201
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Roobol MJ, Schröder FH, Kranse R. A comparison of first and repeat (four years later) prostate cancer screening in a randomized cohort of a symptomatic men aged 55-75 years using a biopsy indication of 3.0 ng/ml (results of ERSPC, Rotterdam). Prostate 2006; 66:604-12. [PMID: 16388508 DOI: 10.1002/pros.20352] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The identification of predictors for prostate biopsy outcome at two screening rounds using a PSA>or=3.0 ng/ml as biopsy indication. MATERIALS AND METHODS We compared predictors by means of descriptive statistics and logistic regression analysis in men (55-75 years) biopsied in either the 1st or 2nd screening round of ERSPC Rotterdam (interval 4 years). RESULTS Positive predictors for biopsy outcome in both screening rounds were an increased PSA level in the absence of a previous negative biopsy (PrevNB), DRE and TRUS suspicious and a positive family history (PFH). A higher than median prostate volume was a consistent negative predictor. Having had a PrevNB at initial screening strongly reduced the chance of cancer detection at repeat screening and in addition canceled the predictive potential of PSA. CONCLUSION If "detecting prostate cancer efficiently" were the aim, this study indicates that a "PSA only based biopsy threshold" may be replaced by another criterion incorporating, e.g., DRE, TRUS and prostate volume in men who were biopsied in the preceding 4 year interval.
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Affiliation(s)
- Monique J Roobol
- Department of Urology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
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202
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize single-institution prostate-cancer-outcomes databases (which are most commonly derived from large academic medical centers, Veterans Affairs medical centers, and military hospitals) to summarize the design and development of three well characterized outcomes databases that combine data from multiple sites (Carcinoma of the Prostate Strategic Urological Research Endeavor, Center for Prostate Disease Research, and the Shared Equal Access Regional Cancer Hospital database) and to use the examples of obesity and prostate-specific antigen changes over time to highlight the importance of these databases in prostate-cancer outcomes. RECENT FINDINGS Multiple databases have demonstrated that obese men are at greater risk of biochemical progression following radical prostatectomy. In addition, objective data have shown that it is more difficult to operate on obese men leading to greater risk of positive surgical margins, which may contribute to poorer outcomes. Several databases have shown that a rapidly increasing prostate-specific antigen, measured either before diagnosis or after failed primary therapy, is associated with increased risk of prostate-cancer-specific mortality. SUMMARY Outcomes databases are extremely useful tools. They have lead to dramatic improvements of our understanding of prostate cancer. The challenge is to use this information from past patients to help us better manage our current and future patients.
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Affiliation(s)
- Stephen J Freedland
- Department of Surgery, Division of Urology, Duke University School of Medicine, Durham, NC 27710, USA.
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203
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204
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Clements R. Contemporary issues in the diagnosis of prostate cancer for the radiologist. Eur Radiol 2006; 16:1580-90. [PMID: 16583213 DOI: 10.1007/s00330-006-0221-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Revised: 02/10/2006] [Accepted: 02/28/2006] [Indexed: 10/24/2022]
Abstract
Prostate cancer diagnostic techniques have improved considerably in recent years, but they must yet be optimised to ensure cancer detection at a potentially curable stage. Arrangements for prostate biopsy vary throughout Europe, and prostate biopsy may be undertaken by urologists or radiologists. This review discusses current issues relevant for radiologists involved in the detection of early prostate cancer. Prostate biopsy should be based on a systematic approach involving 8-12 cores obtained with peri-prostatic infiltration of local anaesthetic. Quality issues being considered by the United Kingdom Prostate Cancer Risk Management Programme are discussed.
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Affiliation(s)
- Richard Clements
- Department of Radiology, Royal Gwent Hospital, Newport, Gwent, NP20 2UB, UK.
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205
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Stachon A. [Significance of the PSA-concentration for the detection of prostate cancer]. DER PATHOLOGE 2006; 26:469-72. [PMID: 16195861 DOI: 10.1007/s00292-005-0788-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Prostate cancer among adult males is the most common neoplasm in western countries. Prostate specific antigen (PSA) is now a well established tumor marker that aids in the early detection of localized prostate cancer. Increased PSA concentrations are found in the serum of patients with benign prostatic hyperplasia or patients with prostate cancer, respectively. Therefore, in general the specificity of this test is low. The diagnostic value of PSA can be improved in consideration of clinical data, patients age, the measurement of free or complexed PSA, and the measurement of PSA velocity, respectively. Furthermore, there is a high variability between commercial PSA assays. Finally, the pre-analytical laboratory procedures have a high impact on the PSA measurement.
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Affiliation(s)
- A Stachon
- Institut für Klinische Chemie, Transfusions- und Laboratoriumsmedizin, Berufsgenossenschaftliche Kliniken Bergmannsheil, Ruhr-Universität Bochum.
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206
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Abstract
The aim of this study is to compare different tools for evaluating prostate-specific antigen (PSA) increase or decrease, such as PSA velocity and PSA slope. This study was conducted on 312 male patients evaluated with transrectal ultrasound-guided biopsy of prostate with six or more cores. Patients with at least three consecutive PSA measurements in at least 18 months entered the study. Prostate-specific antigen slope was estimated by the slope of the least-square regression line fit to PSA versus time in years; PSA velocity was calculated with 3 or more PSA arrays. Median age was 66 years (range 45-86). Overall 67 patients were affected by primary prostate cancer, 245 were controls without prostate cancer. Prostate-specific antigen slope and PSA velocity were significantly higher in patients with prostate cancer than in controls. At the ROC analysis, PSA slope evidenced better results than PSA velocity (area under the curve (AUC) 0.743 for PSA slope; AUC 0.663 for PSA velocity; P=0.037). At PSA slope (calculated with the least-square fit) equal to zero, the sensitivity resulted as being 94% with a specificity of 38.8%. In conclusion prostate-specific antigen slope calculated with three or more PSA assays permits longitudinal evaluation of PSA for prostate diagnosis. Prostate-specific antigen slope improves both sensitivity and specificity in prostate cancer diagnosis, compared with PSA velocity.
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Affiliation(s)
- L Benecchi
- Department of Urology, Fidenza Hospital, Parma, Italy.
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207
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Kristal AR, Chi C, Tangen CM, Goodman PJ, Etzioni R, Thompson IM. Associations of demographic and lifestyle characteristics with prostate-specific antigen (PSA) concentration and rate of PSA increase. Cancer 2006; 106:320-8. [PMID: 16342294 DOI: 10.1002/cncr.21603] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The objective of this study was to examine whether demographic and lifestyle characteristics are associated with prostate-specific antigen (PSA) levels and the rate of PSA increase (PSA velocity). METHODS Data for this study came from 3341 participants in the placebo arm of the Prostate Cancer Prevention Trial who, based on biopsies at the end of the study, were free of prostate carcinoma. Linear regression was used to assess associations of age, race, smoking, body mass index (BMI), physical activity, diet, and supplement use with PSA concentration during the second year of the trial, and linear mixed models were used to assess associations of these factors with PSA velocity (the percentage increase in PSA per year) during 6 years of the trial. RESULTS Between the group of men ages 50-59 years and the group of men age 70 years and older, mean PSA increased by 0.22 ng/mL, and PSA velocity decreased by 1.2 percentage points (both P < 0.001). The PSA level among men who had a BMI > or = 35 kg/cm(2) was 0.20 ng/mL lower than the PSA level among men who had a BMI < 25 kd/cm(2) (P < 0.001), but BMI was not associated with PSA velocity. PSA velocity was 1.2 percentage points higher in African-American men compared with white men (P = 0.043). Low energy intake and the use of high-dose calcium supplements were associated with significantly lower PSA velocity (both P = 0.05). Weight gain also was associated with lower PSA velocity. CONCLUSIONS Differences in PSA concentration associated with demographic and lifestyle characteristics were small and were not likely to bias the interpretation of a single PSA test. Age, race, energy intake, calcium supplement use, and weight change were associated with substantial differences in PSA velocity, and the clinical interpretation of PSA velocity may be biased by these factors.
