451
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Xu N, Wu YP, Chen DN, Ke ZB, Cai H, Wei Y, Zheng QS, Huang JB, Li XD, Xue XY. Can Prostate Imaging Reporting and Data System Version 2 reduce unnecessary prostate biopsies in men with PSA levels of 4–10 ng/ml? J Cancer Res Clin Oncol 2018; 144:987-995. [DOI: 10.1007/s00432-018-2616-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/20/2018] [Indexed: 11/28/2022]
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452
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453
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Shao H, Im H, Castro CM, Breakefield X, Weissleder R, Lee H. New Technologies for Analysis of Extracellular Vesicles. Chem Rev 2018; 118:1917-1950. [PMID: 29384376 PMCID: PMC6029891 DOI: 10.1021/acs.chemrev.7b00534] [Citation(s) in RCA: 981] [Impact Index Per Article: 163.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Extracellular vesicles (EVs) are diverse, nanoscale membrane vesicles actively released by cells. Similar-sized vesicles can be further classified (e.g., exosomes, microvesicles) based on their biogenesis, size, and biophysical properties. Although initially thought to be cellular debris, and thus under-appreciated, EVs are now increasingly recognized as important vehicles of intercellular communication and circulating biomarkers for disease diagnoses and prognosis. Despite their clinical potential, the lack of sensitive preparatory and analytical technologies for EVs poses a barrier to clinical translation. New analytical platforms including molecular ones are thus actively being developed to address these challenges. Recent advances in the field are expected to have far-reaching impact in both basic and translational studies. This article aims to present a comprehensive and critical overview of emerging analytical technologies for EV detection and their clinical applications.
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Affiliation(s)
- Huilin Shao
- Departments of Biomedical Engineering and Surgery, National University of Singapore
- Biomedical Institute for Global Health Research and Technology, National University of Singapore
- Institute of Molecular and Cell Biology, Agency for Science Technology and Research
| | - Hyungsoon Im
- Center for Systems Biology, Massachusetts General Hospital
- Department of Radiology, Massachusetts General Hospital
| | - Cesar M. Castro
- Center for Systems Biology, Massachusetts General Hospital
- Department of Medicine, Massachusetts General Hospital
| | - Xandra Breakefield
- Department of Radiology, Massachusetts General Hospital
- Department of Neurology, Massachusetts General Hospital
| | - Ralph Weissleder
- Center for Systems Biology, Massachusetts General Hospital
- Department of Radiology, Massachusetts General Hospital
- Department of Systems Biology, Harvard Medical School
| | - Hakho Lee
- Center for Systems Biology, Massachusetts General Hospital
- Department of Radiology, Massachusetts General Hospital
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454
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Nieboer D, Tomer A, Rizopoulos D, Roobol MJ, Steyerberg EW. Active surveillance: a review of risk-based, dynamic monitoring. Transl Androl Urol 2018; 7:106-115. [PMID: 29594025 PMCID: PMC5861286 DOI: 10.21037/tau.2017.12.27] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Active surveillance (AS) is an important treatment modality aiming to reduce the overtreatment of patients with prostate cancer (PCa) who have a low risk of disease reclassification. After enrolling in AS patients are actively monitored using different diagnostic tests (e.g., prostate specific-antigen, digital rectal exams (DREs), medical imaging, and prostate biopsies). Biopsy is the most burdensome test. We aimed to review schedules for monitoring men on AS. We compare fixed versus risk based dynamic monitoring, where biopsies are scheduled during follow-up based on dynamic risk predictions. Several prediction models and scheduling techniques have been published. All proposed risk prediction models need further external validation. We conclude that risk based, dynamic monitoring is a promising new strategy to further reduce overtreatment in PCa patients.
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Affiliation(s)
- Daan Nieboer
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Anirudh Tomer
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
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455
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Drost FJH, Rannikko A, Valdagni R, Pickles T, Kakehi Y, Remmers S, van der Poel HG, Bangma CH, Roobol MJ. Can active surveillance really reduce the harms of overdiagnosing prostate cancer? A reflection of real life clinical practice in the PRIAS study. Transl Androl Urol 2018; 7:98-105. [PMID: 29594024 PMCID: PMC5861273 DOI: 10.21037/tau.2017.12.28] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Active surveillance (AS) for low-risk prostate cancer (PCa) appears to provide excellent long-term PCa-specific and overall survival. The choice for AS as initial treatment is mainly based on avoiding side effects from invasive treatment; but AS entails regular check-ups and the possibility of still having to switch or deciding to switch to invasive treatment. Here, we assessed the long-term follow-up data from AS in real life clinical practices. Methods Data from the first 500 men, enrolled in PRIAS before July 2008 by 30 centers across 8 countries, were analyzed to provide long-term follow-up results. Men were advised to be regularly examined with prostate-specific antigen (PSA) tests, digital rectal examinations, and prostate biopsies. Men were advised to switch to invasive treatment if they had disease reclassification [Gleason score (GS) ≥3+4 on biopsy, more than two positive biopsy cores, a stage higher than cT2] or a PSA-doubling time of 0-3 years. We assessed time on AS, outcomes and reasons for discontinuing AS, and rates of potential unnecessary biopsies and treatments. Results The median follow-up time was 6.5 years. During this period, 325 (65%) men discontinued after a median of 2.3 years and 121 (24%) men had no recent (>1 year) data-update after a median of 7.3 years. The remaining 54 (11%) men were confirmed to be still on AS. Most men discontinued based on protocol advice; 38% had other reasons. During follow-up, 838 biopsy sessions were performed of which 79% to 90% did not lead to reclassification, depending on the criteria. Of the 325 discontinued men, 112 subsequently underwent radical prostatectomy (RP), 126 underwent radiotherapy, 57 switched to watchful waiting (WW) or died, and 30 had another or unknown treatment. RP results were available of 99 men: 34% to 68%, depending on definition, had favorable outcomes; 50% of unfavorable the outcomes occurred in the first 2 years. Of the 30 (6%) men who died, 1 man died due to PCa. Conclusions These data, reflecting real life clinical practice, show that more than half of men switched to invasive treatment within 2.3 years, indicating limitations to the extent in which AS is able to reduce the adverse effects of overdiagnosis. Therefore, despite guidelines stating that PCa diagnosis must be uncoupled from treatment, it remains important to avoid overdiagnosing PCa as much as possible.
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Affiliation(s)
- Frank-Jan H Drost
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Antti Rannikko
- Department of Urology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Riccardo Valdagni
- Prostate Cancer Program and Radiation Oncology, Fondazione IRCSS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tom Pickles
- Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | - Yoshiyuki Kakehi
- Department of Urology, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Sebastiaan Remmers
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Henk G van der Poel
- The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Chris H Bangma
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
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456
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Verbeek JFM, Roobol MJ. What is an acceptable false negative rate in the detection of prostate cancer? Transl Androl Urol 2018; 7:54-60. [PMID: 29594020 PMCID: PMC5861290 DOI: 10.21037/tau.2017.12.12] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background In prostate cancer (PCa) screening men and their physicians aim to rule out the presence of potentially life threatening PCa. To date, prostate specific antigen (PSA) testing and systematic prostate biopsy (Bx)—in case of an elevated PSA—are still the main modes of PCa detection. Often uncertainty remains when a PSA-test is <3.0 ng/mL or a Bx shows a benign result, leading to the continuous repeating of procedures. Here we assess the potential consequences of false negatives by studying follow-up data of a purely PSA-based approach with applying sextant Bx, an approach considered to have a high risk of missing PCa diagnosis. Methods Our study population consisted of 19,970 men from the ERSPC project section Rotterdam, initially screened in 1993–1999. We assessed clinically significant Gleason ≥3+4 PCa (csPCa) diagnosis within the 4-year screening interval and subsequent screening round 4 years later in men having a PSA <3.0 ng/mL at initial screening (no Bx) and men with Bx (PSA >3.0 ng/mL), but no PCa detected at that time. In addition, we addressed PCa mortality and PCa diagnosis for men with a negative PSA test and negative Bx, who were retested every 4 years covering a 15-year follow-up. Results A total of 14,935 men had PSA <3.0 ng/mL in the initial screening round, of whom 75 (0.5%) were diagnosed with csPCa at a subsequent screening examination and 2 (<0.1%) in the 4-year screening interval. For 2,260 men with a previously negative Bx at first screening, the figures were 17 (0.8%) and 2 (0.1%) respectively. Indolent PCa (Gleason ≤3+3) was diagnosed in 312 (2%) men with PSA <3.0 ng/mL initially and 115 (5%) men with initial negative Bx. After a 15-year follow-up, 45 (0.3%) PCa deaths occurred in men with initially low PSA, and 29 men (0.2%) had metastasis. For men with negative Bx, 11 (0.5%) PCa deaths occurred and 4 (0.2%) experienced metastasis. Conclusions The false negative rates for men with PSA <3.0 ng/mL and negative sextant Bx are extremely low but not negligible. Proper risk stratification before deciding to biopsy is expected to hardly miss any clinical significant PCa diagnosis. This is especially relevant with the increased use of the relatively expensive multi-parametric magnetic resonance imaging (mpMRI) guided targeted Bx procedures.
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Affiliation(s)
- Jan F M Verbeek
- Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands
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457
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Herden J, Ansmann L, Ernstmann N, Schnell D, Weißbac L. The Treatment of Localized Prostate Cancer in Everyday Practice in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 113:329-36. [PMID: 27232362 DOI: 10.3238/arztebl.2016.0329] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 12/21/2015] [Accepted: 12/21/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Prostate cancer is now often diagnosed in the localized, welldifferentiated stage. In the HAROW study, we investigated the care situation with respect to the various treatment options for localized prostate cancer in everyday clinical practice in Germany. METHODS Study physicians for this prospective, multicenter observational study were recruited through the Federation of German Urologists. At six-month intervals, clinical variables were recorded (T category, prostate-specific antigen [PSA], Gleason score, d'Amico risk profile, Charlson Comorbidity Index [CCI]) and patients filled out questionnaires (QLQ-C30) regarding their indicationrelated quality of life (QoL). Covariance analysis was used to adjust for the variable distribution of patient features among the treatment groups. RESULTS Data from 2957 patients were available for analysis. The mean followup time was 28.4 months overall, and 47.6 months in the active surveillance (AS) group. Younger patients and patients with a CCI of 0 or 1 predominated in the AS and surgery groups; older patients and patients with a CCI of 2 or above predominated in the groups in which palliative treatment strategies such as hormone therapy (HT) and watchful waiting were applied. The HT group had the highest percentage of patients with a Gleason score of 8 or above (21.2%), while the AS group had the highest percentage of patients with a Gleason score of 6 or below (92.5%), as well as the lowest mean PSA value (5.8 ± 3.4 ng/mL) and the highest percentage of patients with a low-risk profile (82.5%). Of 468 patients in the AS group, 170 (36.3%) underwent a change of treatment strategy. After adjustment for the severity of disease, no significant difference with respect to the global quality of life was found between AS and the curative treatment options over the long term. CONCLUSION The study physicians drew a clear distinction between curative and palliative treatment strategies, and the inclusion criteria for AS were largely respected. The observed preference for surgery in low-risk patients indicates overtreatment in this patient group.
