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ogen activator inhibitor type 1. J Natl Cancer Inst 2001; 93:913.
2. Look MP: Pooled analysis of uPA and PAI-1 for prognosis inprimary breast cancer patients. EORTC Receptor and Bi-omarker Study Group. Int J Biol Markers 2000; 15: 70.
3. Sier CF, Stephens R, Bizik J, Mariani A, Bassan M, Pedersen Net al: The level of urokinase-type plasminogen activator re-ceptor is increased in serum of ovarian cancer patients.Cancer Res 1998; 58: 1843.
4. Fernebro E, Madsen RR, Ferno M, Brunner N, Bendahl P,Christensen IJ et al: Prognostic importance of the solubleplasminogen activator receptor, suPAR, in plasma from rec-tal cancer patients. Eur J Cancer 2001; 37: 486.
5. Stephens RW, Nielsen HJ, Christensen IJ, Thorlacius-UssingO, Sorensen S, Dano K et al: Plasma urokinase receptorlevels in patients with colorectal cancer: relationship to prog-nosis. J Natl Cancer Inst 1999; 91: 869.
6. Kattan MW: When and how to use informatics tools in caring forurologic patients. Nat Clin Pract Urol 2005; 2: 183.
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The authors have analyzed the influence of circulating levelsof plasminogen activation inhibitor-1 on the accuracy ofpreoperative and postoperative nomograms for prediction ofprostate cancer recurrence after RP. Preoperative PAI-1 wasindependently associated with BCR. The addition of PAI-1increased the predictive accuracy of the preoperative modelby 1.2%, 7.7%, 10.3%, 6.7% and 5.4% at 1 to 5 years, respec-tively, whereas on the postoperative models the benefitranged from 0.5% to 3.6%.
As is the case with all nomograms, whether improvingthe accuracy by a limited percentage actually directly im-pacts general management remains to be seen, especiallywhen the accuracy of the model is far from 90%. The work isnot strikingly new because the same authors analyzed theusefulness of the plasminogen activation pathway in pros-tate cancer (reference 6 in article). Nevertheless, addinganother potential useful marker is a small brick in the hugewall of cancer behavior prediction.
It remains to be seen whether preoperative predictivevalues of 70% to 78.5%, even if improved compared to theuse of each variable alone, make a real difference for thepatient and treatment on an individual basis. Most likelythey do not, but this should not prevent the urological com-munity from further investigating new biological pathways.
The postoperative prediction of circulating levels of plas-minogen activation inhibitor-1 that and especially the ROCcurves are encouraging. It would have been interesting toknow whether the authors have the data at this stage tosupport that PAI-1 is rather associated with local or distantrecurrence. They obviously have a database and followup ofthese patients, which eventually could influence decisionsregarding adjuvant therapies.
Alexandre R. ZlottaDepartment of Surgery (Urology)
University of TorontoToronto, Canada
PLASMA LEVELS OF PLASMINOGEN ACTIVATION INHIBITOR-1 IN PROSTATE CANCER 1237