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Affiliation(s)
- Alan R Kristal
- Fred Hutchinson Cancer Research Center, Seattle, Washington 98109-1024, USA.
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208
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Schröder FH, Roobol MJ, van der Kwast TH, Kranse R, Bangma CH. Does PSA Velocity Predict Prostate Cancer in Pre-Screened Populations? Eur Urol 2006; 49:460-5; discussion 465. [PMID: 16442212 DOI: 10.1016/j.eururo.2005.12.026] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Revised: 12/04/2005] [Accepted: 12/05/2005] [Indexed: 10/25/2022]
Abstract
UNLABELLED PSA-driven screening has been applied to a large part of the male population in many countries. An elevated PSA in secondary screens may indicate benign enlargement of the prostate rather than prostate cancer. In such cases the yearly rate of increase of PSA (PSA velocity [PSAV]) may improve the test characteristics of PSA. MATERIALS AND METHODS Data from the European Randomized Study of Screening for Prostate Cancer Rotterdam are used to study the issue. Relative sensitivity, relative specificity, and positive predictive value (PPV) are calculated. Logistic regression analysis is used to compare odds ratios for positive biopsies. The relationship between PSAV and parameters of tumour aggressiveness is investigated. RESULTS Five hundred eighty-eight consecutive participants were identified who presented at their first screening with PSA values <4.0 and who progressed to PSA values >4.0 ng/ml four years later. None were biopsied in round one, all were biopsied in round two. Relative sensitivity and specificity depend strongly on PSAV cut-offs of 0.25-1.0 ng/ml/yr. The use of PSAV cut-offs does not improve the PPV of the PSA cut-off of 4.0 ng/ml, nor do any of the PSAV cut-offs improve the odds ratio for identifying prostate cancer with respect to the cut-off value of 4.0 ng/ml. The rate of aggressive cancers seems to increase with increasing PSAV. CONCLUSIONS PSAV does not improve the detection characteristics of a PSA cut-off of 4.0 ng/ml in secondary screening after four years.
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Affiliation(s)
- Fritz H Schröder
- Department of Urology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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209
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Reiter RE, Shurtleff B. What are the operating characteristics of PSA screening for prostate cancer? NATURE CLINICAL PRACTICE. UROLOGY 2006; 3:74-5. [PMID: 16470202 DOI: 10.1038/ncpuro0405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Accepted: 11/14/2005] [Indexed: 05/06/2023]
Affiliation(s)
- Robert E Reiter
- RE Reiter is Professor of Urology in the Department of Urology and the Molecular Biology Institute, and B Shurtleff is a Resident in the Department of Urology, at the Geffen School of Medicine-UCLA, Los Angeles, CA, USA
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210
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211
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Kim JY, Cho JS, Kwon MS, Jang WS, Park SY, Chung BS, Kang HJ. Biological Variation of Serum Prostate Specific Antigen Levels in Men Aged 50 or Older without Prostate Cancer. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.12.1284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jung-Yub Kim
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
| | - Jin Seon Cho
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
| | - Moon Sic Kwon
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
| | - Won Seok Jang
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
| | - Sung Yul Park
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
| | - Byung Soo Chung
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
| | - Hee Jung Kang
- Department of Laboratory Medicine, Hallym University College of Medicine, Chuncheon, Korea
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212
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Jeon HJ, Kim YS, Kang DR, Nam CM, Kim CI, Seong DH, Kim SJ, Cheon SH, Cho IR, Cho JS, Hong SJ, Choi YD. Age-Specific Reference Ranges for Serum Prostate-Specific Antigen in Korean Men. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.6.586] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hyung Jin Jeon
- Department of Urology & Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Sik Kim
- Department of Urology, Ilsan Hospital, National Health Insurance Corporation, Ilsan, Korea
| | - Dae Ryeong Kang
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Chung Mo Nam
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Chun Il Kim
- Department of Urology, College of Medicine, Keimyung University, Daegu, Korea
| | - Do Hwan Seong
- Department of Urology, Inha University, Incheon, Korea
| | - Se Joong Kim
- Department of Urology, Ajou University, Suwon, Korea
| | | | - In Rae Cho
- Department of Urology, Inje University, Busan, Korea
| | - Jin Seon Cho
- Department of Urology, Hallym University, Chuncheon, Korea
| | - Sung Joon Hong
- Department of Urology & Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology & Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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213
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Svatek RS, Shulman M, Choudhary PK, Benaim E. Critical analysis of prostate-specific antigen doubling time calculation methodology. Cancer 2006; 106:1047-53. [PMID: 16456812 DOI: 10.1002/cncr.21696] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Prostate-specific antigen (PSA) doubling time (PSADT) has emerged as an important surrogate marker of disease progression and survival in men with prostate carcinoma. The literature is replete with different methods for calculating PSADT. The objective of the current study was to identify the method that best described PSA growth over time and predicted disease-specific survival in men with androgen-independent prostate carcinoma. METHODS PSADT was calculated for 122 patients with androgen-independent prostate carcinoma using 2 commonly used methods: best-line fit (BLF) and first and last observations (FLO). Then, PSADT was calculated by using both a random coefficient linear (RCL) model and a random coefficient quadratic (RCQ) model. Statistical analysis was used to compare the ability of the methods to fit the patients' PSA profiles and to predict disease-specific survival. RESULTS The RCQ model provided the best fit of the patients' PSA profiles, as determined according to the significance of the added parameters for the RCQ equation (P < or = 0.002). The PSADT estimates from the FLO method, the RCL model, and the RCQ model were highly significant predictors (P < 0.001) of disease-specific survival, whereas estimates from the BLF method were not found to be significant predictors (P = 0.66). PSADT estimates from the RCQ and RCL models provided an improved correlation of disease-specific survival (both R(2) = 0.55) compared to the FLO (R(2) = 0.11) and BFL (R(2) = 0.003) methods. CONCLUSIONS Random coefficient methods provided a more reliable fit of PSA profiles than other models and were superior to other available models for predicting disease-specific survival in patients with androgen-independent prostate carcinoma. The authors concluded that consideration should be given to applying the RCL or RCQ models in future assessments of PSADT as a predictive parameter.
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Affiliation(s)
- Robert S Svatek
- Department of Urology, University of Texas Southwestern Medical Center and Dallas Veterans Administration Hospital, Dallas, Texas 77030, USA
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214
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Abstract
Malignancy is a recognized complication of transplantation. Genitourinary cancers are the second most common tumors in transplant recipients with prostate cancer and renal cell carcinoma the most common. Unlike the more common skin malignancies, genitourinary tumors have a significant impact on both graft and patient survival. Surgical and radiation treatments need to consider the location of heterotopic transplants and administration of chemotherapy may need alteration in light of immunosuppression being used. The major genitourinary malignancies and their management will be reviewed in this article with emphasis on the concerns that arise in a transplant recipient.
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Affiliation(s)
- Nicolas A Muruve
- Department of Urology and Kidney Transplantation, Cleveland Clinic Florida, Weston, FL 33332, USA.
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215
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Freedland SJ. Can we preoperatively identify men who are at high risk for aggressive prostate cancer? ACTA ACUST UNITED AC 2005; 2:584-5. [PMID: 16474541 DOI: 10.1038/ncpuro0355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2005] [Accepted: 10/20/2005] [Indexed: 11/09/2022]
Affiliation(s)
- Stephen J Freedland
- Department of Surgery, Division of Urology, Duke University School of Medicine, Durham, NC 27710, USA.
