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Ribeiro TS, Simões TC, Silva IFD, Koifman RJ, Borges MFDSO, Opitz SP. Effects of age, period, and cohort on mortality by prostate cancer among men in the state of Acre, in the Brazilian Western Amazon. CIENCIA & SAUDE COLETIVA 2024; 29:e14782022. [PMID: 39194117 DOI: 10.1590/1413-81232024299.14782022] [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: 05/30/2023] [Accepted: 09/01/2023] [Indexed: 08/29/2024] Open
Abstract
The present study aimed to analyze the effects of age, time period, and birth cohort on the temporal evolution of mortality rates due to prostate cancer in men from the state of Acre, Brazil, in the period of 1990 to 2019. This is an ecological study in which the temporal trend was evaluated by the joinpoint method, estimating the annual percentage variations of the mortality rates. The age-period-birth cohort effects were calculated by using the Poisson Regression method, using estimation functions. The mortality rates showed an increase of 2.20% (95%CI: 1.00-3.33) in the period studied, tended to increase with age. A relative risk (RR) of 0.67 (95%CI: 0.59-0.76) was observed between 2005 and 2009, 0.76 (95%CI: 0.67-0.87) from 2005 on, and 1.44 (95%CI: 1.25-1.68) from 2015 on. The cohorts from 1910 to 1924 presented a risk reduction (RR < 1), when compared to the reference cohort (1935). Regarding the time period, the creation of public policies and the establishment of guidelines are suggested as factors which may have contributed to more access to diagnosis, in consonance with the cohort effect. These findings can contribute to a better understanding of the epidemiological scenario of prostate cancer in regions that are more vulnerable in terms of socioeconomic conditions.
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Affiliation(s)
- Thainá Souza Ribeiro
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Acre. Campus da Universidade Federal do Acre. 69917-400 Rio Branco AC Brasil.
| | | | - Ilce Ferreira da Silva
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | - Rosalina Jorge Koifman
- Programa de Pós-Graduação em Saúde e Meio Ambiente Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | | | - Simone Perufo Opitz
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Acre. Campus da Universidade Federal do Acre. 69917-400 Rio Branco AC Brasil.
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Nirei T, Tabei T, Sakai N, Koh H, Yoshida M, Fujikawa A, Ito H, Tsutsumi S, Furuhata S, Noguchi S, Taguri M, Kobayashi K. Real-world data in elderly men from Yokosuka City 15 years after introducing prostate-specific antigen-based population screening. Mol Clin Oncol 2022; 16:38. [PMID: 35003736 PMCID: PMC8739438 DOI: 10.3892/mco.2021.2471] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/21/2021] [Indexed: 01/05/2023] Open
Abstract
Mass screening based on prostate-specific antigen (PSA) reduces mortality in prostate cancer. However, the effectiveness of this screening in the elderly has not been demonstrated. In the city of Yokosuka, Japan, PSA screening has been conducted since 2001 and the present study examined the real-world status of PSA-based population screening in the elderly. It retrospectively evaluated 1,117 prostate cancer patients >75 years of age. The patients were divided into two groups: The screened group comprising patients diagnosed by PSA-based population screening or workplace screening and PSA follow-up patients at urology clinics; and the non-screened group comprising patients detected by other methods. Overall survival (OS), cancer-specific survival (CSS) and factors contributing to shorter CSS between the groups were compared. In patients >75 years of age, the screened group had significantly longer OS (171 vs. 154 months; P=0.019) and CSS (median not reached; P=0.020) but screening was not an independent factor associated with prolonged OS or CSS on multivariate analysis. The factors contributing to shorten CSS in the elderly were ≥T3 (odds ratio: 3.301 [1.704-6.369], P<0.001), M1 (odds ratio: 4.856 [2.809-8.393], P<0.001) and Gleason score ≥8 (odds ratio: 4.691 [2.479-8.876], P<0.001). In those with metastasis, PSA screening was not associated with prolonged OS or CSS. Real-world data 15 years after introducing PSA-based population screening was not an independent factor for both OS and CSS in multivariate analyses for patients >75 years of age.
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Affiliation(s)
- Takuma Nirei
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa 238-8558, Japan
| | - Tadashi Tabei
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa 238-8558, Japan
| | - Naoki Sakai
- Department of Urology, Wakakusa Hospital, Yokohama, Kanagawa 236-8653, Japan
| | - Hideshige Koh
- Department of Urology, Yokosuka City Uwamachi Hospital, Yokosuka, Kanagawa 238-8567, Japan
| | - Minoru Yoshida
- Department of Urology, Kinugasa Hospital, Yokosuka, Kanagawa 238-8588, Japan
| | - Atsushi Fujikawa
- Department of Urology, Yokosuka City Hospital, Yokosuka, Kanagawa 240-0195, Japan
| | - Hiroki Ito
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa 238-8558, Japan
| | - Sohgo Tsutsumi
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa 238-8558, Japan
| | | | - Sumio Noguchi
- Satomi Jin-Hinyokika Clinic, Yokosuka, Kanagawa 238-0007, Japan
| | - Masataka Taguri
- Department of Data Science, School of Data Science, Yokohama City University, Yokohama, Kanagawa 236-0027, Japan
| | - Kazuki Kobayashi
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa 238-8558, Japan
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3
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Saito T, Komatsubara S, Hara N, Nishiyama T, Katagiri A, Ishizaki F, Hatano A, Komeyama T, Hanyu S, Terunuma M, Imai T, Go H, Iida H, Kurumada S, Yamaguchi S, Takeda K, Ando T, Hoshii T, Kasahara T, Tomita Y. Significance of PSA Screening in Niigata, Japan: Survey of Actual Status of New Cases of Prostate Cancer. Res Rep Urol 2022; 13:859-866. [PMID: 34993159 PMCID: PMC8713882 DOI: 10.2147/rru.s341347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/10/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aims to investigate the utility of prostate-specific antigen (PSA) screening by conducting an all-case survey of newly diagnosed prostate cancer patients at Niigata Prefecture, Japan. Patients and Methods Depending on whether patients were subjected to screening, information was prospectively collected on all prostate cancer patients newly diagnosed between October 1, 2019, and September 30, 2020, at all institutions in Niigata Prefecture where urologists performing prostate biopsy routinely work and differences in clinical parameters were investigated. Results PSA was measured in 478 out of 1332 patients (35.8%) as part of a community health screening. The rate of metastatic carcinoma (M1) in all patients was 14.9%. When patients were divided into three categories of population-based screening (community health screening and workplace health screening), opportunistic screening (PSA measurements at complete medical check-ups or on patient request), and testing triggered by clinical symptoms or findings, the proportion of metastatic cancer was 4.5%, 3.7%, and 30.6%, respectively, demonstrating that the number of distant metastases was significantly lesser in all patients who underwent screening. Conclusion The one-year all-case survey of newly diagnosed prostate cancer patients demonstrated that PSA screening significantly contributed to the early diagnosis of current prostate cancer in Japan.
