ArticleProstate cancer and prostatic diseases2019
Role of the 4Kscore test as a predictor of reclassification in prostate cancer active surveillance.
Article in Prostate cancer and prostatic diseases, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02865330 (Spanish Urological Association Registry of Patients on Active Surveillance), which is not on this map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Spanish Urological Association Registry of Patients on Active Surveillance
Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Role of multiparametric magnetic resonance imaging for patients under active surveillance for prostate cancer: a systematic review with diagnostic meta-analysis.Prostate cancer and prostatic diseases · 2019Pooled it
- Patients with high-risk features on active surveillance for prostate cancer.Prostate international · 2026Review
- 4K density: Adjusting the 4Kscore for prostate volume to improve risk stratification of clinically significant prostate cancer in men undergoing prostate biopsy.Prostate cancer and prostatic diseases · 2026Article
- Article
- Review
- Risk of reclassification and novel tools in active surveillance.Asian journal of urology · 2025Review
- Blood and urine-based biomarkers in prostate cancer: Current advances, clinical applications, and future directions.The journal of liquid biopsy · 2025Review
- Mitigating bias in prostate cancer diagnosis using synthetic data for improved AI driven Gleason grading.NPJ precision oncology · 2025Article
- Evaluating 4Kscore's role in predicting progression on active surveillance for prostate cancer independently of clinical information and PIRADS score.Prostate cancer and prostatic diseases · 2025Article
- Liquid Biomarkers in Prostate Cancer Diagnosis: Current Status and Emerging Prospects.The world journal of men's health · 2025Review
- Methylated DNA Markers in Voided Urine for the Identification of Clinically Significant Prostate Cancer.Life (Basel, Switzerland) · 2024Article
- Using active surveillance for Gleason 7 (3+4) prostate cancer: A narrative review.Canadian Urological Association journal = Journal de l'Association des urologues du Canada · 2024Review
- A Novel Blood Proteomic Signature for Prostate Cancer.Cancers · 2023Article
- Active Surveillance in Prostate Cancer: Role of Available Biomarkers in Daily Practice.International journal of molecular sciences · 2021Review
- Role of Multiparametric Prostate Magnetic Resonance Imaging before Confirmatory Biopsy in Assessing the Risk of Prostate Cancer Progression during Active Surveillance.Korean journal of radiology · 2021Article
- [Active surveillance in prostate cancer].Der Urologe. Ausg. A · 2019Review
- An Ultra-Rapid Biosensory Point-of-Care (POC) Assay for Prostate-Specific Antigen (PSA) Detection in Human Serum.Sensors (Basel, Switzerland) · 2018Article
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Authors and funding
21 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundManagement of active surveillance (AS) in low-risk prostate cancer (PCa) patients could be improved with new biomarkers, such as the 4Kscore test. We analyze its ability to predict tumor reclassification by upgrading at the confirmatory biopsy at 6 months.
methodsObservational, prospective, blinded, and non-randomized study, within the Spanish National Registry on AS (AEU/PIEM/2014/0001; NCT02865330) with 181 patients included after initial Bx and inclusion criteria: PSA ≤10 ng/mL, cT1c-T2a, Grade group 1, ≤2 cores, and ≤5 mm/50% length core involved. Central pathological review of initial and confirmatory Bx was performed on all biopsy specimens. Plasma was collected 6 months after initial Bx and just before confirmatory Bx to determine 4Kscore result. In order to predict reclassification defined as Grade group ≥2, we analyzed 4Kscore, percent free to total (%f/t) PSA ratio, prostate volume, PSA density, family history, body mass index, initial Bx, total cores, initial Bx positive cores, initial Bx % of positive cores, initial Bx maximum cancer core length and initial Bx cancer % involvement. Wilcoxon rank-sum test, non-parametric trend test or Fisher's exact test, as appropriate established differences between groups of reclassification.
resultsA total of 137 patients met inclusion criteria. Eighteen patients (13.1%) were reclassified at confirmatory Bx. The %f/t PSA ratio and 4Kscore showed differences between the groups of reclassification (Yes/No). Using 7.5% as cutoff for the 4Kscore, we found a sensitivity of 89% and a specificity of 29%, with no reclassifications to Grade group 3 for patients with 4Kscore below 7.5% and 2 (6%) missed Grade group 2 reclassified patients. Using this threshold value there is a biopsy reduction of 27%. Additionally, 4Kscore was also associated with changes in tumor volume.
conclusionsOur preliminary findings suggest that the 4Kscore may be a useful tool in the decision-making process to perform a confirmatory Bx in active surveillance management.
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