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216
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Bruun L, Becker C, Hugosson J, Lilja H, Christensson A. Assessment of intra-individual variation in prostate-specific antigen levels in a biennial randomized prostate cancer screening program in Sweden. Prostate 2005; 65:216-21. [PMID: 15948137 PMCID: PMC1951509 DOI: 10.1002/pros.20286] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The degree of variability in prostate-specific antigen (PSA) measurements is important for interpreting test results in screening programs, and particularly for interpreting the significance of changes between repeated tests. This study aimed to determine the long-term intra-individual variation for PSA in healthy men. METHODS A randomly selected cohort of men in a biennial prostate cancer screening program (ERSPC) conducted in Sweden from 1995-1996 to 2001-2002. We studied men who had total PSA (tPSA) levels < 2.0 ng/ml in 2001-2002. This included 791 men with tPSA < or = 0.61 ng/ml (group A), 1,542 men with tPSA < or = 0.99 ng/ml (group B), and 1,029 men with tPSA 1.00-1.99 ng/ml (group C). The intra-individual variability of free PSA (fPSA) and tPSA was assessed by calculating coefficients of variation (CV) for each individual's PSA measurements from the first and second round of screening (1995-1996 and 1997-1998). RESULTS Intra-individual CV (geometric means) for tPSA were 13.7%, 12.7%, and 11.5% in groups A, B, and C, respectively. Corresponding CVs for fPSA were significantly lower, ranging from 12.1% to 10.4%. The estimated biological variation of tPSA and fPSA in groups A to C were 12.5%, 11.4%, 10.0% and 9.7%, 7.8%, 7.5%, respectively. CONCLUSIONS In healthy men with PSA levels less than 2 ng/ml, the natural long-term variability for tPSA was less than 14%, and with 95% probability, a change in tPSA greater than 30% indicates a change beyond normal random variation.
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Affiliation(s)
- Laila Bruun
- Department of Nephrology and Transplantation, Lund University, University Hospital (UMAS), Malmö, Sweden.
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217
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Schröder FH. Rising prostate specific antigen (PSA) during follow-up of prostate cancer patients — what to do? EJC Suppl 2005. [DOI: 10.1016/s1359-6349(05)80290-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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218
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Thompson IM, Bermejo C, Hernandez J, Basler JA, Canby-Hagino E. Screening for Prostate Cancer: Opportunities and Challenges. Surg Oncol Clin N Am 2005; 14:747-60. [PMID: 16226689 DOI: 10.1016/j.soc.2005.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Prostate cancer screening with PSA and with digital rectal examination isa reality in the United States. Regardless of recent observations regarding the complexities of PSA interpretation, millions of U.S. men expect an annual PSA test and physicians have come to rely on the test, in combination with digital rectal examination, to assess for prostate cancer risk. What has become evident is that PSA can no longer be interpreted dichotomously as a simple yes or no. The test reflects a range of risk and PSA value must be merged with other risk factors of an individual man including ethnicity, family history, as well as the individual's risk aversion to complications from prostate cancer. The future of prostate cancer screening will be built upon incorporation of new biomarkers to the prediction of risk of disease. As these markers move forward in testing, it will no longer be acceptable to move these into clinical usage without formal validation studies and, because of the high frequency of prostate cancer in the general male population, these validation studies will almost certainly have to include measures of prognosis. It is the holy grail of cancer biomarker development to acquire a test that is positive in the man with clinically-aggressive prostate cancer but is negative in both the patient without disease and in the man with disease that will be of no clinical consequence over his lifetime.
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Affiliation(s)
- Ian M Thompson
- Department of Urology, University of Texas Health Science Center at San Antonio, TX 78229, USA.
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219
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Abstract
Benign prostatic hyperplasia (BPH) is common among aging men. Untreated BPH may lead to complications including urinary tract infection, acute urinary retention, and obstructive nephropathy. Diagnosing BPH can be challenging because lower urinary tract symptoms are found in conditions other than BPH, and prostate size correlates poorly with symptoms of obstruction. Nonetheless, a careful medical history and physical examination, along with prudent use of diagnostic tests, can yield an accurate diagnosis. We review the evaluation of men with suspected BPH and indications for referral to a urologist for invasive therapy. We also review supporting evidence and treatment considerations for saw palmetto and the 2 major classes of prescription medications, alpha1-adrenergic antagonists and 5alpha-reductase inhibitors.
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Affiliation(s)
- Thomas J Beckman
- Division of General Internal Medicine, Men's Health Center for Urology, and Department of Urology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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220
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D'Amico AV, Chen MH, Roehl KA, Catalona WJ. Identifying patients at risk for significant versus clinically insignificant postoperative prostate-specific antigen failure. J Clin Oncol 2005; 23:4975-9. [PMID: 16051949 DOI: 10.1200/jco.2005.08.904] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We evaluated whether men at risk for significant versus clinically insignificant prostate-specific antigen (PSA) failure after radical prostatectomy could be identified using information available at diagnosis. PATIENTS AND METHODS A prospective prostate cancer screening study that enrolled, diagnosed, and treated 1,011 men with radical prostatectomy at Barnes-Jewish Hospital (St Louis, MO) from January 1, 1989, to June 1, 2002, for localized prostate cancer formed the study cohort. Preoperative predictors of a postoperative PSA doubling time (DT) of less than 3 months and more than 12 months or no PSA failure were identified using logistic regression. RESULTS A preoperative PSA velocity more than 2.0 ng/mL/yr (P = .001) and biopsy Gleason score 7 (P = .006) or 8 to 10 (P = .003) were significantly associated with having a postoperative PSA DT less than 3 months. A PSA level less than 10 ng/mL (P = .005), a nonpalpable cancer (P = .001) with a Gleason score < or = 6 (P = .0002), and a preoperative PSA increase that did not exceed 0.5 ng/mL/yr (P = .03) were significantly associated with a postoperative PSA DT of at least 12 months or no PSA failure. Most men with these preoperative characteristics and a postoperative PSA DT of 12 months or more had a persistent postoperative PSA level of at least 0.2 ng/mL that did not exceed 0.25 ng/mL after a median follow-up of 3.6 years. CONCLUSION A postoperative PSA DT less than 3 months is associated with a preoperative PSA velocity more than 2.0 ng/mL/yr and high-grade disease. Select men with a postoperative PSA DT more than 12 months may not require salvage radiation therapy.
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Affiliation(s)
- Anthony V D'Amico
- Brigham and Women's Hospital, Department of Radiation Oncology, Dana-Faber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA.
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221
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Early Diagnosis of Prostate Cancer: Why and How? APOLLO MEDICINE 2005. [DOI: 10.1016/s0976-0016(11)60256-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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222
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Pfister C, Basuyau JP. Current usefulness of free/total PSA ratio in the diagnosis of prostate cancer at an early stage. World J Urol 2005; 23:236-42. [PMID: 16096832 DOI: 10.1007/s00345-005-0506-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2004] [Accepted: 03/25/2005] [Indexed: 11/27/2022] Open
Abstract
The aim of our study was to evaluate five different free/total PSA (f/t PSA) kits for the diagnosis of early stage prostate cancer. We compared the PSA density and the f/t PSA ratio to differentiate between benign prostatic hyperplasia (BPH) and prostate cancer. This prospective study included a total of 120 patients with suspected prostate cancer (PSA between 4 and 15 ng/ml) observed over a period of 30 months. All patients had a blood test as well as a prostate biopsy prior to inclusion. Serum immunoassay total-PSA (t PSA) and free-PSA (f PSA) were carried out using five different assay kits: IMX Abbott (A), Kryptor Brahms (B), Immulite DPC (D), IRMA Immunotech (I) and IRMA DiaSorin (S). The results were compared to determine sensitivity, specificity, threshold values, and to differentiate between BPH and cancer. No difference was found between assay reproducibility and variation in the assays, however, only a slight variation was observed in the mean t PSA values, whereas a significant difference was found with f/t PSA. Receiver operating curves were generated for t-PSA and f/t PSA. The area under the curves did not show any significant differences for either t PSA or f/t PSA. A low comparative variability between the five kits tested for tPSA was observed, which suggest that the f/t PSA ratio has no current usefulness in the initial diagnosis of prostate cancer, particularly in patients with larger prostates. Furthermore, no prognostic value was found for surgically positive margins in radical prostatectomy.
