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Patrik Finne - One of the best experts on this subject based on the ideXlab platform.
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algorithms based on Prostate specific antigen psa free psa digital rectal examination and Prostate Volume reduce false postitive psa results in Prostate cancer screening
International Journal of Cancer, 2004Co-Authors: Jonas Hugosson, Chris H Bangma, Patrik Finne, Anssi Auvinen, Matti Hakama, Ralf Finne, Ulfhakan StenmanAbstract:Our objective was to determine whether multivariate algorithms based on serum total PSA, the free proportion of PSA, age, digital rectal examination and Prostate Volume can reduce the rate of false-positive PSA results in Prostate cancer screening more effectively than the proportion of free PSA alone at 95% sensitivity. A total of 1,775 consecutive 55- to 67-year-old men with a serum PSA of 4–10 μg/l in the European Randomized Study of Screening for Prostate Cancer were included. To predict the presence of cancer, multivariate algorithms were constructed using logistic regression (LR) and a multilayer perceptron neural network with Bayesian regularization (BR-MLP). A prospective setting was simulated by dividing the data set chronologically into one set for training and validation (67%, n = 1,183) and one test set (33%, n = 592). The diagnostic models were calibrated using the training set to obtain 95% sensitivity. When applied to the test set, the LR model, the BR-MLP model and the proportion of free PSA reached 92%, 87% and 94% sensitivity and reduced 29%, 36% and 22% of the false-positive PSA results, respectively. At a fixed sensitivity of 95% in the test set, the LR model eliminated more false-positive PSA results (22%) than the proportion of free PSA alone (17%) (p < 0.001), whereas the BR-MLP model did not (19%) (p = 0.178). The area under the ROC curve was larger for the LR model (0.764, p = 0.030) and the BR-MLP model (0.760, p = 0.049) than for the proportion of free PSA (0.718). A multivariate algorithm can be used to reduce unnecessary Prostate biopsies in screening more effectively than the proportion of free PSA alone, but the algorithms will require updating when clinical practice develops with time. © 2004 Wiley-Liss, Inc.
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algorithms based on Prostate specific antigen psa free psa digital rectal examination and Prostate Volume reduce false postitive psa results in Prostate cancer screening
International Journal of Cancer, 2004Co-Authors: Jonas Hugosson, Chris H Bangma, Patrik Finne, Anssi Auvinen, Matti Hakama, Ralf Finne, Ulfhakan StenmanAbstract:Our objective was to determine whether multivariate algorithms based on serum total PSA, the free proportion of PSA, age, digital rectal examination and Prostate Volume can reduce the rate of false-positive PSA results in Prostate cancer screening more effectively than the proportion of free PSA alone at 95% sensitivity. A total of 1,775 consecutive 55- to 67-year-old men with a serum PSA of 4-10 microg/l in the European Randomized Study of Screening for Prostate Cancer were included. To predict the presence of cancer, multivariate algorithms were constructed using logistic regression (LR) and a multilayer perceptron neural network with Bayesian regularization (BR-MLP). A prospective setting was simulated by dividing the data set chronologically into one set for training and validation (67%, n = 1,183) and one test set (33%, n = 592). The diagnostic models were calibrated using the training set to obtain 95% sensitivity. When applied to the test set, the LR model, the BR-MLP model and the proportion of free PSA reached 92%, 87% and 94% sensitivity and reduced 29%, 36% and 22% of the false-positive PSA results, respectively. At a fixed sensitivity of 95% in the test set, the LR model eliminated more false-positive PSA results (22%) than the proportion of free PSA alone (17%) (p < 0.001), whereas the BR-MLP model did not (19%) (p = 0.178). The area under the ROC curve was larger for the LR model (0.764, p = 0.030) and the BR-MLP model (0.760, p = 0.049) than for the proportion of free PSA (0.718). A multivariate algorithm can be used to reduce unnecessary Prostate biopsies in screening more effectively than the proportion of free PSA alone, but the algorithms will require updating when clinical practice develops with time.
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estimation of Prostate cancer risk on the basis of total and free Prostate specific antigen Prostate Volume and digital rectal examination
European Urology, 2002Co-Authors: Patrik Finne, Anssi Auvinen, Harri Juusela, Liisa Maattanen, S Rannikko, Matti Hakama, Teuvo L J Tammela, Ulfhakan StenmanAbstract:BACKGROUND AND OBJECTIVE: Approximately 70% of the men with an elevated serum Prostate-specific antigen (PSA) identified in Prostate cancer screening do not have Prostate cancer. Other available diagnostic variables may be utilized to reduce the number of false positive PSA results, but few algorithms for calculation of the combined impact of multiple variables are available. The objective of this study was to establish nomograms showing the probability of detecting Prostate cancer at biopsy on the basis of total PSA, and the percentage of free PSA in serum, Prostate Volume and digital rectal examination (DRE) findings. METHODS: In a randomized, population-based Prostate cancer screening trial 10284 men aged 55-67 years were screened during 1996 and 1997 in two metropolitan areas in Finland. Results for men (n=758) with a serum PSA of 4-20 microg/l were used to establish the risk nomograms. Of these 200 (26%) had Prostate cancer at biopsy. RESULTS: Prostate cancer probability depended most strongly on the percentage of free PSA. Total PSA, Prostate Volume, and DRE also contributed to Prostate cancer probability, whereas age and family history of Prostate cancer did not. More false positive PSA results could be eliminated by using the multivariate risk model rather than the percentage of free PSA (p<0.001) or PSA density (p=0.003) alone. CONCLUSIONS: Wide variation in probability of detecting Prostate cancer among screened men with a serum PSA of 4-20 microg/l was observed. The nomograms established can be used to avoid or defer biopsy in men with a low Prostate cancer probability in spite of a serum PSA level exceeding 4 microg/l.