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Affiliation(s)
- Toshihiro Saito
- Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan
| | | | - Noboru Hara
- Department of Urology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minamiuonuma, Japan
| | - Tsutomu Nishiyama
- Department of Urology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minamiuonuma, Japan
| | - Akiyoshi Katagiri
- Department of Urology, Niigata Prefectural Central Hospital, Joetsu, Japan
| | - Fumio Ishizaki
- Department of Renal and Urinary Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Akihiko Hatano
- Department of Urology, Niigata Prefectural Shibata Hospital, Shibata, Japan
| | - Takeshi Komeyama
- Department of Urology, Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - Shugo Hanyu
- Department of Urology, Kashiwazaki General Hospital and Medical Center, Kashiwazaki, Japan
| | - Masahiro Terunuma
- Department of Urology, Nagaoka Chuo General Hospital, Nagaoka, Japan
| | - Tomoyuki Imai
- Department of Urology, Niigata City General Hospital, Niigata, Japan
| | - Hideto Go
- Department of Urology, Niigata Saiseikai Sanjo Hospital, Sanjo, Japan
| | - Hiroaki Iida
- Department of Urology, Joetsu General Hospital, Joetsu, Japan
| | | | - Shunsuke Yamaguchi
- Department of Urology, Niigata Prefectural Central Hospital, Joetsu, Japan.,Department of Urology, Tachikawa General Hospital, Nagaoka, Japan
| | - Keisuke Takeda
- Department of Renal and Urinary Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.,Department of Urology, Murakami General Hospital, Murakami, Japan
| | - Takashi Ando
- Department of Urology, Tachikawa General Hospital, Nagaoka, Japan.,Department of Urology, Murakami General Hospital, Murakami, Japan
| | - Tatsuhiko Hoshii
- Department of Renal and Urinary Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Takashi Kasahara
- Department of Renal and Urinary Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Yoshihiko Tomita
- Department of Renal and Urinary Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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Matsugasumi T, Okihara K, Tsujimoto M, Sato O, Imura T, Yamada Y, Fujihara A, Shiraishi T, Hongo F, Ukimura O. Impact of prostate-specific antigen screening on tumor size in patients with prostate cancer in a super-aging district in Kyoto, Japan. Int J Clin Oncol 2021; 26:2303-2309. [PMID: 34537890 DOI: 10.1007/s10147-021-02016-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Population-based prostate-specific antigen (PSA) screening is effective for reducing prostate cancer (PCa)-related mortality rates. In this study, we assessed biopsy-proven maximum cancer core length (MCCL) and maximum cancer diameter on magnetic resonance imaging (MRI; MCDM) in prostate biopsy and multiparametric MRI (mp-MRI) by PCa detection. METHODS We retrospectively assessed 214 male PCa patients and 187 PCa patients with Prostate Imaging Reporting and Data System version 2 (PI-RADS) category 3-5 lesions in pre-biopsy mp-MRI and targeted biopsy characteristics. The mean biopsy-proven MCCL and MCDM were compared among three PSA screening groups, namely the population-based PSA screening (PBS), opportunistic PSA screening (OPS), and symptomatic outpatient PSA examination (SOP) groups. RESULTS The median age and PSA value of the 214 participants were 75 years and 7.9 ng/mL, respectively. In the PBS, OPS, and SOP groups, the median ages were 73, 76, and 76 years, respectively (p = 0.046); PSA values were 7.2, 9.5, and 11.5 ng/mL, respectively (p < 0.001); and biopsy-proven MCCL and MCDM were significantly increased to 7, 10, and 14 mm (p < 0.001) and to 11, 15, and 17 mm (p < 0.001), respectively. In the 187 PCa patients with PI-RADS category 3-5 lesions on mp-MRI, MCDM were 11, 14, and 17 mm (p < 0.001), respectively. CONCLUSIONS The biopsy-proven MCCL and MCDM were significantly smaller in the PBS and OPS groups than in the SOP group, which suggests that PSA screening detected PCa earlier than in symptomatic patients. PSA screening with MRI could objectively lead to earlier diagnosis based on tumor size.
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Affiliation(s)
- Toru Matsugasumi
- Department of Urology, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.,Department of Urology, North Medical Center, Kyoto Prefectural University of Medicine, 481 Otokoyama, Yosano-cho, Kyoto, 629-2261, Japan
| | - Koji Okihara
- Department of Urology, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.,Department of Urology, North Medical Center, Kyoto Prefectural University of Medicine, 481 Otokoyama, Yosano-cho, Kyoto, 629-2261, Japan
| | - Masashi Tsujimoto
- Department of Urology, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.,Department of Urology, North Medical Center, Kyoto Prefectural University of Medicine, 481 Otokoyama, Yosano-cho, Kyoto, 629-2261, Japan
| | - Osamu Sato
- Department of Radiology, North Medical Center, Kyoto Prefectural University of Medicine, 481 Otokoyama, Yosano-cho, Kyoto, 629-2261, Japan
| | - Tetsuya Imura
- Department of Pathology, North Medical Center, Kyoto Prefectural University of Medicine, 481 Otokoyama, Yosano-cho, Kyoto, 629-2261, Japan
| | - Yasuhiro Yamada
- Department of Urology, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Atsuko Fujihara
- Department of Urology, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takumi Shiraishi
- Department of Urology, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Fumiya Hongo
- Department of Urology, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Osamu Ukimura
- Department of Urology, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
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Prostate Cancer Screening with PSA: Ten Years' Experience of Population Based Early Prostate Cancer Detection Programme in Lithuania. J Clin Med 2020; 9:jcm9123826. [PMID: 33255919 PMCID: PMC7760278 DOI: 10.3390/jcm9123826] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 11/24/2022] Open
Abstract
The aim of this study is to report key performance estimates from the ten years of a population-based prostate cancer screening programme in Lithuania. Retrospective analysis of screening activities recorded in 2006–2015 among men aged 50–74 years was performed. We estimated screening coverage, cancer detection rate, compliance to biopsy, and positive predictive values in each screening round inside and outside the target population. In the first 10 years of screening, 16,061 prostate cancer cases were registered within the screening programme, 10,202 were observed among screened men but reported outside the screening programme, and 1455 prostate cancers were observed in a screening-naïve population. Screening cover reached up to 45.5% of the target population in the recent rounds. The proportion of prostate specific antigen (PSA) test-positive men decreased from 16.9% in 2006 to 10.7% in 2014–2015. Up to 40.0% of PSA test-positive men received a biopsy, of whom 42.0% were positive for prostate cancer. The cancer detection rate was 10.4−15.0% among PSA test-positives and 1.4–1.9% among screened individuals. Screening participants were more likely to be diagnosed with organ-confined disease as compared to non-participants. Despite the unorganized screening practices being employed and low coverage per screening round, 70% of the target population were screened at least once in the first 10 years of screening.
