Eight years of "Prostate Cancer Awareness Week": lessons in screening and early detection. Prostate Cancer Education Council

Rational design of effective solid-state electrochemiluminescence platform of Gold@Polyluminol nanocomposite as an ultrasensitive immuno-probe for selective detection of prostate specific antigen

An electrodeposited gold@poly-luminol nanocomposite on glassy carbon electrode (Au@PL-NC/GCE) has been developed and demonstrated as solid-state electrochemiluminescence (ECL) immunosensor platform for prostate specific antigen (PSA) sensing. In-situ electro-generated reactive oxygen species (ROS) from oxygen reduction reaction in oxygen saturated PBS (pH 7.4) acts as sole co-reactant augmenting the signal transduction. Protein-G bio-affinity layer interfaced with Au@PL-NC/GCE (Protein-G/Au@PL-NC/GCE) to support the effective localization of Fc region of the monoclonal antibodies of PSA (mAb-PSA). As-developed ECL probe exhibit selective recognition of target analyte, PSA, enabling wide linearity of 1 fg mL^-1 to 10 μg mL^-1 with a calculated limit of detection (LOD) and limit of quantification (LOQ) of 0.45 fg mL^-1 and 1.37 fg mL^-1, respectively. The selectivity and specificity of the ECL probe was tested using human serum albumin, immunoglobulin G and mixtures of the same with target analyte. Fabricated ECL probe not only exhibit high sensitivity and specificity against commercial PSA samples but also enable clinical detection in real human serum and urine samples with acceptable recovery range from 97% to 103%. Our results suggest that the fabricated reagent-less solid-state ECL platform holds promising application in the field of prostate oncological screening and its point-of-care applications.

Prostate-specific antigen in the early detection of prostate cancer

Throughout Canada, the United States and much of Europe, prostate-specific antigen (PSA) screening for prostate cancer has proliferated over the past 2 decades, leading to dramatic increases in detection rates of prostate cancer. Although it has unquestionably led to increased detection of cancer and a migration to lower-stage and -volume tumours, it is still unknown whether PSA screening significantly reduces mortality from prostate cancer. Often thought to be dichotomous (i.e., either normal or elevated), PSA measurements actually reflect cancer risk, with the risks of cancer and of aggressive cancer increasing with the level of PSA. The recently developed risk calculator from the Prostate Cancer Prevention Trial, which integrates family history of prostate cancer, digital rectal examination findings, PSA test result, age, ethnicity, and history of a prior prostate biopsy with a negative result, allows clinicians to assess a patient's individual risk of cancer. This risk should be examined in the context of a patient's life expectancy and comorbidity as well as his concern about the possibility of prostate cancer. The terms "normal" and "elevated" as descriptors of PSA results should be abandoned.

Screening for Prostate Cancer: Opportunities and Challenges

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.

Screening for prostate cancer in Romania

In Romania, more than 95% of patients present with advanced stage prostate cancer at the time of diagnosis. Our purpose was to detect early prostate cancer in the Romanian city of Oradea, with a screening based on digital rectal examination and fine needle aspiration biopsy. We performed digital rectal examinations on 701 men, between 50 to 80 years of age. Four men with a history of prostate cancer were excluded from the study. Transrectal fine-needle aspiration biopsies were done in 15 men who presented with suspicious findings at the digital rectal examination. Prostate cancer was cytologically proven in eleven men. Nine of these were low- to intermediate grade (GI-II) and clinically localized (T2). Two patients had clinical stage T3 tumors. The prostate cancer detection rate in the screened population was 1.6% (11/697). Currently, eight men have undergone total retropubic prostatectomy. One patient presented with pelvic lymph node metastases and, after a staging lymphadenectomy, only a bilateral orchiectomy was performed. This first Romanian mass screening study for prostate cancer revealed a great interest in early cancer detection among the general public. Continued effort to make asymptomatic men aware of the disease may ultimately lead to an overall stage reduction at the time of diagnosis in Romania.

Barriers to prostate cancer screening

The revised prostate cancer screening guidelines of the American Cancer Society recommend that men be informed of the risks associated with prostate cancer screening. However, there are no published studies on men's fear of impotence and its impact on prostate cancer screening. In addition, little is known about barriers to prostate cancer screening when the two main barriers of cost and lack of knowledge are eliminated. This study reports the association between barriers and free prostate cancer screening after a prostate cancer education program. All men were called 1 month after a prostate cancer education program and asked: "What would (or did) make it hard for you to get your prostate checkup done?" A total postbarrier score was created to measure how many barriers each man indicated. The following barriers were significant in predicting participation in prostate cancer screening: "put it off," "doctor hours not convenient," "didn't know kind of doctor," "didn't know where to go," and "refuse to go." Fear of impotence was not a significant barrier. Suggestions for reducing barriers to prostate cancer screening are given.

Urinary symptoms as a predictor for participation in prostate cancer screening among African American men

BACKGROUND

There are minimal data on the influence of urinary symptoms and participation in prostate cancer screening in African American men.

METHODS

This correlational study examined the influence of urinary symptoms on 1) participation in a free prostate cancer screening program and 2) abnormal screening results. The 1,402 African American men in the South Carolina Prostate Cancer Project (SCPCP), mean age of 50 years, completed a survey that included self-reported urinary symptoms, participated in a prostate cancer educational program, and received a free prostate cancer screening consisting of a digital rectal examination (DRE) and prostate-specific antigen (PSA) from their personal physician.

RESULTS

One in 5 men reported the presence of urinary symptoms. Over 60% of the 1,402 men participated in the free CaP screening. Among the 852 men who participated in the free prostate cancer screening, 73 (8.6%) had abnormal screening results as classified by abnormal DRE and/or PSA >4.0 ng/ml. Urinary symptoms were significant predictors, both of participation in screening (OR = 1.30, CI = 1.00, 1.70) and of obtaining an abnormal screening result (OR = 1.78, CI = 1.17, 2.72).

CONCLUSIONS

Prostate cancer health education needs to include the fact that prostate cancer, in its early stages, has no urinary symptoms.