Nour Abdallah, Rebecca A Campbell, Tarik Benidir, Andrew Wood, Zaeem Lone, Ao Zhang, Onuralp Ergun, Caleb Curry, Patrick Michael, Ross Liao, Jaya Sai Chavali, Alberto Pieretti, Jesse McKenney, Andrei Purysko, Samuel Haywood, Zeyad Schwen, Ruben Olivares, Jihad Kaouk, Robert Abouassaly, Eric A Klein, Christopher J Weight
{"title":"低基线IsoPSA指数与PSA升高的男性临床显著前列腺癌诊断的低风险相关。","authors":"Nour Abdallah, Rebecca A Campbell, Tarik Benidir, Andrew Wood, Zaeem Lone, Ao Zhang, Onuralp Ergun, Caleb Curry, Patrick Michael, Ross Liao, Jaya Sai Chavali, Alberto Pieretti, Jesse McKenney, Andrei Purysko, Samuel Haywood, Zeyad Schwen, Ruben Olivares, Jihad Kaouk, Robert Abouassaly, Eric A Klein, Christopher J Weight","doi":"10.1016/j.urology.2025.01.019","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To compare the rate of diagnosing clinically significant prostate cancer (csPCa) in men with elevated PSA stratified by baseline IsoPSA Index, thus assessing IsoPSA's intermediate-term predictive ability for csPCa.</p><p><strong>Material and methods: </strong>Single-center retrospective review of consecutive patients (n=1578) who underwent IsoPSA testing from November 2016-August 2022. Data dichotomized into patients with low(≤6) and high IsoPSA Indices (>6). Most recent subsequent IsoPSA and PSA tests, prostate biopsy, and MRI collected. Time-to-event Kaplan-Meier estimates generated for the risk of csPCa stratified by baseline IsoPSA Index.</p><p><strong>Results: </strong>Among 541 patients with initial low IsoPSA Indices (≤6), 23 (4.3%) were diagnosed with csPCa on a subsequent biopsy. Also, among these 541 patients, 204 had an MRI, of which 48/204 (23.5%) showed suspicious lesions(PIRADS≥4). Among 1037 patients with initial high IsoPSA Indices, 366 (35.3%) were diagnosed with csPCa on a subsequent biopsy. Also, among these 1037 patients, 712 had an MRI, of which 342/712 (48.0%) showed suspicious lesions (PIRADS≥4). After 12, 24, and 30 months, respectively, the risk of developing csPCa was 0.4% (95% CI 0.1%-1.6%), 2.5% (1.4%-4.4%), and 6.3% (4%-9.6%) in patients with low IsoPSA Indices, compared to 5.9% (4.6%-7.6%), 31.7% (28.3%-35.4%), and 49.5% (45.3%-53.9%) in patients with high IsoPSA Indices. Limitations include the retrospective review of prospectively collected data and unknown true csPCa rates as not all patients were biopsied.</p><p><strong>Conclusions: </strong>The risk of developing csPCa was smaller in patients with initial low vs high IsoPSA Indices over the ensuing 30 months, which supports using IsoPSA to safely avoid follow-up testing.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Low baseline IsoPSA Index is associated with a Prolonged Low Risk of Clinically Significant Prostate Cancer Diagnosis in Men with an Elevated PSA.\",\"authors\":\"Nour Abdallah, Rebecca A Campbell, Tarik Benidir, Andrew Wood, Zaeem Lone, Ao Zhang, Onuralp Ergun, Caleb Curry, Patrick Michael, Ross Liao, Jaya Sai Chavali, Alberto Pieretti, Jesse McKenney, Andrei Purysko, Samuel Haywood, Zeyad Schwen, Ruben Olivares, Jihad Kaouk, Robert Abouassaly, Eric A Klein, Christopher J Weight\",\"doi\":\"10.1016/j.urology.2025.01.019\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To compare the rate of diagnosing clinically significant prostate cancer (csPCa) in men with elevated PSA stratified by baseline IsoPSA Index, thus assessing IsoPSA's intermediate-term predictive ability for csPCa.</p><p><strong>Material and methods: </strong>Single-center retrospective review of consecutive patients (n=1578) who underwent IsoPSA testing from November 2016-August 2022. Data dichotomized into patients with low(≤6) and high IsoPSA Indices (>6). Most recent subsequent IsoPSA and PSA tests, prostate biopsy, and MRI collected. Time-to-event Kaplan-Meier estimates generated for the risk of csPCa stratified by baseline IsoPSA Index.</p><p><strong>Results: </strong>Among 541 patients with initial low IsoPSA Indices (≤6), 23 (4.3%) were diagnosed with csPCa on a subsequent biopsy. Also, among these 541 patients, 204 had an MRI, of which 48/204 (23.5%) showed suspicious lesions(PIRADS≥4). Among 1037 patients with initial high IsoPSA Indices, 366 (35.3%) were diagnosed with csPCa on a subsequent biopsy. Also, among these 1037 patients, 712 had an MRI, of which 342/712 (48.0%) showed suspicious lesions (PIRADS≥4). After 12, 24, and 30 months, respectively, the risk of developing csPCa was 0.4% (95% CI 0.1%-1.6%), 2.5% (1.4%-4.4%), and 6.3% (4%-9.6%) in patients with low IsoPSA Indices, compared to 5.9% (4.6%-7.6%), 31.7% (28.3%-35.4%), and 49.5% (45.3%-53.9%) in patients with high IsoPSA Indices. 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引用次数: 0
