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Abstract
PURPOSE To review available prostate cancer biomarkers and their performance in a clinical order, from prostate cancer detection, to treatment of localized and advanced disease. METHODS We used an electronic literature search of the PubMed database using the key words "prostate biomarkers," "genomic markers," and "prostate cancer screening," as well as specific biomarkers, until March 2019. RESULTS Prostate-specific antigen (PSA) lacks sensitivity for prostate cancer detection, and PSA derivatives have slightly improved its specificity, but have not resolved the limitations of PSA screening. Prostate cancer biomarkers have emerged as an ancillary tool to guide the clinical decision-making in different clinical scenarios. Urine-based tests can identify patients who may benefit from a prostate biopsy, and issue-based markers are helpful in guiding the decision regarding a second biopsy, stratifying patient with newly diagnosed prostate cancer to active surveillance or treatment, and identifying patients who may benefit from adjuvant treatment after surgery. CONCLUSIONS New biomarkers have improved risk stratification in diagnosing and treating prostate cancer. Many of these markers are still considered experimental, and their efficacy and cost utility have not been determined.
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Affiliation(s)
- Amihay Nevo
- Department of Urology, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA.
| | - Anojan Navaratnam
- Department of Urology, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Paul Andrews
- Department of Urology, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
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102
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Poulsen MH, Feddersen S, Albitar M, Poulsen CA, Lund M, Pedersen TB, Mortensen MA, Lund L. A prospective study of a urine and plasma biomarker test for the prediction of gleason ≥3 + 4 prostate cancer in a mixed cohort. Scand J Urol 2020; 54:323-327. [PMID: 32608296 DOI: 10.1080/21681805.2020.1782979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose: Definitive diagnosis of prostate cancer is based on biopsies, a procedure associated with side-effects. The use of biomarkers in blood and urine could potentially help clinicians select patients for whom biopsies are needed. The aim of the study was to test a new urine and plasma biomarker test in detecting medium and high grade prostate cancer.Materials and methods: Blood and urine samples were prospectively collected from 41 patients prior to prostate biopsy or TUR-P and again after 3 months. The cohort included patients with suspicion of prostate cancer and patients with prior prostate cancer diagnosis. The mRNA expression of ten selected genes measured by PCR were used together with clinical data in multiple algorithms for prediction of medium-high grade prostate cancer in prostate biopsies. The testing was originally developed and validated in the USA. The method was transferred to a local Danish laboratory. Medium and high grade cancer was defined as Gleason score ≥ 3 + 4.Results: Using the biomarker test, prior to any prostate procedures, the sensitivity for detecting medium-high grade prostate cancer was 100% and the specificity was 56% and 63%, depending on the cut-off point used. When using the biomarker test, following biopsy or TUR-P, the sensitivity and specificity were reduced to 89% and 28-34% respectively. When comparing results, there was a significant difference (p < 0.05), favoring the test performed prior to the procedures.Conclusions: We were able to predict the presence of medium-high grade prostate cancer, thereby confirming earlier findings of the biomarker test.
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Affiliation(s)
- Mads Hvid Poulsen
- Department of Urology, Odense University Hospital, Odense, Denmark.,Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Søren Feddersen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Maher Albitar
- Research and Development Department, NeoGenomics Laboratories, Carlsbad, CA, USA
| | | | - Martin Lund
- Department of Urology, Odense University Hospital, Odense, Denmark
| | | | - Mike Allan Mortensen
- Department of Urology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lars Lund
- Department of Urology, Odense University Hospital, Odense, Denmark.,Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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103
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Teoh JYC, Leung CH, Wang MH, Chiu PKF, Yee CH, Ng CF, Wong MCS. The cost-effectiveness of prostate health index for prostate cancer detection in Chinese men. Prostate Cancer Prostatic Dis 2020; 23:615-621. [PMID: 32606435 DOI: 10.1038/s41391-020-0243-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/16/2020] [Accepted: 06/17/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Prostate-specific antigen (PSA) and prostate health index (PHI) have been used as biomarkers for prostate cancer detection. In this study, we aimed to evaluate the cost-effectiveness of PHI for prostate cancer detection in Chinese men. METHOD We developed a Markov model for Chinese male patient aged 50-75 years old. The PSA strategy was to offer TRUS-PB for all patients with elevated PSA of 4-10 ng/mL. The PHI strategy was to offer PHI for patients with elevated PSA of 4-10 ng/mL. TRUS-PB would only be offered for patients with PHI >35.0. Model inputs were extracted from local data when available. The cost per quality-adjusted life years gained for both strategies were calculated. The incremental cost-effectiveness ratios in relation to the willingness-to-pay (WTP) threshold were compared. One-way sensitivity analysis and probabilistic sensitivity analysis were performed. Cost-effectiveness acceptability curves were also constructed. RESULTS With a Markov model of 25 screening cycles from age 50 to 75 years, the mean total costs per man were estimated to be USD 27,439 in the PSA strategy and USD 22,877 in the PHI strategy. The estimated effects were estimated to be 15.70 in the PSA strategy and 16.05 in the PHI strategy. The PHI strategy was associated with an expected decrease in cost of USD 4562 and an expected gain of 0.35 QALY, resulting in an ICER of USD -13056.56. The results were shown to be robust upon one-way sensitivity analysis. Upon Monte Carlo simulation, the PHI strategy was more cost-effective for 100% of the iterations. The PHI strategy demonstrated dominance over the PSA strategy regardless of what WTP threshold we use. CONCLUSIONS A PHI-based screening strategy may be more cost-effective than a PSA-based strategy for prostate cancer detection in Chinese men. These results support consideration of a PHI-based approach for prostate cancer in Hong Kong.
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Affiliation(s)
- Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
| | - Chi-Ho Leung
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Maggie Haitian Wang
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Peter Ka-Fung Chiu
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Hang Yee
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Martin Chi-Sang Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
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104
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Brönimann S, Pradere B, Karakiewicz P, Abufaraj M, Briganti A, Shariat SF. An overview of current and emerging diagnostic, staging and prognostic markers for prostate cancer. Expert Rev Mol Diagn 2020; 20:841-850. [DOI: 10.1080/14737159.2020.1785288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Stephan Brönimann
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, CHRU Tours, Francois Rabelais University, Tours, France
| | - Pierre Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada
| | - Mohammad Abufaraj
- Division of Urology, Department of Special Surgery, Jordan University Hospital, the 2 University of Jordan, Amman, Jordan
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Shahrokh F. Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Departments of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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105
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Serum and urinary biomarkers for detection and active surveillance of prostate cancer. Curr Opin Urol 2020; 29:593-597. [PMID: 31436568 DOI: 10.1097/mou.0000000000000670] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW To provide a comprehensive review of the available biomarkers for the detection and active surveillance of prostate cancer and simplify decision-making while choosing between them. RECENT FINDINGS The limitations of PSA and mpMRI and the invasive nature of prostate biopsy has led to a constant search for serum and urinary biomarkers for both the detection and monitoring during active surveillance of prostate cancer. 4K, PHI and PCA3 have been validated in prospective clinical trials for initial detection of prostate cancer and recent evidence points to potential differentiation between indolent and aggressive cancer. However, the usage in monitoring tumor dynamics is debatable because of lack of conclusive evidence. The answer to the existing problems lies in high-quality studies to establish definitive evidence and also to help choose between the plethora of biomarkers available today. SUMMARY Despite the advancements in innovation and usage of biomarkers in prostate cancer, there exists tremendous potential in improving them to fulfil the unmet need that exists today. Studies to establish conclusive evidence and integration with imaging can tremendously aid diagnosis and monitoring.
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106
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Shore ND, Pieczonka CM, Henderson RJ, Bailen JL, Saltzstein DR, Concepcion RS, Beebe-Dimmer JL, Ruterbusch JJ, Le TH, Levin RA, Wissmueller S, Prah P, Borotkanics R, Paivanas TA, van Breda A, Campbell DH, Walsh BJ. A comparison of prostate health index, total PSA, %free PSA, and proPSA in a contemporary US population-The MiCheck-01 prospective trial. Urol Oncol 2020; 38:683.e1-683.e10. [PMID: 32360170 DOI: 10.1016/j.urolonc.2020.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/27/2020] [Accepted: 03/14/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Increasing numbers of patients are presenting with aggressive prostate cancer (CaP); therefore, there exists a need to optimally identify these patients pre-biopsy. OBJECTIVES To compare the accuracy of total prostate specific antigen (PSA), %free PSA, and prostate health index (PHI) to differentiate between patients without CaP, with non-aggressive (Gleason 3 + 3, non-AgCaP) and with aggressive (Gleason ≥ 3 + 4, AgCaP) in a contemporary US population. DESIGN, SETTINGS, AND PARTICIPANTS Serum samples were collected from 332 US patients scheduled for biopsy due to an elevated age-adjusted PSA. Site and Central biopsy pathologic assessment were performed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Testing of PSA, free PSA, proPSA, and PHI was performed along with central pathology review. Test performance using logistic regression analysis for differentiating CaP from non-CaP as well as non-AgCaP from AgCaP was evaluated. RESULTS AND LIMITATIONS Central pathology review resulted in 32 upgrades including 14 Gleason 3 + 3 scores being upgraded to AgCaP with final distribution of 148 no-CaP, 64 non-AgCaP, and 120 AgCaP patients. Receiver operator curve (ROC) analysis of the different tests showed that PHI performed best at differentiating CaP from no-CaP subjects (area under the receiver operator curve 0.79). In contrast, the different tests were essentially equivalent in differentiating AgCaP vs. non-AgCaP. CONCLUSIONS In this recent US study of prebiopsy patients we observed a high proportion of AgCaP patients consistent with previous studies in contemporary US populations. Central Gleason review is recommended for multi-institutional studies comparing biomarkers. PHI was superior to PSA, free PSA, %free PSA, and proPSA in detecting CaP in this population but was not superior at differentiating AgCaP from non-AgCaP.
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Affiliation(s)
| | | | | | | | | | | | - Jennifer L Beebe-Dimmer
- Barbara Ann Karmanos Cancer Institute and Wayne State University School of Medicine Department of Oncology, Detroit, MI
| | - Julie J Ruterbusch
- Barbara Ann Karmanos Cancer Institute and Wayne State University School of Medicine Department of Oncology, Detroit, MI
| | - Thao Ho Le
- Minomic International Ltd, NSW, Sydney, Australia
| | | | | | - Philip Prah
- Department of biostatistics and Epidemiology, Auckland University of Technology, Auckland, New Zealand
| | - Robert Borotkanics
- School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
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107
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孙 奎, 闫 存, 李 志, 刘 平, 张 伟, 何 群. [Clinical value of serum isoform [-2] proprostate-specific antigen and its derivatives in predicting aggressive prostate cancer]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2020; 52:234-239. [PMID: 32306004 PMCID: PMC7433460 DOI: 10.19723/j.issn.1671-167x.2020.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To explore the clinical value of serum isoform [-2] proprostate-specific antigen (p2PSA) and its derivatives %p2PSA and prostate health index (PHI) in predicting aggressive prostate cancer (PCa). METHODS The pre-operation serum and basic clinical data of 322 patients with PCa (including 143 patients diagnosed with PCa by transrectal ultrasound-guided prostate biopsy and 179 patients undergoing radical prostatectomy) in Peking University First Hospital were collected from August 2015 to May 2018. Serum total prostate-specific antigen (tPSA), free prostate antigen (fPSA) and fPSA/tPSA (f/t) and the p2PSA level of all these patients were measured on automatic immune analyzers DxI800, and then %p2PSA and PHI were calculated. The prostate pathologic result was considered as the gold standard to evaluate the Gleason score of the patients with PCa. Receiver operator curves (ROC) were used to assess the ability of p2PSA, %p2PSA and PHI to predict aggressive PCa (pathologic Gleason score≥7) compared with those traditional markers tPSA, fPSA and f/t. RESULTS Among these patients, the p2PSA, %p2PSA and PHI median levels were significantly higher in patients with pathologic Gleason score≥7 than those with Gleason score<7 (p2PSA: 30.22 ng/L vs. 18.33 ng/L; %p2PSA: 2.50 vs. 1.27; PHI: 91.81 vs. 35.44; all P<0.01). The area under curve (AUC) of %p2PSA and PHI (0.770, 0.760) in predicting Gleason score≥7 were higher than those of the traditional indicators tPSA, fPSA and f/t (AUC were 0.648, 0.536 and 0.693, respectively). Among those patients diagnosed with PCa by transrectal ultrasound-guided prostate biopsy, the AUC of %p2PSA and PHI (AUC were 0.808 and 0.801, respectively) in predicting Gleason score≥7 were higher than those of the traditional indicators tPSA, fPSA and f/t (AUC were 0.729, 0.655 and 0.665 respectively). Among those patients undergoing radical prostatectomy, PHI and %p2PSA also had the trend of higher predictive value than those of the traditional indicators. The AUC of %p2PSA and PHI were 0.798 and 0.744, respectively while the AUC of tPSA, fPSA and f/t were 0.625, 0.507 and 0.697, respectively. CONCLUSION Compared with traditional markers tPSA, fPSA and f/t, %p2PSA and PHI had much higher predictive value for aggressive PCa, which may help clinicians to evaluate the therapeutic regime and make more appropriate management plan for the patients.
