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Volume 19, Number 3

Review Articles

Clinical Performance of the 4Kscore Test to Predict High-grade Prostate Cancer at Biopsy: A Meta-analysis of US and European Clinical Validation Study Results

Predictive Performance Evaluation

David Okrongly Vincent Linder Yan Dong Peter T Scardino Stephen M Zappala

The 4Kscore® Test (OPKO Diagnostics, Woburn, MA) is a blood test utilized prior to a prostate biopsy to determine a patient’s risk of high-grade prostate cancer (PCa) should the biopsy be performed, thus providing critical information in the clinical management of men with a suspicious prostate-specific antigen value or digital rectal examination result. Multiple US and European clinical studies confirmed that a prebiopsy 4Kscore Test has a high degree of discrimination for a subsequent discovery of high-grade (Gleason score ≥7) PCa. The aim of this study was to evaluate the predictive accuracy of the 4Kscore Test to discriminate between patients with and without high-grade PCa based on published clinical validation studies. A systematic review and meta-analysis of the eligible 4Kscore Test clinical validation studies was conducted. The pooled area under the curve (AUC) of the 4Kscore Test as reported from all the studies, and the heterogeneity among these studies were analyzed and repeated for subgroups of the studies. Twelve clinical validation studies were included in the meta-analysis, comprising a total of 11,134 patients. The pooled AUC to discriminate for high-grade PCa for all 12 studies was 0.81 (fixed effects 95% CI, 0.80-0.83). Restricting the analysis to the six publications that used the contemporary 4Kscore Test algorithm led to very similar results (AUC 0.81; 95% CI, 0.79-0.83). Heterogeneity was high among all of the 12 studies, as well as among the six publications that used the contemporary 4Kscore Test (Cochrane’s Q test, p = 0.001 for both); however, in both cases, after exclusion of a single outlying study with a much lower AUC, heterogeneity was no longer significant (p = 0.08 and p = 0.21). The pooled estimate of 4Kscore Test discrimination (AUC) for high-grade PCa is .0.80, and is consistent across multiple US and European clinical validation studies. [Rev Urol. 2017;19(3):149–155 doi: 10.3909/riu0776] © 2017 MedReviews®, LLC

Biopsy Biomarkers 4Kscore High-grade prostate cancer Early detection

Review Articles

Osteitis Pubis: A Rare Cause of Suprapubic Pain

Diagnosis and Treatment Review

Patrick Gomella Patrick Mufarrij

Osteitis pubis is a noninfectious inflammatory condition affecting the pubic symphysis. First described in a series of patients undergoing urologic procedures, it is an uncommon cause of lower abdominal and suprapubic pain. However, this condition can cause significant morbidity in patients affected, often requiring lengthy recovery periods. Given its rarity, the diagnosis and management is challenging, as many urologists are unfamiliar with the condition and may ascribe the constellation of symptoms as expected side effects from a recent surgical procedure. This review describes the urologic considerations for osteitis pubis, its potential etiologies, and clinical findings, and identifies treatment strategies for this potentially debilitating condition. [Rev Urol. 2017;19(3):156–163 doi: 10.3909/riu0767] © 2017 MedReviews®, LLC

Postoperative pain Osteitis pubis Suprapubic pain

Practice Management for Urology Groups: LUGPA’s Guidebook

[Rev Urol. 2017;19(3):164–168 doi: 10.3909/riu0774] © 2017 MedReviews®, LLC

NYU Case of the Month

Management of Prostate Cancer

July 2017

[Rev Urol. 2017;19(3):180–184 doi: 10.3909/riu0771] © 2017 MedReviews®, LLC

NYU Case of the Month

Midurethral Sling Erosion

August 2017

[Rev Urol. 2017;19(3):185–186 doi: 10.3909/riu0773] © 2017 MedReviews®, LLC

NYU Case of the Month

Management of High-risk Localized Kidney Cancer

September 2017

William C Huang

[Rev Urol. 2017;19(3):187–189 doi: 10.3909/riu1903NYUSept] © 2017 MedReviews®, LLC

High Postprostatectomy Prostate-specific Antigen Level Prior to Salvage Radiation Therapy Is Not Always a Bad Sign

Steven C Eberhardt Thomas M Schroeder John T Rathbun

Although radical prostatectomy is a popular treatment modality for clinically localized prostate cancer, 10-year biochemical recurrence can reach 28%. Before salvage radiation therapy (SRT), prostate-specific antigen (PSA) values alone should be used cautiously in predicting SRT eligibility. A long, slow PSA rise may suggest locally confined disease still amenable to SRT; corresponding imaging to identify potential gross recurrence is useful. Patients with local disease may safely benefit from higher doses of radiation. [Rev Urol. 2017;19(3):190–194 doi: 10.3909/riu0754] © 2017 MedReviews®, LLC

Prostate-specific antigen Radical prostatectomy Salvage radiation therapy

Surgical Solution to an Intracorporeal Nickel Allergy

Jared Brandenberger Paul Kozlowski Andrew Stamm

A previously healthy 30-year-old man with a symptomatic varicocele underwent gonadal vein embolization using nickel vascular plugs. He developed a painful hypersensitivity to his nickel plugs and elected to pursue laparoscopic excision and proximal gonadal vein ligation. In the operating room, the gonadal vein was isolated from the ureter, and ligated proximal to the cephalad plug and distal to the caudal coil. His pain is completely resolved 5 months after surgery. Metal allergies are well documented in orthopedics and cardiology implants, but there are a limited number of case reports of metal allergies after varicocele embolization. Interestingly, nickel is the most common type of metal hypersensitivity. [Rev Urol. 2017;19(3):195–197 doi: 10.3909/riu0769] © 2017 MedReviews®, LLC

Varicocele Metal allergy Nickel Coil embolization Gonadal vein

News in Urology

Alternative Payment Models

Deepak A Kapoor Neal D Shore

[Rev Urol. 2017;19(3):198–199 doi: 10.3909/riu193NewsinUro] © 2017 MedReviews®, LLC

Practice Profile

Imaging and Treatment Recommendations in Patients With Castrate-resistant Prostate Cancer

David M. Albala

[Rev Urol. 2017;19(3):200–202 doi: 10.3909/riu193PracticeProfile] © 2017 MedReviews®, LLC