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Affiliation(s)
- Jan Herden
- Department of Urology, Cologne University Hospital, Cologne, Institute for Medical Sociology, Healthcare Research and Rehabilitation Science, Cologne University, Cologne, Foundation of Men's Health, Berlin
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458
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Hoogland AM, Böttcher R, Verhoef E, Jenster G, van Leenders GJLH. Gene-expression analysis of gleason grade 3 tumor glands embedded in low- and high-risk prostate cancer. Oncotarget 2018; 7:37846-37856. [PMID: 27191985 PMCID: PMC5122354 DOI: 10.18632/oncotarget.9344] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 04/25/2016] [Indexed: 12/02/2022] Open
Abstract
The Gleason score (GS) of prostate cancer on diagnostic biopsies is an important parameter for therapeutic decision-making. Biopsy GS under-estimates the actual GS at radical prostatectomy in a significant number of patients due to sampling artifact. The aim of this study was to identify markers that are differentially expressed in Gleason grade 3 (GG3) tumor glands embedded in GS 4 + 3 = 7 and GS 3 + 3 = 6 prostate cancer using laser capture microdissection and RNA sequencing. GG3 tumor glands embedded in nine GS 3 + 3 = 6 and nine GS 4 + 3 = 7 prostate cancers were isolated by laser capture microdissection of frozen radical prostatectomy specimens. After RNA amplification and RNA sequencing, differentially expressed genes in both GG3 components were identified by a 2log fold change > 1.0 and p-value < 0.05. We applied immunohistochemistry on a tissue micro-array representing 481 radical prostatectomy samples for further validation on protein level. A total of 501 genes were up-regulated and 421 down-regulated in GG3 glands embedded in GS 4 + 3 = 7 as compared to GS 3 + 3 = 6 prostate cancer. We selected HELLS, ZIC2 and ZIC5 genes for further validation. ZIC5 mRNA was up-regulated 17 fold (p = 8.4E–07), ZIC2 8 fold (p = 1.3E–05) and HELLS 2 fold (p = 0.006) in GG3 glands derived from GS 4 + 3 = 7. HELLS expression of ≥ 1% occurred in 10% GS < 7, 17% GS 7 and 43% GS >7 prostate cancer (p < 0.001). Using a cut-off of ≥ 1%, protein expression of ZIC5 was present in 28% GS < 7, 43% GS 7 and 57% GS > 7 cancer (p < 0.001). ZIC2 was neither associated with GS nor outcome in our validation set. HELLS was independently predictive for biochemical-recurrence after radical prostatectomy (HR 2.3; CI 1.5–3.6; p < 0.01). In conclusion, HELLS and ZIC5 might be promising candidate markers for selection of biopsy GS 6 prostate cancer being at risk for up-grading at prostatectomy.
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Affiliation(s)
- A Marije Hoogland
- Departments of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - René Böttcher
- Departments of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Bioinformatics, University of Applied Sciences Wildau, Wildau, Germany
| | - Esther Verhoef
- Departments of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Guido Jenster
- Departments of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
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459
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Seibert TM, Fan CC, Wang Y, Zuber V, Karunamuni R, Parsons JK, Eeles RA, Easton DF, Kote-Jarai ZS, Al Olama AA, Garcia SB, Muir K, Grönberg H, Wiklund F, Aly M, Schleutker J, Sipeky C, Tammela TL, Nordestgaard BG, Nielsen SF, Weischer M, Bisbjerg R, Røder MA, Iversen P, Key TJ, Travis RC, Neal DE, Donovan JL, Hamdy FC, Pharoah P, Pashayan N, Khaw KT, Maier C, Vogel W, Luedeke M, Herkommer K, Kibel AS, Cybulski C, Wokolorczyk D, Kluzniak W, Cannon-Albright L, Brenner H, Cuk K, Saum KU, Park JY, Sellers TA, Slavov C, Kaneva R, Mitev V, Batra J, Clements JA, Spurdle A, Teixeira MR, Paulo P, Maia S, Pandha H, Michael A, Kierzek A, Karow DS, Mills IG, Andreassen OA, Dale AM. Polygenic hazard score to guide screening for aggressive prostate cancer: development and validation in large scale cohorts. BMJ 2018; 360:j5757. [PMID: 29321194 PMCID: PMC5759091 DOI: 10.1136/bmj.j5757] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To develop and validate a genetic tool to predict age of onset of aggressive prostate cancer (PCa) and to guide decisions of who to screen and at what age. DESIGN Analysis of genotype, PCa status, and age to select single nucleotide polymorphisms (SNPs) associated with diagnosis. These polymorphisms were incorporated into a survival analysis to estimate their effects on age at diagnosis of aggressive PCa (that is, not eligible for surveillance according to National Comprehensive Cancer Network guidelines; any of Gleason score ≥7, stage T3-T4, PSA (prostate specific antigen) concentration ≥10 ng/L, nodal metastasis, distant metastasis). The resulting polygenic hazard score is an assessment of individual genetic risk. The final model was applied to an independent dataset containing genotype and PSA screening data. The hazard score was calculated for these men to test prediction of survival free from PCa. SETTING Multiple institutions that were members of international PRACTICAL consortium. PARTICIPANTS All consortium participants of European ancestry with known age, PCa status, and quality assured custom (iCOGS) array genotype data. The development dataset comprised 31 747 men; the validation dataset comprised 6411 men. MAIN OUTCOME MEASURES Prediction with hazard score of age of onset of aggressive cancer in validation set. RESULTS In the independent validation set, the hazard score calculated from 54 single nucleotide polymorphisms was a highly significant predictor of age at diagnosis of aggressive cancer (z=11.2, P<10-16). When men in the validation set with high scores (>98th centile) were compared with those with average scores (30th-70th centile), the hazard ratio for aggressive cancer was 2.9 (95% confidence interval 2.4 to 3.4). Inclusion of family history in a combined model did not improve prediction of onset of aggressive PCa (P=0.59), and polygenic hazard score performance remained high when family history was accounted for. Additionally, the positive predictive value of PSA screening for aggressive PCa was increased with increasing polygenic hazard score. CONCLUSIONS Polygenic hazard scores can be used for personalised genetic risk estimates that can predict for age at onset of aggressive PCa.
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Affiliation(s)
- Tyler M Seibert
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, USA
| | - Chun Chieh Fan
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, USA
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, USA
| | - Yunpeng Wang
- NORMENT, KG Jebsen Centre, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Verena Zuber
- NORMENT, KG Jebsen Centre, Oslo University Hospital and University of Oslo, Oslo, Norway
- MRC Biostatistics Unit, Cambridge Biomedical Campus, Cambridge CB2 0SR, UK
| | - Roshan Karunamuni
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, USA
| | - J Kellogg Parsons
- Department of Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Rosalind A Eeles
- Institute of Cancer Research, London, SM2 5NG, UK
- Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
| | | | - Ali Amin Al Olama
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
- Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, R3, Box 83, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Sara Benlloch Garcia
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
| | - Kenneth Muir
- Institute of Population Health, University of Manchester, Manchester, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Henrik Grönberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Wiklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Markus Aly
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Solna, 171 76 Stockholm, Sweden
- Department of Urology, Karolinska University Hospital, Solna, 171 76 Stockholm, Sweden
| | - Johanna Schleutker
- Department of Medical Biochemistry and Genetics, Institute of Biomedicine, Kiinamyllynkatu 10, FI-20014 University of Turku, Finland
- Tyks Microbiology and Genetics, Department of Medical Genetics, Turku University Hospital, Turku, Finland
- BioMediTech, 30014 University of Tampere, Tampere, Finland
| | - Csilla Sipeky
- Department of Medical Biochemistry and Genetics, Institute of Biomedicine, Kiinamyllynkatu 10, FI-20014 University of Turku, Finland
- Tyks Microbiology and Genetics, Department of Medical Genetics, Turku University Hospital, Turku, Finland
| | - Teuvo Lj Tammela
- Department of Urology, Tampere University Hospital and Medical School, University of Tampere, Finland
| | - Børge G Nordestgaard
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Sune F Nielsen
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Maren Weischer
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Rasmus Bisbjerg
- Department of Urology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - M Andreas Røder
- Copenhagen Prostate Cancer Centre, Department of Urology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Iversen
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Copenhagen Prostate Cancer Centre, Department of Urology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tim J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health University of Oxford, Oxford OX3 7LF, UK
| | - Ruth C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health University of Oxford, Oxford OX3 7LF, UK
| | - David E Neal
- Nuffield Department of Surgical Sciences, Faculty of Medical Science, University of Oxford, John Radcliffe Hospital, Oxford, UK
- University of Cambridge, Department of Oncology, Box 279, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Jenny L Donovan
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, Faculty of Medical Science, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Paul Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - Nora Pashayan
- University College London, Department of Applied Health Research, London WC1E 7HB, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - Kay-Tee Khaw
- Clinical Gerontology Unit, University of Cambridge, Cambridge UK
| | - Christiane Maier
- Institute of Human Genetics, University Hospital of Ulm, Ulm, Germany
| | - Walther Vogel
- Institute of Human Genetics, University Hospital of Ulm, Ulm, Germany
| | - Manuel Luedeke
- Institute of Human Genetics, University Hospital of Ulm, Ulm, Germany
| | - Kathleen Herkommer
- Department of Urology, Klinikum rechts der Isar der Technischen Universitaet Muenchen, Munich, Germany
| | - Adam S Kibel
- Division of Urologic Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, 75 Francis Street, Boston, MA 02115, USA
| | - Cezary Cybulski
- International Hereditary Cancer Centre, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Dominika Wokolorczyk
- International Hereditary Cancer Centre, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Wojciech Kluzniak
- International Hereditary Cancer Centre, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Lisa Cannon-Albright
- Division of Genetic Epidemiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Katarina Cuk
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kai-Uwe Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jong Y Park
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Thomas A Sellers
- Office of the Center Director, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Chavdar Slavov
- Department of Urology and Alexandrovska University Hospital, Medical University, Sofia, Bulgaria
| | - Radka Kaneva
- Department of Medical Chemistry and Biochemistry, Molecular Medicine Center, Medical University, Sofia, 2 Zdrave Str, 1431 Sofia, Bulgaria
| | - Vanio Mitev
- Department of Medical Chemistry and Biochemistry, Molecular Medicine Center, Medical University, Sofia, 2 Zdrave Str, 1431 Sofia, Bulgaria
| | - Jyotsna Batra
- Australian Prostate Cancer Research Centre-Qld, Institute of Health and Biomedical Innovation and School of Biomedical Science, Queensland University of Technology, Brisbane, Australia
| | - Judith A Clements
- Australian Prostate Cancer Research Centre-Qld, Institute of Health and Biomedical Innovation and School of Biomedical Science, Queensland University of Technology, Brisbane, Australia
| | - Amanda Spurdle
- Molecular Cancer Epidemiology Laboratory, Queensland Institute of Medical Research, Brisbane, Australia
- Australian Prostate Cancer Research Centre-Qld, Institute of Health and Biomedical Innovation and School of Biomedical Science, Queensland University of Technology, Brisbane, Australia
- Australian Prostate Cancer BioResource, Institute of Health and Biomedical Innovation and School of Biomedical Science, Queensland University of Technology, Brisbane, Australia
| | - Manuel R Teixeira
- Department of Genetics, Portuguese Oncology Institute, Porto, Portugal
- Biomedical Sciences Institute (ICBAS), University of Porto, Porto, Portugal
| | - Paula Paulo
- Department of Genetics, Portuguese Oncology Institute, Porto, Portugal
| | - Sofia Maia
- Department of Genetics, Portuguese Oncology Institute, Porto, Portugal
| | | | | | | | - David S Karow
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, USA
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Ian G Mills
- NORMENT, KG Jebsen Centre, Oslo University Hospital and University of Oslo, Oslo, Norway
- Centre for Cancer Research and Cell Biology, Queens University Belfast, Belfast, UK
- Nuffield Department of Surgical Sciences, Faculty of Medical Science, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Ole A Andreassen
- NORMENT, KG Jebsen Centre, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Anders M Dale
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, USA
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
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460
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Druskin SC, Tosoian JJ, Young A, Collica S, Srivastava A, Ghabili K, Macura KJ, Carter HB, Partin AW, Sokoll LJ, Ross AE, Pavlovich CP. Combining Prostate Health Index density, magnetic resonance imaging and prior negative biopsy status to improve the detection of clinically significant prostate cancer. BJU Int 2018; 121:619-626. [PMID: 29232037 DOI: 10.1111/bju.14098] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To determine the performance of Prostate Health Index (PHI) density (PHID) combined with MRI and prior negative biopsy (PNB) status for the diagnosis of clinically significant prostate cancer (PCa). PATIENTS AND METHODS Patients without a prior diagnosis of PCa, with elevated prostate-specific antigen and a normal digital rectal examination who underwent PHI testing prospectively prior to prostate biopsy were included in this study. PHID was calculated retrospectively using prostate volume derived from transrectal ultrasonography at biopsy. Univariable and multivariable logistic regression modelling, along with receiver-operating characteristic (ROC) curve analysis, was used to determine the ability of serum biomarkers to predict clinically significant PCa (defined as either grade group [GG] ≥2 disease or GG1 PCa detected in >2 cores or >50% of any one core) on biopsy. Age, PNB status and Prostate Imaging Reporting and Data System (PI-RADS) score were incorporated into the regression models. RESULTS Of the 241 men who qualified for the study, 91 (37.8%) had clinically significant PCa on biopsy. The median (interquartile range) PHID was 0.74 (0.44-1.24); it was 1.18 (0.77-1.83) and 0.55 (0.38-0.89) in those with and without clinically significant PCa on biopsy, respectively (P < 0.001). On univariable logistic regression, age and PNB status were associated with clinically significant cancer. Of the tested biomarkers, PHID demonstrated the highest discriminative ability for clinically significant disease (area under the ROC curve [AUC] 0.78 for the univariable model). That continued to be the case in multivariable logistic regression models incorporating age and PNB status (AUC 0.82). At a threshold of 0.44, representing the 25th percentile of PHID in the cohort, PHID was 92.3% sensitive and 35.3% specific for clinically significant PCa; the sensitivity and specificity were 93.0% and 32.4% and 97.4% and 29.1% for GG ≥2 and GG ≥3 disease, respectively. In the 104 men who underwent MRI, PI-RADS score was complementary to PHID, with a PI-RADS score ≥3 or, if PI-RADS score ≤2, a PHID ≥0.44, detecting 100% of clinically significant disease. For that subgroup, of the biomarkers tested, PHID (AUC 0.90) demonstrated the highest discriminative ability for clinically significant disease on multivariable logistic regression incorporating age, PNB status and PI-RADS score. CONCLUSIONS In this contemporary cohort of men undergoing prostate biopsy for the diagnosis of PCa, PHID outperformed PHI and other PSA derivatives in the diagnosis of clinically significant cancer. Incorporating age, PNB status and PI-RADS score led to even further gains in the diagnostic performance of PHID. Furthermore, PI-RADS score was found to be complementary to PHID. Using 0.44 as a threshold for PHID, 35.3% of unnecessary biopsies could have been avoided at the cost of missing 7.7% of clinically significant cancers. Despite these encouraging results, prospective validation is needed.
