Role of the 4Kscore test as a predictor of reclassification in prostate cancer active surveillance View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2019-03

AUTHORS

Ángel Borque-Fernando, José Rubio-Briones, Luis M. Esteban, Yan Dong, Ana Calatrava, Álvaro Gómez-Ferrer, Enrique Gómez-Gómez, Jesús M. Gil Fabra, Nuria Rodríguez-García, Pedro Á. López González, Jorge García-Rodríguez, Miguel Rodrigo-Aliaga, Bernardo Herrera-Imbroda, Juan Soto-Villalba, Sara Martínez-Breijo, Virginia Hernández-Cañas, Ana M. Soto-Poveda, Carlos Sánchez-Rodríguez, Carlos Carrillo-George, Yumaira E. Hernández-Martínez, David Okrongly

ABSTRACT

BACKGROUND: Management of active surveillance (AS) in low-risk prostate cancer (PCa) patients could be improved with new biomarkers, such as the 4Kscore test. We analyze its ability to predict tumor reclassification by upgrading at the confirmatory biopsy at 6 months. METHODS: Observational, prospective, blinded, and non-randomized study, within the Spanish National Registry on AS (AEU/PIEM/2014/0001; NCT02865330) with 181 patients included after initial Bx and inclusion criteria: PSA ≤10 ng/mL, cT1c-T2a, Grade group 1, ≤2 cores, and ≤5 mm/50% length core involved. Central pathological review of initial and confirmatory Bx was performed on all biopsy specimens. Plasma was collected 6 months after initial Bx and just before confirmatory Bx to determine 4Kscore result. In order to predict reclassification defined as Grade group ≥2, we analyzed 4Kscore, percent free to total (%f/t) PSA ratio, prostate volume, PSA density, family history, body mass index, initial Bx, total cores, initial Bx positive cores, initial Bx % of positive cores, initial Bx maximum cancer core length and initial Bx cancer % involvement. Wilcoxon rank-sum test, non-parametric trend test or Fisher's exact test, as appropriate established differences between groups of reclassification. RESULTS: A total of 137 patients met inclusion criteria. Eighteen patients (13.1%) were reclassified at confirmatory Bx. The %f/t PSA ratio and 4Kscore showed differences between the groups of reclassification (Yes/No). Using 7.5% as cutoff for the 4Kscore, we found a sensitivity of 89% and a specificity of 29%, with no reclassifications to Grade group 3 for patients with 4Kscore below 7.5% and 2 (6%) missed Grade group 2 reclassified patients. Using this threshold value there is a biopsy reduction of 27%. Additionally, 4Kscore was also associated with changes in tumor volume. CONCLUSIONS: Our preliminary findings suggest that the 4Kscore may be a useful tool in the decision-making process to perform a confirmatory Bx in active surveillance management. More... »

PAGES

84-90

Identifiers

URI

http://scigraph.springernature.com/pub.10.1038/s41391-018-0074-5

DOI

http://dx.doi.org/10.1038/s41391-018-0074-5

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1106149926

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30108375


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