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Tabei T, Taguri M, Sakai N, Koh H, Yosida M, Fujikawa A, Nirei T, Tsutsumi S, Ito H, Furuhata S, Kawahara T, Miyoshi Y, Noguchi S, Uemura H, Kobayashi K. Does screening for prostate cancer improve cancer-specific mortality in Asian men? Real-world data in Yokosuka City 15 years after introducing PSA-based population screening. Prostate 2020; 80:824-830. [PMID: 32433780 DOI: 10.1002/pros.23997] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/26/2020] [Accepted: 04/29/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Studies of prostate-specific antigen (PSA)-based population screening have been conducted in western countries, but there is little data in Asian populations. The objective of this study was to determine the efficacy of PSA screening in Asian men using real-world data over a period of 15 years after introducing population screening in Yokosuka City, Japan. METHODS We investigated patients with pathologically diagnosed prostate cancer at four hospitals and two clinics across the Yokosuka area (Miura peninsula) between April 2001 and March 2015. Patients were divided into two groups; the S group consisted of those diagnosed by PSA-based population screening in Yokosuka City and the NS group consisted of those diagnosed by methods other than screening. Cancer-specific survival (CSS) and overall survival (OS) rates were calculated using the Kaplan-Meier method with the log-rank test to compare survival between the two groups. Clinical and pathological factors for cancer-specific mortality were assessed with Cox regression analyses to calculate the hazard ratio (HR) and 95% confidence interval (CI). RESULTS A total of 3094 patients had been diagnosed with prostate cancer over the 15-year period. The median follow-up period was 77 months. The S group and the NS group consisted of 977 and 2117 patients, respectively. Patients in the S group were younger (age: 71 years vs 73 years, P < .001) and had a lower Charlson comorbidity index (CCI) with favorable oncological factors, such as lower initial PSA, Gleason score (GS), and risk category. Kaplan-Meier curves for OS and CSS revealed significant differences between the two groups (OS: P < .001, CSS: P < .001). Analysis with Cox proportional hazards model indicated the NS group (HR: 1.584, 95% CI, 1.065-2.356, P = .023), a CCI > 4 (HR: 1.552, 95% CI, 1.136-2.120, P = .006), a GS ≥ 8 (HR: 4.869, 95% CI, 2.631-9.001, P < .001), and nonlocalized cancer (locally advanced; HR: 2.632, 95% CI, 1.676-4.133, P < .001, advanced; HR: 9.468, 95% CI, 6.279-14.278, P < .001) as independent risk factors for cancer-specific mortality. CONCLUSIONS PSA-based population screening of prostate cancer might be useful in the Japanese population.
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Affiliation(s)
- Tadashi Tabei
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Masataka Taguri
- Department of Data Science, School of Data Science, Yokohama City University, Yokohama, Japan
| | - Naoki Sakai
- Department of Urology, Saiseikai Wakakusa Hospital, Yokohama, Japan
| | - Hideshige Koh
- Department of Urology, Yokosuka City Uwamachi Hospital, Yokosuka, Japan
| | - Minoru Yosida
- Department of Urology, Kinugasa Hospital, Yokosuka, Japan
| | | | - Takuma Nirei
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Sohgo Tsutsumi
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Hiroki Ito
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | | | - Takashi Kawahara
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Yasuhide Miyoshi
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | | | - Hiroji Uemura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazuki Kobayashi
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
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7
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Klocker H, Golding B, Weber S, Steiner E, Tennstedt P, Keller T, Schiess R, Gillessen S, Horninger W, Steuber T. Development and validation of a novel multivariate risk score to guide biopsy decision for the diagnosis of clinically significant prostate cancer. BJUI COMPASS 2020; 1:15-20. [PMID: 35474911 PMCID: PMC8988838 DOI: 10.1002/bco2.8] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 01/01/2023] Open
Abstract
Objectives Selecting patients suspected of having prostate cancer (PCa) for a prostate biopsy remains a challenge. Prostate-specific antigen (PSA)-based testing is hampered by its low specificity that often leads to negative biopsy results or detection of clinically insignificant cancers, especially in the 2-10 ng/mL range. The objective was to evaluate a novel diagnostic test called Proclarix incorporating thrombospondin-1 and cathepsin D alongside total and free PSA as well as age for predicting clinically significant PCa. Patients and methods The test was developed following a retrospective study design using biobanked samples of 955 men from two reference centres. A multivariate approach was used for model development followed by validation to discriminate significant (grade group ≥2) from insignificant or no cancer at biopsy. The test specificity, positive predictive value (PPV) and negative predictive value (NPV) at a fixed sensitivity of 90% were compared to percent free PSA (%fPSA) alone. The number of avoidable prostate biopsies deemed to be representative of clinical utility was also assessed. Results In the targeted patient population, the test displayed increased diagnostic accuracy compared to %fPSA alone. Application of the established model on 955 patients at a fixed sensitivity of 90% for significant disease resulted in a specificity of 43%, NPV of 95% and a PPV of 25%. This is in comparison to a specificity of 17%, NPV of 89% and PPV of 19% for %fPSA alone and had the potential to reduce the total number of biopsies needed to identify clinically significant cancer. Further, the test score correlated with significance of cancer assessed on prostate biopsy. Conclusions The Proclarix test can be used as an aid in the decision-making process if to biopsy men in this challenging patient population. The use of the test could reduce the number of biopsies performed avoiding invasive procedures, anxiety, discomfort, pain and complications.
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Affiliation(s)
- Helmut Klocker
- Department of UrologyMedical University InnsbruckInnsbruckAustria
| | | | | | - Eberhard Steiner
- Department of UrologyMedical University InnsbruckInnsbruckAustria
| | - Pierre Tennstedt
- Martini Clinic Prostate Cancer CenterUniversity Hospital Hamburg‐EppendorfHamburgGermany
| | | | | | - Silke Gillessen
- Medical Oncology DepartmentOncology Institute of Southern SwitzerlandBellinzonaSwitzerland
| | | | - Thomas Steuber
- Martini Clinic Prostate Cancer CenterUniversity Hospital Hamburg‐EppendorfHamburgGermany
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9
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Ito K, Oki R, Sekine Y, Arai S, Miyazawa Y, Shibata Y, Suzuki K, Kurosawa I. Screening for prostate cancer: History, evidence, controversies and future perspectives toward individualized screening. Int J Urol 2019; 26:956-970. [PMID: 31183923 DOI: 10.1111/iju.14039] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/15/2019] [Indexed: 12/12/2022]
Abstract
Differences in the incidence and mortality rate of prostate cancer between the USA and Japan have been decreasing over time, and were only twofold in 2017. Therefore, countermeasures against prostate cancer could be very important not only in Western countries, but also in developed Asian countries. Screening for prostate cancer in the general population using transrectal ultrasonography, digital rectal examination and/or prostate acid phosphatase began in Japan in the early 1980s, and screening with prostate-specific antigen and digital rectal examination has been widespread in the USA since the late 1980s. Large- and mid-scale randomized controlled trials on screening for prostate cancer began around 1990 in the USA, Canada and Europe. However, most of these studies failed as randomized controlled trials because of high contamination in the control arm, low compliance in the screening arm or insufficient screening setting about screening frequency and/or biopsy indication. The best available level 1 evidence is data from the European Randomized Study of Screening for Prostate Cancer and the Göteborg screening study. However, several non-urological organizations and lay media around the world have mischaracterized the efficacy of prostate-specific antigen screening. To avoid long-term confusion about screening for prostate cancer, leading professional urological organizations, including the Japanese Urological Association, are moving toward the establishment of an optimal screening system that minimizes the drawbacks of overdetection, overtreatment and loss of quality of life due to treatment, and maximizes reductions in the risk of death as a result of prostate cancer and the development of metastatic prostate cancer.