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Affiliation(s)
- Christian Pfister
- Department of Urology, Rouen University Hospital-Charles Nicolle, Rouen, France,
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223
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Berger AP, Deibl M, Steiner H, Bektic J, Pelzer A, Spranger R, Klocker H, Bartsch G, Horninger W. Longitudinal PSA changes in men with and without prostate cancer: assessment of prostate cancer risk. Prostate 2005; 64:240-5. [PMID: 15712213 DOI: 10.1002/pros.20210] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND To determine longitudinal PSA changes over a period of 10 years in patients with and without prostate cancer. METHODS Serial PSA measurements performed over 10 years were evaluated in 353 men who eventually developed prostate cancer and in 2.462 participants of a screening program without prostatic malignancy. RESULTS In men with cancer, mean tPSA increased from 2.28 ng/ml at 10 years before diagnosis to 6.37 ng/ml at the time of postive biopsy (PSA velocity: 0.409 ng/ml/year). PSA velocity was significantly associated with Gleason scores and pathologic stage. In the benign group (n=2.462), mean tPSA increased from 1.18 to 1.49 ng/ml over a period of 10 years (PSA velocity of 0.03 ng/ml/year). Of the subjects with tPSA levels of 2 ng/ml or less, 2 years prior to cancer diagnosis, 11.4% had tPSA values of more than 4 ng/ml at the time of biopsy. Of the 972 men with tPSA below 1 ng/ml 2 years before the most recent measurement was obtained, 966 (99.4%) had no evidence of prostate cancer 2 years later, while six were found to have malignancies (0.6%). CONCLUSIONS Longitudinal PSA changes in men with and without prostate cancer are significantly different. Annual testing may not be required in men with baseline tPSA levels of 1 ng/ml or below, whereas in patients with levels higher than 1 ng/ml, it seems to be indicated because of the significant percentage of men presenting with tPSA levels of more than 4 ng/ml two years later.
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Affiliation(s)
- Andreas P Berger
- Department of Urology, University of Innsbruck, Innsbruck, Austria.
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224
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Routh JC, Leibovich BC. Adenocarcinoma of the prostate: epidemiological trends, screening, diagnosis, and surgical management of localized disease. Mayo Clin Proc 2005; 80:899-907. [PMID: 16007895 DOI: 10.4065/80.7.899] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Prostate cancer is a leading cause of mortality and morbidity worldwide. Despite years of study and effort, certain key questions remain unanswered, including how prostate cancer is best detected and diagnosed, how it is best treated, and how best to minimize the complications of treatment. The aim of this article is to briefly address these topics to shed light on the current best practices in prostate cancer screening, diagnosis, and surgical treatment of localized disease. We examine current trends in prostate cancer epidemiology and screening, including genetic and dietary risk factors and the newer prostate-specific antigen-derived screening modalities. Methods of diagnosis, including an overview of prostate biopsy technique and indications, and a brief review of relevant pathologic findings are provided. An in-depth analysis of traditional prostate cancer surgical management highlights the relevant advantages and disadvantages of radical retropubic and perineal prostatectomy. Complications of surgery, prognostic factors, and the many risk prediction models currently available are discussed. In all, this article aims to give the reader a broad overview of the basic elements of prostate cancer diagnosis and surgical treatment in the modem era.
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Affiliation(s)
- Jonathan C Routh
- Department of Urology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
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225
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Hernandez J, Canby-Hagino E, Thompson IM. Biomarkers for the detection and prognosis of prostate cancer. Curr Urol Rep 2005; 6:171-6. [PMID: 15869720 DOI: 10.1007/s11934-005-0004-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Recent studies have cast doubt on the reliability of serum total prostate-specific antigen as a biomarker for the detection and prognosis of prostate cancer. Biomarkers that can identify those men at risk for clinically significant prostate cancer are desperately needed. The search for biomarkers that may improve the detection of biologically consequential prostate cancer is one of the most active areas under current investigation. In this review, we highlight some of these ongoing efforts. Proper validation of newly discovered biomarkers is of paramount importance.
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Affiliation(s)
- Javier Hernandez
- Department of Urology, University of Texas Health Sciences Center, A7703, Floyd Curl Drive, San Antonio, TX 78229, USA.
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226
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Postma R, Schröder FH. Screening for prostate cancer. Eur J Cancer 2005; 41:825-33. [PMID: 15808952 DOI: 10.1016/j.ejca.2004.12.029] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2004] [Accepted: 12/02/2004] [Indexed: 11/23/2022]
Abstract
Epidemiologically, prostate cancer is the most common cancer in the Western world after skin cancer. To date, it is still unknown whether screening for prostate cancer is justified, because results of randomised clinical trials are not yet available. The available screening tests (i.e. prostate-specific antigen (PSA) test) do not always detect cancers that otherwise would have resulted in prostate cancer mortality. Favourable results from prostate cancer screening include an increasing number of men with localised disease and an increase in the number of well-differentiated tumours. However, the risk of overdiagnosis and subsequent over-treatment (due to the diagnosis of localised disease), using aggressive therapies fuels arguments against screening. Therefore, until more evidence is available proving otherwise, prostate cancer screening can only be justified in the context of clinical trials.
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Affiliation(s)
- R Postma
- Department of Urology, Josephine Nefkens Institute, Erasmus MC, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
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227
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Meraney AM, Haese A, Palisaar J, Graefen M, Steuber T, Huland H, Klein EA. Surgical management of prostate cancer: Advances based on a rational approach to the data. Eur J Cancer 2005; 41:888-907. [PMID: 15808956 DOI: 10.1016/j.ejca.2005.02.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2005] [Revised: 02/08/2005] [Accepted: 02/08/2005] [Indexed: 11/18/2022]
Abstract
The management of localised prostate cancer has undergone important changes in the past two decades, with major improvements in surgical technique, a greater emphasis on structured assessment of quality of life, and a greater attempt to tailor treatment to biological risk. Disease diagnosis is predicated on identification of demographic risk factors, serum levels of prostate-specific antigen and its derivatives, and extended biopsy techniques. Surgical removal of the prostate may be accomplished by open or minimally invasive techniques and in experienced hands results in good functional outcomes a high rate of cure for those with organ confined disease. Radical prostatectomy is also appropriate in selected patients with locally advanced disease and after failed radiation therapy.
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Affiliation(s)
- Anoop M Meraney
- Glickman Urological Institute A-100, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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228
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Figueirêdo MDF, Lopes GT, Naidu TG. Digital rectal examination (DRE) does not influence total serum levels of prostate specific antigen (tPSA), in individuals without prostate pathology. Int Braz J Urol 2005; 29:423-7. [PMID: 15745587 DOI: 10.1590/s1677-55382003000500006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2003] [Accepted: 06/11/2003] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate if the digital rectal examination (DRE) performed before determination of total serum prostate specific antigen (tPSA) influences the levels of this protein. MATERIALS AND METHODS Forty-eight men without a diagnosis of prostate pathology were assessed for tPSA levels, before and 30 minutes after DRE examination. Values of tPSA in the individuals' serum were measured by the electrochemoluminescence (ECLIA), in Roche's Elecys 1010 analyzer. RESULTS DRE examination induced a modest elevation in tPSA values in 34 of the 48 men, with a variation in mean elevation from 2.19% in the age range >/= 70 years to 11.96% in the age range of 60-69 years. Additionally, moderate decreases in values were detected in 11 individuals and 3 did not present any alteration following the procedure. Differences in mean values of tPSA, pre- and post-DRE were not statistically significant, neither in the total sample of individuals or in the age range groups. CONCLUSION DRE examination does not significantly influence the tPSA values in individuals under study.
