title: Prostate specific antigen density to predict prostate cancer upgrading in a contemporary radical prostatectomy series: a single center experience.
abstract: OBJECTIVE
  We investigated the value of pretreatment prostate specific antigen density to predict Gleason score upgrading in light of significant changes in grading routine in the last 2 decades.
  
  
  METHODS
  Of 1,061 consecutive men who underwent radical prostatectomy between 1999 and 2004, 843 were eligible for study. Prostate specific antigen density was calculated and a cutoff for highest accuracy to predict Gleason upgrading was determined using ROC curve analysis. The predictive accuracy of prostate specific antigen and prostate specific antigen density to predict Gleason upgrading was evaluated using ROC curve analysis based on predicted probabilities from logistic regression models.
  
  
  RESULTS
  Prostate specific antigen and prostate specific antigen density predicted Gleason upgrading on univariate analysis (as continuous variables OR 1.07 and 7.21, each p <0.001) and on multivariate analysis (as continuous variables with prostate specific antigen density adjusted for prostate specific antigen OR 1.07, p <0.001 and OR 4.89, p = 0.037, respectively). When prostate specific antigen density was added to the model including prostate specific antigen and other Gleason upgrading predictors, prostate specific antigen lost its predictive value (OR 1.02, p = 0.423), while prostate specific antigen density remained an independent predictor (OR 4.89, p = 0.037). Prostate specific antigen density was more accurate than prostate specific antigen to predict Gleason upgrading (AUC 0.61 vs 0.57, p = 0.030).
  
  
  CONCLUSIONS
  Prostate specific antigen density is a significant independent predictor of Gleason upgrading even when accounting for prostate specific antigen. This could be especially important in patients with low risk prostate cancer who seek less invasive therapy such as active surveillance since potentially life threatening disease may be underestimated. Further studies are warranted to help evaluate the role of prostate specific antigen density in Gleason upgrading and its significance for biochemical outcome.
authors.affiliation: Department of Urology, Charité Hospital Berlin, Campus Mitte, University Medicine Berlin, Berlin, Germany. amagheli@gmail.com
authors.forename: Ahmed
authors.initials: A
authors.lastname: Magheli
authors.forename: Stefan
authors.initials: S
authors.lastname: Hinz
authors.forename: Claudia
authors.initials: C
authors.lastname: Hege
authors.forename: Carsten
authors.initials: C
authors.lastname: Stephan
authors.forename: Klaus
authors.initials: K
authors.lastname: Jung
authors.forename: Kurt
authors.initials: K
authors.lastname: Miller
authors.forename: Michael
authors.initials: M
authors.lastname: Lein
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011467:Prostate / Q000737:chemistry*; D017430:Prostate-Specific Antigen / Q000032:analysis* / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000737:chemistry / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies
chemical_list: D017430:Prostate-Specific Antigen