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estimation of Prostate cancer risk on the basis of total and free Prostate specific antigen Prostate Volume and digital rectal examination
European Urology, 2002Co-Authors: Patrik Finne, Anssi Auvinen, Harri Juusela, Liisa Maattanen, S Rannikko, Matti Hakama, Teuvo L J Tammela, Jussi Aro, Ulfhakan StenmanAbstract:Abstract Background and Objective: Approximately 70% of the men with an elevated serum Prostate-specific antigen (PSA) identified in Prostate cancer screening do not have Prostate cancer. Other available diagnostic variables may be utilized to reduce the number of false positive PSA results, but few algorithms for calculation of the combined impact of multiple variables are available. The objective of this study was to establish nomograms showing the probability of detecting Prostate cancer at biopsy on the basis of total PSA, and the percentage of free PSA in serum, Prostate Volume and digital rectal examination (DRE) findings. Methods: In a randomized, population-based Prostate cancer screening trial 10284 men aged 55–67 years were screened during 1996 and 1997 in two metropolitan areas in Finland. Results for men ( n =758) with a serum PSA of 4–20μg/l were used to establish the risk nomograms. Of these 200 (26%) had Prostate cancer at biopsy. Results: Prostate cancer probability depended most strongly on the percentage of free PSA. Total PSA, Prostate Volume, and DRE also contributed to Prostate cancer probability, whereas age and family history of Prostate cancer did not. More false positive PSA results could be eliminated by using the multivariate risk model rather than the percentage of free PSA ( p p =0.003) alone. Conclusions: Wide variation in probability of detecting Prostate cancer among screened men with a serum PSA of 4–20μg/l was observed. The nomograms established can be used to avoid or defer biopsy in men with a low Prostate cancer probability in spite of a serum PSA level exceeding 4μg/l.
Ulfhakan Stenman - One of the best experts on this subject based on the ideXlab platform.
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algorithms based on Prostate specific antigen psa free psa digital rectal examination and Prostate Volume reduce false postitive psa results in Prostate cancer screening
International Journal of Cancer, 2004Co-Authors: Jonas Hugosson, Chris H Bangma, Patrik Finne, Anssi Auvinen, Matti Hakama, Ralf Finne, Ulfhakan StenmanAbstract:Our objective was to determine whether multivariate algorithms based on serum total PSA, the free proportion of PSA, age, digital rectal examination and Prostate Volume can reduce the rate of false-positive PSA results in Prostate cancer screening more effectively than the proportion of free PSA alone at 95% sensitivity. A total of 1,775 consecutive 55- to 67-year-old men with a serum PSA of 4–10 μg/l in the European Randomized Study of Screening for Prostate Cancer were included. To predict the presence of cancer, multivariate algorithms were constructed using logistic regression (LR) and a multilayer perceptron neural network with Bayesian regularization (BR-MLP). A prospective setting was simulated by dividing the data set chronologically into one set for training and validation (67%, n = 1,183) and one test set (33%, n = 592). The diagnostic models were calibrated using the training set to obtain 95% sensitivity. When applied to the test set, the LR model, the BR-MLP model and the proportion of free PSA reached 92%, 87% and 94% sensitivity and reduced 29%, 36% and 22% of the false-positive PSA results, respectively. At a fixed sensitivity of 95% in the test set, the LR model eliminated more false-positive PSA results (22%) than the proportion of free PSA alone (17%) (p < 0.001), whereas the BR-MLP model did not (19%) (p = 0.178). The area under the ROC curve was larger for the LR model (0.764, p = 0.030) and the BR-MLP model (0.760, p = 0.049) than for the proportion of free PSA (0.718). A multivariate algorithm can be used to reduce unnecessary Prostate biopsies in screening more effectively than the proportion of free PSA alone, but the algorithms will require updating when clinical practice develops with time. © 2004 Wiley-Liss, Inc.
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algorithms based on Prostate specific antigen psa free psa digital rectal examination and Prostate Volume reduce false postitive psa results in Prostate cancer screening
International Journal of Cancer, 2004Co-Authors: Jonas Hugosson, Chris H Bangma, Patrik Finne, Anssi Auvinen, Matti Hakama, Ralf Finne, Ulfhakan StenmanAbstract:Our objective was to determine whether multivariate algorithms based on serum total PSA, the free proportion of PSA, age, digital rectal examination and Prostate Volume can reduce the rate of false-positive PSA results in Prostate cancer screening more effectively than the proportion of free PSA alone at 95% sensitivity. A total of 1,775 consecutive 55- to 67-year-old men with a serum PSA of 4-10 microg/l in the European Randomized Study of Screening for Prostate Cancer were included. To predict the presence of cancer, multivariate algorithms were constructed using logistic regression (LR) and a multilayer perceptron neural network with Bayesian regularization (BR-MLP). A prospective setting was simulated by dividing the data set chronologically into one set for training and validation (67%, n = 1,183) and one test set (33%, n = 592). The diagnostic models were calibrated using the training set to obtain 95% sensitivity. When applied to the test set, the LR model, the BR-MLP model and the proportion of free PSA reached 92%, 87% and 94% sensitivity and reduced 29%, 36% and 22% of the false-positive PSA results, respectively. At a fixed sensitivity of 95% in the test set, the LR model eliminated more false-positive PSA results (22%) than the proportion of free PSA alone (17%) (p < 0.001), whereas the BR-MLP model did not (19%) (p = 0.178). The area under the ROC curve was larger for the LR model (0.764, p = 0.030) and the BR-MLP model (0.760, p = 0.049) than for the proportion of free PSA (0.718). A multivariate algorithm can be used to reduce unnecessary Prostate biopsies in screening more effectively than the proportion of free PSA alone, but the algorithms will require updating when clinical practice develops with time.
