MR-US Fusion Biopsy to Diagnose Prostate Cancer: First 1000 Men at UCLA: Evaluating the first 1,000 men who underwent mpMRI and MR-ultrasound (MR-US) fusion prostate biopsy between 2009 -- 2014, researchers at University of California, Los Angeles, CA, found that among those who had MR-US, an increased risk of finding prostate cancer was directly related to age, MRI findings, PSA, and PSA density
15) PSA density
(adjusted for prostate volume determined by ultrasound) can improve test accuracy at intermediate PSA levels, (16) and PSA velocity, change in PSA level over time, has also been examined to differentiate tumor from benign disease.
IQR: interquartile range; PSA: prostate-specific antigen; PSAD: PSA density
(value PSA prior to surgery divided by volume prostate cancer in prostatectomy specimen); RP: radical prostatectomy; Nx, not taken; NA: not applicable.
The usefulness of PSA density
in patients with intermediate serum PSA level in country with low incidence of prostate cancer.
With CaP these various assessment indicators would include the patient's chemical exposure, CaP family history, genetic heritage, work history, sexual history, aspirin use, obesity level, PSA fluctuations as its velocity and pattern, % free PSA, PSA density
, urinary symptoms, and even new genetic molecular tests such as the PCA3 urine test.
The NCCN criteria for active surveillance are Tlc disease, Gleason score of 6 or less, fewer than three positive biopsy cores, PSA less than 10 ng/mL, and PSA density
less than 0.
PSA, free PSA (fPSA) subforms, and additional analytes, including other kallikreins or the PCA3 gene (prostate cancer antigen 3, non-protein coding)], as well as combined indices (the ratio of PSA to prostate volume, PSA density
, and the change in PSA values over time, i.
In studies at Columbia University, my colleagues and I have found that the lower the PSA density
(less than 0.
Variations of the routine total PSA test include PSA velocity, age-adjusted PSA, ethnically-adjusted PSA, PSA density
, and, as of 1998, the so-called free PSA (fPSA) which measures the percentage of PSA not bound in the blood.
The PSA density
formula may help physicians decide how aggressively to re-biopsy men who end up in diagnostic limbo--those whose PSA tests identify them as cancer candidates, but whose biopsies do not reflect a tumor.
The decision to proceed to prostate biopsy should be based not only on PSA and DRE results, but should take into account multiple factors including free and total PSA, patient age, PSA velocity, PSA density
, family history, ethnicity, prior biopsy history and co-morbidities.
Baseline characteristics (diagnostic age, family history of prostate cancer, PSA, PSA density
[PSAD], prostate volume, clinical stage, Gleason score, D'Amico risk classification, number of biopsy cores, number of positive cores, maximum percent of core involvement) were included in a multivariate Cox regression analysis to assess factors associated with disease reclassification on surveillance biopsy.