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Affiliation(s)
- Kazuto Ito
- Institute for Preventive Medicine, Kurosawa Hospital, Takasaki, Gunma, Japan.,Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Ryo Oki
- Institute for Preventive Medicine, Kurosawa Hospital, Takasaki, Gunma, Japan
| | - Yoshitaka Sekine
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Seiji Arai
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yoshiyuki Miyazawa
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yasuhiro Shibata
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Kazuhiro Suzuki
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Isao Kurosawa
- Institute for Preventive Medicine, Kurosawa Hospital, Takasaki, Gunma, Japan
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10
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Sampson N, Brunner E, Weber A, Puhr M, Schäfer G, Szyndralewiez C, Klocker H. Inhibition of Nox4-dependent ROS signaling attenuates prostate fibroblast activation and abrogates stromal-mediated protumorigenic interactions. Int J Cancer 2018; 143:383-395. [PMID: 29441570 PMCID: PMC6067067 DOI: 10.1002/ijc.31316] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/18/2017] [Accepted: 01/17/2018] [Indexed: 12/31/2022]
Abstract
Carcinoma-associated fibroblasts (CAFs) play a key onco-supportive role during prostate cancer (PCa) development and progression. We previously reported that the reactive oxygen species (ROS)-producing enzyme NADPH oxidase 4 (Nox4) is essential for TGFβ1-mediated activation of primary prostate human fibroblasts to a CAF-like phenotype. This study aimed to further investigate the functional relevance of prostatic Nox4 and determine whether pharmacological inhibition of stromal Nox4 abrogates paracrine-mediated PCa-relevant processes. RNA in situ hybridization revealed significantly elevated Nox4 mRNA levels predominantly in the peri-tumoral stroma of clinical PCa with intense stromal Nox4 staining adjacent to tumor foci expressing abundant TGFβ protein levels. At pharmacologically relevant concentrations, the Nox1/Nox4 inhibitor GKT137831 attenuated ROS production, CAF-associated marker expression and migration of TGFβ1-activated but not nonactivated primary human prostate fibroblasts. Similar effects were obtained upon shRNA-mediated silencing of Nox4 but not Nox1 indicating that GKT137831 primarily abrogates TGFβ1-driven fibroblast activation via Nox4 inhibition. Moreover, inhibiting stromal Nox4 abrogated the enhanced proliferation and migration of PCa cell lines induced by TGFβ1-activated prostate fibroblast conditioned media. These effects were not restricted to recombinant TGFβ1 as conditioned media from PCa cell lines endogenously secreting high TGFβ1 levels induced fibroblast activation in a stromal Nox4- and TGFβ receptor-dependent manner. Importantly, GKT137831 also attenuated PCa cell-driven fibroblast activation. Collectively, these findings suggest the TGFβ-Nox4 signaling axis is a key interface to dysregulated reciprocal stromal-epithelial interactions in PCa pathophysiology and provide a strong rationale for further investigating the applicability of Nox4 inhibition as a stromal-targeted approach to complement current PCa treatment modalities.
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Affiliation(s)
- Natalie Sampson
- Department of Urology, Division of Experimental UrologyMedical University of InnsbruckInnsbruckAustria
| | - Elena Brunner
- Department of Urology, Division of Experimental UrologyMedical University of InnsbruckInnsbruckAustria
| | - Anja Weber
- Department of Urology, Division of Experimental UrologyMedical University of InnsbruckInnsbruckAustria
| | - Martin Puhr
- Department of Urology, Division of Experimental UrologyMedical University of InnsbruckInnsbruckAustria
| | - Georg Schäfer
- Division of PathologyMedical University of InnsbruckInnsbruckAustria
| | | | - Helmut Klocker
- Department of Urology, Division of Experimental UrologyMedical University of InnsbruckInnsbruckAustria
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11
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Abstract
In this article, the principle of randomised trials are first described and then prostate cancer screening trials published to date are evaluated based on these principles. A summary of the randomised prostate cancer screening is provided. The conclusion that can be made from the results of the screening trials, as well as limitations of the evidence and open questions are outlined in the end.
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Affiliation(s)
- Anssi Auvinen
- Faculty of Social Sciences/Health Sciences, University of Tampere, Tampere, Finland
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12
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Braga SFM, de Souza MC, Cherchiglia ML. Time trends for prostate cancer mortality in Brazil and its geographic regions: An age–period–cohort analysis. Cancer Epidemiol 2017; 50:53-59. [DOI: 10.1016/j.canep.2017.07.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 07/26/2017] [Accepted: 07/30/2017] [Indexed: 11/16/2022]
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13
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Kakehi Y, Sugimoto M, Taoka R. Evidenced-based clinical practice guideline for prostate cancer (summary: Japanese Urological Association, 2016 edition). Int J Urol 2017; 24:648-666. [PMID: 28667698 DOI: 10.1111/iju.13380] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 04/11/2017] [Indexed: 12/18/2022]
Abstract
These guidelines cover a wide range of topics from prostate cancer epidemiology to palliative care. Questions arising in daily clinical practice have been extracted and formulated as clinical questions. In the 4 years since the previous edition, there have been major changes - for example, robot-assisted prostatectomy has rapidly come into widespread use, and new hormones and anticancer drugs have been developed for castration-resistant prostate cancer. In response to these developments, the number of fields included in this guideline was increased from 11 in the 2012 edition to 16, and the number of clinical questions was increased from 63 to 70. The number of papers identified in searches of the existing literature increased from 4662 in the first edition, published in 2006, to 10 490 in the 2012 edition. The number of references has reached 29 448 just during this review period, indicating the exponential increase in research on the topic of prostate cancer. Clinical answers have been prepared based on the latest evidence. Recommendation grades for the clinical answers were determined by radiologists, pathologists, and other specialists in addition to urologists in order to reflect the recent advances and diversity of prostate cancer treatment. Here, we present a short English version of the original guideline, and overview its key clinical issues.
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Affiliation(s)
- Yoshiyuki Kakehi
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Mikio Sugimoto
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Rikiya Taoka
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan
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14
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Mühlberger N, Boskovic K, Krahn MD, Bremner KE, Oberaigner W, Klocker H, Horninger W, Sroczynski G, Siebert U. Benefits and harms of prostate cancer screening - predictions of the ONCOTYROL prostate cancer outcome and policy model. BMC Public Health 2017. [PMID: 28651567 PMCID: PMC5485506 DOI: 10.1186/s12889-017-4439-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background A recent recalibration of the ONCOTYROL Prostate Cancer Outcome and Policy (PCOP) Model, assuming that latent prostate cancer (PCa) detectable at autopsy might be detectable by screening as well, resulted in considerable worsening of the benefit-harm balance of screening. In this study, we used the recalibrated model to assess the effects of familial risk, quality of life (QoL) preferences, age, and active surveillance. Methods Men with average and elevated familial PCa risk were simulated in separate models, differing in familial risk parameters. Familial risk was assumed to affect PCa onset and progression simultaneously in the base-case, and separately in scenario analyses. Evaluated screening strategies included one-time screening at different ages, and screening at different intervals and age ranges. Optimal screening strategies were identified depending on age and individual QoL preferences. Strategies were additionally evaluated with active surveillance by biennial re-biopsy delaying treatment of localized cancer until grade progression to Gleason score ≥ 7. Results Screening men with average PCa risk reduced quality-adjusted life expectancy (QALE) even under favorable assumptions. Men with elevated familial risk, depending on age and disutilities, gained QALE. While for men with familial risk aged 55 and 60 years annual screening to age 69 was the optimal strategy over most disutility ranges, no screening was the preferred option for 65 year-old men with average and above disutilities. Active surveillance greatly reduced overtreatment, but QALE gains by averted adverse events were opposed by losses due to delayed treatment and additional biopsies. The effect of active surveillance on the benefit-harm balance of screening differed between populations, as net losses and gains in QALE predicted for screening without active surveillance in men with average and familial PCa risk, respectively, were both reduced. Conclusions Assumptions about PCa risk and screen-detectable prevalence significantly affect the benefit-harm balance of screening. Based on the assumptions of our model, PCa screening should focus on candidates with familial predisposition with consideration of individual QoL preferences and age. Active surveillance may require treatment initiation before Gleason score progression to 7. Alternative active surveillance strategies should be evaluated in further modeling studies.