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estimation of Prostate cancer risk on the basis of total and free Prostate specific antigen Prostate Volume and digital rectal examination
European Urology, 2002Co-Authors: Patrik Finne, Anssi Auvinen, Harri Juusela, Liisa Maattanen, S Rannikko, Matti Hakama, Teuvo L J Tammela, Ulfhakan StenmanAbstract:BACKGROUND AND OBJECTIVE: Approximately 70% of the men with an elevated serum Prostate-specific antigen (PSA) identified in Prostate cancer screening do not have Prostate cancer. Other available diagnostic variables may be utilized to reduce the number of false positive PSA results, but few algorithms for calculation of the combined impact of multiple variables are available. The objective of this study was to establish nomograms showing the probability of detecting Prostate cancer at biopsy on the basis of total PSA, and the percentage of free PSA in serum, Prostate Volume and digital rectal examination (DRE) findings. METHODS: In a randomized, population-based Prostate cancer screening trial 10284 men aged 55-67 years were screened during 1996 and 1997 in two metropolitan areas in Finland. Results for men (n=758) with a serum PSA of 4-20 microg/l were used to establish the risk nomograms. Of these 200 (26%) had Prostate cancer at biopsy. RESULTS: Prostate cancer probability depended most strongly on the percentage of free PSA. Total PSA, Prostate Volume, and DRE also contributed to Prostate cancer probability, whereas age and family history of Prostate cancer did not. More false positive PSA results could be eliminated by using the multivariate risk model rather than the percentage of free PSA (p<0.001) or PSA density (p=0.003) alone. CONCLUSIONS: Wide variation in probability of detecting Prostate cancer among screened men with a serum PSA of 4-20 microg/l was observed. The nomograms established can be used to avoid or defer biopsy in men with a low Prostate cancer probability in spite of a serum PSA level exceeding 4 microg/l.
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estimation of Prostate cancer risk on the basis of total and free Prostate specific antigen Prostate Volume and digital rectal examination
European Urology, 2002Co-Authors: Patrik Finne, Anssi Auvinen, Harri Juusela, Liisa Maattanen, S Rannikko, Matti Hakama, Teuvo L J Tammela, Jussi Aro, Ulfhakan StenmanAbstract:Abstract Background and Objective: Approximately 70% of the men with an elevated serum Prostate-specific antigen (PSA) identified in Prostate cancer screening do not have Prostate cancer. Other available diagnostic variables may be utilized to reduce the number of false positive PSA results, but few algorithms for calculation of the combined impact of multiple variables are available. The objective of this study was to establish nomograms showing the probability of detecting Prostate cancer at biopsy on the basis of total PSA, and the percentage of free PSA in serum, Prostate Volume and digital rectal examination (DRE) findings. Methods: In a randomized, population-based Prostate cancer screening trial 10284 men aged 55–67 years were screened during 1996 and 1997 in two metropolitan areas in Finland. Results for men ( n =758) with a serum PSA of 4–20μg/l were used to establish the risk nomograms. Of these 200 (26%) had Prostate cancer at biopsy. Results: Prostate cancer probability depended most strongly on the percentage of free PSA. Total PSA, Prostate Volume, and DRE also contributed to Prostate cancer probability, whereas age and family history of Prostate cancer did not. More false positive PSA results could be eliminated by using the multivariate risk model rather than the percentage of free PSA ( p p =0.003) alone. Conclusions: Wide variation in probability of detecting Prostate cancer among screened men with a serum PSA of 4–20μg/l was observed. The nomograms established can be used to avoid or defer biopsy in men with a low Prostate cancer probability in spite of a serum PSA level exceeding 4μg/l.
Claus G Roehrborn - One of the best experts on this subject based on the ideXlab platform.
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statin use and longitudinal changes in Prostate Volume results from the reduction by dutasteride of Prostate cancer events reduce trial
BJUI, 2020Co-Authors: Claus G Roehrborn, Stephen J. Freedland, Emma H Allott, Ilona Csizmadi, Lauren E Howard, Roberto L Muller, Daniel M Moreira, Gerald L AndrioleAbstract:Objective To test the association between statin use and Prostate Volume (PV) change over time using data from the REduction by DUtasteride of Prostate Cancer Events (REDUCE) trial, a 4-year randomised controlled trial testing dutasteride for Prostate cancer chemoprevention. Subjects/patients and methods We identified men with a baseline negative Prostate biopsy from REDUCE who did not undergo Prostate surgery or develop Prostate cancer over the trial period. Men reported statin use at baseline. PV was determined from transrectal ultrasonography performed to guide Prostate biopsy at baseline, and 2- and 4-years after randomisation. Multivariable generalised estimating equations tested differences in PV change over time by statin use, overall and stratified by treatment arm. We tested for interactions between statins and time in association with PV using the Wald test. Results Of 4106 men, 17% used statins at baseline. Baseline PV did not differ by statin use. Relative to non-users, statin users had decreasing PVs over the trial period (P = 0.027). Similar patterns were seen in the dutasteride and placebo arms, although neither reached statistical significance. The mean estimated PV was modestly but significantly lower in statin users relative to non-users in the dutasteride arm at 2-years (4.5%, P = 0.032) and 4-years (4.0%, P = 0.033), with similar (3-3.3%) but non-significant effects in the placebo arm. Conclusion If confirmed, our present findings support a role for statins in modestly attenuating PV growth, with a magnitude of effect in line with previously reported Prostate-specific antigen-lowering effects of statins (~4%). Future studies are needed to assess whether this putative role for statins in PV growth could impact lower urinary tract symptom development or progression.