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Affiliation(s)
- Maria de F Figueirêdo
- Department of Pathology and Legal Medicine, Medicine School, Federal University of Ceará, Fortaleza, Ceará, Brazil
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229
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Forrest MS, Edwards SM, Houlston R, Kote-Jarai Z, Key T, Allen N, Knowles MA, Turner F, Ardern-Jones A, Murkin A, Williams S, Oram R, Bishop DT, Eeles RA. Association between hormonal genetic polymorphisms and early-onset prostate cancer. Prostate Cancer Prostatic Dis 2005; 8:95-102. [PMID: 15711606 DOI: 10.1038/sj.pcan.4500785] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We investigated the association between seven polymorphisms in four candidate genes involved in vitamin D and androgen metabolism with early-onset prostate cancer (CaP) risk. The polymorphisms were genotyped in 288 UK males who were diagnosed with CaP at the age of 55 y or younger and up to 700 population-based controls. An additional 50 cases (not selected for age) and 76 controls were also genotyped. Short (< or =22 repeats) AR (CAG)(n) repeats were associated with a significantly reduced risk of early onset CaP (OR 0.68, 95% CI 0.50-0.91) compared with men with long (> 22) repeats. Men homozygous for the leucine variant of SRD5A2 p.89V > L were also found to be at a significantly increased risk of CaP compared with men who were homozygous for the valine allele (OR 1.84, 95% CI 1.15-2.98). No associations were found with the AR (GGC)(n), CYP17 Msp A1 I, VDR Taq I, SRD5A2 (TA)(n) and p.49A >T polymorphisms and CaP risk. These findings suggest that common polymorphisms in the AR and SRD5A2 genes may be associated with early-onset CaP in British men.
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Affiliation(s)
- M S Forrest
- Cancer Research UK Cancer Medicine Research Division, University of Leeds, Leeds, UK
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230
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Ciatto S, Lombardi C, Rubeca T, Zappa M. Predictors of random sextant biopsy outcome in screened men with PSA > 4 ng/mL and a negative sextant biopsy at previous screening. Experience in a population-based screening program in Florence. Int J Biol Markers 2005; 19:89-92. [PMID: 15255539 DOI: 10.1177/172460080401900201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to evaluate possible pedictors of the outcome of repeat random sextant biopsy of the prostate prompted by a rise in prostate-specific antigen (PSA). Random biopsies performed for PSA elevation (>4 ng/mL) in the course of a randomized study of screening efficacy were reviewed, and 87 consecutive biopsies (carcinoma = 13, high-grade prostatic intraepithelial neoplasia = 6, negative = 68) performed in subjects with a negative random biopsy at the previous screening round were considered. Findings at digital rectal examination or transrectal ultrasonography and total PSA value were not useful predictors of repeat biopsy outcome, whereas PSA velocity was significantly associated with biopsy outcome. The positive predictive value for a cancer biopsy was 2.7% (1/36), 28.5% (2/7), and 22.7% (10/44) for PSA velocity values of <0.1, 0.1-0.19, and >0.19 ng/mL/yr, respectively. A cutoff of 0.1 ng/mL/yr for PSA velocity would have allowed to avoid approximately half (35/74 = 47.2%) of the benign biopsies while decreasing the sensitivity by 7.6% (1/13), and is thus suggested as a possible criterion for the indication of repeat random biopsy for persistent PSA elevation.
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Affiliation(s)
- S Ciatto
- Centro per lo Studio e la Prevenzione Oncologica, Florence, Italy.
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231
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Abstract
The discovery and the use of serum prostate specific antigen (PSA) has considerably improved the diagnosis of prostate cancer during the past 20 years. Before PSA era, early diagnosis was only based on the digital rectal examination (DRE) of which the Limitations have been evidenced; over half of the tumours diagnosed by such means had already spread out of the prostate and were incurable. Assessment of serum PSA has allowed the diagnosis to be made at an earlier stage of the disease, curable by current treatments. Whichever the diagnostic tools, transrectal ultrasound (TRUS) prostatic biopsies remain necessary for diagnosis ascertainment, taking into account the low specificity of PSA assessment. The feasibility of a diagnosis at an early and curable stage of the disease has logically resulted in screening procedures aimed at reducing the high mortality related to prostate cancer. The numerous publications on prostate cancer screening provide precise information on the accuracy of available diagnostic means (PSA, DRE, TRUS, combined PSA and DRE), on the characteristics of screened tumours (stage and differentiation), and also on the population of men likely to benefit from the screening (age at beginning and end of the screening, frequency of PSA testing, identification of the men with ethnic and/or genetic predisposition). In those early diagnosed prostate cancers, the assessment of loco-regional cancer extension (extracapsular and/or, microscopic nodal involvement), remains unsatisfactory because no imaging technique (ultrasonography, CT scan, MRI,...) allows visualising the tumour itself or microscopic metastases. Nevertheless, the combination of multiple parameters such as DRE data, PSA level, biopsy data and tumour differentiation helps approaching with an increasing precision (nomograms) the true pathologic stage of the disease. Such advances allow distinguishing, among the very heterogeneous group of prostate cancers, tumours that differ from one to another in terms of disease stage, progression and prognosis, which is helpful for the determination of an adapted therapeutic strategy.
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Affiliation(s)
- G Fournier
- Service d'urologie, Centre hospitalier universitaire de Brest, hôpital de la Cavale Blanche, boulevard Tanguy-Prigent, 29609 Brest, France.
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232
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Grall J, Corbel L. [PSA and benign prostatic hyperplasia]. ANNALES D'UROLOGIE 2004; 38 Suppl 2:S43-5. [PMID: 15651490 DOI: 10.1016/s0003-4401(04)80006-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
In the opinion of many urologists, prostate-specific antigen (PSA), which is not specific of any disease, is not considered in the diagnosis and follow-up of benign prostatic hyperplasia (BPH). Nonetheless, prostate cancer diagnosis is based on PSA screening. PSA value is thus available for a majority of men above 50. Recent data suggest that there is a link between PSA value and BPH natural history, turning PSA into a tool for BPH management and prevention of complications such as retention. It hasn't got into practice so far, as recommended criteria for PSA screening in BPH have not been issued. The debate over this topic is only at its beginning.
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Affiliation(s)
- J Grall
- Cabinet médical, 3, place de la République, 21000 Dijon, France.
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233
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Lopez-Saez JB, Otero M, Senra-Varela A, Ojea A, MartÍn JSÁ, MuÑoz BD, Fuentes JV. Prospective Observational Study to Assess Value of Prostate Cancer Diagnostic Methods. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2004. [DOI: 10.1177/8756479304269944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this article is to evaluate the efficiency and effectiveness of analytical and imaging methods for diagnosing prostate cancer in northwest Spain. The authors investigated prospectively two groups of patients with a pathological digital rectal examination (DRE) or prostate-specific antigen (PSA). Sensitivity, specificity, positive predictive value, negative predictive value, receiver operating characteristics curves, and other analyses were performed to determine the relative contributions of PSA, DRE, gray-scale transrectal ultrasonography (TRUS), color Doppler ultrasound (CDUS), symptoms, and patient age to cancer prediction. The presence of prostatic disease symptoms did not distinguish between subjects with and without cancer. The most sensitive (98%) was total PSA (> 4 ng/mL), and the most specific (78%) was DRE and TRUS (65%). The contribution of PSA, DRE, and TRUS to the diagnosis of prostate cancer was significant. In patients with a PSA between 4 and 10 ng/mL, PSA specificity increased, using a free/total PSA ratio of 15%. The PSA continues to be the most sensitive method for prostate cancer diagnosis. DRE tends to be more negative at early stages of cancer detection. Comparing the conventional TRUS echography with the CDUS, the latter is a better detector in the diagnosis of cancer.