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Affiliation(s)
- Sasha C Druskin
- James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey J Tosoian
- James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allen Young
- James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah Collica
- James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Arnav Srivastava
- James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kamyar Ghabili
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | - Katarzyna J Macura
- James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - H Ballentine Carter
- James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alan W Partin
- James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lori J Sokoll
- James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ashley E Ross
- James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christian P Pavlovich
- James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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461
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Pestova K, Koch AJ, Quesenberry CP, Shan J, Zhang Y, Leimpeter AD, Blondin B, Sitailo S, Buckingham L, Du J, Fei H, Van Den Eeden SK. Identification of fluorescence in situ hybridization assay markers for prediction of disease progression in prostate cancer patients on active surveillance. BMC Cancer 2018; 18:2. [PMID: 29291731 PMCID: PMC5749018 DOI: 10.1186/s12885-017-3910-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 12/13/2017] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Prostate Cancer (PCa) is the second most prevalent cancer among U.S. males. In recent decades many men with low risk PCa have been over diagnosed and over treated. Given significant co-morbidities associated with definitive treatments, maximizing patient quality of life while recognizing early signs of aggressive disease is essential. There remains a need to better stratify newly diagnosed men according to the risk of disease progression, identifying, with high sensitivity and specificity, candidates for active surveillance versus intervention therapy. The objective of this study was to select fluorescence in situ hybridization (FISH) panels that differentiate non-progressive from progressive disease in patients with low and intermediate risk PCa. METHODS We performed a retrospective case-control study to evaluate FISH biomarkers on specimens from PCa patients with clinically localised disease (T1c-T2c) enrolled in Watchful waiting (WW)/Active Surveillance (AS). The patients were classified into cases (progressed to clinical intervention within 10 years), and controls (did not progress in 10 years). Receiver Operating Characteristic (ROC) curve analysis was performed to identify the best 3-5 probe combinations. FISH parameters were then combined with the clinical parameters ─ National Comprehensive Cancer Network (NNCN) risk categories ─ in the logistic regression model. RESULTS Seven combinations of FISH parameters with the highest sensitivity and specificity for discriminating cases from controls were selected based on the ROC curve analysis. In the logistic regression model, these combinations contributed significantly to the prediction of PCa outcome. The combination of NCCN risk categories and FISH was additive to the clinical parameters or FISH alone in the final model, with odds ratios of 5.1 to 7.0 for the likelihood of the FISH-positive patients in the intended population to develop disease progression, as compared to the FISH-negative group. CONCLUSIONS Combinations of FISH parameters discriminating progressive from non-progressive PCa were selected based on ROC curve analysis. The combination of clinical parameters and FISH outperformed clinical parameters alone, and was complimentary to clinical parameters in the final model, demonstrating potential utility of multi-colour FISH panels as an auxiliary tool for PCa risk stratification. Further studies with larger cohorts are planned to confirm these findings.
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Affiliation(s)
- Katerina Pestova
- Abbott Molecular, Inc., 1300 East Touhy Avenue, Des Plaines, IL 60018 USA
| | - Adam J. Koch
- Abbott Molecular, Inc., 1300 East Touhy Avenue, Des Plaines, IL 60018 USA
| | - Charles P. Quesenberry
- Abbott Molecular, Inc., 1300 East Touhy Avenue, Des Plaines, IL 60018 USA
- Rush University Medical Center, Chicago, IL USA
- Kaiser Permanente Division of Research, Oakland, CA USA
| | - Jun Shan
- Kaiser Permanente Division of Research, Oakland, CA USA
| | - Ying Zhang
- Abbott Molecular, Inc., 1300 East Touhy Avenue, Des Plaines, IL 60018 USA
| | | | - Beth Blondin
- Abbott Molecular, Inc., 1300 East Touhy Avenue, Des Plaines, IL 60018 USA
| | - Svetlana Sitailo
- Abbott Molecular, Inc., 1300 East Touhy Avenue, Des Plaines, IL 60018 USA
| | | | - Jing Du
- Abbott Molecular, Inc., 1300 East Touhy Avenue, Des Plaines, IL 60018 USA
| | - Huixin Fei
- Abbott Molecular, Inc., 1300 East Touhy Avenue, Des Plaines, IL 60018 USA
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462
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Evaluation and Treatment for Older Men with Elevated PSA. Prostate Cancer 2018. [DOI: 10.1007/978-3-319-78646-9_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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463
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Guo Y, Liu B, Liu J, Wang S, Wang R, Chang R, Sun W, Ma T, Li Q. Serum and tissue monocyte differentiation in PSA value 4–10 ng/mL prostate cancer and benign prostatic hyperplasia. EUR J INFLAMM 2018. [DOI: 10.1177/2058739218812665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Increased serum prostate-specific antigen (PSA) level is closely associated with prostate cancer; however, there is still no reliable method for distinguishing prostate cancer from benign prostatic hyperplasia (BPH) when the PSA level is between 4 and 10 ng/mL. In this study, we detected the inflammatory cell counts in serum and prostate tissues in prostate cancer and BPH patients. The results showed that the monocyte counts in both serum and prostate tissues were obviously less in patients with prostate cancer than that in those with BPH, which indicates that monocyte may be associated with development of prostate cancer and it is possible to increase positive finding for prostate cancer with 4–10 ng/mL PSA concentration by detecting and analyzing monocyte count in serum and tissue simultaneously.
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Affiliation(s)
- Yuanyuan Guo
- Department of Urology, First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Beibei Liu
- Department of Urology, First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Jianmin Liu
- Department of Urology, First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Sheng Wang
- Department of Urology, First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Rui Wang
- Department of Medical Oncology, First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Rui Chang
- Department of Urology, First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Wenyan Sun
- Department of Urology, First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Tantu Ma
- Department of Urology, First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Qingwen Li
- Department of Urology, First Affiliated Hospital of Bengbu Medical College, Bengbu, China
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464
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Schütz V, Kesch C, Dieffenbacher S, Bonekamp D, Hadaschik BA, Hohenfellner M, Radtke JP. Multiparametric MRI and MRI/TRUS Fusion Guided Biopsy for the Diagnosis of Prostate Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1096:87-98. [DOI: 10.1007/978-3-319-99286-0_5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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465
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Steele CB, Li J, Huang B, Weir HK. Prostate cancer survival in the United States by race and stage (2001-2009): Findings from the CONCORD-2 study. Cancer 2017; 123 Suppl 24:5160-5177. [PMID: 29205313 DOI: 10.1002/cncr.31026] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 07/24/2017] [Accepted: 08/08/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND The 5-year relative survival for prostate cancers diagnosed between 1990 and 1994 in the United States was very high (92%); however, survival in black males was 7% lower compared with white males. The authors updated these findings and examined survival by stage and race. METHODS The authors used data from the CONCORD-2 study for males (ages 15-99 years) who were diagnosed with prostate cancer in 37 states, covering 80% of the US population. Survival was adjusted for background mortality (net survival) using state-specific and race-specific life tables and was age-standardized. Data were presented for 2001 through 2003 and 2004 through 2009 to account for changes in collecting SEER Summary Stage 2000. RESULTS Among the 1,527,602 prostate cancers diagnosed between 2001 and 2009, the proportion of localized cases increased from 73% to 77% in black males and from 77% to 79% in white males. Although the proportion of distant-stage cases was higher among black males than among white males, they represented less than 6% of cases in both groups between 2004 and 2009. Net survival exceeded 99% for localized stage between 2004 and 2009 in both racial groups. Overall, and in most states, 5-year net survival exceeded 95%. CONCLUSIONS Prostate cancer survival has increased since the first CONCORD study, and the racial gap has narrowed. Earlier detection of localized cancers likely contributed to this finding. However, racial disparities also were observed in overall survival. To help understand which factors might contribute to the persistence of this disparity, states could use local data to explore sociodemographic characteristics, such as survivors' health insurance status, health literacy, treatment decision-making processes, and treatment preferences. Cancer 2017;123:5160-77. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- C Brooke Steele
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jun Li
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bin Huang
- Markey Cancer Center, Kentucky Cancer Registry, and College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Hannah K Weir
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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466
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Druskin SC, Macura KJ. MR Imaging for Prostate Cancer Screening and Active Surveillance. Radiol Clin North Am 2017; 56:251-261. [PMID: 29420980 DOI: 10.1016/j.rcl.2017.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The current prostate cancer management paradigm has been criticized in recent years for contributing to the overdiagnosis and overtreatment of the disease. Active surveillance is an avenue by which to reduce overtreatment, but patient selection and monitoring remain a challenge. The use of prostate MR imaging has been growing in recent years and has been incorporated into prostate cancer screening and patient selection and monitoring for active surveillance. This review article discusses the current evidence for the use of MR imaging in each of those settings.
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Affiliation(s)
- Sasha C Druskin
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Marburg 134, Baltimore, MD 21287, USA
| | - Katarzyna J Macura
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Marburg 134, Baltimore, MD 21287, USA; Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Sheikh Zayed Tower, Baltimore, MD 21287, USA.
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467
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Preoperative prostate health index predicts poor pathologic outcomes of radical prostatectomy in patients with biopsy-detected low-risk patients prostate cancer: results from a Chinese prospective cohort. Prostate Cancer Prostatic Dis 2017; 21:64-70. [PMID: 29213105 DOI: 10.1038/s41391-017-0002-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/04/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the performance of the prostate health index (PHI) in predicting pathologic outcomes of radical prostatectomy (RP) in Chinese patients with low-risk prostate cancer (PCa). METHODS Of all consecutive patients who underwent RP in one tertiary center from September 2013 to January 2017, we prospectively examined the data of 140 patients with low-risk PCa based on the Prostate Cancer Research International: Active Surveillance (PRIAS) criteria. All patients were eligible for active surveillance, but underwent RP. Clinical and pathological data were collected. Logistic regression was used to evaluate the associations between the PHI and outcome of RP. The area under the receiver operating curve (AUC) was used to evaluate the accuracy of different models. Decision curve analysis was used to evaluate the potential clinical usefulness of making model-based decisions. RESULTS Only 44 (31.4%) patients were finally confirmed to have organ-confined Gleason ≤6 PCa. A low PHI was significantly predictive of organ-confined Gleason ≤6 PCa (p = 0.001), while tPSA and f/tPSA were not associated with final pathology. In the multivariate analyses, addition of the PHI significantly increased the predictive accuracy (AUC = 0.767, 95% Cl 0.685-0.849, p < 0.001). CONCLUSION The PRIAS criteria for active surveillance may not suitable for Chinese patients with PCa. Addition of the PHI to the PRIAS models improved the prognostic performance. If confirmed in future larger and multicenter studies, PHI may help us to identify patients eligible for AS in China.