摘要
目的：比较基线IsoPSA指数对PSA升高男性临床显著性前列腺癌（csPCa）的诊断率，从而评估IsoPSA对csPCa的中期预测能力。材料和方法：对2016年11月至2022年8月期间接受IsoPSA检测的连续患者（n=1578）进行单中心回顾性研究。数据分为IsoPSA指数低（≤6）和高（>6）两组。收集最近的IsoPSA和PSA检查、前列腺活检和MRI。根据基线IsoPSA指数对csPCa风险进行分层的时间-事件Kaplan-Meier估计。结果：在541例初始IsoPSA指数低（≤6）的患者中，23例（4.3%）在随后的活检中被诊断为csPCa。541例患者中，204例进行MRI检查，其中48/204例（23.5%）出现可疑病变（PIRADS≥4）。在1037例初始IsoPSA指数高的患者中，366例（35.3%）在随后的活检中被诊断为csPCa。1037例患者中，712例进行了MRI检查，其中342/712例（48.0%）显示可疑病变（PIRADS≥4）。在12、24和30个月后，低IsoPSA指数患者发生csPCa的风险分别为0.4% （95% CI 0.1%-1.6%）、2.5%（1.4%-4.4%）和6.3%(4%-9.6%)，而高IsoPSA指数患者发生csPCa的风险分别为5.9%（4.6%-7.6%）、31.7%（28.3%-35.4%）和49.5%（45.3%-53.9%）。局限性包括前瞻性收集数据的回顾性回顾和未知的真实csPCa率，因为并非所有患者都进行了活检。结论：在随后的30个月里，初始IsoPSA指数低与高的患者发生csPCa的风险更小，这支持使用IsoPSA来安全避免后续检测。
Low baseline IsoPSA Index is associated with a Prolonged Low Risk of Clinically Significant Prostate Cancer Diagnosis in Men with an Elevated PSA.
Objective: To compare the rate of diagnosing clinically significant prostate cancer (csPCa) in men with elevated PSA stratified by baseline IsoPSA Index, thus assessing IsoPSA's intermediate-term predictive ability for csPCa.
Material and methods: Single-center retrospective review of consecutive patients (n=1578) who underwent IsoPSA testing from November 2016-August 2022. Data dichotomized into patients with low(≤6) and high IsoPSA Indices (>6). Most recent subsequent IsoPSA and PSA tests, prostate biopsy, and MRI collected. Time-to-event Kaplan-Meier estimates generated for the risk of csPCa stratified by baseline IsoPSA Index.
Results: Among 541 patients with initial low IsoPSA Indices (≤6), 23 (4.3%) were diagnosed with csPCa on a subsequent biopsy. Also, among these 541 patients, 204 had an MRI, of which 48/204 (23.5%) showed suspicious lesions(PIRADS≥4). Among 1037 patients with initial high IsoPSA Indices, 366 (35.3%) were diagnosed with csPCa on a subsequent biopsy. Also, among these 1037 patients, 712 had an MRI, of which 342/712 (48.0%) showed suspicious lesions (PIRADS≥4). After 12, 24, and 30 months, respectively, the risk of developing csPCa was 0.4% (95% CI 0.1%-1.6%), 2.5% (1.4%-4.4%), and 6.3% (4%-9.6%) in patients with low IsoPSA Indices, compared to 5.9% (4.6%-7.6%), 31.7% (28.3%-35.4%), and 49.5% (45.3%-53.9%) in patients with high IsoPSA Indices. Limitations include the retrospective review of prospectively collected data and unknown true csPCa rates as not all patients were biopsied.
Conclusions: The risk of developing csPCa was smaller in patients with initial low vs high IsoPSA Indices over the ensuing 30 months, which supports using IsoPSA to safely avoid follow-up testing.
期刊介绍：
Urology is a monthly, peer–reviewed journal primarily for urologists, residents, interns, nephrologists, and other specialists interested in urology
The mission of Urology®, the "Gold Journal," is to provide practical, timely, and relevant clinical and basic science information to physicians and researchers practicing the art of urology worldwide. Urology® publishes original articles relating to adult and pediatric clinical urology as well as to clinical and basic science research. Topics in Urology® include pediatrics, surgical oncology, radiology, pathology, erectile dysfunction, infertility, incontinence, transplantation, endourology, andrology, female urology, reconstructive surgery, and medical oncology, as well as relevant basic science issues. Special features include rapid communication of important timely issues, surgeon''s workshops, interesting case reports, surgical techniques, clinical and basic science review articles, guest editorials, letters to the editor, book reviews, and historical articles in urology.
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