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Affiliation(s)
- 奎霞 孙
- />北京大学第一医院检验科,北京 100034Department of Clinical Laboratory, Peking University First Hospital, Beijing 100034, China
| | - 存玲 闫
- />北京大学第一医院检验科,北京 100034Department of Clinical Laboratory, Peking University First Hospital, Beijing 100034, China
| | - 志艳 李
- />北京大学第一医院检验科,北京 100034Department of Clinical Laboratory, Peking University First Hospital, Beijing 100034, China
| | - 平 刘
- />北京大学第一医院检验科,北京 100034Department of Clinical Laboratory, Peking University First Hospital, Beijing 100034, China
| | - 伟 张
- />北京大学第一医院检验科,北京 100034Department of Clinical Laboratory, Peking University First Hospital, Beijing 100034, China
| | - 群 何
- />北京大学第一医院检验科,北京 100034Department of Clinical Laboratory, Peking University First Hospital, Beijing 100034, China
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108
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Nassir AM, Kamel HFM. Explication of the roles of prostate health index (PHI) and urokinase plasminogen activator (uPA) as diagnostic and predictor tools for prostate cancer in equivocal PSA range of 4-10 ng/mL. Saudi J Biol Sci 2020; 27:1975-1984. [PMID: 32714021 PMCID: PMC7376136 DOI: 10.1016/j.sjbs.2020.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/11/2020] [Accepted: 04/01/2020] [Indexed: 12/28/2022] Open
Abstract
Background Prostate cancer (PCa) is one of the most commonly encountered cancers and the leading cause of death worldwide. Currently used biomarkers accounts difficulties in discriminating benign from malignant cases or predicting outcome, so investigating new biomarkers performance is needed. Objectives Assessment of diagnostic and predictor roles of prostate health index (PHI) and urokinase plasminogen activator (uPA) in PCa. Methods 194 males with initial tPSA of 4-10 ng/mL were categorized into three groups: PCa, benign prostatic hyperplasia (BPH) and healthy control. Serum levels of tPSA, fPSA, p2PSA, and uPA were performed by ELISA with calculation of PHI as (p2PSA/fPSA) × √PSA. Results PHI and uPA were significantly higher in PCa patients relevant to BPH and healthy control (p ≤ 0.001). Both markers outperformed all assessed biomarkers and showed the highest area under the curve (AUC) in ROC curve analysis. Both were significantly higher in PCa patients with {Gleason score ≥ 7, late stages (cT2b,c; T3), LN extension and distant metastasis}relative to their counterparts. Additionally, PHI and uPA and were independent predictors of distant metastasis and Gleason score ≥ 7, while PHI was predictor of LN invasion (β = 0.25, p = 0.004). Conclusion PHI and uPA would be of potential value in discriminating between PCa, BPH and healthy men in addition, both are promising as independent predictors of adverse pathological features.
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Affiliation(s)
- Anmar M Nassir
- Surgery Department, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Hala F M Kamel
- Biochemistry Department, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia.,Medical Biochemistry Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt
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109
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Becerra MF, Atluri VS, Bhattu AS, Punnen S. Serum and urine biomarkers for detecting clinically significant prostate cancer. Urol Oncol 2020; 39:686-690. [PMID: 32241692 DOI: 10.1016/j.urolonc.2020.02.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 02/05/2020] [Accepted: 02/15/2020] [Indexed: 02/06/2023]
Abstract
Since the "prostate-specific antigen (PSA) era," we have seen an increase in unnecessary biopsies, which has ultimately lead to an overtreatment of low-risk cancers. Given the limitations of prostate-specific antigen and the invasive nature of prostate biopsy several serum and urinary biomarkers have been developed. In this paper, we provide a comprehensive review of the available biomarkers for the detection clinically significant prostate cancer namely PHI, 4Kscore, PCA3, MiPS, SelectMDx, ExosomeDX. Current literature suggests that these biomarkers can improve detection of clinically significant prostate cancer reducing overtreatment and making treatment strategies more cost-effective. Nevertheless, large prospective studies with head-to-head-comparisons of the available biomarkers are necessary to fully assess the potential of incorporating biomarkers in routine clinical practice.
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Affiliation(s)
- Maria F Becerra
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL
| | - Venkatasai S Atluri
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL
| | - Amit S Bhattu
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL
| | - Sanoj Punnen
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL.
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110
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A predictive model for prostate cancer incorporating PSA molecular forms and age. Sci Rep 2020; 10:2463. [PMID: 32051423 PMCID: PMC7016114 DOI: 10.1038/s41598-020-58836-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 01/16/2020] [Indexed: 12/16/2022] Open
Abstract
The diagnostic specificity of prostate specific antigen (PSA) is limited. We aimed to characterize eight anti-PSA monoclonal antibodies (mAbs) to assess the prostate cancer (PCa) diagnostic utility of different PSA molecular forms, total (t) and free (f) PSA and PSA complexed to α1-antichymotrypsin (complexed PSA). MAbs were obtained by immunization with PSA and characterized by competition studies, ELISAs and immunoblotting. With them, we developed sensitive and specific ELISAs for these PSA molecular forms and measured them in 301 PCa patients and 764 patients with benign prostate hyperplasia, and analyzed their effectiveness to discriminate both groups using ROC curves. The free-to-total (FPR) and the complexed-to-total PSA (CPR) ratios significantly increased the diagnostic yield of tPSA. Moreover, based on model selection, we constructed a multivariable logistic regression model to predictive PCa that includes tPSA, fPSA, and age as predictors, which reached an optimism-corrected area under the ROC curve (AUC) of 0.86. Our model outperforms the predictive ability of tPSA (AUC 0.71), used in clinical practice. In conclusion, The FPR and CPR showed better diagnostic yield than tPSA. In addition, the PCa predictive model including age, fPSA and complexed PSA, outperformed tPSA detection efficacy. Our model may avoid unnecessary biopsies, preventing harmful side effects and reducing health expenses.
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111
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Ferro M, De Cobelli O, Lucarelli G, Porreca A, Busetto GM, Cantiello F, Damiano R, Autorino R, Musi G, Vartolomei MD, Muto M, Terracciano D. Beyond PSA: The Role of Prostate Health Index (phi). Int J Mol Sci 2020; 21:ijms21041184. [PMID: 32053990 PMCID: PMC7072791 DOI: 10.3390/ijms21041184] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/05/2020] [Accepted: 02/07/2020] [Indexed: 01/03/2023] Open
Abstract
Background: Widespread use of prostate specific antigen (PSA) in screening procedures allowed early identification of an increasing number of prostate cancers (PCas), mainly including indolent cancer. Availability of different therapeutic strategies which have a very different impact on the patient’s quality of life suggested a strong need for tools able to identify clinically significant cancer at diagnosis. Multi-parametric magnetic resonance showed very good performance in pre-biopsy diagnosis. However, it is an expensive tool and requires an experienced radiologist. In this context, a simple blood-based test is worth investigating. In this context, researchers focused their attention on the development of a laboratory test able to minimize overdiagnosis without losing the identification of aggressive tumors. Results: Recent literature data on PCa biomarkers revealed a clear tendency towards the use of panels of biomarkers or a combination of biomarkers and clinical variables. Phi, the 4Kscore, and Stockholm3 as circulating biomarkers and the Mi-prostate score, Exo DX Prostate, and Select MD-X as urinary biomarker-based tests have been developed. In this scenario, phi is worthy of attention as a noninvasive test significantly associated with aggressive PCa. Conclusions: Literature data showed that phi had good diagnostic performance to identify clinically significant (cs) PCa, suggesting that it could be a useful tool for personalized treatment decision-making. In this review, phi potentialities, limitations, and comparisons with other blood- and urinary-based tests were explored.
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Affiliation(s)
- Matteo Ferro
- Division of Urology, European Institute of Oncology, 20141 Milan, Italy; (M.F.); (O.D.C.); (G.M.)
| | - Ottavio De Cobelli
- Division of Urology, European Institute of Oncology, 20141 Milan, Italy; (M.F.); (O.D.C.); (G.M.)
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation—Urology, Andrology and Kidney Transplantation Unit, University of Bari, 70124 Bari, Italy;
| | - Angelo Porreca
- Department of Urology, Abano Terme Hospital, 35031 Padua, Italy;
| | | | - Francesco Cantiello
- Department of Urology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (F.C.); (R.D.)
| | - Rocco Damiano
- Department of Urology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (F.C.); (R.D.)
| | | | - Gennaro Musi
- Division of Urology, European Institute of Oncology, 20141 Milan, Italy; (M.F.); (O.D.C.); (G.M.)
| | - Mihai Dorin Vartolomei
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
- Department of Cell and Molecular Biology, University of Medicine, Pharmacy, Sciences and Technology, 540139 Targu Mures, Romania
| | - Matteo Muto
- Radiotherapy Unit, “S. G. Moscati” Hospital, 83100 Avellino, Italy;
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples “Federico II”, 8031 Naples, Italy
- Correspondence: ; Tel.: +39-8174-6361-7
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112
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Nassir AM. A piece in prostate cancer puzzle: Future perspective of novel molecular signatures. Saudi J Biol Sci 2020; 27:1148-1154. [PMID: 32256177 PMCID: PMC7105665 DOI: 10.1016/j.sjbs.2020.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/26/2020] [Accepted: 02/01/2020] [Indexed: 12/24/2022] Open
Abstract
Prostate cancer (PCa) has a variable biological potential. It constitutes the second most common cancer amongst men worldwide and the fifth most common cancer in Saudi Arabia. Identifying men at higher risk of developing PCa, differentiating indolent from aggressive disease and predicting the likelihood of progression will improve decision-making and selection for active surveillance protocols. Biomarkers have been utilized for PCa screening and predicting cancer behavior and response to treatment. The prostate specific antigen (PSA) screening helps detect PCa in early stages, while implementing a plan for management and outcome. However, PSA screening is still controversial, due to the risks of over diagnosis and treatment, and its inability to detect a good proportion of advanced tumors. Alternatively, a new era of PCa biomarkers has emerged with higher PCa specificity than PSA and its isoforms hopefully improving screening methods, such as Prostate Health Index (PHI) score, Progensa Prostate Cancer Antigen 3 (PCA3), Mi-Prostate Score (MiPS), Prostate Stem Cell Antigen (PSCA), 4Kscore test, and Urokinase Plasminogen Activation (uPA and uPAR). Few novel biomarkers have shown promise in preliminary results. This review will display promising biomarkers including some important FDA approved ones, highlighting their clinical implication and future place in the PCa puzzle, along with addressing their current limitations.