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468
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Barrier A, Ouzzane A, Villers A. Rôle de l’IRM prostatique dans le cancer de la prostate en 2016: mise au point et perspectives d’avenir. AFRICAN JOURNAL OF UROLOGY 2017. [DOI: 10.1016/j.afju.2016.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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469
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The Use of Prostate Specific Antigen Screening in Purchased versus Direct Care Settings: Data from the TRICARE® Military Database. J Urol 2017; 198:1295-1300. [DOI: 10.1016/j.juro.2017.07.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2017] [Indexed: 11/18/2022]
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470
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Nahlawi L, Goncalves C, Imani F, Gaed M, Gomez JA, Moussa M, Gibson E, Fenster A, Ward A, Abolmaesumi P, Shatkay H, Mousavi P. Stochastic Modeling of Temporal Enhanced Ultrasound: Impact of Temporal Properties on Prostate Cancer Characterization. IEEE Trans Biomed Eng 2017; 65:1798-1809. [PMID: 29989922 DOI: 10.1109/tbme.2017.2778007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Temporal enhanced ultrasound (TeUS) is a new ultrasound-based imaging technique that provides tissue-specific information. Recent studies have shown the potential of TeUS for improving tissue characterization in prostate cancer diagnosis. We study the temporal properties of TeUS-temporal order and length-and present a new framework to assess their impact on tissue information. METHODS We utilize a probabilistic modeling approach using hidden Markov models (HMMs) to capture the temporal signatures of malignant and benign tissues from TeUS signals of nine patients. We model signals of benign and malignant tissues (284 and 286 signals, respectively) in their original temporal order as well as under order permutations. We then compare the resulting models using the Kullback-Liebler divergence and assess their performance differences in characterization. Moreover, we train HMMs using TeUS signals of different durations and compare their model performance when differentiating tissue types. RESULTS Our findings demonstrate that models of order-preserved signals perform statistically significantly better (85% accuracy) in tissue characterization compared to models of order-altered signals (62% accuracy). The performance degrades as more changes in signal order are introduced. Additionally, models trained on shorter sequences perform as accurately as models of longer sequences. CONCLUSION The work presented here strongly indicates that temporal order has substantial impact on TeUS performance; thus, it plays a significant role in conveying tissue-specific information. Furthermore, shorter TeUS signals can relay sufficient information to accurately distinguish between tissue types. SIGNIFICANCE Understanding the impact of TeUS properties facilitates the process of its adopting in diagnostic procedures and provides insights on improving its acquisition.
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471
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Bjurlin MA, Taneja SS. Novel risk stratification nomograms for counseling patients on the need for prostate biopsy. BJU Int 2017; 120:746-747. [PMID: 29168337 DOI: 10.1111/bju.13912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Marc A Bjurlin
- Division of Urology, Department of Surgery, NYU Lutheran Medical Center, NYU Langone Health System, New York, NY, USA
| | - Samir S Taneja
- Division of Urologic Oncology, Department of Urology, NYU Langone Medical Center, New York, NY, USA
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472
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Perlis N, Al-Kasab T, Ahmad A, Goldberg E, Fadak K, Sayyid R, Finelli A, Kulkarni G, Hamilton R, Zlotta A, Ghai S, Fleshner N. Defining a Cohort that May Not Require Repeat Prostate Biopsy Based on PCA3 Score and Magnetic Resonance Imaging: The Dual Negative Effect. J Urol 2017; 199:1182-1187. [PMID: 29175542 DOI: 10.1016/j.juro.2017.11.074] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Prostate cancer over diagnosis and overtreatment are concerns for clinicians and policy makers. Multiparametric magnetic resonance imaging and the PCA3 (prostate cancer antigen 3) urine test select for clinically significant cases. We explored how well the tests performed together with previous biopsies. MATERIALS AND METHODS In accordance with ethics committee approval we collected clinicopathological data on all patients in whom a PCA3 test was done from January 2011 to June 2016. This included patients on active surveillance for low risk prostate cancer and those without prostate cancer who had previous negative biopsies and suspicion of occult disease. We explored whether age, prostate specific antigen, PCA3 score, multiparametric magnetic resonance imaging, digital rectal examination, family history and prostate size would predict clinically significant prostate cancer on repeat biopsy. The negative predictive value of multiparametric magnetic resonance imaging and PCA3 score was calculated. RESULTS A total of 470 patients were included in study. The PCA3 score was abnormal at 35 or greater in 32.5% of cases. In the multivariate model including 154 men only age (OR 1.08, 95% CI 1.01-1.16), multiparametric magnetic resonance imaging PI-RADS™ (Prostate Imaging-Reporting and Data System) score 4 (OR 16.6, 95% CI 3.9-70.0) or 5 (OR 28.3, 95% CI 5.7-138) and PCA3 score (OR 2.9, 95% CI 1.0-8.8) predicted clinically significant cancer on biopsy. No patient with negative multiparametric magnetic resonance imaging and a normal PCA3 score had clinically significant prostate cancer on biopsy for a negative predictive value of 100% (p <0.0001). CONCLUSIONS In patients with dual negative tests (multiparametric magnetic resonance imaging and PCA3 score) clinically significant prostate cancer was never found on biopsy, which may be unnecessary in this group. This study was limited by its retrospective design, selection bias and lack of cost-effectiveness data.
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Affiliation(s)
- Nathan Perlis
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
| | - Thamir Al-Kasab
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ardalan Ahmad
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Estee Goldberg
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kamel Fadak
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Rashid Sayyid
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Girish Kulkarni
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Rob Hamilton
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Alexandre Zlotta
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sangeet Ghai
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Neil Fleshner
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
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473
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Bjurlin MA, Rosenkrantz AB, Sarkar S, Lepor H, Huang WC, Huang R, Venkataraman R, Taneja SS. Prediction of Prostate Cancer Risk Among Men Undergoing Combined MRI-targeted and Systematic Biopsy Using Novel Pre-biopsy Nomograms That Incorporate MRI Findings. Urology 2017; 112:112-120. [PMID: 29155186 DOI: 10.1016/j.urology.2017.09.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 08/26/2017] [Accepted: 09/14/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To develop nomograms that predict the probability of overall prostate cancer (PCa) and clinically significant PCa (Gleason ≥7) on magnetic resonance imaging (MRI)-targeted, and combined MRI-targeted and systematic, prostate biopsy. MATERIALS AND METHODS From June 2012 to August 2014, magnetic resonance imaging to ultrasound fusion-targeted prostate biopsy was performed on 464 men with suspicious regions identified on pre-biopsy 3T MRI along with systematic 12 core biopsy. Logistic regression modeling was used to evaluate predictors of overall and clinically significant PCa, and corresponding nomograms were generated for men who were not previously biopsied or had 1 or more prior negative biopsies. Models were created with 70% of a randomly selected training sample and bias-corrected using bootstrap resampling. The models were then validated with the remaining 30% testing sample pool. RESULTS A total of 459 patients were included for analysis (median age 66 years, prostate-specific antigen [PSA] 5.2 ng/mL, prostate volume 49 cc). Independent predictors of PCa on targeted and systematic prostate biopsy were PSA density, age, and MRI suspicion score. PCa probability nomograms were generated for each cohort using the predictors. Bias-corrected areas under the receiver-operating characteristic curves for overall and clinically significant PCa detection were 0.82 (0.78) and 0.91 (0.84) for men without prior biopsy and 0.76 (0.65) and 0.86 (0.87) for men with a prior negative biopsy in the training (testing) samples. CONCLUSION PSA density, age, and MRI suspicion score predict PCa on combined MRI-targeted and systematic biopsy. Our generated nomograms demonstrate high diagnostic accuracy and may further aid in the decision to perform biopsy in men with clinical suspicion of PCa.
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Affiliation(s)
- Marc A Bjurlin
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, NY
| | - Andrew B Rosenkrantz
- Department of Radiology, New York University Langone Medical Center, New York, NY
| | | | - Herbert Lepor
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, NY
| | - William C Huang
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, NY
| | - Richard Huang
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, NY
| | | | - Samir S Taneja
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, NY.
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474
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Ability of a Genomic Classifier to Predict Metastasis and Prostate Cancer-specific Mortality after Radiation or Surgery based on Needle Biopsy Specimens. Eur Urol 2017; 72:845-852. [DOI: 10.1016/j.eururo.2017.05.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/03/2017] [Indexed: 01/30/2023]
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475
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SFRP4 gene expression is increased in aggressive prostate cancer. Sci Rep 2017; 7:14276. [PMID: 29079735 PMCID: PMC5660209 DOI: 10.1038/s41598-017-14622-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 10/09/2017] [Indexed: 12/05/2022] Open
Abstract
Increased knowledge of the molecular differences between indolent and aggressive prostate cancer is needed for improved risk stratification and treatment selection. Secreted frizzled-related protein 4 (SFRP4) is a modulator of the cancer-associated Wnt pathway, and previously suggested as a potential marker for prostate cancer aggressiveness. In this study, we investigated and validated the association between SFRP4 gene expression and aggressiveness in nine independent cohorts (n = 2157). By differential expression and combined meta-analysis of all cohorts, we detected significantly higher SFRP4 expression in cancer compared with normal samples, and in high (3–5) compared with low (1–2) Grade Group samples. SFRP4 expression was a significant predictor of biochemical recurrence in six of seven cohorts and in the overall analysis, and was a significant predictor of metastatic event in one cohort. In our study cohort, where metabolic information was available, SFRP4 expression correlated significantly with the concentrations of citrate and spermine, two previously suggested biomarkers for aggressive prostate cancer. SFRP4 immunohistochemistry in an independent cohort (n = 33) was not associated with aggressiveness. To conclude, high SFRP4 gene expression is associated with high Grade Group and recurrent prostate cancer after surgery. Future studies investigating the mechanistic and clinical usefulness of SFRP4 in prostate cancer are warranted.
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476
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Thurtle DR, Gordon EM, Brierly RD, Conway CJ, McLoughlin J. General practitioner perception of prostate-specific antigen testing has improved, but more awareness of prostate cancer risk in younger patients is still awaited. Prostate Int 2017; 6:61-65. [PMID: 29922634 PMCID: PMC6004706 DOI: 10.1016/j.prnil.2017.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/07/2017] [Accepted: 10/08/2017] [Indexed: 12/24/2022] Open
Abstract
Background In 2006, a county-wide survey of general practitioners (GPs) in the United Kingdom (UK) identified a reluctance to refer younger men with abnormal prostate specific antigen (PSA) levels. Younger men have the most to gain from early-detection of prostate cancer (PCa), which remains a national government priority in the UK and around the world. We sought to assess changes in perception of abnormal PSA-values amongst UK GPs over the past 10 years. Materials and methods A total of 500 self-administered paper questionnaires were distributed to individually named GPs. One hundred and forty two responded (28.4%), representing a patient population of ∼600,000. A series of visual analogue questions assessed referral thresholds and understanding of risk factors related to the development of PCa. Results GPs with a median of 23-years experience responded. Although mean PSA threshold for referral to urology did fall between 2006 and 2016 in both the 45-year (5.42 ng/mL vs. 4.61 ng/mL P = 0.0003) and 55-year (5.81 ng/mL vs. 5.30 ng/mL P = 0.0164) age groups, the median referral values were unchanged. Significantly, referral thresholds quoted for younger men (<65 years) were considerably higher than recommended UK maximum PSA-levels. Using case-based scenarios, practitioners appeared more likely to refer older men with abnormal PSA values, with GPs reporting an average 56.2% likelihood of referring an asymptomatic 55-year-old with elevated age-adjusted PSA of 4.6 ng/mL. A total of 95.1% recognised a family history of PCa to be a potential risk factor but other at-risk categories were not so clearly understood. Conclusion Awareness of abnormal PSA values in UK primary care is improving, but continues to lag behind the evidence. Strategies to disseminate knowledge of maximum PSA-values to GPs should focus especially on those for younger patients.