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Affiliation(s)
- Juan-Bosco Lopez-Saez
- University Hospital of Puerto Real;Departamento de Medicina, Universidad de Cádiz, c/. Dr. Marañón, no. 3, 11002-Cádiz, Spain
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234
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Linton DK, Hamdy FC. Diagnostic précoce et traitement chirurgical du cancer de la prostate. ACTA ACUST UNITED AC 2004; 38:137-47. [PMID: 15485154 DOI: 10.1016/j.anuro.2004.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Prostate cancer is a significant cause of morbidity and mortality in the United States and Europe. The natural ageing of the population as well as the continued and widespread use of diagnostic tests such as prostate specific antigen (PSA), has led to an increase in the numbers of men diagnosed with localised prostate cancer. Screening to identify organ-confined disease has provoked much public and scientific attention, but remains controversial. Radical prostatectomy is one of the most challenging urological procedures performed. Improvements in technique due to better understanding of pelvic anatomy have reduced complications, with acceptable standards and excellent results in high-volume institutions. Continual refinements in technique and the recent introduction of laparoscopic radical prostatectomy are likely to improve functional outcome further. However the effectiveness of surgery in improving survival and quality of life, in men with early prostate cancer remains to be determined. The results from large randomised controlled trials are eagerly awaited.
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Affiliation(s)
- D K Linton
- Academic Urology Unit, Division of Clinical Sciences (South), University of Sheffield, Sheffield, United Kingdom
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235
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Goodman PJ, Tangen CM, Crowley JJ, Carlin SM, Ryan A, Coltman CA, Ford LG, Thompson IM. Implementation of the Prostate Cancer Prevention Trial (PCPT). ACTA ACUST UNITED AC 2004; 25:203-22. [PMID: 15020037 DOI: 10.1016/j.cct.2003.11.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2002] [Accepted: 11/24/2003] [Indexed: 11/19/2022]
Abstract
The Prostate Cancer Prevention Trial is a randomized double blind chemoprevention trial of 18,882 men. It is designed to test the difference in the histologically proven prostate cancer prevalence between a group of participants given finasteride and another given placebo for 7 years. We present an overview of the study design, details of the administrative structure of the study and a description of the successful implementation of the accrual phase.
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Affiliation(s)
- Phyllis J Goodman
- Southwest Oncology Group Statistical Center, M/S M3-C102, 1100 Fairview Avenue North, Box 19024, Seattle, WA 98109-1024, USA.
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236
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Fandella A, Maccatrozzo L, Merlo F, Collodel L, Durante E, Anselmo G. Survellaince Program for Prostate Carcinoma: Preliminary Results on 585 Blood Donors. Urologia 2004. [DOI: 10.1177/039156030407100312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Population screening for prostatic carcinoma (CP) is a struggled subject, and we don't know the real utility of it. Nowadays the Authors suggest only survey on little groups. In this study the male population of blood donors of our hospital between 45 and 65 years underwent a complete valutation for CP. From this study we hope to obtain the following results: a) early diagnosis of CP (eradicable); b) eliminate keeper of neoplastic pathology from blood donations (theoretic risk of transmission of neoplastic cells in immunodepressed patients); c) studying the practicability, if we achieve a high percentage of ahdesions at this program, our model could be exportable.
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Affiliation(s)
- A. Fandella
- Divisione di Urologia, Ospedale Regionale di Treviso
| | | | - F. Merlo
- Divisione di Urologia, Ospedale Regionale di Treviso
| | - L. Collodel
- Centro Trasfusionale, Ospedale Regionale di Treviso
| | - E. Durante
- Centro Trasfusionale, Ospedale Regionale di Treviso
| | - G. Anselmo
- Divisione di Urologia, Ospedale Regionale di Treviso
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237
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Auvinen A, Määttänen L, Finne P, Stenman UH, Aro J, Juusela H, Rannikko S, Tammela TLJ, Hakama M. Test sensitivity of prostate-specific antigen in the Finnish randomised prostate cancer screening trial. Int J Cancer 2004; 111:940-3. [PMID: 15300807 DOI: 10.1002/ijc.20352] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We estimated the sensitivity of serum prostate-specific antigen (PSA) as a screening test for prostate cancer in the Finnish randomised, population-based prostate cancer screening trial. The study population consisted of 80,458 men aged 55-67 years identified from the national population registry and randomised to the screening or control arm of the trial. The screening algorithm was based on determination of serum PSA concentration. Test sensitivity was estimated based on interval cancer incidence during the first 4 years of follow-up among screening participants with a negative screening test. Interval cancers were defined as those occurring among men with a negative screening test. Altogether, 19 interval cancers were detected among 17,897 men with serum PSA < 3 ng/ml during the first screening interval. A further 5 cases were diagnosed among 811 men with PSA 3.0-3.9 ng/ml with a benign digital rectal examination or free total PSA ratio > or = 0.16. Test sensitivity based on serum PSA of 3 ng/ml was estimated to be 0.89 (95% confidence interval 0.84-0.93) and that based on PSA of 4 ng/ml combined with an ancillary test (digital rectal examination or free total PSA ratio in the PSA range 3.0-3.9) was 0.87 (0.82-0.92). Test sensitivity achieved with serum PSA in prostate cancer screening appears excellent in the context of a population-based effectiveness trial.
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Affiliation(s)
- Anssi Auvinen
- School of Public Health, University of Tampere, Tampere, Finland.
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238
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Ozdal OL, Aprikian AG, Bégin LR, Behlouli H, Tanguay S. Comparative evaluation of various prostate specific antigen ratios for the early detection of prostate cancer. BJU Int 2004; 93:970-4; discussion 974. [PMID: 15142145 DOI: 10.1111/j.1464-410x.2003.04762.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the performance of various ratios using total prostate specific antigen (PSA), complexed PSA (cPSA) and free PSA (fPSA) in the early detection of prostate cancer. PATIENTS AND METHODS The study included 535 consecutive patients evaluated at a prostate cancer detection clinic between January 1998 and October 1999. Patients had blood samples drawn before transrectal ultrasonography and prostate biopsy to measure PSA, cPSA and fPSA. Receiver operating characteristic (ROC) curves (sensitivity vs 1 - specificity) were used to evaluate the performance of PSA, cPSA, f/tPSA, cPSA/tPSA, fPSA/cPSA, tPSA/prostate volume (PV), fPSA/PV, and cPSA/PV. The areas under the curve (AUC) were calculated for each ratio. The performance of each ratio over all patients or in those with a tPSA of 4-6 or 4-10 ng/mL were evaluated. RESULTS Of the 535 patients, 204 (38%) had biopsy-confirmed prostate cancer. The AUC obtained with tPSA alone was 0.64; when measured for all patients the cPSA/PV (0.78), PSA/PV (0.77), f/tPSA (0.76) and fPSA/cPSA (0.75) performed better than tPSA alone. Furthermore, in patients with a tPSA of 4-10 ng/mL, tPSA/PV (0.72), cPSA/PV (0.71), f/tPSA (0.69), fPSA/cPSA (0.69) and cPSA/tPSA (0.62) performed better than tPSA alone (0.52). Finally, in patients with a tPSA of 4-6 ng/mL, PSA/PV and cPSA/PV performed better than the other ratios. CONCLUSIONS The use of PSA ratios gives a higher sensitivity and specificity for detecting prostate cancer than the use of tPSA alone.