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Affiliation(s)
- Nikolai Mühlberger
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, A-6060, Hall i.T, Austria.,Division of Health Technology Assessment, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Kristijan Boskovic
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, A-6060, Hall i.T, Austria
| | - Murray D Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, ON, Canada.,Toronto General Research Institute, Toronto General Hospital, Toronto, ON, Canada
| | - Karen E Bremner
- Toronto General Research Institute, Toronto General Hospital, Toronto, ON, Canada
| | - Willi Oberaigner
- Cancer Registry of Tyrol, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Helmut Klocker
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Horninger
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gaby Sroczynski
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, A-6060, Hall i.T, Austria.,Division of Health Technology Assessment, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, A-6060, Hall i.T, Austria. .,Division of Health Technology Assessment, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria. .,Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA. .,Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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15
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Van Rij S, Everaerts W, Murphy DG. International Trends in Prostate Cancer. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00015-3] [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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16
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Siebert U, Jahn B, Rochau U, Schnell-Inderst P, Kisser A, Hunger T, Sroczynski G, Mühlberger N, Willenbacher W, Schnaiter S, Endel G, Huber L, Gastl G. Oncotyrol--Center for Personalized Cancer Medicine: Methods and Applications of Health Technology Assessment and Outcomes Research. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2015; 109:330-40. [PMID: 26354133 DOI: 10.1016/j.zefq.2015.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 06/30/2015] [Accepted: 06/30/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Oncotyrol - Center for Personalized Cancer Medicine is an international and interdisciplinary alliance combining research and commercial competencies to accelerate the development, evaluation and translation of personalized healthcare strategies in cancer. The philosophy of Oncotyrol is to collaborate with relevant stakeholders and advance knowledge "from bench to bedside to population and back". Oncotyrol is funded through the COMET Excellence Program by the Austrian government via the national Austrian Research Promotion Agency (FFG). This article focuses on the role of health technology assessment (HTA) and outcomes research in personalized cancer medicine in the context of Oncotyrol. METHODS Oncotyrol, which currently comprises approximately 20 individual projects, has four research areas: Area 1: Biomarker and Drug Target Identification; Area 2: Assay Development and Drug Screening; Area 3: Innovative Therapies; Area 4: Health Technology Assessment and Bioinformatics. Area 4 translates the results from Areas 1 to 3 to populations and society and reports them back to Area 3 to inform clinical studies and guidelines, and to Areas 1 and 2 to guide further research and development. RESULTS In a series of international expert workshops, the Oncotyrol International Expert Task Force for Personalized Cancer Medicine developed the Methodological Framework for Early Health Technology Assessment and Decision Modeling in Cancer and practical guidelines in this field. Further projects included applications in the fields of sequential treatment of patients with chronic myeloid leukemia (CML), benefit-harm and cost-effectiveness evaluation of prostate cancer screening, effectiveness and cost-effectiveness of multiple cervical cancer screening strategies, and benefits and cost-effectiveness of genomic test-based treatment strategies in breast cancer. CONCLUSION An interdisciplinary setting as generated in Oncotyrol provides unique opportunities such as systematically coordinating lab and bench research, product development, clinical studies and decision science/HTA and transparent joint planning of research and development with a partnership of researchers, manufacturers and health policy decision makers. However, generating a joint research and legal framework with numerous partners from different sectors can be challenging, particularly in the starting period of such an endeavor. The journey to translational personalized medicine through multidisciplinary collaborations may still be long and difficult, but it is evident that it must be continued to turn vision into reality.
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Affiliation(s)
- Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria; Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria; Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Beate Jahn
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Ursula Rochau
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria; Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Petra Schnell-Inderst
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria; Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Agnes Kisser
- Ludwig Boltzmann Institute for Health Technology Assessment, Vienna, Austria
| | - Theresa Hunger
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria; Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Gaby Sroczynski
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria; Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Nikolai Mühlberger
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria; Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Wolfgang Willenbacher
- Internal Medicine V - Haematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Gottfried Endel
- Main Association of Austrian Social Insurance Institutions, Vienna, Austria
| | - Lukas Huber
- Center Management, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria; Division of Cell Biology, Medical University Innsbruck, Austria
| | - Guenther Gastl
- Internal Medicine V - Haematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
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17
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Heidegger I, Fritz J, Klocker H, Pichler R, Bektic J, Horninger W. Age-Adjusted PSA Levels in Prostate Cancer Prediction: Updated Results of the Tyrol Prostate Cancer Early Detection Program. PLoS One 2015. [PMID: 26218594 PMCID: PMC4517762 DOI: 10.1371/journal.pone.0134134] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To reduce the number of unnecessary biopsies in patients with benign prostatic disease, however, without missing significant PCa the present study re-evaluates the age-dependent PSA cut-offs in the Tyrol Prostate Cancer (PCa) early detection program. Patients and Methods The study population included 2225 patients who underwent prostate biopsy due to elevated PSA levels at our department. We divided our patient collective into four age groups: ≤49 years (n = 178), 50-59 years (n = 597), 60-69 years (n = 962) and ≥70 years (n = 488). We simulated different scenarios for PSA cut-off values between 1.25 and 6 ng/mL and fPSA% between 15 and 21% for all four age groups and calculated sensitivity, specificity, confidence intervals and predictive values. Results PCa was detected in 1218 men (54.7%). We found that in combination with free PSA ≤21% the following PSA cut-offs had the best cancer specificity: 1.75 ng/ml for men ≤49 years and 50-59 years, 2.25 ng/ml for men aged 60-69 years and 3.25 ng/ml for men ≥70 years. Using these adjusted PSA cut-off values all significant tumors are recognized in all age groups, yet the number of biopsies is reduced. Overall, one biopsy is avoided in 13 to 14 men (number needed to screen = 13.3, reduction of biopsies = 7.5%) when decision regarding biopsy is done according to the “new” cut-off values instead of the “old” ones. For the different age groups the number needed to screen to avoid one biopsy varied between 9.2 (≤49 years) and 17.4 (50-59 years). Conclusion With “new”, fine-tuned PSA cut-offs we detect all relevant PCa with a significant reduction of biopsies compared to the “old” cut-off values. Optimization of age-specific PSA cut-offs is one step towards a smarter strategy in the Tyrol PCa Early Detection Program.
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Affiliation(s)
- Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria; Department of Urology, Division of Experimental Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Helmut Klocker
- Department of Urology, Division of Experimental Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Renate Pichler
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Jasmin Bektic
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
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18
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Mühlberger N, Kurzthaler C, Iskandar R, Krahn MD, Bremner KE, Oberaigner W, Klocker H, Horninger W, Conrads-Frank A, Sroczynski G, Siebert U. The ONCOTYROL Prostate Cancer Outcome and Policy Model: Effect of Prevalence Assumptions on the Benefit-Harm Balance of Screening. Med Decis Making 2015; 35:758-72. [PMID: 25977360 DOI: 10.1177/0272989x15585114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 04/06/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND The ONCOTYROL Prostate Cancer Outcome and Policy (PCOP) model is a state-transition microsimulation model evaluating the benefits and harms of prostate cancer (PCa) screening. The natural history and detection component of the original model was based on the 2003 version of the Erasmus MIcrosimulation SCreening ANalysis (MISCAN) model, which was not calibrated to prevalence data. Compared with data from autopsy studies, prevalence of latent PCa assumed by the original model is low, which may bias the model toward screening. Our objective was to recalibrate the original model to match prevalence data from autopsy studies as well and compare benefit-harm predictions of the 2 model versions differing in prevalence. METHODS For recalibration, we reprogrammed the natural history and detection component of the PCOP model as a deterministic Markov state-transition cohort model in the statistical software package R. All parameters were implemented as variables or time-dependent functions and calibrated simultaneously in a single run. Observed data used as calibration targets included data from autopsy studies, cancer registries, and the European Randomized Study of Screening for Prostate Cancer. Compared models were identical except for calibrated parameters. RESULTS We calibrated 46 parameters. Prevalence from autopsy studies could not be fitted using the original parameter set. Additional parameters, allowing for interruption of disease progression and age-dependent screening sensitivities, were needed. Recalibration to higher prevalence demonstrated a considerable increase of overdiagnosis and decline of screening sensitivity, which significantly worsened the benefit-harm balance of screening. CONCLUSIONS Our calibration suggests that not all cancers are at risk of progression, and screening sensitivity may be lower at older ages. PCa screening models that use calibration to simulate disease progression in the unobservable latent phase are highly sensitive to prevalence assumptions.