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Affiliation(s)
- David R Thurtle
- Academic Urology Group, Department of Surgery, University of Cambridge, UK and West Suffolk Hospital NHS Foundation Trust, Bury St Edmunds, UK
| | - Emma M Gordon
- Department of Urology, West Suffolk Hospital NHS Foundation Trust, Bury St Edmunds, UK
| | | | - Ciaran J Conway
- General Practice Registrar, Severn Deanery, University of Bristol, Bristol, UK
| | - John McLoughlin
- Department of Urology, West Suffolk Hospital NHS Foundation Trust, Bury St Edmunds, UK
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477
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Rendon RA, Mason RJ, Marzouk K, Finelli A, Saad F, So A, Violette P, Breau RH. Recommandations de l'Association des urologues du Canada sur le dépistage et le diagnostic précoce du cancer de la prostate. Can Urol Assoc J 2017; 11:298-309. [PMID: 29381452 DOI: 10.5489/cuaj.4888] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ricardo A Rendon
- Département d'urologie, Université Dalhousie, Halifax, N.-É., Canada
| | - Ross J Mason
- Département d'urologie, Clinique Mayo, Rochester, Minn., États-Unis
| | - Karim Marzouk
- Division d'urologie, Centre de cancérologie Memorial Sloan Kettering, New York, NY, États-Unis
| | - Antonio Finelli
- Division d'urologie, Université de Toronto, Toronto, Ont., Canada
| | - Fred Saad
- Département de chirurgie (urologie), Université de Montréal, Montréal, Qc, Canada
| | - Alan So
- Département des sciences urologiques, Université de la Colombie-Britannique, Vancouver, C.-B., Canada
| | - Phillipe Violette
- Département de chirurgie, Université Western, London, Ont., Canada.,Départements de chirurgie et de méthodologie de recherche en santé, Données et répercussions, Université McMaster, Hamilton, Ont., Canada
| | - Rodney H Breau
- Division d'urologie, Université d'Ottawa, Ottawa, Ont., Canada
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478
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Hendriks RJ, van der Leest MMG, Dijkstra S, Barentsz JO, Van Criekinge W, Hulsbergen-van de Kaa CA, Schalken JA, Mulders PFA, van Oort IM. A urinary biomarker-based risk score correlates with multiparametric MRI for prostate cancer detection. Prostate 2017; 77:1401-1407. [PMID: 28853167 DOI: 10.1002/pros.23401] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 08/03/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Prostate cancer (PCa) diagnostics would greatly benefit from more accurate, non-invasive techniques for the detection of clinically significant disease, leading to a reduction of over-diagnosis and over-treatment. The aim of this study was to determine the association between a novel urinary biomarker-based risk score (SelectMDx), multiparametric MRI (mpMRI) outcomes, and biopsy results for PCa detection. METHODS This retrospective observational study used data from the validation study of the SelectMDx score, in which urine was collected after digital rectal examination from men undergoing prostate biopsies. A subset of these patients also underwent a mpMRI scan of the prostate. The indications for performing mpMRI were based on persistent clinical suspicion of PCa or local staging after PCa was found upon biopsy. All mpMRI images were centrally reviewed in 2016 by an experienced radiologist blinded for the urine test results and biopsy outcome. The PI-RADS version 2 was used. RESULTS In total, 172 patients were included for analysis. Hundred (58%) patients had PCa detected upon prostate biopsy, of which 52 (52%) had high-grade disease correlated with a significantly higher SelectMDx score (P < 0.01). The median SelectMDx score was significantly higher in patients with a suspicious significant lesion on mpMRI compared to no suspicion of significant PCa (P < 0.01). For the prediction of mpMRI outcome, the area-under-the-curve of SelectMDx was 0.83 compared to 0.66 for PSA and 0.65 for PCA3. There was a positive association between SelectMDx score and the final PI-RADS grade. There was a statistically significant difference in SelectMDx score between PI-RADS 3 and 4 (P < 0.01) and between PI-RADS 4 and 5 (P < 0.01). CONCLUSIONS The novel urinary biomarker-based SelectMDx score is a promising tool in PCa detection. This study showed promising results regarding the correlation between the SelectMDx score and mpMRI outcomes, outperforming PCA3. Our results suggest that this risk score could guide clinicians in identifying patients at risk for significant PCa and selecting patients for further radiological diagnostics to reduce unnecessary procedures.
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Affiliation(s)
- Rianne J Hendriks
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marloes M G van der Leest
- Department of Nuclear Medicine and Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Siebren Dijkstra
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jelle O Barentsz
- Department of Nuclear Medicine and Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wim Van Criekinge
- Department of Mathematical Modeling, Statistics and Bio-Informatics, Ghent University, Ghent, Belgium
| | | | - Jack A Schalken
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter F A Mulders
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Inge M van Oort
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
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479
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Comprehensive Evaluation of TFF3 Promoter Hypomethylation and Molecular Biomarker Potential for Prostate Cancer Diagnosis and Prognosis. Int J Mol Sci 2017; 18:ijms18092017. [PMID: 28930171 PMCID: PMC5618665 DOI: 10.3390/ijms18092017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 09/08/2017] [Accepted: 09/13/2017] [Indexed: 01/03/2023] Open
Abstract
Overdiagnosis and overtreatment of clinically insignificant tumors remains a major problem in prostate cancer (PC) due to suboptimal diagnostic and prognostic tools. Thus, novel biomarkers are urgently needed. In this study, we investigated the biomarker potential of Trefoil factor 3 (TFF3) promoter methylation and RNA expression levels for PC. Initially, by quantitative methylation specific PCR (qMSP) analysis of a large radical prostatectomy (RP) cohort (n = 292), we found that the TFF3 promoter was significantly hypomethylated in PC compared to non-malignant (NM) prostate tissue samples (p < 0.001) with an AUC (area under the curve) of 0.908 by receiver operating characteristics (ROC) curve analysis. Moreover, significant TFF3 promoter hypomethylation (p ≤ 0.010) as well as overexpression (p < 0.001) was found in PC samples from another large independent patient sample set (498 PC vs. 67 NM) analyzed by Illumina 450K DNA methylation arrays and/or RNA sequencing. TFF3 promoter methylation and transcriptional expression levels were inversely correlated, suggesting that epigenetic mechanisms contribute to the regulation of gene activity. Furthermore, low TFF3 expression was significantly associated with high ERG, ETS transcription factor (ERG) expression (p < 0.001), as well as with high Gleason score (p < 0.001), advanced pathological T-stage (p < 0.001), and prostate-specific antigen (PSA) recurrence after RP (p = 0.013; univariate Cox regression analysis). There were no significant associations between TFF3 promoter methylation levels, ERG status, or PSA recurrence in these RP cohorts. In conclusion, our results demonstrated diagnostic biomarker potential of TFF3 promoter hypomethylation for PC as well as prognostic biomarker potential of TFF3 RNA expression. To the best of our knowledge, this is the most comprehensive study of TFF3 promoter methylation and transcriptional expression in PC to date.
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480
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Genitourinary tumours in the targeted therapies era: new advances in clinical practice and future perspectives. Anticancer Drugs 2017; 27:917-43. [PMID: 27400375 DOI: 10.1097/cad.0000000000000405] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Genitourinary cancers represent a heterogeneous group of malignancies arising from genitourinary tract, and are responsible for almost 359 000 newly diagnosed cases and 58 420 related deaths in USA. Continuous advances in cancer genetics and genomics have contributed towards changing the management paradigms of these neoplasms. Neoangiogenesis, through the activation of the tyrosine-kinase receptors signalling pathways, represents the key mediator event in promoting tumour proliferation, differentiation, invasiveness and motility. In the last decade, several treatments have been developed with the specific aim of targeting different cell pathways that have been recognized to drive tumour progression. The following review attempts to provide a comprehensive overview of the literature, focusing on new advances in targeted therapies for genitourinary tumours. Furthermore, the promising results of the latest clinical trials and future perspectives will be discussed.
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481
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Prostate cancer clinical presentation, incidence, mortality and survival in Guadeloupe over the period 2008–2013 from a population-based cancer registry. Cancer Causes Control 2017; 28:1265-1273. [DOI: 10.1007/s10552-017-0962-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 09/12/2017] [Indexed: 02/02/2023]
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482
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Comparison of clinical and survival characteristics between prostate cancer patients of PSA-based screening and clinical diagnosis in China. Oncotarget 2017; 9:428-441. [PMID: 29416625 PMCID: PMC5787478 DOI: 10.18632/oncotarget.20787] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 06/29/2017] [Indexed: 12/29/2022] Open
Abstract
Prostate-specific antigen (PSA)-based mass screening remains the most controversial topic in prostate cancer. PSA-based mass screening has not been widely used in China yet. The aim of our study was to evaluate the effect of the PSA-based screening in China. The cohort consisted of 1,012 prostate cancer patients. Data were retrospectively collected and clinical characteristics of the cohorts were investigated. Survival was analyzed for prostatic carcinoma of both PSA screened and clinically diagnosed patients according to clinical characteristics and the National Comprehensive Cancer Network (NCCN) risk classification. Cox Proportional Hazards Model analysis was done for risk predictor identification. The median age was 71 years old. Five-year overall and prostate-cancer-specific survival in prostatic adenocarcinoma patients were 77.52% and 79.65%; 10-year survivals were 62.57% and 68.60%, respectively. Survival was significantly poorer in patients with metastases and non-curative management. T staging and Gleason score by NCCN classification effectively stratified prostatic adenocarcinoma patients into different risk groups. T staging was a significant predictor of survival by COX Proportional Hazard Model. PSA screened patients had a significantly higher percentage diagnosed in early stage. PSA screened prostatic adenocarcinoma patients had a better prognosis in both overall and prostate cancer-specific survivals. This Chinese cohort had a lower overall and prostate cancer survival rate than it is reported in western countries. The incidence of early-stage prostate cancer found in PSA-based mass screening was high and there were significant differences in both overall and prostate cancer-specific survival between the PSA-screened and clinically diagnosed patients.
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483
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Bass EJ, Donaldson IA, Freeman A, Jameson C, Punwani S, Moore C, Arya M, Emberton M, Ahmed HU. Magnetic resonance imaging targeted transperineal prostate biopsy: a local anaesthetic approach. Prostate Cancer Prostatic Dis 2017; 20:311-317. [PMID: 28485391 DOI: 10.1038/pcan.2017.13] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/29/2017] [Accepted: 02/22/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Despite high rates of disease misclassification and sepsis, the use of transrectal biopsy remains commonplace. Transperineal mapping biopsies mitigate these problems but carry increased cost and patient burden. Local anaesthetic, multiparametric magnetic resonance imaging (MRI)-targeted transperineal biopsy may offer an alternative. Here, we aim to determine the feasibility, tolerability and detection rates of clinically significant prostate cancer using a local anaesthetic, transperineal, MRI-targeted biopsy technique. METHODS Tertiary referral centre in which 181 consecutive men underwent local anaesthetic, transperineal MRI-targeted prostate biopsy (September 2014 to January 2016). A standardized local anaesthetic technique was used to obtain targeted biopsies using visual estimation with the number of targeted cores determined by each of a number of users. We assessed adverse events, patient visual analogue pain scores and detection rates of clinically significant cancer (defined by University College London (UCL) definitions one and two and separately by the presence of dominant and non-dominant Gleason pattern 4). We secondarily assessed detection of any cancer, rates of detection by MRI (Likert) score and by presenting PSA. Differences were assessed using Chi-squared tests (P<0.05). RESULTS One hundred eighty-one men with 243 lesions were included. There were no episodes of sepsis or re-admissions and one procedure was abandoned owing to patient discomfort. Twenty-three out of 25 (92%) men would recommend the procedure to another. Median visual analogue pain score was 1.0 (interquartile range: 0.0-2.4). A total 104/181 (57%) had UCL definition 1 disease (Gleason ⩾4+3 and/or maximum cancer length ⩾6 mm) and 129/181 (71%) had UCL definition 2 cancer (Gleason ⩾3+4 and/or maximum cancer length ⩾4 mm). Fifty-four out of 181 (30%) and 124/181 (69%) had dominant and non-dominant pattern 4 disease or greater (irrespective of cancer length). Any cancer was detected in 142/181 (78%). Significant disease was more likely in higher MRI-scoring lesions and in men with PSAs ⩾10 ng ml-1. CONCLUSIONS This approach to prostate biopsy is feasible, tolerable and can be performed in ambulatory settings.