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Affiliation(s)
- O L Ozdal
- Department of Urology, McGill University Health Centre, Montreal, Quebec, Cananda
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239
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Abstract
The diagnosis, staging, and management of prostate cancer as we know it today is greatly dependent on our ability to measure serum prostate-specific antigen (PSA) concentration. Nevertheless, because serum PSA concentration, particularly when less than 10 ng/mL, reflects the presence of benign prostatic hyperplasia more often than cancer, there is a clear need for more specific prostate cancer markers. The most promising new markers for prostate cancer are the various molecular forms of free PSA. Mass spectrometry also is emerging as a potential tool in prostate cancer screening. Because it is unlikely that any one marker will have 100% sensitivity and specificity, as new serum markers are tested, nomograms that incorporate multiple independently predictive parameters for the detection of prostate cancer will become indispensable in our efforts to improve prostate cancer screening.
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Affiliation(s)
- Eduardo I Canto
- Scott Department of Urology, Baylor College of Medicine, The Baylor Prostate Center, 6560 Fannin Street, Suite 2100, Houston, TX 77030, USA
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240
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Boddy JL, Dev S, Pike DJ, Malone PR. Intra-individual variation of serum prostate specific antigen levels in men with benign prostate biopsies. BJU Int 2004; 93:735-8. [PMID: 15049982 DOI: 10.1111/j.1464-410x.2003.04717.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the intra-individual (physiological) variation of prostate-specific antigen (PSA) measurements in men after a benign prostatic biopsy. PATIENTS AND METHODS Sixty-four men were prospectively assessed, all of whom had a benign prostatic biopsy within the preceding 13 months. The degree of intra-individual variability was established by calculating the coefficient of variation on four PSA levels obtained from each patient weekly over a month. RESULTS Six patients were subsequently diagnosed with prostate cancer and their data are presented separately. In the remaining 58 patients the median (range) individual mean PSA value was 6.3 (0.5-34.1) ng/mL. The median (range) coefficient of variation within the group was 9.5 (2.4-76.1)%. There was a clear linear relationship between mean PSA level and the standard deviation. CONCLUSION In 48 of the 63 patients analysed, the coefficient of variation for serum PSA values in the group as a whole was greater than the variation claimed for the assay technique. The significance of the linear relationship between PSA and the standard deviation is discussed, with particular reference to those men who had a benign prostate biopsy.
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Affiliation(s)
- J L Boddy
- Department of Urology, Royal Berkshire and Battle Hospital, Oxford Road, Reading RG30 1AG, UK.
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241
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Abstract
During the evaluation of prostate cancer, men who have undergone transrectal ultrasound-guided biopsy with negative results present a dilemma as to what further follow-up is required. Multiple variables have been proposed throughout the literature to improve cancer detection rates not only in initial biopsy results, but also on repeat evaluation. These variables include prostate-specific antigen (PSA) velocity, PSA density, free-percent PSA, and histological findings, each of which may singly or collectively dictate the need for further biopsy. After performing a Medline literature search using specific Medical Subject Headings (prostate biopsy, repeat prostate biopsy, PSA velocity, PSA density, free-percent PSA, prostate inflammation), we critically evaluated pertinent articles. Using this accumulated data and information, we composed an algorithm to assist in the decision process for repeat biopsy.
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Affiliation(s)
- J E Busby
- Department of Urology, University of California, Davis, Sacramento, California 95817, USA
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242
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Martinez CAL, Dall'Oglio M, Nesrallah L, Leite KM, Ortiz V, Srougi M. Predictive value of PSA velocity over early clinical and pathological parameters in patients with localized prostate cancer who undergo radical retropubic prostatectomy. Int Braz J Urol 2004; 30:12-7. [PMID: 15707507 DOI: 10.1590/s1677-55382004000100003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2003] [Accepted: 02/13/2004] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To analyze the behavior of the prostate specific antigen velocity (PSAV) in localized prostate adenocarcinoma. MATERIALS AND METHODS We conducted a retrospective study of 500 men who had localized prostate adenocarcinoma, who underwent radical retropubic prostatectomy between January 1986 and December 1999. The PSAV was calculated for each patient and subsequently, the values were correlated with 5 groups: age, initial PSA value, clinical stage, tumor volume and Gleason score. RESULTS The behavior of PSAV presented statistic significance with an increment between 1.3 ng/mL and 9.6 ng/mL, ranging from 38.6% and 59.8% when compared with the initial PSA value (p < 0.0001), clinical stage (p = 0.0002), tumor volume (p < 0.0001) and Gleason score (p = 0.0009). CONCLUSION PSAV up to 2.5 ng/mL/year is associated with factors of good prognosis, such as initial PSA below 10 mg/mL, clinical stage T1, tumor volume below 20% and Gleason score lower than 7.
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Affiliation(s)
- Carlos A L Martinez
- Division of Urology, Paulista School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
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243
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Postma R, Roobol M, Schröder FH, van der Kwast TH. Potentially advanced malignancies detected by screening for prostate carcinoma after an interval of 4 years. Cancer 2004; 100:968-75. [PMID: 14983492 DOI: 10.1002/cncr.20048] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND At the Rotterdam branch of the European Randomized Study of Screening for Prostate Cancer, a cohort of 19,970 men ages 55-75 years is screened at an interval of 4 years. Screening includes systematic sextant needle biopsy for men with elevated prostate-specific antigen (PSA) levels and/or positive findings on digital rectal examination or transrectal ultrasound. Detection during the second screening round of a large number of high-grade (Gleason Grade 4 or 5) malignancies and/or a large number of malignancies in general could be considered the result of a failure to identify these malignancies at an early stage, during prevalence screening. METHODS Men diagnosed during the second screening round with potentially advanced carcinoma (PAC), characterized by a biopsy Gleason score of 7 (4 + 3, or 3 + 4 with > 30% malignant involvement) or a biopsy Gleason score of 8-10, were identified. Clinical data, including PSA values on prevalence screening, biopsy history, clinical stage, and follow-up data, were retrieved for these patients. Tumor features were further analyzed in radical prostatectomy specimens. RESULTS During the second screening round, 503 malignancies, including 30 (6.0%) with features of PAC on diagnostic biopsy, were detected in 11,210 patients. Curative treatment was offered to 26 patients. Prostatectomy demonstrated the presence of organ-confined disease in 11 of 12 specimens, and tumor volume ranged from 0.11-7.93 cm3 (median, 1.05 cm3). PSA failure was noted in 6 of 22 patients who were offered curative therapy. CONCLUSIONS PAC is a rare finding in the second round of screening after a 4-year interval, and a substantial proportion of PAC cases detected in the second screening round represent organ-confined disease. The findings of the current study suggest that the screening protocol used is sufficiently effective for detecting > 95% of malignancies before they develop features that would make them incurable.
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Affiliation(s)
- Renske Postma
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
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244
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Lee SE. The Diagnostic Value of Prostate-specific Antigen and the Necessity of Routine Laboratory Examination for Early Detection. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2004. [DOI: 10.5124/jkma.2004.47.5.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sang Eun Lee
- Department of Urology, Seoul National University College of Medicine, Bundang Hospital, Korea.