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Affiliation(s)
- Anmar M Nassir
- Department of Surgery, Umm Al-Qura University, Makkah, Saudi Arabia.,Department of Urology, King Abdullah Medical City, Makkah, Saudi Arabia
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Pardy L, Rosati R, Soave C, Huang Y, Kim S, Ratnam M. The ternary complex factor protein ELK1 is an independent prognosticator of disease recurrence in prostate cancer. Prostate 2020; 80:198-208. [PMID: 31794091 PMCID: PMC7302117 DOI: 10.1002/pros.23932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/18/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Both hormone-sensitive and castration- and enzalutamide-resistant prostate cancers (PCa) depend on the ternary complex factor (TCF) protein ELK1 to serve as a tethering protein for the androgen receptor (AR) to activate a critical set of growth genes. The two sites in ELK1 required for AR binding are conserved in other members of the TCF subfamily, ELK3 and ELK4. Here we examine the potential utility of the three proteins as prognosticators of disease recurrence in PCa. METHODS Transcriptional activity assays; Retrospective analysis of PCa recurrence using data on 501 patients in The Cancer Genome Atlas (TCGA) database; Unpaired Wilcoxon rank-sum test and multiple comparison correction using the Holm's method; Spearman's correlations; Kaplan-Meier methods; Univariable and multivariable Cox regression analyses; LASSO-based penalized Cox regression models; Time-dependent area under the receiver operating characteristic (ROC) curve. RESULTS ELK4 but not ELK3 was coactivated by AR similar to ELK1. Tumor expression of neither ELK3 nor ELK4 was associated with disease-free survival (DFS). ELK1 was associated with higher clinical T-stage, pathology T-stage, Gleason score, prognostic grade, and positive lymph node status. ELK1 was a negative prognosticator of DFS, independent of ELK3, ELK4, clinical T-stage, pathology T-stage, prognostic grade, lymph node status, age, and race. Inclusion of ELK1 increased the abilities of the Oncotype DX and Prolaris gene panels to predict disease recurrence, correctly predicting disease recurrence in a unique subset of patients. CONCLUSIONS ELK1 is a strong, independent prognosticator of disease recurrence in PCa, underscoring its unique role in PCa growth. Inclusion of ELK1 may enhance the utility of currently used prognosticators for clinical decision making in prostate cancer.
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Affiliation(s)
- Luke Pardy
- Department of Oncology and Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Rayna Rosati
- Department of Oncology and Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Claire Soave
- Department of Oncology and Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Yanfang Huang
- Department of Oncology and Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Seongho Kim
- Department of Oncology and Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Manohar Ratnam
- Department of Oncology and Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
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Merging new-age biomarkers and nanodiagnostics for precision prostate cancer management. Nat Rev Urol 2020; 16:302-317. [PMID: 30962568 DOI: 10.1038/s41585-019-0178-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The accurate identification and stratified treatment of clinically significant early-stage prostate cancer have been ongoing concerns since the outcomes of large international prostate cancer screening trials were reported. The controversy surrounding clinical and cost benefits of prostate cancer screening has highlighted the lack of strategies for discriminating high-risk disease (that requires early treatment) from low-risk disease (that could be managed using watchful waiting or active surveillance). Advances in molecular subtyping and multiomics nanotechnology-based prostate cancer risk delineation can enable refinement of prostate cancer molecular taxonomy into clinically meaningful and treatable subtypes. Furthermore, the presence of intertumoural and intratumoural heterogeneity in prostate cancer warrants the development of novel nanodiagnostic technologies to identify clinically significant prostate cancer in a rapid, cost-effective and accurate manner. Circulating and urinary next-generation prostate cancer biomarkers for disease molecular subtyping and the newest complementary nanodiagnostic platforms for enhanced biomarker detection are promising tools for precision prostate cancer management. However, challenges in merging both aspects and clinical translation still need to be overcome.
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Murray NP, Fuentealba C, Salazar A, Reyes E. Platelet-to-lymphocyte ratio and systemic immune-inflammation index versus circulating prostate cells to predict significant prostate cancer at first biopsy. Turk J Urol 2020; 46:115-122. [PMID: 32053099 DOI: 10.5152/tud.2020.19203] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/12/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE It has been reported that the systemic immune-inflammation index (SII) and platelet-to-lymphocyte ratio (PLR) are higher in men with prostate cancer. We compare their use with the percentage of free prostate-specific antigen (PSA), PSA density, and primary circulating prostate cells (CPCs) to predict clinically significant prostate cancer at first biopsy in men with a PSA of 4-10 ng/mL. MATERIAL AND METHODS Consecutive men with suspicion of prostate cancer underwent a 12-core transrectal ultrasound-guided prostate biopsy; total serum PSA, the percentage of free PSA, prostate ultrasound to calculate PSA density, and absolute neutrophil, lymphocyte, and platelet counts were used for risk assessment. CPCs were detected using differential gel centrifugation and immunocytochemistry with anti-PSA and anti-P504S. A malignant CPC was defined as a cell-expressing PSA and P504S and defined as positive or negative. Biopsies were classified as indicating cancer or no cancer. Areas under the curve for each parameter were calculated and compared, and diagnostic yields were calculated. RESULTS A total of 1223 men participated, and 467 (38%) had a biopsy positive for cancer, whereas 353/467 (76%) had clinically significant prostate cancer. The PLR was significantly higher in men with prostate cancer; there was no significant difference for the SII. The areas under the curves were CPC 0.84, the percentage of free PSA was 0.79, PLR 0.65, PSA density 0.62, and SII 0.46. Neither the PLR nor the SII discriminated between patients with clinically significant prostate cancer, indolent cancer, and benign prostatic disease. CONCLUSION Based on the results of this study, neither the SII nor PLR could differentiate between clinically significant prostate cancer and indolent cancer/benign disease at initial biopsy.
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Affiliation(s)
- Nigel P Murray
- Servicio de Medicina, Hospital de Carabineros de Chile, Simón Bolívar 2200, Ñuñoa, Santiago, Chile.,Faculty of Medicine, University Finis Terrae, Av Pedro de Valdivia, Providencia, Santiago, Chile
| | - Cynthia Fuentealba
- Servicio de Urologia, Hospital de Carabineros de Chile, Simón Bolívar 2200, Ñuñoa, Santiago, Chile
| | - Aníbal Salazar
- Servicio de Urologia, Hospital de Carabineros de Chile, Simón Bolívar 2200, Ñuñoa, Santiago, Chile
| | - Eduardo Reyes
- Servicio de Urologia, Hospital DIPRECA, Vital Apoquindo 1200, Las Condes, Santiago, Chile
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Kiebish MA, Cullen J, Mishra P, Ali A, Milliman E, Rodrigues LO, Chen EY, Tolstikov V, Zhang L, Panagopoulos K, Shah P, Chen Y, Petrovics G, Rosner IL, Sesterhenn IA, McLeod DG, Granger E, Sarangarajan R, Akmaev V, Srinivasan A, Srivastava S, Narain NR, Dobi A. Multi-omic serum biomarkers for prognosis of disease progression in prostate cancer. J Transl Med 2020; 18:10. [PMID: 31910880 PMCID: PMC6945688 DOI: 10.1186/s12967-019-02185-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/23/2019] [Indexed: 01/31/2023] Open
Abstract
Background Predicting the clinical course of prostate cancer is challenging due to the wide biological spectrum of the disease. The objective of our study was to identify prostate cancer prognostic markers in patients ‘sera using a multi-omics discovery platform. Methods Pre-surgical serum samples collected from a longitudinal, racially diverse, prostate cancer patient cohort (N = 382) were examined. Linear Regression and Bayesian computational approaches integrated with multi-omics, were used to select markers to predict biochemical recurrence (BCR). BCR-free survival was modeled using unadjusted Kaplan–Meier estimation curves and multivariable Cox proportional hazards analysis, adjusted for key pathologic variables. Receiver operating characteristic (ROC) curve statistics were used to examine the predictive value of markers in discriminating BCR events from non-events. The findings were further validated by creating a training set (N = 267) and testing set (N = 115) from the cohort. Results Among 382 patients, 72 (19%) experienced a BCR event in a median follow-up time of 6.9 years. Two proteins—Tenascin C (TNC) and Apolipoprotein A1V (Apo-AIV), one metabolite—1-Methyladenosine (1-MA) and one phospholipid molecular species phosphatidic acid (PA) 18:0-22:0 showed a cumulative predictive performance of AUC = 0.78 [OR (95% CI) = 6.56 (2.98–14.40), P < 0.05], in differentiating patients with and without BCR event. In the validation set all four metabolites consistently reproduced an equivalent performance with high negative predictive value (NPV; > 80%) for BCR. The combination of pTstage and Gleason score with the analytes, further increased the sensitivity [AUC = 0.89, 95% (CI) = 4.45–32.05, P < 0.05], with an increased NPV (0.96) and OR (12.4) for BCR. The panel of markers combined with the pathological parameters demonstrated a more accurate prediction of BCR than the pathological parameters alone in prostate cancer. Conclusions In this study, a panel of serum analytes were identified that complemented pathologic patient features in predicting prostate cancer progression. This panel offers a new opportunity to complement current prognostic markers and to monitor the potential impact of primary treatment versus surveillance on patient oncological outcome.
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Affiliation(s)
| | - Jennifer Cullen
- Henry Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.,Center for Prostate Disease Research, Department of Surgery, Uniformed Services University and the Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Prachi Mishra
- Henry Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.,Center for Prostate Disease Research, Department of Surgery, Uniformed Services University and the Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Amina Ali
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University and the Walter Reed National Military Medical Center, Bethesda, MD, USA
| | | | | | | | | | | | | | | | - Yongmei Chen
- Henry Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.,Center for Prostate Disease Research, Department of Surgery, Uniformed Services University and the Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Gyorgy Petrovics
- Henry Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.,Center for Prostate Disease Research, Department of Surgery, Uniformed Services University and the Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Inger L Rosner
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University and the Walter Reed National Military Medical Center, Bethesda, MD, USA
| | | | - David G McLeod
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University and the Walter Reed National Military Medical Center, Bethesda, MD, USA
| | | | | | | | - Alagarsamy Srinivasan
- Henry Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Shiv Srivastava
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University and the Walter Reed National Military Medical Center, Bethesda, MD, USA
| | | | - Albert Dobi
- Henry Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA. .,Center for Prostate Disease Research, Department of Surgery, Uniformed Services University and the Walter Reed National Military Medical Center, Bethesda, MD, USA.
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Stabile A, Giganti F, Rosenkrantz AB, Taneja SS, Villeirs G, Gill IS, Allen C, Emberton M, Moore CM, Kasivisvanathan V. Multiparametric MRI for prostate cancer diagnosis: current status and future directions. Nat Rev Urol 2020; 17:41-61. [PMID: 31316185 DOI: 10.1038/s41585-019-0212-4] [Citation(s) in RCA: 191] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 12/31/2022]
Abstract
The current diagnostic pathway for prostate cancer has resulted in overdiagnosis and consequent overtreatment as well as underdiagnosis and missed diagnoses in many men. Multiparametric MRI (mpMRI) of the prostate has been identified as a test that could mitigate these diagnostic errors. The performance of mpMRI can vary depending on the population being studied, the execution of the MRI itself, the experience of the radiologist, whether additional biomarkers are considered and whether mpMRI-targeted biopsy is carried out alone or in addition to systematic biopsy. A number of challenges to implementation remain, such as ensuring high-quality execution and reporting of mpMRI and ensuring that this diagnostic pathway is cost-effective. Nevertheless, emerging clinical trial data support the adoption of this technology as part of the standard of care for the diagnosis of prostate cancer.
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Affiliation(s)
- Armando Stabile
- Division of Surgery and Interventional Science, University College London, London, UK.
