RESUMEN
Introduction: Modern image-guided biopsy pathways at diagnostic centres have greatly refined the investigations of men referred with suspected prostate cancer. However, the referral criteria from primary care are still based on historical prostate-specific antigen (PSA) cut-offs and age-referenced thresholds. Here, we tested whether better contemporary pathways and biopsy methods had improved the predictive utility value of PSA referral thresholds. Methods: PSA referral thresholds, age-referenced ranges and PSA density (PSAd) were assessed for positive predictive value (PPV) in detection of clinically significant prostate cancer (csPCa - histological ⩾ Grade Group 2). Data were analysed from men referred to three diagnostics centres who used multi-parametric magnetic resonance imaging (mpMRI)-guided prostate biopsies for disease characterisation. Findings were validated in a separate multicentre cohort. Results: Data from 2767 men were included in this study. The median age, PSA and PSAd were 66.4 years, 7.3 ng/mL and 0.1 ng/mL2, respectively. Biopsy detected csPCa was found in 38.7%. The overall area under the curve (AUC) for PSA was 0.68 which is similar to historical performance. A PSA threshold of ⩾ 3 ng/mL had a PPV of 40.3%, but this was age dependent (PPV: 24.8%, 32.7% and 56.8% in men 50-59 years, 60-69 years and ⩾ 70 years, respectively). Different PSA cut-offs and age-reference ranges failed to demonstrate better performance. PSAd demonstrated improved AUC (0.78 vs 0.68, p < 0.0001) and improved PPV compared to PSA. A PSAd of ⩾ 0.10 had a PPV of 48.2% and similar negative predictive value (NPV) to PSA ⩾ 3 ng/mL and out-performed PSA age-reference ranges. This improved performance was recapitulated in a separate multi-centre cohort (n = 541). Conclusion: The introduction of MRI-based image-guided biopsy pathways does not appear to have altered PSA diagnostic test characteristics to positively detect csPCa. We find no added value to PSA age-referenced ranges, while PSAd offers better PPV and the potential for a single clinically useful threshold (⩾0.10) for all age groups. Level of evidence: IV.
RESUMEN
The purpose of this investigation was to assess the intrasession and intersession reliability of the Vertec, Just Jump System, and Myotest for measuring countermovement vertical jump (CMJ) height. Forty male and 39 female university students completed 3 maximal-effort CMJs during 2 testing sessions, which were separated by 24-48 hours. The height of the CMJ was measured from all 3 devices simultaneously. Systematic error, relative reliability, absolute reliability, and heteroscedasticity were assessed for each device. Systematic error across the 3 CMJ trials was observed within both sessions for males and females, and this was most frequently observed when the CMJ height was measured by the Vertec. No systematic error was discovered across the 2 testing sessions when the maximum CMJ heights from the 2 sessions were compared. In males, the Myotest demonstrated the best intrasession reliability (intraclass correlation coefficient [ICC] = 0.95; SEM = 1.5 cm; coefficient of variation [CV] = 3.3%) and intersession reliability (ICC = 0.88; SEM = 2.4 cm; CV = 5.3%; limits of agreement = -0.08 ± 4.06 cm). Similarly, in females, the Myotest demonstrated the best intrasession reliability (ICC = 0.91; SEM = 1.4 cm; CV = 4.5%) and intersession reliability (ICC = 0.92; SEM = 1.3 cm; CV = 4.1%; limits of agreement = 0.33 ± 3.53 cm). Additional analysis revealed that heteroscedasticity was present in the CMJ when measured from all 3 devices, indicating that better jumpers demonstrate greater fluctuations in CMJ scores across testing sessions. To attain reliable CMJ height measurements, practitioners are encouraged to familiarize athletes with the CMJ technique and then allow the athletes to complete numerous repetitions until performance plateaus, particularly if the Vertec is being used.