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245
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Filella X, Truan D, Alcover J, Molina R, Luque P, Coca F, Ballesta AM. Antígeno prostático específico y sus fracciones en el diagnóstico del cáncer de próstata. Med Clin (Barc) 2004; 122:241-4. [PMID: 15012870 DOI: 10.1016/s0025-7753(04)75311-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE The description of different forms of PSA has opened a new strategy in the diagnosis of prostate cancer. The measurement of the ratio between free PSA and PSA in the group of patients with a PSA level between 4 and 10 ng/ml decreases the number of negative biopsies. The aim of our study was to compare the diagnostic efficacy of PSA and PSA fractions (free PSA [fPSA] and complexed PSA [cPSA]) in the differential diagnosis between Pca and benign prostate hyperplasia (BPH). PATIENTS AND METHOD We measured the serum levels of PSA, free PSA and cPSA in 56 patients with Pca and 94 patients with BPH. RESULTS ROC curves were used for the comparison of tests. The biggest area under the curve (AUC) was observed for the ratios fPSA/cPSA and fPSA/PSA (0.718 and 0.712, respectively). When we compared the AUC between PSA and cPSA, then AUC for cPSA was higher than AUC for PSA (0.602 and 0.567, respectively). We observed similar results in the group of patients with PSA levels between 4 and 10 ng/ml. CONCLUSIONS The diagnostic accuracy of cPSA is higher than that of PSA. Moreover, in the differential diagnosis between prostate cancer and BPH, the use of PSA ratios (fPSA/cPSA or fPSA/PSA) increases the diagnostic accuracy obtained with the measurement of PSA or cPSA.
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Affiliation(s)
- Xavier Filella
- Servicio de Bioquímica Clínica (CDB), Hospital Clínic, IDIBAPS, Barcelona, Spain.
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246
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Riffenburgh RH, Amling CL. Use of early PSA velocity to predict eventual abnormal PSA values in men at risk for prostate cancer. Prostate Cancer Prostatic Dis 2003; 6:39-44. [PMID: 12664063 DOI: 10.1038/sj.pcan.4500614] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2002] [Revised: 06/05/2002] [Accepted: 06/17/2002] [Indexed: 11/09/2022]
Abstract
The purpose of this study was to determine if early PSA velocity (EPSAV), drawn from PSA values within normal ranges, predicts the later occurrence of abnormally high PSA values or positive prostate biopsy early enough to be clinically beneficial. Early PSAV (ng/ml/y) calculated from two normal PSA readings was tested to predict later PSA exceeding 4 ng/ml (1551 evaluable patients) or 10 ng/ml (1905 evaluable patients) and positive prostate biopsy. The time from EPSAV to develop abnormal PSA was recorded.A post-EPSAV PSA>4 ng/ml was reached by 367 patients and >10 by 293. EPSAV was significantly different (P<0.001) between patients whose PSA did or did not reach the PSA cut-off point and also significantly predicted a positive biopsy result (P<0.001). EPSAV predicted abnormal PSA more than 1 y in advance in 68 and 52% of the PSA 4 and 10 ng/ml cut-off point groups, respectively. Early PSAV from normal PSA readings may allow early detection of men at risk for prostate cancer. This may help identify men for earlier prostate biopsy or for less frequent PSA monitoring.
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Affiliation(s)
- R H Riffenburgh
- Department of Clinical Investigation, Naval Medical Center, San Diego, California 92134-5000, USA.
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247
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Foley CL, Bott SRJ, Thomas K, Parkinson MC, Kirby RS. A large prostate at radical retropubic prostatectomy does not adversely affect cancer control, continence or potency rates. BJU Int 2003; 92:370-4. [PMID: 12930421 DOI: 10.1046/j.1464-410x.2003.04361.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To determine the effect of a large prostate at radical retropubic prostatectomy (RRP) on the pathological outcome, biochemical recurrence rates, potency and continence. PATIENTS AND METHODS From a database of 440 patients treated with RRP, retrospective information was obtained on prostate weights, patient and tumour characteristics, and follow-up. Potency and continence after RRP was obtained using a self-reported validated questionnaire. Patients with prostates of > 75 or < or = 75 g were compared. RESULTS The median (range) prostate size was 87 (76-182) and 42 (4.1-75) g in the two groups. The response rate to the questionnaire was 78% (344 men). Patients with prostates of > 75 g were older, with a median (range) age of 65 (51-74) years, than the other group, at 61 (40-76) years (P = 0.01), and had higher initial prostate-specific antigen (PSA) levels, at 9.6 (3.4-37.8) and 7.6 (0.1-30.0) ng/mL, respectively (P = 0.001). Tumours within larger prostates were of a lower stage (P = 0.035), lower Gleason grade (median 6 and 7, P = 0.015), of smaller volume (median 1.0, 0.1-12.4; and 1.5, 0.1-21.1 mL; P = 0.04) and more often 'clinically insignificant' (23% and 6%, P = 0.001). There was no difference in the number or distribution of positive surgical margins. For a limited median follow-up of 20-25 months, patients with prostates of > 75 g were less likely to have biochemical recurrence (5% vs 24%, P < 0.001). Potency and continence rates were similar between the groups. CONCLUSIONS Prostate size at RRP does not affect the risk of impotence or incontinence afterward. A prostate of > 75 g is associated with a lower likelihood of PSA-relapse, potentially as a result of lead-time bias. While an enlarged prostate may contraindicate other potentially curative cancer treatments, the outcomes of RRP appear to be unaffected.
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Affiliation(s)
- C L Foley
- Prostate Cancer Research Laboratory, The Institute of Urology and Nephrology, University College London, London, UK.
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248
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Schmid HP, Prikler L, Sturgeon CM, Semjonow A. Diagnosis of Prostate Cancer—The Clinical Use of Prostate Specific Antigen. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s1570-9124(03)00003-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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249
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Scorilas A, Plebani M, Mazza S, Basso D, Soosaipillai AR, Katsaros N, Pagano F, Diamandis EP. Serum human glandular kallikrein (hK2) and insulin-like growth factor 1 (IGF-1) improve the discrimination between prostate cancer and benign prostatic hyperplasia in combination with total and %free PSA. Prostate 2003; 54:220-9. [PMID: 12518327 DOI: 10.1002/pros.10186] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND There is growing evidence describing an association of hK2 and IGFs with cancer. The aim of this study is to investigate the differences in serum levels of hK2 and IGFs in a large group of patients with benign prostatic hyperplasia (BPH) or prostatic carcinoma (CaP) and to examine the value of these variables, as well as their various combinations with PSA, for discriminating between these two clinical entities. METHODS Human glandular kallikrein 2 (hK2), insulin-like growth factor-1 (IGF-1), free and total PSA concentrations were measured with non-competitive immunological procedures. Receiver operating characteristic (ROC) analysis as well as univariate and multivariate logistic regression analysis were performed to investigate the potential utility of the various markers and their combinations for discriminating between BPH and CaP. RESULTS hK2 and IGF-1 concentrations were increased in CaP patients, in comparison to BPH patients. hK2/free PSA and free/total PSA ratios (area under the curve, AUC = 0.70) were stronger predictors of prostate cancer than the IGF-1/total PSA ratio (AUC = 0.56) in the group of patients with total PSA <4 microg/L. The hK2/free PSA ratio (AUC = 0.74) was found to have significant discriminatory value in patients with total PSA within the "gray zone" (4-10 microg/L). Multivariate logistic regression models confirmed the observed relationships and identified IGF-1/free PSA and hK2/free PSA as independent predictors of CaP. CONCLUSIONS hK2/free PSA and IGF-1/free PSA ratios may be useful adjuncts in improving patient selection for prostate biopsy.
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Affiliation(s)
- Andreas Scorilas
- National Center for Scientific Research Demokritos, IPC, Athens, Greece
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250
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Staging of Prostate Cancer, PSA Issues Leading up to Prostate Biopsy and Biopsy Technique. Prostate Cancer 2003. [DOI: 10.1016/b978-012286981-5/50010-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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