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Affiliation(s)
- Nikolai Mühlberger
- Department of Public Health and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Tyrol, Austria (NM, CK, RI, ACF, GS, US),Division of Health Technology Assessment and Bioinformatics, ONCOTYROL-Center for Personalized Cancer Medicine, Innsbruck, Austria (NM, CK, RI, ACF, GS, US)
| | - Christina Kurzthaler
- Department of Public Health and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Tyrol, Austria (NM, CK, RI, ACF, GS, US),Division of Health Technology Assessment and Bioinformatics, ONCOTYROL-Center for Personalized Cancer Medicine, Innsbruck, Austria (NM, CK, RI, ACF, GS, US)
| | - Rowan Iskandar
- Department of Public Health and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Tyrol, Austria (NM, CK, RI, ACF, GS, US),Division of Health Technology Assessment and Bioinformatics, ONCOTYROL-Center for Personalized Cancer Medicine, Innsbruck, Austria (NM, CK, RI, ACF, GS, US),Department of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA (RI)
| | - Murray D Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, Ontario, Canada (MDK),Toronto General Research Institute, Toronto General Hospital, Toronto, Ontario, Canada (MDK, KEB)
| | - Karen E Bremner
- Toronto General Research Institute, Toronto General Hospital, Toronto, Ontario, Canada (MDK, KEB)
| | | | - Helmut Klocker
- Department of Urology, Innsbruck Medical University, Innsbruck, Austria (HK, WH)
| | - Wolfgang Horninger
- Department of Urology, Innsbruck Medical University, Innsbruck, Austria (HK, WH)
| | - Annette Conrads-Frank
- Department of Public Health and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Tyrol, Austria (NM, CK, RI, ACF, GS, US),Division of Health Technology Assessment and Bioinformatics, ONCOTYROL-Center for Personalized Cancer Medicine, Innsbruck, Austria (NM, CK, RI, ACF, GS, US)
| | - Gaby Sroczynski
- Department of Public Health and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Tyrol, Austria (NM, CK, RI, ACF, GS, US),Division of Health Technology Assessment and Bioinformatics, ONCOTYROL-Center for Personalized Cancer Medicine, Innsbruck, Austria (NM, CK, RI, ACF, GS, US)
| | - Uwe Siebert
- Department of Public Health and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Tyrol, Austria (NM, CK, RI, ACF, GS, US),Division of Health Technology Assessment and Bioinformatics, ONCOTYROL-Center for Personalized Cancer Medicine, Innsbruck, Austria (NM, CK, RI, ACF, GS, US),Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA (US),Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (US)
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19
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Alberts AR, Schoots IG, Roobol MJ. Prostate-specific antigen-based prostate cancer screening: Past and future. Int J Urol 2015; 22:524-32. [PMID: 25847604 DOI: 10.1111/iju.12750] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/29/2015] [Accepted: 02/01/2015] [Indexed: 12/21/2022]
Abstract
Prostate-specific antigen-based prostate cancer screening remains a controversial topic. Up to now, there is worldwide consensus on the statement that the harms of population-based screening, mainly as a result of overdiagnosis (the detection of clinically insignificant tumors that would have never caused any symptoms), outweigh the benefits. However, worldwide opportunistic screening takes place on a wide scale. The European Randomized Study of Screening for Prostate Cancer showed a reduction in prostate cancer mortality through prostate-specific antigen based-screening. These population-based data need to be individualized in order to avoid screening in those who cannot benefit and start screening in those who will. For now, lacking a more optimal screening approach, screening should only be started after the process of shared decision-making. The focus of future research is the reduction of unnecessary testing and overdiagnosis by further research to better biomarkers and the value of the multiparametric magnetic resonance imaging, potentially combined in already existing prostate-specific antigen-based multivariate risk prediction models.
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Affiliation(s)
- Arnout R Alberts
- Department of Urology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ivo G Schoots
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, the Netherlands
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20
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Geiger-Gritsch S, Oberaigner W, Mühlberger N, Siebert U, Ladurner M, Klocker H, Horninger W. Patient-reported urinary incontinence and erectile dysfunction following radical prostatectomy: results from the European Prostate Centre Innsbruck. Urol Int 2015; 94:419-27. [PMID: 25662301 DOI: 10.1159/000369475] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 10/28/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Urinary and erectile functions were assessed by using self-administered validated questionnaires in patients undergoing radical prostatectomy. MATERIALS AND METHODS In a prospective observational study, a total of 253 consecutive patients diagnosed with clinically localised prostate cancer between 2008 and 2009 at the European Prostate Centre Innsbruck were included. Patient-reported outcomes were assessed before radical prostatectomy and 12 months postoperatively using the validated International Consultation on Incontinence Questionnaire (ICIQ) and the International Index of Erectile Function (IIEF). The Wilcoxon signed-rank test and Chi square statistics were used for analysis. RESULTS The study showed that before radical prostatectomy, urinary incontinence of various severity grades was reported in 18.8, postoperatively in 63.0% (p < 0.001) and erectile dysfunction of various degrees was reported in 39.6 at baseline compared to 80.1% 12 months postoperatively (p < 0.001). CONCLUSIONS This study suggests that radical prostatectomy is associated with a significantly increased risk of urinary incontinence and erectile dysfunction 12 months postoperatively.