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effect of estimated Prostate Volume on silodosin mediated improvements in the signs and symptoms of bph does Prostate size matter
Open Access Journal of Urology, 2011Co-Authors: Steven A Kaplan, Claus G Roehrborn, Lawrence A Hill, Weining VolinnAbstract:OBJECTIVE The uroselective α-blocker silodosin significantly improved International Prostate Symptom Score (IPSS) in two 12-week, double-blind (DB), placebo-controlled Phase III studies in men aged ≥ 50 years with symptoms of benign prostatic hyperplasia (BPH) and maintained symptom improvement during a 9-month open-label (OL) extension. This post-hoc analysis evaluated the effects of estimated Prostate Volume (EPV) on silodosin-mediated symptom improvement. METHODS Patients were stratified by EPV (<30 mL or ≥ 30 mL) calculated from Prostate-specific antigen (PSA) concentrations using a published algorithm. Group comparisons were done by analysis of covariance with last observations carried forward. RESULTS Of 890 patients with PSA baseline data, 192 had EPV < 30 mL and 698 had EPV ≥ 30 mL. During DB treatment, silodosin was associated with significant symptom improvement (adjusted mean difference versus placebo) in men with EPV < 30 mL (-2.0; P = 0.038) and those with EPV ≥ 30 mL (-3.0; P < 0.0001). Among patients who received silodosin during DB treatment, changes from baseline in IPSS to the end of OL extension (mean ± standard deviation) were similar for EPV < 30 mL (n = 60, -7.0 ± 6.8) and EPV ≥ 30 mL (n = 242, -8.0 ± 7.1; P = 0.416). Also, among patients who received placebo as DB treatment, symptom improvement at the end of OL extension was similar for EPV < 30 mL (n = 62, -6.2 ± 8.1) and EPV ≥ 30 mL (n = 275, -6.7 ± 6.1; P = 0.339). CONCLUSION Silodosin effectively relieved BPH-related symptoms for up to 12 months, irrespective of Prostate size, including in patients with enlarged Prostates.
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long term treatment with finasteride results in a clinically significant reduction in total Prostate Volume compared to placebo over the full range of baseline Prostate sizes in men enrolled in the mtops trial
The Journal of Urology, 2008Co-Authors: Steven A Kaplan, Claus G Roehrborn, Alan G Meehan, John D Mcconnell, Shailaja Surynawanshi, Jeannette Y Lee, Jennifer Rotonda, John W Kusek, Leroy M NybergAbstract:Purpose: In the present analysis we examined data from the MTOPS (Medical Therapy of Prostatic Symptoms) trial to determine the effect of long-term finasteride treatment, either alone or in combination with doxazosin, on total Prostate Volume across the full range of baseline total Prostate Volume values in men enrolled in this study.Materials and Methods: In this trial a total of 3,047 patients with lower urinary tract symptoms were randomized to placebo, doxazosin (4 to 8 mg), finasteride (5 mg) or the combination of doxazosin and finasteride (average length of treatment 4.5 years). Total Prostate Volume was measured by transrectal ultrasound in all patients at baseline, yearly and at study end or at termination of participation.Results: Long-term treatment with finasteride led to a consistent reduction of approximately 25% in total Prostate Volume compared to placebo in men with a relatively small Prostate (less than 25 to 30 ml), as well as in those with a moderate size (30 to less than 40 ml) or enla...
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serum Prostate specific antigen and Prostate Volume predict long term changes in symptoms and flow rate results of a four year randomized trial comparing finasteride versus placebo
Urology, 1999Co-Authors: Claus G Roehrborn, Peter Boyle, Donald Bergner, Todd Gray, Marc Gittelman, Thomas Shown, Arnold Melman, Bruce R BrackenAbstract:Objectives. To determine whether baseline Prostate-specific antigen (PSA), in addition to Prostate Volume, is associated with long-term changes in symptoms and urinary flow rate. Methods. Three thousand forty men with benign prostatic hyperplasia enrolled in the PLESS trial were randomly assigned to finasteride 5 mg or placebo for 4 years. Symptoms and flow rate were assessed every 4 months, and data were analyzed by dividing the patients into three groups by baseline PSA tertiles (0 to 1.3, 1.4 to 3.2, and 3.3 ng/mL or greater) and baseline Prostate Volume tertiles (14 to 41, 42 to 57, and 58 to 150 mL). Results. After the initial placebo effect, a slow deterioration in symptoms over time was observed in the placebo-treated men with a baseline PSA 1.4 ng/mL or greater. However, placebo-treated men in the lowest PSA tertile (less than 1.4 ng/mL) had sustained symptomatic improvement that was not seen in placebo-treated men in the higher tertiles (P <0.001). In all finasteride-treated groups, there was initial improvement followed by maintenance or continued symptom improvement over time (∼3 to 3.5 points by the end of 4 years). The differences in symptom score improvement between placebo and finasteride were marginal for men with baseline PSA levels less than 1.4 ng/mL (P = 0.128) but were highly significant for men with PSA levels 1.4 ng/mL or greater (P <0.001). Urinary flow rate results were similar to those observed for symptoms. Analysis of symptom and flow rate data by Prostate Volume tertiles in a 10% subset of men yielded similar results, namely a deterioration of symptoms and flow rate in the two higher tertiles treated with placebo (greater than 41 mL) and a sustained improvement in all three groups of finasteride-treated patients. Conclusions. Baseline PSA and Prostate Volume are good predictors of long-term symptomatic and flow rate changes. Baseline PSA levels of 1.4 ng/mL or greater and enlarged Prostate glands predict the best long-term response to finasteride compared with placebo.
