title: A comparative performance analysis of total PSA, percentage free PSA, PSA velocity, and PSA density versus the detection of primary circulating prostate cells in predicting initial prostate biopsy findings in Chilean men.
abstract: BACKGROUND
  PSA parameters have been used in an attempt to improve the diagnostic yield of prostate screening tests; the detection of primary malignant circulating prostate cells (CPCs) may improve the diagnostic yield of screening and therefore avoid unnecessary biopsies.
  
  
  METHODS
  Prospective study of all men undergoing initial prostate biopsy due to an elevated total serum PSA. Free percent PSA, PSA velocity, and PSA density were determined. Primary CPCs were detected using standard immunocytochemistry. A positive test for CPCs was defined as one cell PSA (+) P504S (+) in an 8 ml blood sample. Positive predictive and negative predictive values, specificity, and sensitivity were calculated for each test as well as the number of biopsies avoided and cancers missed.
  
  
  RESULTS
  303 men participated in the study of whom 113/303 (37.3%) men had prostate cancer. Of the three PSA based parameters, free percent PSA was superior, sensitivity 70.8%, and specificity 67.4%. Primary CPCs detection had a sensitivity of 88.5% and a specificity of 88.4% avoiding 181 (59.7%) biopsies, detecting 93/95 (98%) of clinically significant cancers, and missing 13 (11.5%) low grade, small volume tumors.
  
  
  CONCLUSIONS
  The use of primary CPCs as a sequential test could decrease the number of initial prostate biopsies missing those cancers which are treated by active observation.
authors.affiliation: Hospital Carabineros of Chile, Nuñoa, 7770199 Santiago, Chile ; Circulating Tumor Cell Unit, Faculty of Medicine, University Mayor, Las Condes, 7550224 Santiago, Chile ; Institute of Bio-Oncology, Providencia, 7500710 Santiago, Chile.
authors.forename: Nigel P
authors.initials: NP
authors.lastname: Murray
authors.affiliation: Hospital Carabineros of Chile, Nuñoa, 7770199 Santiago, Chile ; Faculty of Medicine, Diego Portales University, Manuel Rodríguez Sur 415, 8370179 Santiago, Chile.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Reyes
authors.affiliation: Hospital Carabineros of Chile, Nuñoa, 7770199 Santiago, Chile.
authors.forename: Nelson
authors.initials: N
authors.lastname: Orellana
authors.affiliation: Hospital Carabineros of Chile, Nuñoa, 7770199 Santiago, Chile.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Fuentealba
authors.affiliation: Hospital Carabineros of Chile, Nuñoa, 7770199 Santiago, Chile.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Dueñas
mesh_terms: D000368:Aged; D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D011237:Predictive Value of Tests; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology
chemical_list: D017430:Prostate-Specific Antigen
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