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Affiliation(s)
- E J Bass
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - I A Donaldson
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - A Freeman
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
- The Prostate Unit, BUPA Cromwell Hospital, London, UK
| | - C Jameson
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
- The Prostate Unit, BUPA Cromwell Hospital, London, UK
| | - S Punwani
- Centre for Medical Imaging, University College London, London, UK
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - C Moore
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Arya
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Emberton
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - H U Ahmed
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
- The Prostate Unit, BUPA Cromwell Hospital, London, UK
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484
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Gaither TW, Awad MA, Osterberg EC, Murphy GP, Allen IE, Chang A, Rosen RC, Breyer BN. The Natural History of Erectile Dysfunction After Prostatic Radiotherapy: A Systematic Review and Meta-Analysis. J Sex Med 2017; 14:1071-1078. [PMID: 28859870 DOI: 10.1016/j.jsxm.2017.07.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/12/2017] [Accepted: 07/25/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Erectile dysfunction (ED) after treatment for prostate cancer with radiotherapy (RT) is well known, and pooled estimates of ED after RT will provide more accurate patient education. AIM To systematically evaluate the natural history of ED in men with previous erectile function after prostate RT and to determine clinical factors associated with ED. METHODS We performed a review of the PubMed and Medline, Embase, Cochrane Library, and Web of Science databases in April 2016 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Identified reports included a measurement of ED before and after prostate RT. Two hundred seventy-eight abstracts were screened and 105 publications met the criteria for inclusion. Only men with known erectile function before RT were included in the analysis. OUTCOME ED after RT of the prostate. RESULTS In total, 17,057 men underwent brachytherapy (65%), 8,166 men underwent external-beam RT (31%), and 1,046 men underwent both (4%). Seven common instruments were used to measure ED, including 23 different cutoffs for ED. The Sexual Health Inventory for Men (SHIM) was used in 31 studies (30%). Pooled estimates of SHIM-confirmed ED (score <10-17) suggested the prevalence of ED after RT is 34% of men (95% CI = 0.29-0.39) at 1 year and 57% (95% CI = 0.53-0.61) at 5.5 years. Compared with brachytherapy, studies of the two types of radiation increased the proportion of new-onset ED found by 12.3% of studies (95% CI = 2.3-22.4). For every 10% who were lost to follow-up, the proportion of ED reported increased by 2.3% (95% CI = 0.03-4.7). CLINICAL IMPLICATIONS ED is common regardless of RT modality and increases during each year of follow-up. Using the SHIM, ED is found in approximately 50% patients at 5 years. STRENGTHS AND LIMITATIONS The strengths of this systematic review include strict inclusion criteria of studies that measured baseline erectile function, no evidence for large effect size bias, and a large number of studies, which allow for modeling techniques. However, all data included in this analysis were observational, which leaves the possibility that residual confounding factors increase the rates of ED. CONCLUSION Definitions and measurements of ED after RT vary considerably in published series and could account for variability in the prevalence of reported ED. Loss to follow-up in studies could bias the results to overestimate ED. Gaither TW, Awad MA, Osterberg EC, et al. The Natural History of Erectile Dysfunction After Prostatic Radiotherapy: A Systematic Review and Meta-Analysis. J Sex Med 2017;14:1071-1078.
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Affiliation(s)
- Thomas W Gaither
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Mohannad A Awad
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA; Department of Surgery, King Abdul Aziz University, Rabigh, Saudi Arabia
| | - E Charles Osterberg
- Department of Surgery, University of Texas-Dell Medical School, Austin, TX, USA
| | - Gregory P Murphy
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Isabel E Allen
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, USA
| | - Albert Chang
- Department of Radiation Oncology, University of California-San Francisco, San Francisco, CA, USA
| | | | - Benjamin N Breyer
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, USA.
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485
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Nahar B, Katims A, Barboza MP, Soodana Prakash N, Venkatramani V, Kava B, Satyanarayana R, Gonzalgo ML, Ritch CR, Parekh DJ, Punnen S. Reclassification Rates of Patients Eligible for Active Surveillance After the Addition of Magnetic Resonance Imaging-Ultrasound Fusion Biopsy: An Analysis of 7 Widely Used Eligibility Criteria. Urology 2017; 110:134-139. [PMID: 28842208 DOI: 10.1016/j.urology.2017.08.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/17/2017] [Accepted: 08/09/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the impact of adding magnetic resonance imaging-ultrasound (MRI-US) fusion biopsy cores to standard 12-core biopsy in selecting men for active surveillance (AS). MATERIALS AND METHODS Among men undergoing a fusion biopsy for evaluation of prostate cancer, we selected men who were eligible for at least 1 of 7 different AS criteria based on the standard biopsy alone. We assessed each patient's eligibility for each AS criterion with and without the inclusion of fusion biopsy cores. The primary end point was the proportion of men who were initially eligible for AS but became ineligible after addition of the fusion biopsy cores. RESULTS A total of 100 men were eligible for at least 1 AS criterion. After addition of fusion biopsy cores, the proportion of men who became ineligible for AS varied from 10.3% to 40.7%. Criteria that incorporated an absolute maximum number of cores positive had the highest rates of ineligibility. Using a percentage of cores positive helped to reduce the number of patients who would have been excluded. Combining the targeted biopsy cores into one, or taking the single core with the highest grade or volume did not appear to reduce the proportion of men who became ineligible. CONCLUSIONS The addition of fusion biopsy to standard 12-core biopsy significantly increased the number of men who became ineligible for AS. Using the percent of cores positive, instead of an absolute number, allowed fewer exclusions. AS criteria may need to be updated to prevent the unnecessary exclusion of men due to an oversampling of low-risk disease.
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Affiliation(s)
- Bruno Nahar
- Department of Urology, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL
| | - Andrew Katims
- Department of Urology, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL
| | - Marcelo Panizzutti Barboza
- Department of Urology, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL
| | - Nachiketh Soodana Prakash
- Department of Urology, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL
| | - Vivek Venkatramani
- Department of Urology, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL
| | - Bruce Kava
- Department of Urology, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL
| | - Ramgopal Satyanarayana
- Department of Urology, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL
| | - Mark L Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL
| | - Chad R Ritch
- Department of Urology, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL
| | - Dipen J Parekh
- Department of Urology, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL
| | - Sanoj Punnen
- Department of Urology, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL.
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486
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Zhang Q, Yao J, Cai Y, Zhang L, Wu Y, Xiong J, Shi J, Wang Y, Wang Y. Elevated hardness of peripheral gland on real-time elastography is an independent marker for high-risk prostate cancers. LA RADIOLOGIA MEDICA 2017; 122:944-951. [DOI: 10.1007/s11547-017-0803-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/16/2017] [Indexed: 11/29/2022]
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487
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Bainor AJ, Deng FM, Wang Y, Lee P, Cantor DJ, Logan SK, David G. Chromatin-Associated Protein SIN3B Prevents Prostate Cancer Progression by Inducing Senescence. Cancer Res 2017; 77:5339-5348. [PMID: 28807943 DOI: 10.1158/0008-5472.can-16-3410] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 05/09/2017] [Accepted: 07/27/2017] [Indexed: 12/12/2022]
Abstract
Distinguishing between indolent and aggressive prostate adenocarcinoma remains a priority to accurately identify patients who need therapeutic intervention. SIN3B has been implicated in the initiation of senescence in vitro Here we show that in a mouse model of prostate cancer, SIN3B provides a barrier to malignant progression. SIN3B was required for PTEN-induced cellular senescence and prevented progression to invasive prostate adenocarcinoma. Furthermore, SIN3B was downregulated in human prostate adenocarcinoma correlating with upregulation of its target genes. Our results suggest a tumor suppressor function for SIN3B that limits prostate adenocarcinoma progression, with potential implications for the use of SIN3B and its target genes as candidate diagnostic markers to distinguish indolent from aggressive disease. Cancer Res; 77(19); 5339-48. ©2017 AACR.
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Affiliation(s)
- Anthony J Bainor
- Department of Biochemistry and Molecular Pharmacology, NYU Langone Medical Center, New York, New York
| | - Fang-Ming Deng
- Department of Pathology, NYU Langone Medical Center, New York, New York
| | - Yu Wang
- Department of Biochemistry and Molecular Pharmacology, NYU Langone Medical Center, New York, New York
| | - Peng Lee
- Department of Pathology, NYU Langone Medical Center, New York, New York.,NYU Cancer Institute, NYU Langone Medical Center, New York, New York
| | - David J Cantor
- Department of Biochemistry and Molecular Pharmacology, NYU Langone Medical Center, New York, New York
| | - Susan K Logan
- Department of Biochemistry and Molecular Pharmacology, NYU Langone Medical Center, New York, New York.,Department of Urology, NYU Langone Medical Center, New York, New York.,NYU Cancer Institute, NYU Langone Medical Center, New York, New York
| | - Gregory David
- Department of Biochemistry and Molecular Pharmacology, NYU Langone Medical Center, New York, New York. .,Department of Urology, NYU Langone Medical Center, New York, New York.,NYU Cancer Institute, NYU Langone Medical Center, New York, New York
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488
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Hauke RJ, Sissung TM, Figg WD. Discussing the predictive, prognostic, and therapeutic value of germline DNA-repair gene mutations in metastatic prostate cancer patients. Cancer Biol Ther 2017; 18:545-546. [PMID: 28678600 PMCID: PMC5653188 DOI: 10.1080/15384047.2017.1345398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 06/17/2017] [Indexed: 01/22/2023] Open
Abstract
Recent trends in cancer therapy have begun emphasizing the use of precision medicine, especially genetic tools, in the evaluation of malignancies and decision-making. Prostate cancer is a malignancy where the benefits and utility of screening and early treatment are still heavily controversial. A recent paper in the New England Journal of Medicine found that patients with metastatic prostate cancer presented germline mutations in DNA-repair genes at a significantly higher incidence than those with localized prostate cancer. These findings indicate the need for further research in this field as genetic differences between metastatic and localized prostate cancer could have great clinical value.
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Affiliation(s)
- Ralph J. Hauke
- Molecular Pharmacology Section, Genitourinary Malignancies Branch, National Institutes of Health, Bethesda, MD, USA
| | - Tristan M. Sissung
- Clinical Pharmacology Program, Office of the Clinical Director, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - William D. Figg
- Molecular Pharmacology Section, Genitourinary Malignancies Branch, National Institutes of Health, Bethesda, MD, USA
- Clinical Pharmacology Program, Office of the Clinical Director, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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489
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Wildeboer RR, Postema AW, Demi L, Kuenen MPJ, Wijkstra H, Mischi M. Multiparametric dynamic contrast-enhanced ultrasound imaging of prostate cancer. Eur Radiol 2017; 27:3226-3234. [PMID: 28004162 PMCID: PMC5491563 DOI: 10.1007/s00330-016-4693-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 11/28/2016] [Accepted: 12/01/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim of this study is to improve the accuracy of dynamic contrast-enhanced ultrasound (DCE-US) for prostate cancer (PCa) localization by means of a multiparametric approach. MATERIALS AND METHODS Thirteen different parameters related to either perfusion or dispersion were extracted pixel-by-pixel from 45 DCE-US recordings in 19 patients referred for radical prostatectomy. Multiparametric maps were retrospectively produced using a Gaussian mixture model algorithm. These were subsequently evaluated on their pixel-wise performance in classifying 43 benign and 42 malignant histopathologically confirmed regions of interest, using a prostate-based leave-one-out procedure. RESULTS The combination of the spatiotemporal correlation (r), mean transit time (μ), curve skewness (κ), and peak time (PT) yielded an accuracy of 81% ± 11%, which was higher than the best performing single parameters: r (73%), μ (72%), and wash-in time (72%). The negative predictive value increased to 83% ± 16% from 70%, 69% and 67%, respectively. Pixel inclusion based on the confidence level boosted these measures to 90% with half of the pixels excluded, but without disregarding any prostate or region. CONCLUSIONS Our results suggest multiparametric DCE-US analysis might be a useful diagnostic tool for PCa, possibly supporting future targeting of biopsies or therapy. Application in other types of cancer can also be foreseen. KEY POINTS • DCE-US can be used to extract both perfusion and dispersion-related parameters. • Multiparametric DCE-US performs better in detecting PCa than single-parametric DCE-US. • Multiparametric DCE-US might become a useful tool for PCa localization.