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serum Prostate specific antigen as a predictor of Prostate Volume in men with benign prostatic hyperplasia
Urology, 1999Co-Authors: Claus G Roehrborn, Peter Boyle, Lawrence A Gould, Joanne WaldstreicherAbstract:Objectives. To assess the utility of Prostate-specific antigen (PSA) as a predictor of Prostate Volume by characterizing the relationship between Prostate Volume and serum PSA in men with symptomatic benign prostatic hyperplasia (BPH) and no evidence of Prostate cancer, stratified by decade of life. Methods. Placebo-controlled multicenter trials in patients with BPH and a safety study in normal young men provided baseline measurements of serum PSA and Prostate Volume. The analyses included patients with a baseline Prostate Volume measured by either transrectal ultrasound (TRUS) or magnetic resonance imaging and baseline serum PSA. A common central laboratory was used for all but one of the individual studies; both laboratories used the Hybritech method. Patients 80 years of age or older were excluded. Patients with a baseline serum PSA greater than 10 ng/mL were excluded to reduce the likelihood of including occult Prostate cancer cases. The patients in the BPH trials were screened at baseline by digital rectal examination (DRE) and serum PSA. Those with suspicious findings underwent TRUS-guided biopsy; only patients with negative biopsies are included in these analyses. Results. The analyses included 4627 patients, 4448 from the BPH trials and 179 from the safety study. The men in the BPH trials were older (mean age ± SE, 63.7 ± 0.10 years) than the men in the safety study (mean age ± SE, 30.8 ± 0.43), had larger Prostates (mean Volume ± SE, 43.7 ± 0.38 mL versus 26.3 ± 0.49 mL in the safety study), and had higher serum PSA values (mean ± SE, 2.6 ± 0.03 ng/mL versus 0.7 ± 0.39 ng/mL in the safety study). The relationship between Prostate Volume and serum PSA was evaluated using only the BPH trial data. Prostate Volume and serum PSA have an age-dependent log-linear relationship (ie, their logarithms are linearly related, and the parameters of the relationship depend on age). Older men tend to have a steeper rate of increase in Prostate Volume with increasing serum PSA (P < 0.001 for differences between slopes), and there was a slight tendency for PSA density to increase with age. Receiver operating characteristic (ROC) curves were constructed to evaluate the ability of serum PSA to predict threshold Prostate sizes in men with BPH. The ROC curve analyses revealed that PSA had good predictive value for assessing Prostate Volume, with areas under the curve ranging from 0.76 to 0.78 for various Prostate Volume cutoff points (30, 40, and 50 mL). Conclusions. Prostate Volume is strongly related to serum PSA in men with BPH and no evidence of Prostate cancer, and the relationship depends on age. Since treatment outcome or risk of long-term complications depend on baseline Prostate Volume, serum PSA can estimate the degree of Prostate enlargement sufficiently accurately to be useful for therapeutic decision making. To achieve a specificity of 70% while maintaining a sensitivity between 65% and 70%, approximate age-specific criteria for detecting men with Prostate glands exceeding 40 mL are PSA >1.6 ng/mL, >2.0 ng/mL, and >2.3 ng/mL for men with BPH in their 50s, 60s, and 70s, respectively.
Fritz H Schroder - One of the best experts on this subject based on the ideXlab platform.
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can one blood draw replace transrectal ultrasonography estimated Prostate Volume to predict Prostate cancer risk
BJUI, 2013Co-Authors: Fritz H Schroder, Peter T. Scardino, Andrew J. Vickers, Jonas Hugosson, Sigrid Carlsson, Mari T Peltola, Daniel Sjoberg, Kim Pettersson, Hans LiljaAbstract:Objective To explore whether a panel of kallikrein markers in blood: total, free and intact Prostate-specific antigen (PSA) and kallikrein-related peptidase 2, could be used as a non-invasive alternative for predicting Prostate cancer on biopsy in a screening setting. Subjects and Methods The study cohort comprised previously unscreened men who underwent sextant biopsy owing to elevated PSA (3 ng/mL) in two different centres of the European Randomized Study of Screening for Prostate Cancer, Rotterdam (n = 2914) and Gteborg (n = 740). A statistical model, based on kallikrein markers, was compared with one based on established clinical factors for the prediction of biopsy outcome. Results The clinical tests were found to be no better than blood markers, with an area under the curve in favour of the blood measurements of 0.766 vs. 0.763 in Rotterdam and 0.809 vs. 0.774 in Gteborg. Adding digital rectal examination (DRE) or DRE plus transrectal ultrasonography (TRUS) Volume to the markers improved discrimination, although the increases were small. Results were similar for predicting high-grade cancer. There was a strong correlation between the blood measurements and TRUS-estimated Prostate Volume (Spearman's correlation 0.60 in Rotterdam and 0.57 in Gteborg). Conclusions In previously unscreened men, each with indication for biopsy, a statistical model based on kallikrein levels was similar to a clinical model in predicting Prostate cancer in a screening setting, outside the day-to-day clinical practice. Whether a clinical approach can be replaced by laboratory analyses or used in combination with decision models (nomograms) is a clinical judgment that may vary from clinician to clinician depending on how they weigh the different advantages and disadvantages (harms, costs, time, invasiveness) of both approaches. (Less)
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importance of Prostate Volume in the european randomised study of screening for Prostate cancer erspc risk calculators results from the Prostate biopsy collaborative group
World Journal of Urology, 2012Co-Authors: Monique J Roobol, Fritz H Schroder, Jonas Hugosson, Stephen J Jones, Michael W Kattan, Eric A Klein, Freddie C Hamdy, D E Neal, Jenny L Donovan, Dipen J ParekhAbstract:Objectives To compare the predictive performance and potential clinical usefulness of risk calculators of the European Randomized Study of Screening for Prostate Cancer (ERSPC RC) with and without information on Prostate Volume.
