PONE-D-19-30700

Prediction of metastatic prostate cancer by prostate-specific antigen in combination with T stage and Gleason Grade. Nationwide, population-based register study

PLOS ONE

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The image quality in Figure 1 needs to be improved.

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http://dx.doi.org/10.1016/j.eururo.2017.06.036

https://doi.org/10.1080/0284186X.2019.1662084

https://doi.org/10.1111/bju.14563

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Reviewer #2: Yes

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Reviewer #1: “Prediction of metastatic prostate cancer by prostate-specific antigen in combination with T stage and Gleason Grade. Nationwide, population-based register study “

Thomsen et al.

Submitted to PLOS One

Higher T stage, Gleason grade, and serum PSA have previously been associated with bone metastases in prostate cancer patients. PSA above 100ng/mL has been used as a surrogate for metastatic prostate cancer, based on previous studies. However, two recent imaging studies suggested that PSA above 100ng/mL was associated with only a 45-75% presence of metastasis, and there are some concerns with selection bias in these studies.

Thomsen and colleagues sought to avoid the shortcoming of previous studies, and investigated the proportion of men with metastatic prostate cancer in groups defined by T stage, Gleason Grade Group (GGG), and serum PSA levels; and to determine if PSA can rule in metastatic disease when combined with T stage and GGG.

Conclusions are: 1) Advanced T stage, higher GGG, and higher PSA were strongly related to bone metastatic prostate cancer; and 2) PSA, regardless of cut-off, could not correctly identify men with metastatic disease with either sensitivity or specificity. Based on the second conclusion, omitting bone imaging could not safely be suggested. Main take home is metastatic prostate cancer could not be ruled in with sufficient accuracy by any combination of T stage, Gleason grade and PSA.

Critique:

Authors present the data and draw conclusions nicely. The only (minor) concern is the image quality of Figure 1. If a less “fuzzy” image could be supplied, that would be beneficial.

Reviewer #2: The goal of the manuscript “Prediction of metastatic prostate cancer by prostate-specific antigen in combination with T stage and Gleason Grade. Nationwide, population-based register study” is to assess whether serum PSA levels combined with T stage and Gleason Grade can be utilized to rule in metastatic prostate cancer. The study utilized a large Swedish cohort of patients (102,076 men) diagnosed with prostate cancer between 2006 and 2016. The study is well presented and suggests a necessity of imaging to detect bone metastases in men with advanced prostate cancer as serum PSA levels in combination with T stage and Gleason score could not accurately rule in metastatic prostate cancer. Publishing such a study will be valuable.

Minor concern that needs to be addressed before publication:

1. The authors need to provide a high resolution image for Fig 1.

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Reviewer #1: No

Reviewer #2: No

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Prediction of metastatic prostate cancer by prostate-specific antigen in combination with T stage and Gleason Grade. Nationwide, population-based register study

PONE-D-19-30700R1

Dear Dr. Thomsen,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

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With kind regards,

Lucia R. Languino, Ph.D.

Academic Editor

PLOS ONE

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