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Affiliation(s)
- Rogier R Wildeboer
- Laboratory of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, PO-Box 513, 5600 MB, Eindhoven, The Netherlands.
| | - Arnoud W Postema
- Department of Urology, Academic Medical Center University Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Libertario Demi
- Laboratory of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, PO-Box 513, 5600 MB, Eindhoven, The Netherlands
| | | | - Hessel Wijkstra
- Laboratory of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, PO-Box 513, 5600 MB, Eindhoven, The Netherlands
- Department of Urology, Academic Medical Center University Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Massimo Mischi
- Laboratory of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, PO-Box 513, 5600 MB, Eindhoven, The Netherlands
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490
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Na R, Ye D, Qi J, Liu F, Helfand BT, Brendler CB, Conran CA, Packiam V, Gong J, Wu Y, Zheng SL, Mo Z, Ding Q, Sun Y, Xu J. Prostate health index significantly reduced unnecessary prostate biopsies in patients with PSA 2-10 ng/mL and PSA >10 ng/mL: Results from a Multicenter Study in China. Prostate 2017; 77:1221-1229. [PMID: 28664580 DOI: 10.1002/pros.23382] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/07/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND The performance of prostate health index (phi) in predicting prostate biopsy outcomes has been well established for patients with prostate-specific antigen (PSA) values between 2 and 10 ng/mL. However, the performance of phi remains unknown in patients with PSA >10 ng/mL, the vast majority in Chinese biopsy patients. We aimed to assess the ability of phi to predict prostate cancer (PCa) and high-grade disease (Gleason Score ≥7) on biopsy in a Chinese population. METHODS This is a prospective, observational, multi-center study of consecutive patients who underwent a transrectal ultrasound guided prostate biopsy at four hospitals in Shanghai, China from August 2013 to December 2014. RESULTS In the cohort of 1538 patients, the detection rate of PCa was 40.2%. phi had a significantly better predictive performance for PCa than total PSA (tPSA). The areas under the receiver operating characteristic curve (AUC) were 0.90 and 0.79 for phi and tPSA, respectively, P < 0.0001. A considerable proportion of patients in the cohort had PSAs >10 ng/mL (N = 838, 54.5%). The detection rates of PCa were 35.9% and 57.7% in patients with tPSA 10.1-20 and 20.1-50 ng/mL, respectively. The AUCs of phi (0.79 and 0.89, for these two groups, respectively) were also significantly higher than tPSA (0.57 and 0.63, respectively), both P < 0.0001. If a phi ≤35 was used as the cutoff, 599/1538 (39%) biopsies could have been avoided at a cost of missing small numbers of PCa patients: 49 (7.93%) PCa patients, including 18 (3.69%) high-grade tumors. CONCLUSIONS Results from this study suggest that phi can be used to predict PCa and high-grade disease in Chinese men with high PSA levels (>10 ng/mL).
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Affiliation(s)
- Rong Na
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, PR China
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, PR China
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois
- Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, Illinois
- Fudan Universtiy Shanghai Medical College, Shanghai, PR China
| | - Dingwei Ye
- Department of Urology, Shanghai Cancer Center, Fudan University, Shanghai, PR China
| | - Jun Qi
- Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Fang Liu
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Brian T Helfand
- Division of Urology, NorthShore University HealthSystem, Evanston, Illinois
| | - Charles B Brendler
- Division of Urology, NorthShore University HealthSystem, Evanston, Illinois
| | - Carly A Conran
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois
| | - Vignesh Packiam
- Division of Urology, NorthShore University HealthSystem, Evanston, Illinois
| | - Jian Gong
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Yishuo Wu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, PR China
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Siqun L Zheng
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois
| | - Zengnan Mo
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, PR China
| | - Qiang Ding
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, PR China
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Yinghao Sun
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai, PR China
| | - Jianfeng Xu
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, PR China
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois
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491
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Ball MW, Ross AE, Ghabili K, Kim C, Jun C, Petrisor D, Pan L, Epstein JI, Macura KJ, Stoianovici DS, Allaf ME. Safety and Feasibility of Direct Magnetic Resonance Imaging-guided Transperineal Prostate Biopsy Using a Novel Magnetic Resonance Imaging-safe Robotic Device. Urology 2017; 109:216-221. [PMID: 28735018 DOI: 10.1016/j.urology.2017.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/22/2017] [Accepted: 07/07/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate safety and feasibility in a first-in-human trial of a direct magnetic resonance imaging (MRI)-guided prostate biopsy using a novel robotic device. METHODS MrBot is an MRI-safe robotic device constructed entirely with nonconductive, nonmetallic, and nonmagnetic materials and developed by our group. A safety and feasibility clinical trial was designed to assess the safety and feasibility of a direct MRI-guided biopsy with MrBot and to determine its targeting accuracy. Men with elevated prostate-specific antigen levels, prior negative prostate biopsies, and cancer-suspicious regions (CSRs) on MRI were enrolled in the study. Biopsies targeting CSRs, in addition to sextant locations, were performed. RESULTS Five men underwent biopsy with MrBot. Two men required Foley catheter insertion after the procedure, with no other complications or adverse events. Even though this was not a study designed to detect prostate cancer, biopsies confirmed the presence of a clinically significant cancer in 2 patients. On a total of 30 biopsy sites, the robot achieved an MRI-based targeting accuracy of 2.55 mm and a precision of 1.59 mm normal to the needle, with no trajectory corrections and no unsuccessful attempts to target a site. CONCLUSION Robot-assisted MRI-guided prostate biopsy appears safe and feasible. This study confirms that a clinically significant prostate cancer (≥5-mm radius, 0.5 cm3) depicted in MRI may be accurately targeted. Direct confirmation of needle placement in the CSR may present an advantage over fusion-based technology and gives more confidence in a negative biopsy result. Additional study is warranted to evaluate the efficacy of this approach.
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Affiliation(s)
- Mark W Ball
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ashley E Ross
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kamyar Ghabili
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chunwoo Kim
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Changhan Jun
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Doru Petrisor
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Li Pan
- Siemens Healthcare, Baltimore, MD
| | - Jonathan I Epstein
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Katarzyna J Macura
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dan S Stoianovici
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mohamad E Allaf
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD.
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492
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Kim TH, Jeon HG, Jeong BC, Seo SI, Jeon SS, Choi HY, Lee HM. Development of a new nomogram to predict insignificant prostate cancer in patients undergoing radical prostatectomy. Scand J Urol 2017; 51:27-32. [PMID: 28168924 DOI: 10.1080/21681805.2016.1266384] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to develop a nomogram to predict the probability of insignificant prostate cancer. MATERIALS AND METHODS A retrospective analysis was conducted of patients who underwent radical prostatectomy at a Korean hospital between January 2005 and December 2014. Patients with pathologically insignificant prostate cancer were defined as having organ-confined disease with tumor volume less than 0.5 cm³ without Gleason scores of 4 or 5. Multivariable logistic regression analysis with a stepwise selection was used to model the relationship between preoperative characteristics and insignificant prostate cancer, and a nomogram to predict the probability of insignificant prostate cancer was created. Receiver operating characteristics (ROC) analysis was performed to assess the predictive value of the model. RESULTS The final study population consisted of 1343 patients. Among these patients, insignificant prostate cancer was confirmed in 188 men (14.0%) at the time of prostatectomy. Six independent predictors of insignificant prostate cancer were identified: number of positive cores (p < 0.001), maximal single core tumor involvement (p < 0.001), biopsy Gleason score (p < 0.001), prostate volume (p = 0.024), patient age (p < 0.001) and prostate-specific antigen density (p < 0.001) in the multivariable model. A nomogram to predict insignificant prostate cancer was developed using these six preoperative characteristics. The area under the ROC curve for nomogram predictions was 0.87. CONCLUSION The nomogram developed in this paper identifies the probability of insignificant prostate cancer and gives providers more information to guide their clinical decisions.
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Affiliation(s)
- Tae Heon Kim
- a Department of Urology , Samsung Changwon Hospital, Sungkyunkwan University School of Medicine , Changwon , Republic of Korea
| | - Hwang Gyun Jeon
- b Department of Urology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea
| | - Byong Chang Jeong
- b Department of Urology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea
| | - Seong Il Seo
- b Department of Urology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea
| | - Seong Soo Jeon
- b Department of Urology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea
| | - Han Yong Choi
- b Department of Urology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea
| | - Hyun Moo Lee
- b Department of Urology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea
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493
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Abstract
Aberrations in telomere biology are among the earliest events in prostate cancer tumorigenesis and continue during tumour progression. Substantial telomere shortening occurs in prostate cancer cells and high-grade prostatic intraepithelial neoplasia. Not all mechanisms of telomere shortening are understood, but oxidative stress from local inflammation might accelerate prostatic telomere loss. Critically short telomeres can drive the accumulation of tumour-promoting genomic alterations; however, continued telomere erosion is unsustainable and must be mitigated to ensure cancer cell survival and unlimited replication potential. Prostate cancers predominantly maintain telomeres by activating telomerase, but alternative mechanisms of telomere extension can occur in metastatic disease. Telomerase activity and telomere length assessment might be useful in prostate cancer diagnosis and prognosis. Telomere shortening in normal stromal cells has been associated with prostate cancer, whereas variable telomere lengths in prostate cancer cells and telomere shortening in cancer-associated stromal cells correlated with lethal disease. Single-agent telomerase-targeted treatments for solid cancers were ineffective in clinical trials but have not been investigated in prostate cancer and might be useful in combination with established regimens. Telomere-directed strategies have not been explored as extensively. Telomere deprotection strategies have the advantage of being effective in both telomerase-dependent and telomerase-independent cancers. Disruption of androgen receptor function in prostate cancer cells results in telomere dysfunction, indicating telomeres and telomerase as potential therapeutic targets in prostate cancer.
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494
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Stavrinides V, Parker C, Moore C. When no treatment is the best treatment: Active surveillance strategies for low risk prostate cancers. Cancer Treat Rev 2017; 58:14-21. [DOI: 10.1016/j.ctrv.2017.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 05/14/2017] [Accepted: 05/16/2017] [Indexed: 01/02/2023]
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495
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Pruthi DK, Ankerst DP, Liss MA. Novel Definitions of Low-risk and High-risk Prostate Cancer: Implications for the European Randomized Study of Screening for Prostate Cancer Risk Assessment Tool. Eur Urol 2017; 72:52-53. [DOI: 10.1016/j.eururo.2017.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/04/2017] [Indexed: 11/26/2022]
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496
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Tosoian JJ, Chappidi MR, Bishoff JT, Freedland SJ, Reid J, Brawer M, Stone S, Schlomm T, Ross AE. Prognostic utility of biopsy-derived cell cycle progression score in patients with National Comprehensive Cancer Network low-risk prostate cancer undergoing radical prostatectomy: implications for treatment guidance. BJU Int 2017; 120:808-814. [PMID: 28481440 DOI: 10.1111/bju.13911] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To determine the prognostic utility of the cell cycle progression (CCP) score in men with National Comprehensive Cancer Network (NCCN)-defined low-risk prostate cancer (PCa) undergoing radical prostatectomy (RP). PATIENTS AND METHODS Men who underwent RP for Gleason score ≤6 PCa at three institutions (Martini Clinic [MC], Durham Veterans Affairs Medical Center [DVA] and Intermountain Healthcare [IH]) were identified. The CCP score was obtained from diagnostic (DVA, IH) or simulated biopsies (MC). The primary outcome was biochemical recurrence (BCR; prostate-specific antigen ≥0.2 ng/mL) after RP. The prognostic utility of the CCP score was assessed using Kaplan-Meier analysis and multivariable Cox proportional hazards models in the subset of men meeting NCCN low-risk criteria and in the overall cohort. RESULTS Among the 236 men identified, 80% (188/236) met the NCCN low-risk criteria. Five-year BCR-free survival for the low (<0), intermediate (0-1) and high (>1) CCP score groups was 89.2%, 80.4%, 64.7%, respectively, in the low-risk cohort (P = 0.03), and 85.9%, 79.1%, 63.1%, respectively, in the overall cohort (P = 0.041). In multivariable models adjusting for clinical and pathological variables with the Cancer of the Prostate Risk Assessment (CAPRA) score, the CCP score was an independent predictor of BCR in the low-risk (hazard ratio [HR] 1.77 per unit score, 95% confidence interval [CI] 1.21, 2.58; P = 0.003) and overall cohorts (HR 1.41 per unit score, 95% CI 1.02, 1.96; P = 0.039). CONCLUSION In a cohort of men with NCCN-defined low-risk PCa, the CCP score improved clinical risk stratification of men who were at increased risk of BCR, which suggests the CCP score could improve the assessment of candidacy for active surveillance and guide optimum treatment selection in these patients with otherwise similar clinical characteristics.
