Published in
2023
May 2023, Volume 175, Pages 132-136; doi: 10.1016/j.urology.2023.01.037
IsoPSA Performance Characteristics are Unaffected by 5-Alpha Reductase Inhibitors or Alpha-Blockers: Results From the IsoPSA Validation Study Jason M Scovell, Mark Stovsky, Alan Partin, Yair Lotan, Jack Baniel, Martin Dineen, Jason Hafron, Kannan Manickam, Marc Pliskin, Matthew Wagner, Aimee Kestranek, Eric A Klein
Objective Methodology
To determine the impact of 5-alpha reductase inhibitor (5-ARIs) or α-blocker medication use on IsoPSA test performance for the detection of actionable prostate cancer.
• Secondary analysis of data collected from a prospective, multicenter study (eight sites) • Of the 888 patients enrolled, 40 and 217 patients reported 5-ARI and α-blocker use respectively • Clinically significant prostate cancer (csPCa) on biopsy was defined as grade group ≥2
Results
Clinical Performance of IsoPSA for Patients with csPCa* w/o 5-ARI
w/ 5-ARI
w/o α-blocker
w/ α-blocker
Sensitivity
90.0%
93.8%
91.5%
84.5%
Specificity
45.8%
45.2%
39.5%
61.0%†
PPV
47.6%
50.0%
48.6%
44.1%
NPV
89.3%
90.0%
88.1%
91.5%
AUC
0.782
0.799
0.770
0.804
*IsoPSA cutoff: ≥6 | n (population): w/o 5-ARI = 848 | w/ 5-ARI = 40 | w/o α-blockers = 671 | w/ α-blockers = 217 Prevalence of csPCa: w/o 5-ARI = 0.353 | w/ 5-ARI = 0.400 | w/o α-blockers = 0.267 | w/ α-blockers = 0.385 †
Increased specificity was noted in patients on α-blockers, likely due to the discrepant prevalence of prostate cancer in patients on α-blockers compared to the remainder of the cohort.
Conclusion
The performance of IsoPSA for detecting csPCa is unaffected by commonly used medications (5-ARI and α-blockers) for symptoms of benign prostatic hyperplasia.