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The ability of free to total prostate-specific antigen and prostate-specific antigen density to detect clinically significant prostate cancer in men undergoing transperineal template biopsy Show all authors Surayne V Segaran, Amr M Emara, Tharani Mahesan, ... First Published September 12, 2017 Research Article Download PDFPDF download for The ability of free to total prostate-specific antigen and prostate-specific antigen density to detect clinically significant prostate cancer in men undergoing transperineal template biopsy Article information Full Access Article Information Volume: 10 issue: 6, page(s): 529-534 Article first published online: September 12, 2017; Issue published: November 1, 2017 Received: May 04, 2017; Accepted: August 08, 2017 https://doi.org/10.1177/2051415817730494 Surayne V Segaran1, Amr M Emara1, 2, Tharani Mahesan3, Joshua Silverman1, Hashim U Ahmed4, Simon RJ Bott3, Richard G Hindley1 1Urology Department, North Hampshire Hospitals NHS Trust, UK 2Urology Department, Ain Shams University, Egypt 3Urology Department, Frimley Park Hospital, UK 4Imperial College London, UK Corresponding Author: Surayne V Segaran, Urology Department, North Hampshire Hospitals NHS Trust, Aldermaston Road, Basingstoke, RG24 9NA, UK. Email: surayne.segaran@fhft.nhs.uk Abstract Objective: The purpose of this study was to determine the ability of the ratio of free to total prostate-specific antigen and prostate-specific antigen density to predict the presence of clinically significant prostate cancer on template biopsies. The value of these tests may be underestimated as they were previously validated against sextant transrectal biopsy of the prostate, which has been proved to miss a large proportion of significant prostate cancers. The ability of these tests to specifically detect clinically significant cancers has not previously been studied. Patients and methods: A retrospective analysis was performed of patients undergoing transperineal template biopsy who also had free to total prostate-specific antigen and prostate-specific antigen density. Receiver-operating characteristic analysis was performed to determine the comparative utility of each test in the detection of all cancers as well as clinically significant cancers, by means of the area under the curve. Results: Data from 293 patients were analysed. Prostate cancer was detected in 72% of patients, of which 62% of this group had clinically significant disease. Receiver-operating characteristic analysis demonstrated the superiority of prostate-specific antigen density and free to total prostate-specific antigen over standard prostate-specific antigen in the overall detection of cancer (area under the curve 0.662 and 0.674 vs 0.534, p=0.003 and 0.02 respectively). Both tests were even more effective in the detection of clinically significant cancers (area under the curve 0.755 and 0.715 vs 0.572, p

With the requirement to accurately risk stratify men in order to prioritise their treatment allocation (active surveillance vs radical therapy) the questions that we ask of our staging investigations are different from those that we have traditionally posed. Less important is the question, 'Is cancer present?'. More and more important becomes the question, 'Is this cancer important?'. The current interest in focal therapies requires us to ask even more novel questions such as: 'What are the limits of the cancer?'; 'How many lesions are present?'; 'What is the relationship between index and satellite lesions?' All these questions require precise imaging of the tumour at low threshold volumes, probably at the 0.2 cm3 or 0.1 cm3 level, something that until very recently was beyond the specification of imaging platforms. Developments in MRI and in the rapidly evolving field of tissue characterisation will hopefully provide the inputs that modern management of prostate cancer requires. Crown Copyright © 2008.

In adults but not children, small-bowel intussusception is usually traceable to a physical lesion. We report a causation that does not seem to have been described before.