Combined PSA density and Biopsy Features

(Prepared by Cecilia Lacks, PhD, from AUA presentation by William J. Catalona, MD and his Research Collaborators)

INTRO: Active monitoring protocols, including “watchful waiting,” are being increasingly used to avoid unnecessary treatment for men with “clinically insignificant prostate cancer.”

QUESTION: Can the PSAD (PSA density), the number of positive biopsy cores and biopsy Gleason grade predict “insignificant” cancer in a new group of men undergoing RRP?

STUDY: From 1999 to 2005, 274 men who had undergone RRP had the required data available for analysis – PSA density, number of positive biopsy cores, and biopsy Gleason grade. Seven of the 274 men involved in the research met the criteria for “insignificant” cancer.

CONCLUSION: A statistical model including PSAD, number of positive biopsy cores and biopsy Gleason grade did not provide an accurate means of selecting patients for watchful waiting or active monitoring. However it was helpful in identifying men with a high likelihood of having clinically significant prostate cancer.

(Dr. Catalona’s position is that once cancer is present in a form that PSA tests and additional diagnostic tools can detect, the best action is to remove the cancer and not to watch it for additional changes.)