title: [The significance of PSA density as predictive factor in Afro-Caribbean patients eligible for active surveillance by the French protocol criteria].
abstract: OBJECTIVE
  Study the interest of addition of PSA density (PSAD), to the selection criteria of the French protocol for inclusion patients Afro-Caribbean on active surveillance prostate cancer.
  
  
  METHODS
  A retrospective analysis of 1505 patients who had, in turn, a radical prostatectomy for cancer between 2000 and 2012, in a single reference center. One hundred and forty-one patients was eligible, at the time of their diagnosis, for active surveillance by the criteria of the French protocol. This population was divided into 2 groups according to the histological analysis of the prostatectomy specimen confirmed indolent cancer or overturned. The median PSAD of each group was calculated to be compared. Secondarily, the most discriminating PSAD was investigated by the method of ROC after constitution tables intrinsic validity in this population. This threshold has secondary conducting a comparative analysis of the underestimation of cancer in terms of aggressiveness and/or extension between patients selected according to the criteria of the French protocol and "on-selected" patients according to these criteria and their PSAD.
  
  
  RESULTS
  Of the 141 patients identified for analysis, histological examination of the prostatectomy specimen has to show that 42 patients (29.7 %) were actually more aggressive cancer (20.6 % of Gleason ≥ 7), wider (4.2 % ≥ pT3) or larger and more aggressive (4.9 %) than foreshadowed criteria French protocol. The median PSAD these 42 patients were significantly higher than the median PSAD patients correctly estimated (0.18 vs. 0.14, p-value=0.046). The application of the most discriminating threshold: 0.15 ng/ml/cm(3) in this population allowed to significantly improve the selection of candidates of the 79 "on-selected" patients, six (20.2 %) were actually more aggressive cancer (13.9 % of Gleason ≥ 7), wider (2.5 % ≥ pT3) or larger and more aggressive (3.8 %).
  
  
  CONCLUSIONS
  The criteria for the French protocol for active surveillance, applied to the Caribbean population underestimate 29 % of non-latent cancers. Adjuvants criteria that must be inexpensive, sensitive and specific seem necessary in this population. A PSAD<0.15 ng/ml/cm(3) could be one of these criteria.
authors.affiliation: CHU de Brest, boulevard Tanguy-Prigent, 29200 Brest, France. Electronic address: Aurelien.Loiselle@etudiant.univ-brest.fr.
authors.forename: A
authors.initials: A
authors.lastname: Loiselle
authors.affiliation: CHU de Pointe-à-Pitre, route de Chauvel, 97159 Pointe-à-Pitre, Guadeloupe.
authors.forename: C
authors.initials: C
authors.lastname: Senechal
authors.affiliation: CHU de Pointe-à-Pitre, route de Chauvel, 97159 Pointe-à-Pitre, Guadeloupe.
authors.forename: P
authors.initials: P
authors.lastname: Nevoux
authors.affiliation: CHU de Rabat, Rabat, Maroc.
authors.forename: H
authors.initials: H
authors.lastname: Benazzouz
authors.affiliation: CHU de Pointe-à-Pitre, route de Chauvel, 97159 Pointe-à-Pitre, Guadeloupe.
authors.forename: B
authors.initials: B
authors.lastname: Bhakkan-Mambir
authors.affiliation: CHU de Pointe-à-Pitre, route de Chauvel, 97159 Pointe-à-Pitre, Guadeloupe.
authors.forename: J
authors.initials: J
authors.lastname: Casenave
authors.affiliation: CHU de Pointe-à-Pitre, route de Chauvel, 97159 Pointe-à-Pitre, Guadeloupe.
authors.forename: G
authors.initials: G
authors.lastname: Gourtaud
authors.affiliation: CHU de Pointe-à-Pitre, route de Chauvel, 97159 Pointe-à-Pitre, Guadeloupe.
authors.forename: M
authors.initials: M
authors.lastname: Fofana
authors.affiliation: CHU de Pointe-à-Pitre, route de Chauvel, 97159 Pointe-à-Pitre, Guadeloupe.
authors.forename: P
authors.initials: P
authors.lastname: Blanchet
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D017691:Caribbean Region / Q000208:ethnology; D002985:Clinical Protocols; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D011159:Population Surveillance / Q000379:methods; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen
keywords: Active surveillance; Cancer de prostate; Densité du PSA; PSA density; Prostate cancer; Surveillance active