influence management in biopsy GG 3 + 4 is less strong and requires further investigation.

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type
Contribution to journal
publication status
published
subject
in
British Journal of Cancer
volume
123
issue
4
pages
6 pages
publisher
Nature Publishing Group
external identifiers
  • scopus:85085488493
  • pmid:32467601
ISSN
0007-0920
DOI
10.1038/s41416-020-0914-7
language
English
LU publication?
yes
id
3a069f31-81a6-4b2c-8410-a4626ccea77d
date added to LUP
2020-06-16 14:23:15
date last changed
2024-10-03 03:23:53
@article{3a069f31-81a6-4b2c-8410-a4626ccea77d,
  abstract     = {{<p>Background: A pre-specified model based on four kallikrein markers in blood, commercially available as 4Kscore, predicts Gleason Grade (GG) 3 + 4 or higher prostate cancer on biopsy. However, sampling error and variation in pathology reporting may miss aggressive disease. Methods: The 4Kscore was measured in cryopreserved blood from 2330 men obtained before prostatectomy at a single institution between 2002 and 2010. Adverse surgical pathology and biochemical recurrence (BCR) were pre-specified to be assessed in all men, biopsy GG 3 + 3, and 3 + 4. Results: Adjusted for established clinical predictors, the 4Kscore was significantly associated with adverse pathology (OR 1.49; 95% CI 1.32, 1.67; p &lt; 0.0001). Adding 4Kscore increased discrimination from (AUC) 0.672 to 0.718 and 0.644 to 0.659 within biopsy GG 3 + 3 and 3 + 4, respectively. Higher 4Kscore was associated with higher risk of BCR (HR 1.16, 95% CI 1.06, 1.26; p = 0.001). Adding 4Kscore improved the prediction of BCR (C-index 0.630–0.660) within GG 3 + 3, but not GG 3 + 4. Conclusions: The 4Kscore can help guide the clinical decision whether additional risk assessment—such as confirmatory biopsy—is needed to decide between active surveillance versus curative therapy. Evidence that the panel could influence management in biopsy GG 3 + 4 is less strong and requires further investigation.</p>}},
  author       = {{Haese, Alexander and Tin, Amy L. and Carlsson, Sigrid V. and Sjoberg, Daniel D. and Pehrke, Dirk and Steuber, Thomas and Huland, Hartwig and Graefen, Markus and Scardino, Peter T. and Schlomm, Thorsten and Vickers, Andrew J. and Lilja, Hans and Sauter, Guido}},
  issn         = {{0007-0920}},
  language     = {{eng}},
  month        = {{08}},
  number       = {{4}},
  pages        = {{604--609}},
  publisher    = {{Nature Publishing Group}},
  series       = {{British Journal of Cancer}},
  title        = {{A pre-specified model based on four kallikrein markers in blood improves predictions of adverse pathology and biochemical recurrence after radical prostatectomy}},
  url          = {{http://dx.doi.org/10.1038/s41416-020-0914-7}},
  doi          = {{10.1038/s41416-020-0914-7}},
  volume       = {{123}},
  year         = {{2020}},
}