PSA velocity in conservatively managed BPH: can it predict the need for BPH-related invasive therapy?

Development of Interpretable Predictive Models for BPH and Prostate Cancer

BACKGROUND

Traditional methods for deciding whether to recommend a patient for a prostate biopsy are based on cut-off levels of stand-alone markers such as prostate-specific antigen (PSA) or any of its derivatives. However, in the last decade we have seen the increasing use of predictive models that combine, in a non-linear manner, several predictives that are better able to predict prostate cancer (PC), but these fail to help the clinician to distinguish between PC and benign prostate hyperplasia (BPH) patients. We construct two new models that are capable of predicting both PC and BPH.

METHODS

An observational study was performed on 150 patients with PSA ≥3 ng/mL and age >50 years. We built a decision tree and a logistic regression model, validated with the leave-one-out methodology, in order to predict PC or BPH, or reject both.

RESULTS

Statistical dependence with PC and BPH was found for prostate volume (P-value < 0.001), PSA (P-value < 0.001), international prostate symptom score (IPSS; P-value < 0.001), digital rectal examination (DRE; P-value < 0.001), age (P-value < 0.002), antecedents (P-value < 0.006), and meat consumption (P-value < 0.08). The two predictive models that were constructed selected a subset of these, namely, volume, PSA, DRE, and IPSS, obtaining an area under the ROC curve (AUC) between 72% and 80% for both PC and BPH prediction.

CONCLUSION

PSA and volume together help to build predictive models that accurately distinguish among PC, BPH, and patients without any of these pathologies. Our decision tree and logistic regression models outperform the AUC obtained in the compared studies. Using these models as decision support, the number of unnecessary biopsies might be significantly reduced.

Postoperative PSA and PSA velocity identify presence of prostate cancer after various surgical interventions for benign prostatic hyperplasia

OBJECTIVES

To determine whether prostate-specific antigen (PSA) values can distinguish those with prostate cancer (CaP) from those with histologic benign prostatic hyperplasia (BPH) only after surgical intervention. Prostatic adenoma inevitably remains after BPH surgery; therefore, patients remain at risk of developing CaP. Although the PSA level can be used for CaP screening in this population, it might be influenced by the efficacies of different BPH procedures.

METHODS

We performed a review of patients who had undergone transurethral resection of the prostate (TURP; n = 343), holmium laser resection of the prostate (HoLRP; n = 54), or open prostatectomy (OP; n = 68). The PSA and PSA velocity values were collected at regular intervals both pre- and postoperatively for all patients. Only patients with histologic BPH and those with incidental CaP who underwent a watchful waiting strategy were included.

RESULTS

The average preoperative PSA values were significantly different between the TURP, HoLRP, and OP groups. Only 1 patient had incidental CaP in the HoLRP group. No differences were present between the preoperative PSA values for patients with histologic BPH and those with incidental CaP undergoing a watchful waiting strategy (P > .05). However, the postoperative PSA values were increased in the patients with CaP (watchful waiting compared with the patient with BPH only (2.4 vs 1.7 ng/mL TURP and 4.1 vs 1.1 ng/mL OP). Similarly, patients with incidental CaP had a significantly elevated postoperative mean PSA velocity compared with patients without CaP (0.38 vs 0.06 ng/mL/y TURP and 0.47 vs -0.13 ng/mL/y OP; P < .05).

CONCLUSIONS

Postoperative PSA and PSA velocity measurements can be used to distinguish patients with CaP from those with histologic BPH only.

Digital rectal examination, serum prostatic specific antigen or transrectal ultrasonography: the best tool to guide the treatment of men with benign prostatic hyperplasia

PURPOSE OF REVIEW

Benign prostatic hyperplasia can be considered a progressive disease, and identifying men with progressive disease could have a significant impact on the decision to choose the different therapeutic options. Numerous pieces of evidence demonstrate the impact of the prostate volume on the disease progression. It has been accepted that digital rectal examination, serum prostatic specific antigen and transrectal prostate ultrasound are the available tools for the prostate volume estimation. This review examines the updated information on these tools for their guidance in the benign prostatic hyperplasia management.

RECENT FINDINGS

Digital rectal examination is unreliable in assessing the prostate volume; however, it is still important to use it to rule out prostate cancer or neurological problems. Prostatic specific antigens should be recommended as a part of patient evaluation because of their impact on the prediction of disease progression. Transrectal prostate ultrasound may be the best tool in the estimation of the exact prostate size.

SUMMARY

Numerous pieces of evidence have clearly demonstrated the impact of the prostate volume on the disease progression. Digital rectal examination seems to be good at identifying very large prostate. Prostatic specific antigen is the best tool for predicting disease progression and guiding the therapeutic options. For surgical guidance, transrectal prostate ultrasound is the useful tool available for the exact prostate volume estimation.