PSA density of the lesion: a mathematical formula that uses clinical and pathological data to predict biochemical recurrence in prostate cancer patients

JUNQUEIRA, PEDRO HENRIQUE REZENDE; SANTOS, GABRIEL ARANTES DOS; XAVIER, MARCELO; ROMÃO, POLIANA; REIS, SABRINA; SROUGI, MIGUEL; NAHAS, WILLIAN CARLOS; PASSEROTTI, CARLO CARMARGO

doi:10.1590/0100-6991e-20212965

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Original article • Rev. Col. Bras. Cir. 48 • 2021 • https://doi.org/10.1590/0100-6991e-20212965 copy

PSA density of the lesion: a mathematical formula that uses clinical and pathological data to predict biochemical recurrence in prostate cancer patients

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

A main challenge in the clinical management of prostate cancer is to identify which tumor is aggressive and needs invasive treatment. Thus, being able to predict which cancer will progress to biochemical recurrence is a great strategy to stratify prostate cancer patients. With that in mind, we created a mathematical formula that takes into account the patients clinical and pathological data resulting in a quantitative variable, called PSA density of the lesion, which has the potential to predict biochemical recurrence. To test if our variable is able to predict biochemical recurrence, we use a cohort of 219 prostate cancer patients, associating our new variable and classic parameters of prostate cancer with biochemical recurrence. Total PSA, lesion weight, volume and classic PSA density were positively associated with biochemical recurrence (p<0.05). ISUP score was also associated with biochemical recurrence in both biopsy and surgical specimen (p<0.001). The increase of PSA density of the lesion was significantly associated with the biochemical recurrence (p=0.03). Variables derived from the formula, PSA 15% and PSA 15², were also positive associated with the biochemical recurrence (p=0.01 and p=0.002 respectively). Logistic regression analysis shows that classic PSA density, PSA density of the lesion and total PSA, together, can explain up to 13% of cases of biochemical recurrence. PSA density of the lesion alone would have the ability to explain up to 7% of cases of biochemical recurrence. In conclusion, this new mathematical approach could be a useful tool to predict disease recurrence in prostate cancer.

Keywords:
Recurrence; Prognosis; Prostate-Specific Antigen; Prostatic Neoplasms

	Mean ± Standart Deviation	Median	Interquartile range
Age	25p - 75p	62.00	58.00 - 68.00
Total PSA	6.48 ± 4.84	5.10	4.00 - 7.50
PSA of the lesion	0.83 ± 5.10	0.13	1.68 - 2.02
PSA of the lesion 15²	26.54 ± 159.14	3.31	0.79 - 12.15
PSA density of the lesion	2.70 ± 7.49	0.60	0.15 - 2.01
Weight of the prostate	45.15 ± 17.84	44.00	34.00 - 55.00
Prostate Volume	44.94 ± 19.91	41.60	31.50 - 54.30
Lesion Volume (%)	17.66 ± 12.30	15.00	10.00 - 24.00
Lesion Weight	7.49 ± 5.46	6.00	3.50 - 10.00
Classic PSA Density	0.16 ± 0.11	0.13	0.09 - 0.17

	n	%
Biochemical Recurrence
No	179	81.7
Yes	40	18.3
Biopsy ISUP
1	74	33.8
2	70	32.0
3	37	16.9
4	29	13.2
5	9	4.1
Surgical Specimen ISUP
1	21	9.6
2	104	47.5
3	61	27.9
4	11	5.0
5	22	10.0
Extraprostatic Extension
No	133	60.7
Yes	86	39.3
Margins
Negative	156	71.2
Positive	63	28.8
Potency
Impotent	57	26.0
Potent	162	74.0
Continence
Continent	211	96.3
Incontinent	8	3.7

	Biochemical Recurrence
	No	Yes	p*
	Median (25p - 75p)	Median (25p - 75p)	p*
Age	63.00 (59.00 - 68.00)	61.50 (55.25 - 65.75)	0.18
Total PSA	5.00 (3.98 - 7.10)	6.29 (4.40 - 11.26)	0.01
PSA of the lesion 15%	-0.12 (-1.83 - 1.76)	1.10 (-0.63 - 5.88)	0.002
PSA of the lesion 15²	3.20 (0.77 - 11.22)	4.53 (0.81 - 34.60)	0.01
PSA density of the lesion	0.54 (0.15 - 1.88)	0.68 (0.17 - 4.03)	0.03
Prostate Weight	45.00 (32.00 - 55.00)	40.00 (35.00 - 50.00)	0.47
Prostate Volume	41.60 (32.00 - 54.30)	41.00 (29.25 - 54.00)	0.56
Lesion Volume (%)	15.00 (10.00 - 20.00)	20.00 (10.25 - 30.00)	0.02
Lesion Weight	6.00 (3.47 - 9.00)	7.75 (4.68 - 12.00)	0.03
Classic PSA Density	0.12 (0.09 - 0.17)	0.16 (0.12 - 0.26)	0.005

Model	Predictors	r²	B	Standard Error	Wald	p
1	Total PSA	0.15	0.13	0.07	3.88	0.05
	PSA of the lesion 15²		0.00	0.01	0.03	0.86
	PSA density of the lesion		-0.10	0.08	1.56	0.21
	Lesion Weight		0.05	0.04	1.63	0.20
	Classic PSA Density		4.47	2.84	2.48	0.11
2	Total PSA	0.15	0.14	0.07	4.17	0.04
	PSA Density of the lesion		-0.09	0.04	3.85	0.04
	Lesion Weight		0.05	0.03	2.07	0.15
	Classic PSA Density		4.47	2.82	2.51	0.11
3	Total PSA	0.13	0.16	0.06	6.22	0.01
	PSA Density of the lesion	0.13	-0.09	0.04	4.54	0.03
	Classic PSA Density		4.23	2.79	2.30	0.13
4	Total PSA	0.12	0.20	0.06	12.78	<0.01
4	PSA Density of the lesion	0.12	-0.07	0.04	3.69	0.04
5	Total PSA	0.05	0.13	0.04	9.22	<0.01

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