A pre-specified model based on four kallikrein markers in blood improves predictions of adverse pathology and biochemical recurrence after radical prostatectomy

Background A pre-specified model based on four kallikrein markers in blood, commercially available as 4Kscore, predicts Gleason Grade (GG) 3 + 4 or higher prostate cancer on biopsy. However, sampling error and variation in pathology reporting may miss aggressive disease. Methods The 4Kscore was measured in cryopreserved blood from 2330 men obtained before prostatectomy at a single institution between 2002 and 2010. Adverse surgical pathology and biochemical recurrence (BCR) were pre-specified to be assessed in all men, biopsy GG 3 + 3, and 3 + 4. Results Adjusted for established clinical predictors, the 4Kscore was significantly associated with adverse pathology (OR 1.49; 95% CI 1.32, 1.67;p < 0.0001). Adding 4Kscore increased discrimination from (AUC) 0.672 to 0.718 and 0.644 to 0.659 within biopsy GG 3 + 3 and 3 + 4, respectively. Higher 4Kscore was associated with higher risk of BCR (HR 1.16, 95% CI 1.06, 1.26;p = 0.001). Adding 4Kscore improved the prediction of BCR (C-index 0.630-0.660) within GG 3 + 3, but not GG 3 + 4. Conclusions The 4Kscore can help guide the clinical decision whether additional risk assessment-such as confirmatory biopsy-is needed to decide between active surveillance versus curative therapy. Evidence that the panel could influence management in biopsy GG 3 + 4 is less strong and requires further investigation.

Tin, A. L.Memorial Sloan-Kettering Cancer Center (author)
Carlsson, Sigrid,1982University of Gothenburg,Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för urologi,Institute of Clinical Sciences, Department of Urology,Memorial Sloan-Kettering Cancer Center(Swepub:lu)si5270ca (author)
Sjoberg, D. D.Memorial Sloan-Kettering Cancer Center (author)
Pehrke, D.Charité - University Medicine Berlin (author)
Steuber, T.University Medical Center Hamburg-Eppendorf (author)
Huland, H.University Medical Center Hamburg-Eppendorf (author)
Graefen, M.University Medical Center Hamburg-Eppendorf (author)
Scardino, P. T.Memorial Sloan-Kettering Cancer Center (author)
Schlomm, T.Charité - University Medicine Berlin (author)
Vickers, A. J.Memorial Sloan-Kettering Cancer Center (author)
Lilja, HansLund University,Lunds universitet,Klinisk kemi, Malmö,Forskargrupper vid Lunds universitet,LUCC: Lunds universitets cancercentrum,Övriga starka forskningsmiljöer,Clinical Chemistry, Malmö,Lund University Research Groups,LUCC: Lund University Cancer Centre,Other Strong Research Environments,Memorial Sloan-Kettering Cancer Center,University of Oxford(Swepub:lu)klke-hli (author)
Sauter, G.University Medical Center Hamburg-Eppendorf (author)
University Medical Center Hamburg-EppendorfMemorial Sloan-Kettering Cancer Center (creator_code:org_t)

In:British Journal of Cancer: Springer Science and Business Media LLC123:4, s. 604-6090007-09201532-1827

By the author/editor: Haese, A.; Tin, A. L.; Carlsson, Sigrid ...; Sjoberg, D. D.; Pehrke, D.; Steuber, T.; show more...; Huland, H.; Graefen, M.; Scardino, P. T.; Schlomm, T.; Vickers, A. J.; Lilja, Hans; Sauter, G.; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Cancer and Oncol ...

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