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Affiliation(s)
- Sabine Geiger-Gritsch
- Department of Clinical Epidemiology of the Tyrolean State Hospitals Ltd., Cancer Registry of Tyrol, Innsbruck, Austria
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21
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Dörr M, Hölzel D, Schubert-Fritschle G, Engel J, Schlesinger-Raab A. Changes in Prognostic and Therapeutic Parameters in Prostate Cancer from an Epidemiological View over 20 Years. Oncol Res Treat 2015; 38:8-14. [DOI: 10.1159/000371717] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 12/22/2014] [Indexed: 11/19/2022]
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22
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Höll M, Koziel R, Schäfer G, Pircher H, Pauck A, Hermann M, Klocker H, Jansen-Dürr P, Sampson N. ROS signaling by NADPH oxidase 5 modulates the proliferation and survival of prostate carcinoma cells. Mol Carcinog 2015; 55:27-39. [PMID: 25559363 PMCID: PMC4949723 DOI: 10.1002/mc.22255] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 10/14/2014] [Accepted: 11/03/2014] [Indexed: 01/31/2023]
Abstract
Prostate cancer (PCa) is the most commonly diagnosed cancer and second leading cause of male cancer death in Western nations. Thus, new treatment modalities are urgently needed. Elevated production of reactive oxygen species (ROS) by NADPH oxidase (Nox) enzymes is implicated in tumorigenesis of the prostate and other tissues. However, the identity of the Nox enzyme(s) involved in prostate carcinogenesis remains largely unknown. Analysis of radical prostatectomy tissue samples and benign and malignant prostate epithelial cell lines identified Nox5 as an abundantly expressed Nox isoform. Consistently, immunohistochemical staining of a human PCa tissue microarray revealed distinct Nox5 expression in epithelial cells of benign and malignant prostatic glands. shRNA‐mediated knockdown of Nox5 impaired proliferation of Nox5‐expressing (PC‐3, LNCaP) but not Nox5‐negative (DU145) PCa cell lines. Similar effects were observed upon ROS ablation via the antioxidant N‐acetylcysteine confirming ROS as the mediators. In addition, Nox5 silencing increased apoptosis of PC‐3 cells. Concomitantly, protein kinase C zeta (PKCζ) protein levels and c‐Jun N‐terminal kinase (JNK) phosphorylation were reduced. Moreover, the effect of Nox5 knockdown on PC‐3 cell proliferation could be mimicked by pharmacological inhibition of JNK. Collectively, these data indicate that Nox5 is expressed at functionally relevant levels in the human prostate and clinical PCa. Moreover, findings herein suggest that Nox5‐derived ROS and subsequent depletion of PKCζ and JNK inactivation play a critical role in modulating intracellular signaling cascades involved in the proliferation and survival of PCa cells. © 2014 The Authors. Molecular Carcinogenesis published by Wiley Periodicals, Inc.
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Affiliation(s)
- Monika Höll
- Institute for Biomedical Aging Research, University of Innsbruck, Innsbruck, Austria.,Tyrolean Cancer Research Institute, Medical University of Innsbruck, Innsbruck, Austria
| | - Rafal Koziel
- Institute for Biomedical Aging Research, University of Innsbruck, Innsbruck, Austria
| | - Georg Schäfer
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Haymo Pircher
- Institute for Biomedical Aging Research, University of Innsbruck, Innsbruck, Austria
| | - Alexander Pauck
- Institute for Biomedical Aging Research, University of Innsbruck, Innsbruck, Austria
| | - Martin Hermann
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Helmut Klocker
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Pidder Jansen-Dürr
- Institute for Biomedical Aging Research, University of Innsbruck, Innsbruck, Austria.,Tyrolean Cancer Research Institute, Medical University of Innsbruck, Innsbruck, Austria
| | - Natalie Sampson
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
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Conceição MBM, Boing AF, Peres KG. Time trends in prostate cancer mortality according to major geographic regions of Brazil: an analysis of three decades. CAD SAUDE PUBLICA 2014; 30:559-66. [PMID: 24714945 DOI: 10.1590/0102-311x00005813] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 08/22/2013] [Indexed: 01/28/2023] Open
Abstract
The aim of this study was to analyze prostate cancer mortality and time trends in Brazil, according to major geographic regions, States, and age brackets. Data on deaths from 1980 to 2010 were obtained from the Mortality Information System. Mortality trends were estimated using Prais-Winsten generalized linear regression. An upward time trend was observed in mortality in all regions of Brazil, with a mean annual increase of 2.8%. The upward trend in mortality occurred in most of the age brackets, with a concentration of deaths in men 70 to 79 years of age (41%) and a significant increase in the 40 to 60-year age bracket. The mortality rate increased significantly in all age brackets in the Northeast, compared to the other regions of Brazil. The study highlighted the importance of redistributing deaths from ill-defined causes in order to correct the mortality rates. The results point to significant regional differences and the need for continuous monitoring of mortality from prostate cancer in Brazil.
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24
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Prediction of cancer incidence in Tyrol/Austria for year of diagnosis 2020. Wien Klin Wochenschr 2014; 126:642-9. [DOI: 10.1007/s00508-014-0596-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 08/09/2014] [Indexed: 02/01/2023]
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25
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26
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MALDI-MS tissue imaging identification of biliverdin reductase B overexpression in prostate cancer. J Proteomics 2013; 91:500-14. [DOI: 10.1016/j.jprot.2013.08.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 07/30/2013] [Accepted: 08/03/2013] [Indexed: 01/18/2023]
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27
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Vercelli M, Quaglia A, Lillini R, Rossi S, Foschi R, Orengo MA, Marani E, Casella C, Puppo A, Celesia MV, Cogno R, Levreri I, Benfatto L, Manenti S, Cappellano D, Garrone E. Estimates of cancer burden in Liguria. TUMORI JOURNAL 2013; 99:285-95. [DOI: 10.1177/030089161309900303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background The regional health care system of Liguria caters for a resident population which is among the oldest in Europe. One population-based cancer registry is present in the region, providing incidence and survival data for the Genoa province (covering 55% of the regional population). This paper will estimate the incidence, prevalence and mortality in the Liguria region for cancers of the lung, breast, prostate, colon-rectum, stomach and uterine cervix and melanoma of the skin in 1970—2015. Methods The estimated figures were obtained by applying the MIAMOD method. Starting from mortality and survival data, incidence and prevalence were derived using a statistical back-calculation approach. Survival was modeled on the basis of published data from the Italian cancer registries. The MIAMOD method was applied also to estimate the colorectal cancer incidence, mortality and prevalence rates in the Ligurian provinces in the period 1988—2015. Results In 2012 about 1,500 new cases of breast cancer were expected in Ligurian women. The estimates for the other cancer sites were considerably lower, ranging from 839 (colon-rectum) to 54 (cervix). In men about 1,400 new cases were estimated for prostate cancer, while the incidence for the other sites ranged from 1,118 (colon-rectum) to 208 (skin melanoma). The breast cancer prevalence rate was more than 10 times the incidence rate in women, and the lung cancer prevalence rate was more than double the incidence rate in both sexes. Mortality rates were highest for lung cancer in men and breast cancer in women; the lowest rates were estimated for melanoma and cancer of the uterine cervix. Conclusion In Liguria a large portion of the health expenditure has been devoted to diagnostic and therapeutic resources. This may have contributed to the reduction of mortality rates and to the improvement of cancer survival. This phenomenon, added to population aging, will inflate the cancer prevalence. One of the major challenges for the Liguria region is to face the increasing demand for oncology services.