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prediction of Prostate cancer risk the role of Prostate Volume and digital rectal examination in the erspc risk calculators
European Urology, 2012Co-Authors: Monique J Roobol, Chris H Bangma, Stacy Loeb, Heidi A Van Vugt, Arno Van Leenders, Ewout W Steyerberg, Fritz H SchroderAbstract:Abstract Background The European Randomized Study of Screening for Prostate Cancer (ERSPC) risk calculators (RCs) are validated tools for Prostate cancer (PCa) risk assessment and include Prostate Volume (PV) data from transrectal ultrasound (TRUS). Objective Develop and validate an RC based on digital rectal examination (DRE) that circumvents the need for TRUS but still includes information on PV. Design, setting, and participants For development of the DRE-based RC, we studied the original ERSPC Rotterdam RC population including 3624 men (885 PCa cases) and 2896 men (547 PCa cases) detected at first and repeat screening 4 yr later, respectively. A validation cohort consisted of 322 men, screened in 2010–2011 as participants in ERSPC Rotterdam. Measurements Data on TRUS-assessed PV in the development cohorts were re-coded into three categories (25, 40, and 60cm 3 ) to assess the loss of information by categorization of Volume information. New RCs including PSA, DRE, and PV categories (DRE-based RC) were developed for men with and without a previous negative biopsy to predict overall and clinically significant PCa (high-grade [HG] PCa) defined as T stage >T2b and/or Gleason score ≥7. Predictive accuracy was quantified by the area under the receiver operating curve. We compared performance with the Prostate Cancer Prevention Trial (PCPT) RC in the validation study. Results and limitations Areas under the curve (AUC) of Prostate-specific antigen (PSA) alone, PSA and DRE, the DRE-based RC, and the original ERSPC RC to predict PCa at initial biopsy were 0.69, 0.73, 0.77, and 0.79, respectively. The corresponding AUCs for predicting HG PCa were higher (0.74, 0.82, 0.85, and 0.86). Similar results were seen in men previously biopsied and in the validation cohort. The DRE-based RC outperformed the PCPT RC (AUC 0.69 vs 0.59; p =0.0001) and a model based on PSA and DRE only (AUC 0.69 vs 0.63; p =0.0075) in the relatively small validation cohort. Further validation is required. Conclusions An RC should contain Volume estimates based either on TRUS or DRE. Replacing TRUS measurements by DRE estimates may enhance implementation in the daily practice of urologists and general practitioners.
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Prostate specific antigen in a community based sample of men without Prostate cancer correlations with Prostate Volume age body mass index and symptoms of prostatism
The Prostate, 1995Co-Authors: J Ruud L H Bosch, Wim C J Hop, Chris H Bangma, Wim J Kirkels, Fritz H SchroderAbstract:The correlation between both Prostate specific antigen levels (PSA) and Prostate specific antigen density (PSAD) and age, Prostate Volume parameters, body mass index, and the International Prostate Symptom Score (IPSS) were studied in a community-based population. A sample of 502 men aged 55 through 74 years was evaluated, excluding those with a serum PSA above 10 ng/ml, those with biopsy proven Prostate cancer, and those who had previously undergone a Prostate operation. PSA and PSAD did not correlate with the body mass index. Weak correlations were found between PSA and age (r = 0.25; P < 0.001), PSAD and age (r = 0.17; P < 0.001) and between PSA and the total Prostate Volume (r = 0.58; P < 0.001). PSA did not correlate independently with age after adjustment for Volume (P = 0.22). The finding that PSAD correlates with age (r = 0.17; P < 0.001) is partly explained by the incomplete Volume adjustment of PSAD which is proved by the positive correlation between PSAD and Prostate Volume (r = 0.26; P < 0.001). In the main target age-range for Prostate cancer screening there is a poor basis for the use of age-specific reference values or Volume adjustment for PSA levels in order to increase the clinical usefulness of this serum marker. Comparison of the results of the present study and studies conducted in others regions shows that there may be significant differences in PSA values per age stratum. Further studies are needed to clarify the reasons for these differences. © 1995 Wiley-Liss, Inc.