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
- Department of Urology and Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Francesco Giganti
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Samir S Taneja
- Department of Radiology, NYU Langone Health, New York, NY, USA
- Department of Urology, NYU Langone Health, New York, NY, USA
| | - Geert Villeirs
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Inderbir S Gill
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Clare Allen
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Veeru Kasivisvanathan
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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Optimal threshold of the prostate health index in predicting aggressive prostate cancer using predefined cost-benefit ratios and prevalence. Int Urol Nephrol 2019; 52:893-901. [PMID: 31875279 DOI: 10.1007/s11255-019-02367-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/16/2019] [Indexed: 12/27/2022]
Abstract
PURPOSES The aim of the study was to determine optimal threshold of the Prostate Health Index (Phi) for predicting aggressive prostate cancer (PCa), taking into account misclassification costs, prevalence, and plausible risk factors. METHODS This prospective cohort study analyzed patients undergoing prostate biopsy and Phi testing. The primary endpoint was aggressive PCa, defined as biopsy Gleason score ≥ 7. The data about age, total prostate-specific antigen (PSA), percentage of free PSA (%fPSA), and digital rectal examination (DRE) were extracted from the patient files. We divided the patients to the low- and high-risk group. The clinical usefulness of the Phi was assessed by the decision curve analysis. The predictive performance was assessed using the area under the receiver operating characteristic curve (AUC), per-class metrics, and the potential reduction in unnecessary biopsies. The uncertain interval of Phi values was also determined. RESULTS There were 200 men included in the study, 35 (17.5%) of them having aggressive PCa. Important predictors of aggressive PCa were %fPSA, DRE, Phi, and belonging to the high-risk group. With optimal threshold of 30.7, about 32% unnecessary biopsies would be avoided. The optimal threshold of Phi was lower in the high-risk group than in the low-risk group. The AUC for detection of aggressive PCa was 0.791. Per-class metrics showed that the Phi has insufficient diagnostic accuracy. The lower and upper limits of the uncertain interval were 41.8 and 51.4, respectively. CONCLUSION Different thresholds of the Phi could be optimal, depending on prevalence, patient characteristics, and misclassification costs. Further studies with a larger patient sample are necessary to confirm our conclusions.
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Huang YP, Lin TP, Cheng WM, Wei TC, Huang IS, Fan YH, Lin CC, Huang EYH, Chung HJ, Kuo JY, Wu HHH, Lu SH, Chang YH, Lin ATL, Huang WJS. Prostate health index density predicts aggressive pathological outcomes after radical prostatectomy in Taiwanese patients. J Chin Med Assoc 2019; 82:835-839. [PMID: 31425303 DOI: 10.1097/jcma.0000000000000169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There are models to predict pathological outcomes based on established clinical and prostate-specific antigen (PSA)-derived parameters; however, they are not satisfactory. p2PSA and its derived biomarkers have shown promise for the diagnosis and prognosis of prostate cancer (PCa). The aim of this study was to investigate whether p2PSA-derived biomarkers can assist in the prediction of aggressive pathological outcomes after radical prostatectomy (RP). METHODS We prospectively enrolled patients who were diagnosed with PCa and treated with RP between February 2017 and December 2018. Preoperative blood samples were analyzed for tPSA, free PSA (fPSA), percentage of fPSA (%fPSA), [-2]proPSA (p2PSA), and percentage of p2PSA (%p2PSA). Prostate health index (PHI) was calculated as (p2PSA/fPSA) × √tPSA. Prostate volume was determined by transrectal ultrasound using the ellipsoid formula, and PHI density was calculated as PHI/prostate volume. The areas under the receiver operating characteristic curve were estimated for various PSA/p2PSA derivatives. Aggressive pathological outcomes measured after RP were defined as pathological T3 or a Gleason score (GS) >6 as determined in RP specimens. RESULTS One hundred and forty-four patients were included for analysis. Postoperative GS was >6 in 86.1% of the patients, and pT stage was T3a or more in 54.2%. Among all PSA- and p2PSA-derived biomarkers, PHI density was the best biomarker to predict aggressive pathological outcomes after RP. The odds ratio of having an aggressive pathological outcome of RP was 8.796 (p = 0.001). In multivariate analysis, adding %fPSA to base model did not improve the accuracy (area under curve), but adding PHI and PHI density to base model improved the accuracy by 2% and 16%, respectively, in predicting pT3 stage or GS ≥ 7. The risk of pT3 stage or GS ≥ 7 was 20.8% for PHI density <1.125, and 64.6% for PHI density >1.125 (sensitivity: 74.6% and specificity: 88.9%). CONCLUSION PHI density may further aid in predicting aggressive pathological outcomes after RP. This biomarker may be useful in preoperative counseling and may have potential in decision making when choosing between definitive treatment and active surveillance of newly diagnosed PCa.
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Affiliation(s)
- Yu-Pin Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tzu-Ping Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Wei-Ming Cheng
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
- Division of Urology, Department of Surgery, Taipei City Hospital Zhongxiao Branch, Taipei, Taiwan, ROC
| | - Tzu-Chun Wei
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - I-Shen Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Yu-Hua Fan
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Chih-Chieh Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Eric Y H Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Hsiao-Jen Chung
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Junne-Yih Kuo
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Howard H H Wu
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Shing-Hwa Lu
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Yen-Hwa Chang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Alex T L Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - William J S Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
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The importance of plasma arginine level and its downstream metabolites in diagnosing prostate cancer. Int Urol Nephrol 2019; 51:1975-1983. [PMID: 31444697 DOI: 10.1007/s11255-019-02261-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/17/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE There is still no certain threshold value of prostate-specific antigen (PSA) for prostate cancer diagnosis. We aimed to investigate the predictive value of arginine and its metabolites for diagnosing prostate cancer in patients with PSA 4-10 ng/ml and evaluate their usefulness as prognostic tumor markers. METHODS Seventy-eight patients with a mean age of 64.50 ± 5.49 years were included in our prospective observational study between November 2016 and March 2017. They were divided into two equal groups according to the pathologic results of prostate biopsy (benign vs. malignant). Plasma arginine and ornithine levels were analyzed before biopsy by liquid chromatography-tandem mass spectrometry. ELISA was used for analyzing urinary diacetylspermine. RESULTS In PSA-adjusted analysis, the malignant group had lower plasma arginine levels (p = 0.021) and arginine to ornithine ratio (AOR) (p = 0.010), but higher plasma ornithine levels (p = 0.012) and urinary diacetylspermine levels (p < 0.001) as compared with the benign group. While arginine (r = - 0.628, p < 0.001) and AOR (r = - 0.714, p < 0.001) were negatively correlated with D'Amico clinical classification (p < 0.001), ornithine (r = 0.659, p < 0.001) and diacetylspermine (r = 0.710, p < 0.001) were found to be positively correlated (p < 0.001). In multivariate analysis, ornithine [OR 3.264, 95% CI (1.045-10.196), p = 0.042] and diacetylspermine [OR 6.982, 95% CI (2.403-20.290), p < 0.001] were found to be more significant in detection of prostate cancer. CONCLUSION Plasma arginine, ornithine, AOR and urinary diacetylspermine levels may be used as molecular markers to predict prostate biopsy outcomes in patients with PSA 4-10 ng/ml. But according to our results, the use of ornithine and diacethylspermine prior to biopsy seems to be the most cost-effective diagnostic strategy.
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Dandelion Root and Lemongrass Extracts Induce Apoptosis, Enhance Chemotherapeutic Efficacy, and Reduce Tumour Xenograft Growth In Vivo in Prostate Cancer. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:2951428. [PMID: 31391857 PMCID: PMC6662490 DOI: 10.1155/2019/2951428] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 07/02/2019] [Indexed: 01/07/2023]
Abstract
Many conventional chemotherapies have indicated side effects due to a lack of treatment specificity and are thus not suitable for long-term usage. Natural health products are well-tolerated and safe for consumption, and some have pharmaceutical uses particularly for their anticancer effects. We have previously reported the anticancer efficacy of dandelion (Taraxacum officinale) root and lemongrass (Cymbopogon citratus) extracts. However, their efficacy on prostate cancer and their interactions with standard chemotherapeutics have not been studied to determine if they will be suitable for adjuvant therapies. If successful, these extracts could potentially be used in conjunction with chemotherapeutics to minimize the risk of drug-related toxicity and enhance the efficacy of the treatment. We have demonstrated that both dandelion root extract (DRE) and lemongrass extract (LGE) exhibit selective anticancer activity. Importantly, DRE and LGE addition to the chemotherapeutics taxol and mitoxantrone was determined to enhance the induction of apoptosis when compared to individual chemotherapy treatment alone. Further, DRE and LGE were able to significantly reduce the tumour burden in prostate cancer xenograft models when administered orally, while also being well-tolerated. Thus, the implementation of these well-tolerated extracts in adjuvant therapies could be a selective and efficacious approach to prostate cancer treatment.
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Zhang G, Li Y, Li C, Li N, Li Z, Zhou Q. Assessment on clinical value of prostate health index in the diagnosis of prostate cancer. Cancer Med 2019; 8:5089-5096. [PMID: 31313500 PMCID: PMC6718540 DOI: 10.1002/cam4.2376] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/10/2019] [Accepted: 06/12/2019] [Indexed: 12/24/2022] Open
Abstract
In this study, we performed a comprehensive estimation and assessment for the clinical value of prostate health index (PHI) in diagnosing prostate cancer. Using the bivariate mixed-effect model, we calculated the following parameters and their 95% confidence internals (CIs), including sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and symmetric receiver operator characteristic. Twenty eligible studies with a total number of 5543 subjects were included in the final analysis. The estimated sensitivity was 0.75 (95% CI: 0.70-0.79) and the specificity was 0.69 (95% CI: 0.58-0.83). The pooled area under the curve was 0.78 (95% CI: 0.74-0.81). The combined positive likelihood ratio was 2.45 (95% CI: 2.19-2.73) and the negative likelihood ratio was 0.36 (95% CI: 0.31-0.43). The diagnostic odds ratio was 6.73 (95% CI: 5.38-8.44). The posttest probability was 40% under the present positive likelihood ratio of 2.45. It seems there was no significant difference between Asian population and Caucasian population population in sensitivity and specificity. But the overlap of AUC 95% CI indicated that the diagnostic accuracy of PHI was slightly higher in the Asian population population setting than that in the Caucasian population population population (0.83 vs 0.76). Similarly, there was also overlap in AUC 95% CI, which suggested that sample size may be one of heterogeneity source. The PHI has a moderate diagnostic accuracy for detecting prostate cancer. The discrimination ability of PHI is slightly prior to free/total prostate-specific antigen. It seems that ethnicity has an influence on the clinical value of PHI in the diagnostic of prostate cancer.
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Affiliation(s)
- Guangying Zhang
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Yanyan Li
- Department of Outpatient, Xiangya Hospital, Central South University, Changsha, China
| | - Chao Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Na Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhanzhan Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Qin Zhou
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
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Srivastava S, Koay EJ, Borowsky AD, De Marzo AM, Ghosh S, Wagner PD, Kramer BS. Cancer overdiagnosis: a biological challenge and clinical dilemma. Nat Rev Cancer 2019; 19:349-358. [PMID: 31024081 PMCID: PMC8819710 DOI: 10.1038/s41568-019-0142-8] [Citation(s) in RCA: 169] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
For cancer screening to be successful, it should primarily detect cancers with lethal potential or their precursors early, leading to therapy that reduces mortality and morbidity. Screening programmes have been successful for colon and cervical cancers, where subsequent surgical removal of precursor lesions has resulted in a reduction in cancer incidence and mortality. However, many types of cancer exhibit a range of heterogeneous behaviours and variable likelihoods of progression and death. Consequently, screening for some cancers may have minimal impact on mortality and may do more harm than good. Since the implementation of screening tests for certain cancers (for example, breast and prostate cancers), a spike in incidence of in situ and early-stage cancers has been observed, but a link to reduction in cancer-specific mortality has not been as clear. It is difficult to determine how many of these mortality reductions are due to screening and how many are due to improved treatments of tumours. In cancers with lower incidence but high mortality (for example, pancreatic cancer), screening has focused on high-risk populations, but challenges similar to those for general population screening remain, particularly with regard to finding lesions with difficult-to-characterize malignant potential (for example, intraductal papillary mucinous neoplasms). More sensitive screening methods are detecting smaller and smaller lesions, but this has not been accompanied by a comparable reduction in the incidence of invasive cancers. In this Opinion article, we focus on the contribution of screening in general and high-risk populations to overdiagnosis, the effects of overdiagnosis on patients and emerging strategies to reduce overdiagnosis of indolent cancers through an understanding of tumour heterogeneity, the biology of how cancers evolve and progress, the molecular and cellular features of early neoplasia and the dynamics of the interactions of early lesions with their surrounding tissue microenvironment.
