MADRID, SPAIN (UroToday.com) - The appropriate identification of men with truly low-grade, indolent prostate cancer is essential to minimize the potential for disease progression on active surveillance protocols. The 4Kscore is a blood test measuring the levels of 4 kallikrein biomarkers (total PSA, free PSA, intact PSA, and human kallikrein-2) which has been demonstrated to accurately predict an increased likelihood of high-grade disease on biopsy. In this study the authors looked more specifically at the ability of the 4K score to predict the presence of aggressive disease in patients with low-grade disease diagnosed on biopsy, who would thus be poor candidates for active surveillance. To achieve this purpose, the study looked at the rate of disease upgrading in patients with Gleason 6 disease on biopsy who ultimately underwent radical prostatectomy.
The final cohort of this study consisted of 306 patients recruited from October 2013 to April 2014 in a prospective multi-institution study. The authors reported that higher 4Kscores significantly correlated with increasing amounts of cancer detected on biopsy, as measured by positive core number and core length. Of the 51 men who ultimately underwent radical prostatectomy, patients whose disease was upgraded to a Gleason 7 disease or greater had a significantly higher pre-biopsy 4Kscore in comparison to those patients whose disease was not upgraded (15 vs 7 respectively, p=0.02).
The authors concluded that the 4Kscore may be utilized to better risk-stratify patients to active surveillance or immediate treatment. Further investigation will be necessary to determine the optimal use of the 4Kscore in this setting. The identification of specific cutoff levels for observation vs further investigation vs intervention could prove to provide a significant clinical benefit.
Presented by S. Punnen, M. Steiner, S. Zappala, J. Palou, D. Sjoberg, V. Mathur, R. Roberts, V. Linder, M. Reeve, D. Okrongly, J. Newmark, G. Sant, J. Morote, and D. Parekh! at the 30th Annual European Association of Urology (EAU) Congress - March 20 - 24, 2015 - IFEMA - Feria de Madrid - Madrid, Spain
Sylvester Comprehensive Cancer Center/University of Miami Health System, Miami, FL USA
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Reported by Timothy Ito, MD, medical writer for UroToday.com