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the international Prostate symptom score in a community based sample of men between 55 and 74 years of age prevalence and correlation of symptoms with age Prostate Volume flow rate and residual urine Volume
BJUI, 1995Co-Authors: J L H R Bosch, Wim C J Hop, Wim J Kirkels, Fritz H SchroderAbstract:Objectives To study the prevalence of symptoms of pro-statism in the community and the correlation between these symptoms and age, Prostate Volume, flow rate and residual urine Volume. Subjects and methods The International Prostate Symptom Score (IPSS) was administered to a community-based population of 502 men aged between 55 and 74 years with no Prostate Cancer and no history of a Prostate operation. Prostate Volume parameters, flow rate variables and post-void residual urine Volume were measured. Results Overall, 6 and 24% of the men were severely and moderately symptomatic, respectively. The results of a detailed questionnaire such as the IPSS (only 12% of the men scored 0) contrast with the men's global perception of their voiding function (82% claimed to have ‘no voiding complaints’). A good correlation was found between the total symptom score and the single disease-specific quality of life question that is included in the IPSS (r= 0.74, P= 0.001). There was a weak correlation between the IPSS and total Prostate Volume (r= 0.19, P<0.001), and between the IPSS and physiological measures such as peak flow rate (r=— 0.18, P<0.001) and post-void residual urine Volume (r= 0.25, P<0.001). There was a very weak correlation between the IPSS and age (r=0.09, P= 0.04). Conclusions The parameters used to characterize benign prostatic hyperplasia (BPH) should be considered independently because no predictions about the value of a certain parameter can be made by knowing one of the other parameter values. Symptom scores should therefore not be used as a pre-selection criterion in the determination of the prevalence of clinical BPH without taking other measures into account. The interpretation of the parameter values in a clinical setting should take the lack of correlation and the variability of the parameter values into account.
Chris H Bangma - One of the best experts on this subject based on the ideXlab platform.
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Prostate health index phi and Prostate specific antigen psa predictive models for Prostate cancer in the chinese population and the role of digital rectal examination estimated Prostate Volume
International Urology and Nephrology, 2016Co-Authors: Peter Kafung Chiu, Monique J Roobol, Jeremy Yuenchun Teoh, Waiman Lee, Siuying Yip, Seeming Hou, Chris H BangmaAbstract:To investigate PSA- and PHI (Prostate health index)-based models for prediction of Prostate cancer (PCa) and the feasibility of using DRE-estimated Prostate Volume (DRE-PV) in the models. This study included 569 Chinese men with PSA 4–10 ng/mL and non-suspicious DRE with transrectal ultrasound (TRUS) 10-core Prostate biopsies performed between April 2008 and July 2015. DRE-PV was estimated using 3 pre-defined classes: 25, 40, or 60 ml. The performance of PSA-based and PHI-based predictive models including age, DRE-PV, and TRUS Prostate Volume (TRUS-PV) was analyzed using logistic regression and area under the receiver operating curves (AUC), in both the whole cohort and the screening age group of 55–75. PCa and high-grade PCa (HGPCa) was diagnosed in 10.9 % (62/569) and 2.8 % (16/569) men, respectively. The performance of DRE-PV-based models was similar to TRUS-PV-based models. In the age group 55–75, the AUCs for PCa of PSA alone, PSA with DRE-PV and age, PHI alone, PHI with DRE-PV and age, and PHI with TRUS-PV and age were 0.54, 0.71, 0.76, 0.78, and 0.78, respectively. The corresponding AUCs for HGPCa were higher (0.60, 0.70, 0.85, 0.83, and 0.83). At 10 and 20 % risk threshold for PCa, 38.4 and 55.4 % biopsies could be avoided in the PHI-based model, respectively. PHI had better performance over PSA-based models and could reduce unnecessary biopsies. A DRE-assessed PV can replace TRUS-assessed PV in multivariate prediction models to facilitate clinical use.
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prediction of Prostate cancer risk the role of Prostate Volume and digital rectal examination in the erspc risk calculators
European Urology, 2012Co-Authors: Monique J Roobol, Chris H Bangma, Stacy Loeb, Heidi A Van Vugt, Arno Van Leenders, Ewout W Steyerberg, Fritz H SchroderAbstract:Abstract Background The European Randomized Study of Screening for Prostate Cancer (ERSPC) risk calculators (RCs) are validated tools for Prostate cancer (PCa) risk assessment and include Prostate Volume (PV) data from transrectal ultrasound (TRUS). Objective Develop and validate an RC based on digital rectal examination (DRE) that circumvents the need for TRUS but still includes information on PV. Design, setting, and participants For development of the DRE-based RC, we studied the original ERSPC Rotterdam RC population including 3624 men (885 PCa cases) and 2896 men (547 PCa cases) detected at first and repeat screening 4 yr later, respectively. A validation cohort consisted of 322 men, screened in 2010–2011 as participants in ERSPC Rotterdam. Measurements Data on TRUS-assessed PV in the development cohorts were re-coded into three categories (25, 40, and 60cm 3 ) to assess the loss of information by categorization of Volume information. New RCs including PSA, DRE, and PV categories (DRE-based RC) were developed for men with and without a previous negative biopsy to predict overall and clinically significant PCa (high-grade [HG] PCa) defined as T stage >T2b and/or Gleason score ≥7. Predictive accuracy was quantified by the area under the receiver operating curve. We compared performance with the Prostate Cancer Prevention Trial (PCPT) RC in the validation study. Results and limitations Areas under the curve (AUC) of Prostate-specific antigen (PSA) alone, PSA and DRE, the DRE-based RC, and the original ERSPC RC to predict PCa at initial biopsy were 0.69, 0.73, 0.77, and 0.79, respectively. The corresponding AUCs for predicting HG PCa were higher (0.74, 0.82, 0.85, and 0.86). Similar results were seen in men previously biopsied and in the validation cohort. The DRE-based RC outperformed the PCPT RC (AUC 0.69 vs 0.59; p =0.0001) and a model based on PSA and DRE only (AUC 0.69 vs 0.63; p =0.0075) in the relatively small validation cohort. Further validation is required. Conclusions An RC should contain Volume estimates based either on TRUS or DRE. Replacing TRUS measurements by DRE estimates may enhance implementation in the daily practice of urologists and general practitioners.