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Affiliation(s)
- Sudhir Srivastava
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Eugene J Koay
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alexander D Borowsky
- Department of Pathology and Laboratory Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Angelo M De Marzo
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Sharmistha Ghosh
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Paul D Wagner
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Barnett S Kramer
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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The burden of prostate cancer is associated with human development index: evidence from 87 countries, 1990-2016. EPMA J 2019; 10:137-152. [PMID: 31258819 DOI: 10.1007/s13167-019-00169-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 04/26/2019] [Indexed: 01/04/2023]
Abstract
Aim To examine the temporal patterns of the prostate cancer burden and its association with human development. Subject and methods The estimates of the incidence and mortality of prostate cancer for 87 countries were obtained from the Global Burden of Disease 2016 study for the period 1990 to 2016. The human development level of a country was measured using its human development index (HDI): a summary indicator of health, education, and income. The association between the burden of prostate cancer and the human development index (HDI) was measured using pairwise correlation and bivariate regression. Mortality-to-incidence ratio (MIR) was employed as a proxy for the survival rate of prostate cancer. Results Globally, 1.4 million new cases of prostate cancer arose in 2016 claiming 380,916 lives which more than doubled from 579,457 incident cases and 191,687 deaths in 1990. In 2016, the age-standardised incidence rate (ASIR) was the highest in very high-HDI countries led by Australia with ASIR of 174.1/100,000 and showed a strong positive association with HDI (r = 0.66); the age-standardised mortality rate (ASMR), however, was higher in low-HDI countries led by Zimbabwe with ASMR of 78.2/100,000 in 2016. Global MIR decreased from 0.33 in 1990 to 0.26 in 2016. Mortality-to-incidence ratio (MIR) exhibited a negative gradient (r = - 0.91) with human development index with tenfold variation globally with seven countries recording MIR in excess of 1 with the USA recording the minimum MIR of 0.10. Conclusion The high mortality and lower survival rates in less-developed countries demand all-inclusive solutions ranging from cost-effective early screening and detection to cost-effective cancer treatment. In tackling the rising burden of prostate cancer predictive, preventive and personalised medicine (PPPM) can play a useful role through prevention strategies, predicting PCa more precisely and accurately using a multiomic approach and risk-stratifying patients to provide personalised medicine.
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Narayan VM. A critical appraisal of biomarkers in prostate cancer. World J Urol 2019; 38:547-554. [PMID: 30993424 DOI: 10.1007/s00345-019-02759-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/04/2019] [Indexed: 12/14/2022] Open
Abstract
PURPOSE A number of urine and blood-based biomarker tests have been described for prostate cancer, although to date there has only been a limited exploration of the methodology behind the validation studies that underpin these tests. METHODS In this review, a selection of commercially available urine and blood-based biomarker tests for prostate cancer are described, and the underlying key validation studies for each test are critically appraised using the Standards for Reporting Diagnostic Accuracy (STARD) 2015 statement. RESULTS The ExoDx Prostate Intelliscore, SelectMDx, Progensa PCA3, Mi-Prostate Score, 4K Score, and Prostate Health Index (PHI) tests were reviewed. Most of the validation studies supporting these tests perform exploratory analyses to determine cut-off values in a post hoc manner, comprise cohorts that are primarily Caucasian, report receiver operating characteristic curves that combine the biomarker's result with established clinical nomograms and are based on a reference standard (prostate biopsy) that lacks central pathology review. Deficiencies in STARD reporting guidelines include frequent failure to provide a published study protocol, prospective study registration in a registry, a flow diagram, justification for sample size determination, a discussion of adverse events with testing, and information on how missing or indeterminate test results should be managed. CONCLUSIONS Key validation studies that support many commercially available urine and blood-based biomarkers for prostate cancers have deficiencies in transparency based on STARD reporting guidelines, and limitations in methodology must be considered when deciding when these tests should be applied in clinical practice.
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Affiliation(s)
- Vikram M Narayan
- Department of Urology, University of Minnesota, 420 Delaware Street SE, MMC 394, Minneapolis, MN, 55455, USA.
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A Rich Array of Prostate Cancer Molecular Biomarkers: Opportunities and Challenges. Int J Mol Sci 2019; 20:ijms20081813. [PMID: 31013716 PMCID: PMC6515282 DOI: 10.3390/ijms20081813] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 01/30/2023] Open
Abstract
Prostate cancer is the most prevalent non-skin cancer in men and is the leading cause of cancer-related death. Early detection of prostate cancer is largely determined by a widely used prostate specific antigen (PSA) blood test and biopsy is performed for definitive diagnosis. Prostate cancer is asymptomatic in the early stage of the disease, comprises of diverse clinico-pathologic and progression features, and is characterized by a large subset of the indolent cancer type. Therefore, it is critical to develop an individualized approach for early detection, disease stratification (indolent vs. aggressive), and prediction of treatment response for prostate cancer. There has been remarkable progress in prostate cancer biomarker discovery, largely through advancements in genomic technologies. A rich array of prostate cancer diagnostic and prognostic tests has emerged for serum (4K, phi), urine (Progensa, T2-ERG, ExoDx, SelectMDx), and tumor tissue (ConfirmMDx, Prolaris, Oncoytype DX, Decipher). The development of these assays has created new opportunities for improving prostate cancer diagnosis, prognosis, and treatment decisions. While opening exciting opportunities, these developments also pose unique challenges in terms of selecting and incorporating these assays into the continuum of prostate cancer patient care.
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Abstract
Diagnosis of prostate cancer (PCa) and adequate staging play a fundamental role for clinical and patient care. Despite major advances in biology and imaging, rectal examination and prostate-specific antigen (PSA) blood test remain the cornerstone for screening, and multiparametricmagnetic resonance imaging (mpMRI) for local staging. Recent advances in mpMRI lead to standardised interpretation and increased prescription by clinicians in order to improve detection of clinically significant PCa and select patients requiring targeted biopsies. However its indication remains controversial in biopsy-naïve patients. Nuclear medicine is also in a continuous evolution and utilisation of new radiopharmaceutical agent like choline or 68gallium with computed tomography or magnetic resonance imaging has led to the improvement in the detection of lymph nodes, distant metastases and prostate recurrence. Considering this very heterogneneous disease, combined utilisation of these tools will help clinicians and patients in choosing the most appropriate and personalised treatment.
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Lopes Vendrami C, McCarthy RJ, Chatterjee A, Casalino D, Schaeffer EM, Catalona WJ, Miller FH. The Utility of Prostate Specific Antigen Density, Prostate Health Index, and Prostate Health Index Density in Predicting Positive Prostate Biopsy Outcome is Dependent on the Prostate Biopsy Methods. Urology 2019; 129:153-159. [PMID: 30926382 DOI: 10.1016/j.urology.2019.03.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/05/2019] [Accepted: 03/20/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To evaluate prognostic markers, prostate-specific antigen, prostate health index (PHI), and prostate volume indexed measures (prostate-specific antigen density and prostate health index density) for predicting positive prostate cancer biopsies in magnetic resonance (MR) transrectal ultrasound fused versus nonfused transrectal ultrasonography biopsy. METHODS A retrospective cohort of 211 patients that had at least 1 suspected MR lesion, Prostate Imaging-Reporting and Data System ≥3, and subsequent biopsy (2015-2017). Clinical characteristics and prognostic biomarkers were evaluated as predictors of prostate cancer detection by type of biopsy guidance (fused vs nonfused). RESULTS One-hundred twenty-one patients had nonfused and 90 had fused biopsies. PHI and PHID had greater area under the receiver operating characteristics curve (AUC) in predicting positive biopsies than prostate-specific antigen or PSAD for both nonfused and fused biopsy. PHI 0.78 (95% CI 0.67-0.88) and PHID 0.82 (95% CI 0.73-0.91) had the greatest AUC for predicting biopsy results for nonfused and fused biopsies, respectively. Multiple-variable models did not improve model fit compared to single variables. Based on Youden's index, a cut-off value of 45.9 for PHI in nonfused and 0.64 for PHID in fused biopsies would reduce the number of negative biopsies by 77.3% and 63.4%, respectively, but the percentage of missed clinically significant cancer biopsies would be 19% and 12%, respectively. CONCLUSION Our findings demonstrate that the choice of prognostic biomarkers for predicting positive biopsies is a function of the biopsy guidance method. Volume indexed derivatives appear to have greater value when a MRI-US fused method is used.
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Affiliation(s)
- Camila Lopes Vendrami
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Argha Chatterjee
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David Casalino
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Edward M Schaeffer
- Department of Urology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - William J Catalona
- Department of Urology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Frank H Miller
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL.
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Tan GH, Nason G, Ajib K, Woon DTS, Herrera-Caceres J, Alhunaidi O, Perlis N. Smarter screening for prostate cancer. World J Urol 2019; 37:991-999. [PMID: 30859272 DOI: 10.1007/s00345-019-02719-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 03/02/2019] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Prostate cancer is the second commonest cancer among men. In the large European Randomized Study of Screening for Prostate Cancer (ERSPC) trial, prostate-specific antigen (PSA) screening has been shown to substantially reduce prostate cancer mortality. However, PSA screening is known to lead to more unnecessary prostate biopsies and over-diagnosis of clinically insignificant cancer. Therefore, it is imperative that smarter screening methods be developed to overcome the weaknesses of PSA screening. This review explores the novel screening tools that are available. METHODS A comprehensive literature search was performed using PubMed regarding newer biomarkers, imaging techniques and risk-predicting models that are used to screen for prostate cancer in mainly biopsy-naïve men. RESULTS Novel serum-based models like 4Kscore® and prostate health index (PHI) are generally better than PSA alone in detecting clinically significant cancer. Similarly, urine-based biomarkers like prostate cancer antigen 3 (PCA3) and HOXC6/DLX1 have been shown to be more accurate than PSA screening. More recently, multiparametric magnetic resonance imaging (mpMRI) is gaining popularity for its ability to detect clinically significant cancer. There is also evidence that combining individual tests to develop prediction models can reliably predict high-risk prostate cancers while reducing the number of unnecessary biopsies. Combinations such as the Stockholm-3 model (STHLM3) and other novel combinations are presented in this review. CONCLUSION While we continue to find the smarter screening methods that are reliable, precise, and cost-effective, we continue to advocate shared decision-making in prostate cancer screening in order to work in our patients' best interests.
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Affiliation(s)
- Guan Hee Tan
- University Health Network-Toronto General Hospital and Princess Margaret Cancer Center, Division of Urology, University of Toronto, 610 University Avenue, 3-130, Toronto, ON, M6G 2M9, Canada
| | - Gregory Nason
- University Health Network-Toronto General Hospital and Princess Margaret Cancer Center, Division of Urology, University of Toronto, 610 University Avenue, 3-130, Toronto, ON, M6G 2M9, Canada
| | - Khaled Ajib
- University Health Network-Toronto General Hospital and Princess Margaret Cancer Center, Division of Urology, University of Toronto, 610 University Avenue, 3-130, Toronto, ON, M6G 2M9, Canada
| | - Dixon Teck Sing Woon
- University Health Network-Toronto General Hospital and Princess Margaret Cancer Center, Division of Urology, University of Toronto, 610 University Avenue, 3-130, Toronto, ON, M6G 2M9, Canada
| | - Jaime Herrera-Caceres
- University Health Network-Toronto General Hospital and Princess Margaret Cancer Center, Division of Urology, University of Toronto, 610 University Avenue, 3-130, Toronto, ON, M6G 2M9, Canada
| | - Omar Alhunaidi
- University Health Network-Toronto General Hospital and Princess Margaret Cancer Center, Division of Urology, University of Toronto, 610 University Avenue, 3-130, Toronto, ON, M6G 2M9, Canada
| | - Nathan Perlis
- University Health Network-Toronto General Hospital and Princess Margaret Cancer Center, Division of Urology, University of Toronto, 610 University Avenue, 3-130, Toronto, ON, M6G 2M9, Canada.
