Open Access

ARTICLE

Critical assessment of prebiopsy parameters for predicting prostate cancer metastasis and mortality

Pim J. van Leeuwen, Roderick C. N. van den Bergh, Tineke Wolters, Xiaoye Zhu, Meelan Bul, Fritz H. Schröder, Chris H. Bangma, Monique J. Roobol

Erasmus University Medical Center, Rotterdam, The Netherlands
Address correspondence to Dr. Pim J. van Leeuwen, Erasmus MC, University Medical Center, Room NH 227, PO Box 2040, 3000 CA Rotterdam, The Netherlands

Canadian Journal of Urology 2011, 18(6), 6018-6024.

Abstract

Introduction: The value of characteristics assessed prior to diagnosis in predicting aggressive prostate cancer, metastases, and mortality in men participating in a screening study were identified.
Materials and methods: This study included 19,950 men aged 55 to 74 years at first screening in the European Randomized Study of Screening for Prostate Cancer. Factors such as age, Charlson comorbidity index, family history of prostate cancer, vasectomy status, International Prostate Symptom Score (IPSS), digital rectal examination (DRE) status, transrectal ultrasound (TRUS) findings, prostate volume, and prostate-specific antigen (PSA) level were evaluated. Participants were followed for a median of 11.1 years after their initial screening visit. Multivariate estimates of the probability of developing aggressive prostate cancer [stage ≥ T2c, or N1, M1, PSA > 20 ng/mL, or Gleason score ≥ 8], distant metastases, and prostate cancer-specific mortality were stratified based on predictors measured before prostate biopsies. Harrell’s concordance index (c-index) was used to measure predictive accuracy.
Results: Among 19,950 men, 2,420 men (12.1%) were diagnosed with prostate cancer, including 623 men (3.1%) with aggressive prostate cancer, 157 men (0.8%) developed metastases, and 104 men (0.5%) died due to prostate cancer-related causes. In multivariate analysis, PSA, DRE, TRUS findings, and prostate volume showed significant associations with the detection of aggressive prostate cancer, metastases, and prostate cancer mortality. Family history was significantly associated with aggressive prostate cancer. Predictive accuracies were reported as follows: c-index = 0.90 for aggressive prostate cancer, c-index = 0.87 for distant metastases, and c-index = 0.87 for prostate cancer-specific mortality.
Conclusions: In a large population of men screened for prostate cancer, the detection of aggressive prostate cancer, metastases, and prostate cancer mortality can be predicted using predictors available before biopsy. These results highlight the importance of multivariate risk assessment and stratification tools.

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