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Affiliation(s)
- Jeffrey J Tosoian
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Meera R Chappidi
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jay T Bishoff
- Intermountain Urological Institute, Intermountain Health Care, Salt Lake City, UT, USA
| | - Stephen J Freedland
- Durham VA Medical Center, Durham, NC, USA.,Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Julia Reid
- Myriad Genetics, Inc., Salt Lake City, UT, USA
| | | | | | - Thorsten Schlomm
- Institute for Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ashley E Ross
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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497
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Jemal A, Ward EM, Johnson CJ, Cronin KA, Ma J, Ryerson B, Mariotto A, Lake AJ, Wilson R, Sherman RL, Anderson RN, Henley SJ, Kohler BA, Penberthy L, Feuer EJ, Weir HK. Annual Report to the Nation on the Status of Cancer, 1975-2014, Featuring Survival. J Natl Cancer Inst 2017; 109:3092246. [PMID: 28376154 PMCID: PMC5409140 DOI: 10.1093/jnci/djx030] [Citation(s) in RCA: 1034] [Impact Index Per Article: 147.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/07/2017] [Indexed: 12/13/2022] Open
Abstract
Background: The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate to provide annual updates on cancer occurrence and trends in the United States. This Annual Report highlights survival rates. Methods: Data were from the CDC- and NCI-funded population-based cancer registry programs and compiled by NAACCR. Trends in age-standardized incidence and death rates for all cancers combined and for the leading cancer types by sex were estimated by joinpoint analysis and expressed as annual percent change. We used relative survival ratios and adjusted relative risk of death after a diagnosis of cancer (hazard ratios [HRs]) using Cox regression model to examine changes or differences in survival over time and by sociodemographic factors. Results: Overall cancer death rates from 2010 to 2014 decreased by 1.8% (95% confidence interval [CI] = –1.8 to –1.8) per year in men, by 1.4% (95% CI = –1.4 to –1.3) per year in women, and by 1.6% (95% CI = –2.0 to –1.3) per year in children. Death rates decreased for 11 of the 16 most common cancer types in men and for 13 of the 18 most common cancer types in women, including lung, colorectal, female breast, and prostate, whereas death rates increased for liver (men and women), pancreas (men), brain (men), and uterine cancers. In contrast, overall incidence rates from 2009 to 2013 decreased by 2.3% (95% CI = –3.1 to –1.4) per year in men but stabilized in women. For several but not all cancer types, survival statistically significantly improved over time for both early and late-stage diseases. Between 1975 and 1977, and 2006 and 2012, for example, five-year relative survival for distant-stage disease statistically significantly increased from 18.7% (95% CI = 16.9% to 20.6%) to 33.6% (95% CI = 32.2% to 35.0%) for female breast cancer but not for liver cancer (from 1.1%, 95% CI = 0.3% to 2.9%, to 2.3%, 95% CI = 1.6% to 3.2%). Survival varied by race/ethnicity and state. For example, the adjusted relative risk of death for all cancers combined was 33% (HR = 1.33, 95% CI = 1.32 to 1.34) higher in non-Hispanic blacks and 51% (HR = 1.51, 95% CI = 1.46 to 1.56) higher in non-Hispanic American Indian/Alaska Native compared with non-Hispanic whites. Conclusions: Cancer death rates continue to decrease in the United States. However, progress in reducing death rates and improving survival is limited for several cancer types, underscoring the need for intensified efforts to discover new strategies for prevention, early detection, and treatment and to apply proven preventive measures broadly and equitably.
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Affiliation(s)
- Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | | | | | - Kathleen A Cronin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Jiemin Ma
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Blythe Ryerson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Angela Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Andrew J Lake
- Information Management Services, Inc., Rockville, MD, USA
| | - Reda Wilson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Recinda L Sherman
- North American Association of Central Cancer Registries, Springfield, IL, USA
| | - Robert N Anderson
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA
| | - S Jane Henley
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Betsy A Kohler
- North American Association of Central Cancer Registries, Springfield, IL, USA
| | - Lynne Penberthy
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Eric J Feuer
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Hannah K Weir
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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498
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Schouten MG, van der Leest M, Pokorny M, Hoogenboom M, Barentsz JO, Thompson LC, Fütterer JJ. Why and Where do We Miss Significant Prostate Cancer with Multi-parametric Magnetic Resonance Imaging followed by Magnetic Resonance-guided and Transrectal Ultrasound-guided Biopsy in Biopsy-naïve Men? Eur Urol 2017; 71:896-903. [PMID: 28063613 DOI: 10.1016/j.eururo.2016.12.006] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 12/07/2016] [Indexed: 01/28/2023]
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499
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Pahwa S, Schiltz NK, Ponsky LE, Lu Z, Griswold MA, Gulani V. Cost-effectiveness of MR Imaging-guided Strategies for Detection of Prostate Cancer in Biopsy-Naive Men. Radiology 2017; 285:157-166. [PMID: 28514203 DOI: 10.1148/radiol.2017162181] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose To evaluate the cost-effectiveness of multiparametric diagnostic magnetic resonance (MR) imaging examination followed by MR imaging-guided biopsy strategies in the detection of prostate cancer in biopsy-naive men presenting with clinical suspicion of cancer for the first time. Materials and Methods A decision-analysis model was created for biopsy-naive men who had been recommended for prostate biopsy on the basis of abnormal digital rectal examination results or elevated prostate-specific antigen levels (age groups: 41-50 years, 51-60 years, and 61-70 years). The following three major strategies were evaluated: (a) standard transrectal ultrasonography (US)-guided biopsy; (b) diagnostic MR imaging followed by MR imaging-targeted biopsy, with no biopsy performed if MR imaging findings were negative; and (c) diagnostic MR imaging followed by MR imaging-targeted biopsy, with a standard biopsy performed when MR imaging findings were negative. The following three MR imaging-guided biopsy strategies were further evaluated in each MR imaging category: (a) biopsy with cognitive guidance, (b) biopsy with MR imaging/US fusion guidance, and (c) in-gantry MR imaging-guided biopsy. Model parameters were derived from the literature. The primary outcome measure was net health benefit (NHB), which was measured as quality-adjusted life-years (QALYs) gained or lost by investing resources in a new strategy compared with a standard strategy at a willingness-to-pay (WTP) threshold of $50 000 per QALY gained. Probabilistic sensitivity analysis was performed by using Monte Carlo simulations. Results Noncontrast MR imaging followed by cognitively guided MR biopsy (no standard biopsy if MR imaging findings were negative) was the most cost-effective approach, yielding an additional NHB of 0.198 QALY compared with the standard biopsy approach. Noncontrast MR imaging followed by in-gantry MR imaging-guided biopsy (no standard biopsy if MR imaging findings were negative) led to the highest NHB gain of 0.251 additional QALY compared with the standard biopsy strategy. All MR imaging strategies were cost-effective in 94.05% of Monte Carlo simulations. Analysis by age groups yielded similar results. Conclusion MR imaging-guided strategies for the detection of prostate cancer were cost-effective compared with the standard biopsy strategy in a decision-analysis model. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Shivani Pahwa
- From the Departments of Radiology (S.P., M.A.G., V.G.) and Urology (L.E.P.), University Hospitals Case Medical Center, 11100 Euclid Ave, Bolwell B120, Cleveland, OH 44106-0500; Department of Epidemiology and Biostatistics (N.K.S.) and Department of Biomedical Engineering (M.A.G., V.G.), Case Western Reserve University, Cleveland, Ohio; and Case Western Reserve University School of Medicine, Cleveland, Ohio (Z.L.)
| | - Nicholas K Schiltz
- From the Departments of Radiology (S.P., M.A.G., V.G.) and Urology (L.E.P.), University Hospitals Case Medical Center, 11100 Euclid Ave, Bolwell B120, Cleveland, OH 44106-0500; Department of Epidemiology and Biostatistics (N.K.S.) and Department of Biomedical Engineering (M.A.G., V.G.), Case Western Reserve University, Cleveland, Ohio; and Case Western Reserve University School of Medicine, Cleveland, Ohio (Z.L.)
| | - Lee E Ponsky
- From the Departments of Radiology (S.P., M.A.G., V.G.) and Urology (L.E.P.), University Hospitals Case Medical Center, 11100 Euclid Ave, Bolwell B120, Cleveland, OH 44106-0500; Department of Epidemiology and Biostatistics (N.K.S.) and Department of Biomedical Engineering (M.A.G., V.G.), Case Western Reserve University, Cleveland, Ohio; and Case Western Reserve University School of Medicine, Cleveland, Ohio (Z.L.)
| | - Ziang Lu
- From the Departments of Radiology (S.P., M.A.G., V.G.) and Urology (L.E.P.), University Hospitals Case Medical Center, 11100 Euclid Ave, Bolwell B120, Cleveland, OH 44106-0500; Department of Epidemiology and Biostatistics (N.K.S.) and Department of Biomedical Engineering (M.A.G., V.G.), Case Western Reserve University, Cleveland, Ohio; and Case Western Reserve University School of Medicine, Cleveland, Ohio (Z.L.)
| | - Mark A Griswold
- From the Departments of Radiology (S.P., M.A.G., V.G.) and Urology (L.E.P.), University Hospitals Case Medical Center, 11100 Euclid Ave, Bolwell B120, Cleveland, OH 44106-0500; Department of Epidemiology and Biostatistics (N.K.S.) and Department of Biomedical Engineering (M.A.G., V.G.), Case Western Reserve University, Cleveland, Ohio; and Case Western Reserve University School of Medicine, Cleveland, Ohio (Z.L.)
| | - Vikas Gulani
- From the Departments of Radiology (S.P., M.A.G., V.G.) and Urology (L.E.P.), University Hospitals Case Medical Center, 11100 Euclid Ave, Bolwell B120, Cleveland, OH 44106-0500; Department of Epidemiology and Biostatistics (N.K.S.) and Department of Biomedical Engineering (M.A.G., V.G.), Case Western Reserve University, Cleveland, Ohio; and Case Western Reserve University School of Medicine, Cleveland, Ohio (Z.L.)
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Haider MR, Qureshi ZP, Horner R, Friedman DB, Bennett C. What Have Patients Been Hearing From Providers Since the 2012 USPSTF Recommendation Against Routine Prostate Cancer Screening? Clin Genitourin Cancer 2017. [PMID: 28625690 DOI: 10.1016/j.clgc.2017.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND In this study we aimed to determine the relationship between prostate-specific antigen (PSA)-related information obtained from the provider and PSA test uptake. With recent focus on patient-provider communication (PC) and the guidelines recommending against PSA tests for prostate cancer (PCa), PC regarding the PSA test might affect PSA screening rates. MATERIALS AND METHODS We used the fourth edition of the Health Information National Trends Survey, a nationally-representative US survey on the use of cancer-related information. The survey was conducted in 3 cycles: October 2011 to January 2012 (cycle 1); October 2012 to January 2013 (cycle 2); September 2013 to October 2013 (cycle 3). Logistic regression was used to study the effect of PC on respondents' uptake of the PSA test. RESULTS Most of the respondents were 51 to 65 years old, white, with college or higher education, were married, and had health insurance. PC regarding the PSA test greatly increased the chances of screening for PCa using the PSA test in all 3 cycles (odds ratio [OR], 2.51 [95% confidence interval (CI), 2.03-3.10] in cycle 1; OR, 3.50 [95% CI, 2.51-4.88] in cycle 2; OR, 2.69 [95% CI, 2.02-3.58] in cycle 3). CONCLUSION Our study showed that PC increased the likelihood of patients undergoing PSA screening. In light of the 2012 US Preventive Services Task Force guidelines recommending against screening for PCa, PC seemed to have an opposite effect. Although updated PC that educates patients on the risks and benefits of PSA screening is needed, patients classically overemphasize benefits and underemphasize risks-which might increase rather than decrease PSA screening rates.
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Affiliation(s)
- Mohammad Rifat Haider
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC; Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Zaina P Qureshi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC; Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC; William Jennings Bryan Dorn VA Medical Center, Columbia, SC.
| | - Ronnie Horner
- Department of Health Services Policy and Management, and Institute for the Advancement of Healthcare, University of South Carolina, Columbia, SC
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC
| | - Charles Bennett
- Department of Clinical Pharmacy and Outcomes Sciences, and Medication Safety, South Carolina College of Pharmacy, University of South Carolina, Columbia, SC
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