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Chaloupka M, Westhofen T, Kretschmer A, Grimm T, Stief C, Apfelbeck M. [Active surveillance of prostate cancer : An update]. Urologe A 2019; 58:329-340. [PMID: 30824971 DOI: 10.1007/s00120-019-0894-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Prostate cancer is a heterogeneous disease. In cases of low-risk prostate cancer, active surveillance represents an attractive alternative treatment. Significant complications of a definitive treatment can therefore be delayed or completely avoided. Despite strict inclusion criteria for active surveillance, the diagnosis of low-risk prostate cancer can be inaccurate and there is therefore a risk of missing the optimal point in time for definitive treatment. Multimodal diagnostics and continuous aftercare are therefore crucial.
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Affiliation(s)
- M Chaloupka
- Urologische Klinik und Poliklinik, Campus Großhadern, Klinikum der Universität München, Ludwig-Maximilians-Universität, Marchioninistraße 15, 81377, München, Deutschland.
| | - T Westhofen
- Urologische Klinik und Poliklinik, Campus Großhadern, Klinikum der Universität München, Ludwig-Maximilians-Universität, Marchioninistraße 15, 81377, München, Deutschland
| | - A Kretschmer
- Urologische Klinik und Poliklinik, Campus Großhadern, Klinikum der Universität München, Ludwig-Maximilians-Universität, Marchioninistraße 15, 81377, München, Deutschland
| | - T Grimm
- Urologische Klinik und Poliklinik, Campus Großhadern, Klinikum der Universität München, Ludwig-Maximilians-Universität, Marchioninistraße 15, 81377, München, Deutschland
| | - C Stief
- Urologische Klinik und Poliklinik, Campus Großhadern, Klinikum der Universität München, Ludwig-Maximilians-Universität, Marchioninistraße 15, 81377, München, Deutschland
| | - M Apfelbeck
- Urologische Klinik und Poliklinik, Campus Großhadern, Klinikum der Universität München, Ludwig-Maximilians-Universität, Marchioninistraße 15, 81377, München, Deutschland
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Zhao F, Vesprini D, Liu RSC, Olkhov-Mitsel E, Klotz LH, Loblaw A, Liu SK, Bapat B. Combining urinary DNA methylation and cell-free microRNA biomarkers for improved monitoring of prostate cancer patients on active surveillance. Urol Oncol 2019; 37:297.e9-297.e17. [PMID: 30777394 DOI: 10.1016/j.urolonc.2019.01.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/18/2018] [Accepted: 01/31/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Prostate cancer (CaP) patients with low-grade tumors are enrolled in active surveillance (AS) programs and monitored with digital rectal exams (DREs), prostate-specific antigen (PSA) tests, and periodic invasive biopsies. Patients are "reclassified" with higher-risk disease if they show signs of disease progression. However, AS patients who will reclassify cannot be easily identified upfront and suffer morbidities associated with biopsy. Biomarkers derived from noninvasively obtained specimens such as serum or urine samples are promising alternatives to monitor patients with clinically insignificant cancer. Previously, we have characterized and validated a urinary DNA methylation panel and a serum miRNA panel for the prediction of patient reclassification in 2 independent AS cohorts. In this exploratory study, we have investigated cell-free miRNAs in the urinary supernatant combined with urinary DNA methylation markers to form an integrative panel for prediction of AS patient reclassification. METHODS Post-DRE urine was collected from 103 CaP patients on active surveillance. Urinary sediment DNA methylation levels of selected genes were previously analyzed using qPCR-based MethyLight assay. Using qRT-PCR, we analyzed the urinary supernatants for relative quantities of 10 miRNAs previously shown to be associated with AS reclassification. Logistic regression and Receiver Operating Characteristics curve analyses were performed to assess the predictive ability of miRNAs and DNA methylation biomarkers. RESULTS We identified a 3-marker panel, consisting of miR-24, miR-30c and CRIP3 methylation, that was significant for prediction of patient reclassification (Odds ratio = 2.166, 95% confidence interval = 1.22-3.847) with a negative predictive value of 90.9%. Our 3-marker panel also demonstrated additive value to PSA for prediction of patient reclassification (c-statistic = 0.717, ROC bootstrapped 1000 iteration P = 0.041). CONCLUSION A urinary integrated panel of methylation and miRNA markers is a promising approach to identify AS patients at risk for reclassification. Our 3-marker panel, with its high negative predictive value, would be beneficial to identify and preclude AS patients with truly indolent cancer and to personalize monitoring strategies for AS patients.
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Affiliation(s)
- Fang Zhao
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada; Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Danny Vesprini
- Odette Cancer Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Richard S C Liu
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada; Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Ekaterina Olkhov-Mitsel
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada; Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Laurence H Klotz
- Odette Cancer Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Andrew Loblaw
- Odette Cancer Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Stanley K Liu
- Odette Cancer Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Bharati Bapat
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada; Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada.
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Durai P, Wu QH, Chiong E. Clinical Aspects and Investigations in Genitourinary Cancer. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Belczacka I, Latosinska A, Metzger J, Marx D, Vlahou A, Mischak H, Frantzi M. Proteomics biomarkers for solid tumors: Current status and future prospects. MASS SPECTROMETRY REVIEWS 2019; 38:49-78. [PMID: 29889308 DOI: 10.1002/mas.21572] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/08/2018] [Indexed: 06/08/2023]
Abstract
Cancer is a heterogeneous multifactorial disease, which continues to be one of the main causes of death worldwide. Despite the extensive efforts for establishing accurate diagnostic assays and efficient therapeutic schemes, disease prevalence is on the rise, in part, however, also due to improved early detection. For years, studies were focused on genomics and transcriptomics, aiming at the discovery of new tests with diagnostic or prognostic potential. However, cancer phenotypic characteristics seem most likely to be a direct reflection of changes in protein metabolism and function, which are also the targets of most drugs. Investigations at the protein level are therefore advantageous particularly in the case of in-depth characterization of tumor progression and invasiveness. Innovative high-throughput proteomic technologies are available to accurately evaluate cancer formation and progression and to investigate the functional role of key proteins in cancer. Employing these new highly sensitive proteomic technologies, cancer biomarkers may be detectable that contribute to diagnosis and guide curative treatment when still possible. In this review, the recent advances in proteomic biomarker research in cancer are outlined, with special emphasis placed on the identification of diagnostic and prognostic biomarkers for solid tumors. In view of the increasing number of screening programs and clinical trials investigating new treatment options, we discuss the molecular connections of the biomarkers as well as their potential as clinically useful tools for diagnosis, risk stratification and therapy monitoring of solid tumors.
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Affiliation(s)
- Iwona Belczacka
- Mosaiques-Diagnostics GmbH, Hannover, Germany
- University Hospital RWTH Aachen, Institute for Molecular Cardiovascular Research (IMCAR), Aachen, Germany
| | | | | | - David Marx
- Hôpitaux Universitaires de Strasbourg, Service de Transplantation Rénale, Strasbourg, France
- Laboratoire de Spectrométrie de Masse BioOrganique (LSMBO), University of Strasbourg, National Center for Scientific Research (CNRS), Institut Pluridisciplinaire Hubert Curien (IPHC) UMR 7178, Strasbourg, France
| | - Antonia Vlahou
- Biotechnology Division, Biomedical Research Foundation, Academy of Athens (BRFAA), Athens, Greece
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Kumar NB, Dickinson SI, Schell MJ, Manley BJ, Poch MA, Pow-Sang J. Green tea extract for prevention of prostate cancer progression in patients on active surveillance. Oncotarget 2018; 9:37798-37806. [PMID: 30701033 PMCID: PMC6340872 DOI: 10.18632/oncotarget.26519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/10/2018] [Indexed: 01/01/2023] Open
Abstract
Background Active surveillance (AS) has evolved as a management strategy for men with low grade prostate cancer (PCa). However, these patients report anxiety, doubts about the possible progression of the disease as well as higher decisional conflict regarding selection of active surveillance, and have been reported to ultimately opt for treatment without any major change in tumor characteristics. Currently, there is a paucity of research that systematically examines alternate strategies for this target population. Methods We conducted a review the evidence from epidemiological, in vitro, preclinical and early phase trials that have evaluated green tea catechins (GTC) for secondary chemoprevention of prostate cancer, focused on men opting for active surveillanceof low grade PCa. Results Results of our review of the in vitro, preclinical and phase I-II trials, demonstrates that green tea catechins (GTC) can modulate several relevant intermediate biological intermediate endpoint biomarkers implicated in prostate carcinogenesis as well as clinical progression of PCa, without major side effects. Discussion Although clinical trials using GTC have been evaluated in early phase trials in men diagnosed with High-Grade Prostatic Intraepithelial Neoplasia, Atypical Small Acinar Proliferation and in men with localized disease before prostatectomy, the effect of GTC on biological and clinical biomarkers implicated in prostate cancer progression have not been evaluated in this patient population. Conclusion Results of these studies promise to provide a strategy for secondary chemoprevention, reduce morbidities due to overtreatment and improve quality of life in men diagnosed with low-grade PCa.
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Affiliation(s)
- Nagi B Kumar
- H. Lee Moffitt Cancer Center & Research Institute, Inc., Cancer Epidemiology, MRC/CANCONT, Tampa, FL 33612-9497, USA
| | - Shohreh I Dickinson
- H. Lee Moffitt Cancer Center & Research Institute, Inc., Pathology Anatomic MMG, WCB-GU PROG, Tampa, FL 33612-9497, USA
| | - Michael J Schell
- H. Lee Moffitt Cancer Center & Research Institute, Inc., Biostatics and Bioinformatics, MRC-BIOSTAT, Tampa, FL 33612-9497, USA
| | - Brandon J Manley
- H. Lee Moffitt Cancer Center & Research Institute, GU Oncology MMG, Tampa, FL 33612-9497, USA
| | - Michael A Poch
- H. Lee Moffitt Cancer Center & Research Institute, GU Oncology MMG, Tampa, FL 33612-9497, USA
| | - Julio Pow-Sang
- H. Lee Moffitt Cancer Center & Research Institute, GU Oncology MMG, Tampa, FL 33612-9497, USA
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Zhou Y, Guan H, Fu Y, Mao L, Ge J, Liu L, Cheng L, Guan C. The impact of pre-existing cancer on survival of prostate cancer patients: A population-based study. Medicine (Baltimore) 2018; 97:e13479. [PMID: 30558003 PMCID: PMC6320164 DOI: 10.1097/md.0000000000013479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Prostate cancer (PCa) is the second most common malignant tumors for male patients worldwide. However, whether a history of pre-existing cancer cases may affect the survival of prostate cancer patients is still not fully understood.We identified patients diagnosed with PCa between 2000 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) linked database. We further made propensity score matching and then compared all-cause and cancer-specific survival between patients with and those without a pre-existing cancer. Cox proportional hazards models and Kaplan-Meier analysis were used for survival comparison.A total of 153,255 patients with PCa were included for analysis, of whom 5939 had a history of pre-existing cancer, including hematologic and lymph (11%), intestine (19%), urinary system (36%), head and neck (9%), lung (5%), skin (12%), and others (8%). Patients with a pre-existing cancer had a worse prognosis compared with those without a pre-existing cancer [all-cause death: hazard ratio (HR) = 2.74, P < .001; cancer-special death: HR = 3.98, P < .001]. Importantly, cancers in urinary bladder prior to PCa had a most adverse impact on all-cause (HR = 5.00, P < .001) and cancer-specific death risk (HR = 10.45, P < .001). Time between the pre-existing cancer and PCa had a dose-dependent effect on survival of PCa patients, with a decreased death risk as the increase of the interval time.Pre-existing cancer has a negative impact on the prognosis of patients with PCa, which is most evident in the presence of a pre-existing urinary bladder cancer. Our results provide epidemiologic evidence with low between-group bias, large sample size, and long-term follow-up, highlighting the need for site-, and interval-time-based clinical management for patients with PCa who had a pre-existing cancer.
