Oncology - Prostate
Introduction & Objective :
Since the early 1990’s, PSA screening has resulted in a 45% reduction in prostate cancer mortality. Despite this, there has been a lack of consensus among national policy panels about the optimal PSA threshold for biopsy recommendations due to its poor specificity. Hence, there have been efforts to risk-stratify patients with abnormal PSA values to better guide biopsy decisions. The 4Kscore® is a novel test which predicts the percentage risk of clinically significant prostate cancer (>Gleason 3+4) by assessing clinical information and four serum markers. While there have been several validation studies regarding use of the 4Kscore, there is a paucity of data on how this test impacts clinical practice. In this abstract, we aimed to assess how the 4Kscore influenced biopsy related decisions in men evaluated in an academic urology practice.
Methods : We retrospectively reviewed our electronic medical records for all patients who underwent a 4Kscore at our institution. Since the implementation of the 4Kscore® at our institution in 2015, all of our practitioners have implemented it using their own clinical judgement without restrictions.
Results : Our analysis included a total of 308 men. The most common indications for 4Kscore testing were elevated PSA (58%), and abnormal digital rectal exam (34%). The rate of transrectal ultrasound (TRUS) guided prostate biopsy within 6 months of 4Kscore testing was 142/308 (46%). The mean 4Kscore was 26.4% in the biopsy group, while the mean 4Kscore in the non-biopsy group was 6% (p(Fig 1). Clinically significant disease was found in 36/142 (25%) of biopsies. Treatment consisted of radical prostatectomy in 19/36 (53%) patients, while 5/19 (26%) opted for radiation therapy. Fifty patients that underwent TRUS biopsy had a PSA >4 ng/mL and 4Kscore <7.5%, with a TRUS biopsy rate of 15/54 (28%).
Conclusions : Use of the 4Kscore test in conjunction with other clinical factors in an academic urology practice resulted in a reduction in the number of prostate biopsies by over 50%. A significant difference was seen in the 4Kscore of patients who underwent TRUS biopsy and those who did not. Based on our data, the 4Kscore is a beneficial adjunct screening tool to prevent unneeded prostate biopsies and diagnosis of men with clinically insignificant disease.