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the long term relationship between a real change in Prostate Volume and a significant change in lower urinary tract symptom severity in population based men the krimpen study
European Urology, 2008Co-Authors: J Ruud L H Bosch, F P Groeneveld, Chris H Bangma, Arthur M BohnenAbstract:Abstract Objective We used the database of a longitudinal community-based study to investigate whether real changes in Prostate Volume (PV) (ie, changes greater than the combination of intra- and interobserver variation of Volume measurement) corresponded with significant changes in symptom severity. Methods In a community-based study of men aged 50–78 yr, the International Prostate Symptom Score (IPSS) and PV were measured at baseline and at 4.2-yr follow-up. Of 1417 men, 864 completed both rounds. A significant change in IPSS was defined as a change of ≥ 4 points. A real change in PV was defined as a percent change of ≥ 26%, or an absolute change of ≥ 10 cc. Results After 4.2 yr, about 20% of the men had experienced a significant increase in IPSS and 16–23% had a real increase in PV. The age-adjusted odds ratio for a significant increase in symptom severity, which contrasts men who have a real increase in PV and men who do not show such an increase, is 1.38 (95%CI, 1.05–1.85]. The age-adjusted odds ratio for a significant decrease in symptom severity, which contrasts men with a real increase in PV and those without such an increase, is 1.50 (95%CI, 1.11–2.85). Conclusions Benign prostatic hyperplasia can be characterised as a progressive disease in a certain proportion of men older than 50 yr. Men with growing Prostates are at a greater risk of symptomatic deterioration. Men who have Prostates that do not grow significantly are more likely to improve symptomatically.
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algorithms based on Prostate specific antigen psa free psa digital rectal examination and Prostate Volume reduce false postitive psa results in Prostate cancer screening
International Journal of Cancer, 2004Co-Authors: Jonas Hugosson, Chris H Bangma, Patrik Finne, Anssi Auvinen, Matti Hakama, Ralf Finne, Ulfhakan StenmanAbstract:Our objective was to determine whether multivariate algorithms based on serum total PSA, the free proportion of PSA, age, digital rectal examination and Prostate Volume can reduce the rate of false-positive PSA results in Prostate cancer screening more effectively than the proportion of free PSA alone at 95% sensitivity. A total of 1,775 consecutive 55- to 67-year-old men with a serum PSA of 4–10 μg/l in the European Randomized Study of Screening for Prostate Cancer were included. To predict the presence of cancer, multivariate algorithms were constructed using logistic regression (LR) and a multilayer perceptron neural network with Bayesian regularization (BR-MLP). A prospective setting was simulated by dividing the data set chronologically into one set for training and validation (67%, n = 1,183) and one test set (33%, n = 592). The diagnostic models were calibrated using the training set to obtain 95% sensitivity. When applied to the test set, the LR model, the BR-MLP model and the proportion of free PSA reached 92%, 87% and 94% sensitivity and reduced 29%, 36% and 22% of the false-positive PSA results, respectively. At a fixed sensitivity of 95% in the test set, the LR model eliminated more false-positive PSA results (22%) than the proportion of free PSA alone (17%) (p < 0.001), whereas the BR-MLP model did not (19%) (p = 0.178). The area under the ROC curve was larger for the LR model (0.764, p = 0.030) and the BR-MLP model (0.760, p = 0.049) than for the proportion of free PSA (0.718). A multivariate algorithm can be used to reduce unnecessary Prostate biopsies in screening more effectively than the proportion of free PSA alone, but the algorithms will require updating when clinical practice develops with time. © 2004 Wiley-Liss, Inc.
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algorithms based on Prostate specific antigen psa free psa digital rectal examination and Prostate Volume reduce false postitive psa results in Prostate cancer screening
International Journal of Cancer, 2004Co-Authors: Jonas Hugosson, Chris H Bangma, Patrik Finne, Anssi Auvinen, Matti Hakama, Ralf Finne, Ulfhakan StenmanAbstract:Our objective was to determine whether multivariate algorithms based on serum total PSA, the free proportion of PSA, age, digital rectal examination and Prostate Volume can reduce the rate of false-positive PSA results in Prostate cancer screening more effectively than the proportion of free PSA alone at 95% sensitivity. A total of 1,775 consecutive 55- to 67-year-old men with a serum PSA of 4-10 microg/l in the European Randomized Study of Screening for Prostate Cancer were included. To predict the presence of cancer, multivariate algorithms were constructed using logistic regression (LR) and a multilayer perceptron neural network with Bayesian regularization (BR-MLP). A prospective setting was simulated by dividing the data set chronologically into one set for training and validation (67%, n = 1,183) and one test set (33%, n = 592). The diagnostic models were calibrated using the training set to obtain 95% sensitivity. When applied to the test set, the LR model, the BR-MLP model and the proportion of free PSA reached 92%, 87% and 94% sensitivity and reduced 29%, 36% and 22% of the false-positive PSA results, respectively. At a fixed sensitivity of 95% in the test set, the LR model eliminated more false-positive PSA results (22%) than the proportion of free PSA alone (17%) (p < 0.001), whereas the BR-MLP model did not (19%) (p = 0.178). The area under the ROC curve was larger for the LR model (0.764, p = 0.030) and the BR-MLP model (0.760, p = 0.049) than for the proportion of free PSA (0.718). A multivariate algorithm can be used to reduce unnecessary Prostate biopsies in screening more effectively than the proportion of free PSA alone, but the algorithms will require updating when clinical practice develops with time.