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Affiliation(s)
- Yuan Zhou
- Department of Urology Surgery, The Second Affiliated Hospital of Bengbu Medical College
- Bengbu Medical College
| | - Han Guan
- Bengbu Medical College
- Department of Urology Surgery, The Frist Affiliated Hospital of Bengbu Medical College, Longzi, Bengbu
| | - Yong Fu
- Department of Urology Surgery, The Second Affiliated Hospital of Bengbu Medical College
- Bengbu Medical College
| | - Likai Mao
- Department of Urology Surgery, The Second Affiliated Hospital of Bengbu Medical College
- Bengbu Medical College
| | - Jiyue Ge
- Department of Urology Surgery, The Second Affiliated Hospital of Bengbu Medical College
- Bengbu Medical College
| | - Lutan Liu
- Department of Urology Surgery, The Second Affiliated Hospital of Bengbu Medical College
- Bengbu Medical College
| | - Lei Cheng
- Cancer Institute, Collaborative Innovation Center for Cancer Medicine, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University, Xuhui, Shanghai, China
| | - Chao Guan
- Department of Urology Surgery, The Second Affiliated Hospital of Bengbu Medical College
- Bengbu Medical College
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138
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Delporte G, Villers A, Penel N. [Prostate cancer screening: Reasons of controversy]. Bull Cancer 2018; 105:1111-1118. [PMID: 30458966 DOI: 10.1016/j.bulcan.2018.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/11/2018] [Indexed: 10/27/2022]
Abstract
We propose herein a short synthesis of evidence leading to deny organized screening of prostate cancer using PSA plus or minus rectal digital examination. Nevertheless, many scientific societies support opportunistic screening on basis of shared decision. Today, numerous proposals had been made to reduce the overdiagnosis and overtreatreatment.
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Affiliation(s)
- Gauthier Delporte
- CHRU de Lille, hôpital Claude-Huriez, service universitaire d'urologie, rue Michel-Polonowski, 59000 Lille, France
| | - Arnauld Villers
- CHRU de Lille, hôpital Claude-Huriez, service universitaire d'urologie, rue Michel-Polonowski, 59000 Lille, France
| | - Nicolas Penel
- Centre Oscar-Lambret, département de cancérologie générale, 3, rue Combemale, 59020 Lille cedex, France; CHRU de Lille, hôpital Claude-Huriez, service universitaire d'oncologie médicale, rue Michel-Polonowski, 59000 Lille, France.
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139
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Chiu PKF, Ng CF, Semjonow A, Zhu Y, Vincendeau S, Houlgatte A, Lazzeri M, Guazzoni G, Stephan C, Haese A, Bruijne I, Teoh JYC, Leung CH, Casale P, Chiang CH, Tan LGL, Chiong E, Huang CY, Wu HC, Nieboer D, Ye DW, Bangma CH, Roobol MJ. A Multicentre Evaluation of the Role of the Prostate Health Index (PHI) in Regions with Differing Prevalence of Prostate Cancer: Adjustment of PHI Reference Ranges is Needed for European and Asian Settings. Eur Urol 2018; 75:558-561. [PMID: 30396635 DOI: 10.1016/j.eururo.2018.10.047] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/19/2018] [Indexed: 10/27/2022]
Abstract
Asians have a lower incidence of prostate cancer (PC). We compared the performance of the Prostate Health Index (PHI) for 2488 men in different ethnic groups (1688 Asian and 800 European men from 9 sites) with PSA 2-20ng/ml and PHI test and transrectal ultrasound-guided biopsy results available. Of these, 1652 men had PSA 2-10ng/ml and a normal digital rectal examination and underwent initial biopsy. The proportions of PC (Gleason ≥6) and higher-grade PC (HGPC, Gleason ≥7) across different PHI ranges were compared. The performance of PSA and PHI was compared using the area under the receiver operating characteristic curve (AUC) and decision curve analyses (DCA). Among Asian men, HGPC would be diagnosed in 1.0%, 1.9%, 13%, and 30% of men using PHI thresholds of <25, 25-35, 35-55, and >55, respectively. At 90% sensitivity for HGPC (PHI >30), 56% of biopsies and 33% of Gleason 6 PC diagnoses could have been avoided. Among European men, HGPC would be diagnosed in 4.1%, 4.3%, 30%, and 34% of men using PHI thresholds of <25, 25-35, 35-55, and >55, respectively. At 90% sensitivity for HGPC (PHI >40), 40% of biopsies and 31% of Gleason 6 PC diagnoses could have been avoided. AUC and DCA confirmed the benefit of PHI over PSA. The benefit of PHI was also seen at repeat biopsy (n=397) and for PSA 10-20ng/ml (n=439). PHI is effective in cancer risk stratification for both European and Asian men. However, population-specific PHI reference ranges should be used. PATIENT SUMMARY: The Prostate Health Index (PHI) blood test helps to identify individuals at higher risk of prostate cancer among Asian and European men, and could significantly reduce unnecessary biopsies and overdiagnosis of prostate cancer. Different PHI reference ranges should be used for different ethnic groups.
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Affiliation(s)
- Peter K-F Chiu
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands; Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
| | - Chi-Fai Ng
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China; SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China.
| | - Axel Semjonow
- Department of Urology, Prostate Center, University Clinic Münster, Münster, Germany
| | - Yao Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
| | | | | | - Massimo Lazzeri
- Department of Urology, Istituto Clinico Humanitas IRCCS, Rozzano, Italy
| | | | - Carsten Stephan
- Department of Urology, Charite-Universitaetsmedizin and Berlin Institute for Urologic Research, Berlin, Germany
| | - Alexander Haese
- Martini Clinic Prostate Cancer Centre, University Clinic Eppendorf, Hamburg, Germany
| | - Ilse Bruijne
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China; SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi Ho Leung
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China; SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Paola Casale
- Department of Urology, Istituto Clinico Humanitas IRCCS, Rozzano, Italy
| | - Chih Hung Chiang
- Department of Surgery, Taipei Veterans General Hospital and Su-Ao/Yuan-Shan Branch, Yi-Lan, Taiwan
| | - Lincoln Guan-Lim Tan
- Department of Urology, University Surgical Cluster, National University Health System, Singapore
| | - Edmund Chiong
- Department of Urology, University Surgical Cluster, National University Health System, Singapore
| | - Chao Yuan Huang
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsi Chin Wu
- Department of Urology, China Medical University, Taichung, Taiwan
| | - Daan Nieboer
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Ding-Wei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Chris H Bangma
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands
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140
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Tian JY, Guo FJ, Zheng GY, Ahmad A. Prostate cancer: updates on current strategies for screening, diagnosis and clinical implications of treatment modalities. Carcinogenesis 2018; 39:307-317. [PMID: 29216344 DOI: 10.1093/carcin/bgx141] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/29/2017] [Indexed: 01/23/2023] Open
Abstract
Prostate cancer is the most common cancer in men by way of diagnosis and a leading cause of cancer-related deaths. Early detection and intervention remains key to its optimum clinical management. This review provides the most updated information on the recent methods of prostate cancer screening, imaging and treatment modalities. Wherever possible, clinical trial data has been supplemented to provide a comprehensive overview of current prostate cancer research and development. Considering the recent success of immunotherapy in prostate cancer, we discuss cell, DNA and viruses based, as well as combinatorial immunotherapeutic strategies in detail. Furthermore, the potential of nanotechnology is increasingly being realized, especially in prostate cancer research, and we provide an overview of nanotechnology-based strategies, with special emphasis on nanotheranostics and multifunctional nanoconstructs. Understanding these recent developments is critical to the design of future therapeutic strategies to counter prostate cancer.
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Affiliation(s)
- Jing-Yan Tian
- Department of Urology, Second Division of the First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Feng-Jun Guo
- Department of Gynaecology and Obstetrics, The Second Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Guo-You Zheng
- Department of Urology, Second Division of the First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Aamir Ahmad
- Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
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141
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Carneiro A, Priante Kayano P, Gomes Barbosa ÁR, Langer Wroclawski M, Ko Chen C, Cavlini GC, Reche GJ, Sanchez-Salas R, Tobias-Machado M, Sowalsky AG, Bianco B. Are localized prostate cancer biomarkers useful in the clinical practice? Tumour Biol 2018; 40:1010428318799255. [PMID: 30204063 PMCID: PMC6602068 DOI: 10.1177/1010428318799255] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Prostate cancer presents itself in a heterogeneous way with both aggressive and indolent forms. Despite the controversy
surrounding its use, prostate-specific antigen screening ultimately leads to a greater number of diagnosed patients. One of the
biggest challenges in clinical practice is to select the right patients for biopsy and, among diagnosed patients, to differentiate
tumors with an indolent course from those with an unfavorable prognosis, in order to determine the best therapeutic decision for
each case, avoiding unnecessary interventions. Currently, several types of biomarkers are available for clinical use in patients
with prostate cancer, which include blood-based (prostate-specific antigen, Prostate Health Index®, 4K score®);
urine sample-based (PCA3, SelectMDx®, ExoDx Prostate IntelliScore®); and biopsy, transurethral resection, or radical
prostatectomy tissue-based (ConfirmMDx®, Oncotype®, Prolaris®, Decipher®). The aim of this review is
to provide an overview of the current state of evidence and to highlight recent advances in the evaluation and diagnosis of
prostate cancer, with emphasis on biomarkers related to diagnosis and to prognostic evaluation of localized prostate cancer.
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Affiliation(s)
- Arie Carneiro
- 1 Discipline of Urology, Department of Surgery, Faculdade de Medicina do ABC, São Paulo, Brazil.,2 Discipline of Urology, Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Paulo Priante Kayano
- 2 Discipline of Urology, Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Álan Roger Gomes Barbosa
- 2 Discipline of Urology, Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcelo Langer Wroclawski
- 1 Discipline of Urology, Department of Surgery, Faculdade de Medicina do ABC, São Paulo, Brazil.,2 Discipline of Urology, Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Carolina Ko Chen
- 2 Discipline of Urology, Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Giulio Costa Cavlini
- 1 Discipline of Urology, Department of Surgery, Faculdade de Medicina do ABC, São Paulo, Brazil
| | - Guilherme Jose Reche
- 1 Discipline of Urology, Department of Surgery, Faculdade de Medicina do ABC, São Paulo, Brazil
| | | | - Marcos Tobias-Machado
- 1 Discipline of Urology, Department of Surgery, Faculdade de Medicina do ABC, São Paulo, Brazil
| | - Adam G Sowalsky
- 4 Laboratory of Genitourinary Cancer Pathogenesis, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Bianca Bianco
- 5 Center for Human Reproduction and Genetics, Department of Collective Health, Faculdade de Medicina do ABC, São Paulo, Brazil
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142
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Sokoll LJ, Mangold L, Mohr P, Dua R, Partin AW. High "phi"ve. J Appl Lab Med 2018; 3:333-335. [PMID: 33636944 DOI: 10.1373/jalm.2018.027482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 06/28/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Lori J Sokoll
- Departments of Pathology and.,Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Leslie Mangold
- Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | | | | | - Alan W Partin
- Departments of Pathology and.,Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
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143
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Hamidi N, Atmaca AF, Canda AE, Keske M, Ardıçoğlu A. Does extent of prostate-specific antigen fluctuation can predict Gleason score upgrading in low-risk prostate cancer patients? Turk J Urol 2018; 45:S42-S48. [PMID: 30183609 DOI: 10.5152/tud.2018.41017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/21/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the effect of prostate-specific antigen (PSA) fluctuation on Gleason score (GS) upgrading, disease upstaging, oncological outcomes in low-risk prostate cancer (PCa) patients who underwent robot-assisted laparoscopic radical prostatectomy (RARP) and met the inclusion criteria for active surveillance (AS). MATERIAL AND METHODS Data of 354 low-risk PCa patients who underwent RARP were retrospectively evaluated. Patients were divided into two groups: PSA fluctuation rate<9.5%/month (Group 1, n=192) and >9.5%/month (Group 2, n=162). Mainly compared parameters were GS upgrading, disease upstaging, biochemical recurrence (BCR) and surgical margin positivity (SMP) rates. RESULTS GS upgrading, disease upstaging and SMP were detected in 128 (36.2%), 56 (15.8%) and 42 (11.9%) patients, respectively. After a median follow-up of 46 months, BCR was observed in 40 (11.3%) patients. GS upgrading (41.1% vs. 30.2%, p=0.033), disease upstaging (19.8% vs. 11.1%, p=0.028), SMP (15.1% vs. 8%, p=0.035) and BCR development (15.6% vs. 6.2%, p=0.005) rates were statistically significantly higher in Group 1 than Group 2. In multivariate analysis, digital rectal examination positivity, the presence of two positive cores and low PSA fluctuation rate were found to be significant predictors of GS upgrading. CONCLUSION Low PSA fluctuation rate is associated with higher GS upgrading.
