Open AccessClinical significance of the Lacdi NA c‐glycosylated prostate‐specific antigen assay for prostate cancer detection
Author(s) -
Yoneyama Tohru,
Tobisawa Yuki,
Kaneko Tomonori,
Kaya Takatoshi,
Hatakeyama Shingo,
Mori Kazuyuki,
Sutoh Yoneyama Mihoko,
Okubo Teppei,
Mitsuzuka Koji,
Duivenvoorden Wilhelmina,
Pinthus Jehonathan H.,
Hashimoto Yasuhiro,
Ito Akihiro,
Koie Takuya,
Suda Yoshihiko,
Gardiner Robert A.,
Ohyama Chikara
Publication year - 2019
Publication title -
cancer science
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.035
H-Index - 141
eISSN - 1349-7006
pISSN - 1347-9032
DOI - 10.1111/cas.14082
Subject(s) - medicine , prostate specific antigen , urology , prostate cancer , prostatectomy , cohort , area under the curve , receiver operating characteristic , prostate , rectal examination , retrospective cohort study , cancer , oncology
To reduce unnecessary prostate biopsies (Pbx), better discrimination is needed. To identify clinically significant prostate cancer ( CSPC ) we determined the performance of Lacdi NA c‐glycosylated prostate‐specific antigen ( LDN ‐ PSA ) and LDN ‐ PSA normalized by prostate volume ( LDN ‐ PSAD ). We retrospectively measured LDN ‐ PSA , total PSA ( tPSA ), and free PSA / tPSA (F/T PSA ) values in 718 men who underwent a Pbx in 3 academic urology clinics in Japan and Canada (Pbx cohort) and in 174 PC patients who subsequently underwent radical prostatectomy in Australia (preop‐ PSA cohort). The assays were evaluated using the area under the receiver operating characteristics curve ( AUC ) and decision curve analyses to discriminate CSPC . In the Pbx cohort, LDN ‐ PSAD ( AUC 0.860) provided significantly better clinical performance for discriminating CSPC compared with LDN ‐ PSA ( AUC 0.827, P = 0.0024), PSAD ( AUC 0.809, P < 0.0001), tPSA ( AUC 0.712, P < 0.0001), and F/T PSA ( AUC 0.661, P < 0.0001). The decision curve analysis showed that using a risk threshold of 20% and adding LDN ‐ PSA and LDN ‐ PSAD to the base model (age, digital rectal examination status, tPSA , and F/T PSA ) permitted avoidance of even more biopsies without missing CSPC (9.89% and 18.11%, respectively vs 2.23% [base model]). In the preop‐ PSA cohort, LDN ‐ PSA values positively correlated with tumor volume and tPSA and were significantly higher in pT 3, pathological Gleason score ≥ 7. Limitations include limited sample size, retrospective nature, and no family history information prior to biopsy. Lacdi NA c‐glycosylated PSA is significantly better than the conventional PSA test in identifying patients with CSPC . This study was approved by the ethics committee of each institution (“The Study about Carbohydrate Structure Change in Urological Disease”; approval no. 2014‐195).