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Affiliation(s)
- Nurullah Hamidi
- Department of Urology, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Ali Fuat Atmaca
- Department of Urology, Ankara Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Abdullah Erdem Canda
- Department of Urology, Ankara Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Murat Keske
- Department of Urology, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Arslan Ardıçoğlu
- Department of Urology, Ankara Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
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144
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Kearns JT, Lin DW. Improving the Specificity of PSA Screening with Serum and Urine Markers. Curr Urol Rep 2018; 19:80. [PMID: 30105509 DOI: 10.1007/s11934-018-0828-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW Prostate cancer remains a significant public health burden. In order to decrease the morbidity and mortality associated with prostate cancer, serum prostate-specific antigen (PSA) screening has been used since the 1990s. However, there is concern for overdiagnosis of prostate cancer with widespread PSA screening, which could lead to overtreatment and its attendant morbidities. RECENT FINDINGS In order to avoid unnecessary biopsy and downstream effects including treatment of insignificant prostate cancer, a number of tests have been proposed to improve upon PSA screening. Increasing the specificity of prostate cancer screening above that of PSA testing should reduce the incidence of unnecessary prostate biopsy. However, an increase in specificity is associated with a decrease in sensitivity, so these tests must be balanced with the concern for missing the diagnosis of potentially significant disease. In this context, we present a review of six common biomarkers proposed to improve the specificity of prostate cancer screening-free PSA, prostate health index, 4Kscore, PCA3, Select MDx, and ExoDx Prostate(Intelliscore).
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Affiliation(s)
- James T Kearns
- Department of Urology, University of Washington School of Medicine, 1959 NE Pacific, Box 356510, Seattle, WA, 98195, USA.
| | - Daniel W Lin
- Department of Urology, University of Washington School of Medicine, 1959 NE Pacific, Box 356510, Seattle, WA, 98195, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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145
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Jalón Monzón A, Alvarez Múgica M, Jalón Monzón M, Escaf Barmadah S. [What primary care physicians should know about new markers in prostate cancer]. Semergen 2018; 44:430-438. [PMID: 30049576 DOI: 10.1016/j.semerg.2017.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/14/2017] [Accepted: 12/14/2017] [Indexed: 11/16/2022]
Abstract
The use of prostate-specific antigen as a diagnostic tool in the screening of prostate cancer is reflected in an increase in the incidence, an increase in diagnosis at initial stages, and an increase in radical therapies, even at the expense of over-treatment in some cases. It is known from the data collected in the literature that not every patient with high prostate-specific antigen needs a biopsy, and that not every patient diagnosed with prostate cancer needs treatment. With the new emerging prostate markers, we will try to improve the specificity of prostate-specific antigen in the grey area (4-10 ng/ml) should be improved. This should avoid unnecessary biopsies. The sensitivity in the detection of significant prostate cancer with low prostate-specific antigen should also be improved in an attempt to reduce the risk of over-treatment. On the other hand, prognostic biomarkers with genomic tests will help to choose the best therapeutic option for the patient.
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Affiliation(s)
- A Jalón Monzón
- Servicio de Urología, Hospital Universitario Central de Asturias (HUCA), Oviedo (Asturias), España.
| | - M Alvarez Múgica
- Servicio de Urología, Hospital Valle del Nalón, Langreo (Asturias), España
| | | | - S Escaf Barmadah
- Servicio de Urología, Hospital Universitario Central de Asturias (HUCA), Oviedo (Asturias), España
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146
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Potential Epigenetic Biomarkers for Prostate Cancer Screening. Int Neurourol J 2018; 22:142-144. [PMID: 29991236 PMCID: PMC6059910 DOI: 10.5213/inj.1836096.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 05/24/2018] [Indexed: 11/08/2022] Open
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147
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Mathieu R, Castelli C, Fardoun T, Peyronnet B, Shariat SF, Bensalah K, Vincendeau S. Cost analysis of prostate cancer detection including the prostate health index (phi). World J Urol 2018; 37:481-487. [PMID: 29980838 DOI: 10.1007/s00345-018-2362-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 05/29/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To assess the economic impact of introducing the prostate health index (phi) for prostate cancer (PCa) detection. METHODS A total of 177 patients who presented in an academic institution with a tPSA between 2 and 10 ng/ml and underwent prostate biopsies within the 3 months were enrolled. With phi and tPSA thresholds of 43 and 4 ng/ml, respectively, probability for each branch of a decision tree model for PCa diagnosis and corresponding mean cost were estimated with "Monte Carlo" simulations. A sensitivity analysis was performed. RESULTS With a similar sensitivity, phi strategy increased positive predictive value by 13.9 points and negative predictive value by 31.6 points in comparison to tPSA strategy. Mean costs per patient with tPSA and phi strategies were €514 and €528, respectively, for a phi test price at 50€. One-way sensitivity analysis showed that phi strategy was less expensive (508€/patient) than tPSA strategy with a phi test price below 30€. In multi-criteria sensitivity analysis, PPV and the rates of positive phi and tPSA were the parameters with the largest impact on the final cost as opposed to the cost of the biopsy or imaging which have less influence. With an expected rate of positive phi test < 60%, tPSA strategy was more expensive than phi strategy. CONCLUSIONS The introduction of phi index in PCa detection would result in a significant clinical benefit compared to tPSA strategy. In our economic model, the phi strategy was equivalent or slightly more expensive than the current tPSA strategy.
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Affiliation(s)
- Romain Mathieu
- Department of Urology, Service D'urologie, Rennes University Hospital, Hôpital Pontchaillou, 2, rue Henri Le Guillou, 35000, Rennes, France.
| | | | - Tarek Fardoun
- Department of Urology, Service D'urologie, Rennes University Hospital, Hôpital Pontchaillou, 2, rue Henri Le Guillou, 35000, Rennes, France
| | - Benoit Peyronnet
- Department of Urology, Service D'urologie, Rennes University Hospital, Hôpital Pontchaillou, 2, rue Henri Le Guillou, 35000, Rennes, France
| | - Shahrokh F Shariat
- Department of Urology, General Hospital, Medical University Vienna, Vienna, Austria.,Department of Urology, University of Texas, Southwestern Medical Center, Dallas, TX, USA.,Department of Urology, Weill Cornell Medical College, New York, NY, USA.,Karl Landsteiner Institute, Vienna, Austria
| | - Karim Bensalah
- Department of Urology, Service D'urologie, Rennes University Hospital, Hôpital Pontchaillou, 2, rue Henri Le Guillou, 35000, Rennes, France
| | - Sébastien Vincendeau
- Department of Urology, Service D'urologie, Rennes University Hospital, Hôpital Pontchaillou, 2, rue Henri Le Guillou, 35000, Rennes, France
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148
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Sathianathen NJ, Kuntz KM, Alarid-Escudero F, Lawrentschuk NL, Bolton DM, Murphy DG, Weight CJ, Konety BR. Incorporating Biomarkers into the Primary Prostate Biopsy Setting: A Cost-Effectiveness Analysis. J Urol 2018; 200:1215-1220. [PMID: 29906434 DOI: 10.1016/j.juro.2018.06.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE We performed a cost-effectiveness analysis using the PHI (Prostate Health Index), 4Kscore®, SelectMDx™ and the EPI (ExoDx™ Prostate [IntelliScore]) in men with elevated prostate specific antigen to determine the need for biopsy. MATERIALS AND METHODS We developed a decision analytical model in men with elevated prostate specific antigen (3 ng/ml or greater) in which 1 biomarker test was used to determine which hypothetical individuals required biopsy. In the current standard of care strategy all individuals underwent biopsy. Model parameters were derived from a comprehensive review of the literature. Costs were calculated from a health sector perspective and converted into 2017 United States dollars. RESULTS The cost and QALYs (quality adjusted life-years) of the current standard of care, which was transrectal ultrasound guided biopsy, was $3,863 and 18.085, respectively. Applying any of the 3 biomarkers improved quality adjusted survival compared to the current standard of care. The cost of SelectMDx, the PHI and the EPI was lower than performing prostate biopsy in all patients. However, the PHI was more costly and less effective than the SelectMDx strategy. The EPI provided the highest QALY with an incremental cost-effectiveness ratio of $58,404 per QALY. The use of biomarkers could reduce the number of unnecessary biopsies by 24% to 34% compared to the current standard of care. CONCLUSIONS Applying biomarkers in men with elevated prostate specific antigen to determine the need for biopsy improved quality adjusted survival by decreasing the number of biopsies performed and the treatment of indolent disease. Using SelectMDx or the EPI following elevated prostate specific antigen but before proceeding to biopsy is a cost-effective strategy in this setting.
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Affiliation(s)
- Niranjan J Sathianathen
- Department of Urology, University of Minnesota, Minneapolis, Minnesota; Department of Surgery, Urology Unit and Olivia Newton-John Cancer Research Institute Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
| | - Karen M Kuntz
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Fernando Alarid-Escudero
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Nathan L Lawrentschuk
- Department of Surgery, Urology Unit and Olivia Newton-John Cancer Research Institute Austin Health, University of Melbourne, Melbourne, Victoria, Australia; Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Damien M Bolton
- Department of Surgery, Urology Unit and Olivia Newton-John Cancer Research Institute Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Declan G Murphy
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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149
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Ehdaie B, Carlsson S. Reply to 'Clinical utility of the Prostate Health Index (phi) for biopsy decision management in a large group urology practice setting'. Prostate Cancer Prostatic Dis 2018; 21:446-447. [PMID: 29858593 DOI: 10.1038/s41391-018-0052-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/23/2018] [Accepted: 04/09/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Behfar Ehdaie
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
| | - Sigrid Carlsson
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA.,Institute of Clinical Sciences, Department of Urology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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150
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Abstract
Prostate cancer is the most common non-cutaneous cancer among men in the United States. In the last decade there has been a rapid expansion in the field of biomarker assays for diagnosis, prognosis, and treatment prediction in prostate cancer. The evidence base for these assays is rapidly evolving. With several commercial assays available at each stage of the disease, deciding which genomic assays are appropriate for which patients can be nuanced for physicians. In an effort to help guide these decisions in clinical practice, we aim to give an update on the current status of the biomarker field of prostate cancer.
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Affiliation(s)
- Zachary Kornberg
- Department of Radiation Oncology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Matthew R Cooperberg
- Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Felix Y Feng
- Department of Radiation Oncology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
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