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Affiliation(s)
- Marina Vercelli
- RTRL, Registro Tumori Regione Liguria c/o SS Epidemiologia Descrittiva, Azienda Ospedale Università San Martino, IST, Istituto Nazionale Ricerca sul Cancro, Genoa
- DISSAL, Dipartimento di Scienze della Salute, Università di Genova, Genoa
| | - Alberto Quaglia
- RTRL, Registro Tumori Regione Liguria c/o SS Epidemiologia Descrittiva, Azienda Ospedale Università San Martino, IST, Istituto Nazionale Ricerca sul Cancro, Genoa
| | - Roberto Lillini
- RTRL, Registro Tumori Regione Liguria c/o SS Epidemiologia Descrittiva, Azienda Ospedale Università San Martino, IST, Istituto Nazionale Ricerca sul Cancro, Genoa
- Università “Vita - Salute” San Raffaele, Milan
| | - Silvia Rossi
- CNESPS, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome
| | - Roberto Foschi
- SS Epidemiologia Valutativa, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Bruchmann A, Roller C, Walther TV, Schäfer G, Lehmusvaara S, Visakorpi T, Klocker H, Cato ACB, Maddalo D. Bcl-2 associated athanogene 5 (Bag5) is overexpressed in prostate cancer and inhibits ER-stress induced apoptosis. BMC Cancer 2013; 13:96. [PMID: 23448667 PMCID: PMC3598994 DOI: 10.1186/1471-2407-13-96] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 02/18/2013] [Indexed: 02/03/2023] Open
Abstract
Background The Bag (Bcl-2 associated athanogene) family of proteins consists of 6 members sharing a common, single-copied Bag domain through which they interact with the molecular chaperone Hsp70. Bag5 represents an exception in the Bag family since it consists of 5 Bag domains covering the whole protein. Bag proteins like Bag1 and Bag3 have been implicated in tumor growth and survival but it is not known whether Bag5 also exhibits this function. Methods Bag5 mRNA and protein expression levels were investigated in prostate cancer patient samples using real-time PCR and immunoblot analyses. In addition immunohistological studies were carried out to determine the expression of Bag5 in tissue arrays. Analysis of Bag5 gene expression was carried out using one-way ANOVA and Bonferroni’s Multiple Comparison test. The mean values of the Bag5 stained cells in the tissue array was analyzed by Mann-Whitney test. Functional studies of the role of Bag5 in prostate cancer cell lines was performed using overexpression and RNA interference analyses. Results Our results show that Bag5 is overexpressed in malignant prostate tissue compared to benign samples. In addition we could show that Bag5 levels are increased following endoplasmic reticulum (ER)-stress induction, and Bag5 relocates from the cytoplasm to the ER during this process. We also demonstrate that Bag5 interacts with the ER-resident chaperone GRP78/BiP and enhances its ATPase activity. Bag5 overexpression in 22Rv.1 prostate cancer cells inhibited ER-stress induced apoptosis in the unfolded protein response by suppressing PERK-eIF2-ATF4 activity while enhancing the IRE1-Xbp1 axis of this pathway. Cells expressing high levels of Bag5 showed reduced sensitivity to apoptosis induced by different agents while Bag5 downregulation resulted in increased stress-induced cell death. Conclusions We have therefore shown that Bag5 is overexpressed in prostate cancer and plays a role in ER-stress induced apoptosis. Furthermore we have identified GRP78/BiP as a novel interaction partner of Bag5.
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Affiliation(s)
- Anja Bruchmann
- Karlsruhe Institute of Technology, Institute of Toxicology and Genetics, Hermann-von-Helmholtz Platz 1, Eggenstein-Leopoldshafen 76344, Germany
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Schaefer G, Mosquera JM, Ramoner R, Park K, Romanel A, Steiner E, Horninger W, Bektic J, Ladurner-Rennau M, Rubin MA, Demichelis F, Klocker H. Distinct ERG rearrangement prevalence in prostate cancer: higher frequency in young age and in low PSA prostate cancer. Prostate Cancer Prostatic Dis 2013; 16:132-8. [PMID: 23381693 PMCID: PMC3655380 DOI: 10.1038/pcan.2013.4] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: The TMPRSS2-ERG gene fusion resulting in ERG overexpression has been found in around 50% of prostate cancers (PCa) and is a very early event in tumorigenesis. Most studies have reported on selected surgical cohorts with inconsistent results. We hypothesized that ERG gene rearrangements impact tumor development and investigated the frequency of ERG overexpression in the context of clinicopathological tumor characteristics. Methods: ERG overexpression (ERG+ or ERG-) was determined by immunohistochemistry (IHC) in 1039 radical prostatectomy (RP) tumors and association with PSA, D'Amico risk score, histopathology, biochemical recurrence, body mass index and age of PCa cases was analyzed. Results: ERG+ was associated with younger age at diagnosis (P<0.0001), lower serum PSA (P=0.002) and lower prostate volume (PV) (P=0.001). It was most frequent in the youngest age quartile (⩽55 years, 63.9% ERG+) and decreased constantly with increasing age to 40.8% in the oldest age quartile (⩾67 years, P<0.0001). In the PSA range <4 ng ml−1 the frequency of ERG positivity was 60.2% compared with 47.5 and 49.1% in the PSA ranges 4–10 and ⩾10 ng ml−1, respectively. In the first age quartile, ERG+ patients had lower median serum PSA and fPSA% and smaller PV. In the highest age quartile tumor volume (TV) was increased. Similar differences were observed in the low PSA range. Multivariate analysis identified the first age quartile as a predictor for ERG status (odds ratios (OR) 2.05, P=0.007). No association was found with the D'Amico progression risk score and with biochemical tumor recurrence. Conclusions: ERG+ tumors manifest clinically at lower PSA levels and their prevalence is age dependent. This suggests acceleration of tumor development by ERG overexpression that results in earlier tumor detection in young patients. Long-term results are warranted to determine the impact of ERG overexpression on disease outcome.
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Affiliation(s)
- G Schaefer
- Department of Urology, Innsbruck Medical University, Innsbruck, Austria
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Abstract
• Prostate-specific antigen (PSA) has been widely applied to diagnosis and follow-up of prostate cancer, which led to research on its potential role in the early detection of the disease and its use in screening. • The value of PSA screening in reducing disease mortality is controversial and several studies have been conducted to determine the actual benefits. One of the early studies, the Tyrol Screening Study conducted in 1993, showed that during 2004 to 2008 there was a significant reduction in prostate cancer mortality in men aged >60 years compared with the mortality rate during 1989 to 1993. • Two studies that showed no benefit of screening in terms of prostate cancer death were conducted in Sweden in 1987 and 1988. • The Prostate, Lung, Colorectal, and Ovarian Screening Study conducted in the USA during 1993 to 2001 and involving 76,693 men showed no benefit of screening at 10 years but the trial can be criticised due to excessive contamination of the unscreened group. • In contrast, the European Randomized Study of Screening for Prostate Cancer (ERSPC), the largest randomised study with 162,388 participants study, showed that at a median follow-up of 9 years a prostate cancer mortality reduction of 20% resulted (P= 0.04). In an analysis limited to four ERSPC centres with a follow-up of 12.0 years, screening resulted in an overall reduction of metastatic disease of 31%. • The arguments against PSA screening include the risks associated with screening tests themselves, e.g. biopsy-related haematuria, urosepsis, and over diagnosis and overtreatment of prostate cancer. The overall evidence points in favour of PSA screening and steps can be taken to avoid overtreatment by offering patients active surveillance.
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The maternal embryonic leucine zipper kinase (MELK) is upregulated in high-grade prostate cancer. J Mol Med (Berl) 2012; 91:237-48. [PMID: 22945237 DOI: 10.1007/s00109-012-0949-1] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 08/06/2012] [Accepted: 08/15/2012] [Indexed: 12/13/2022]
Abstract
Loss of cell cycle control is a prerequisite for cancer onset and progression. In prostate cancer, increased activity of cell cycle genes has been associated with prognostic parameters such as biochemical relapse and survival. The identification of novel oncogenic and druggable targets in patient subgroups with poor prognosis may help to develop targeted therapy approaches. We analyzed prostate cancer and corresponding benign tissues (n = 98) using microarrays. The comparison of high- and low-grade tumors (Gleason score ≥ 4 + 3 vs. ≤ 3 + 4) revealed 144 differentially expressed genes (p < 0.05). Out of these, 15 genes were involved in the cell cycle process. The gene maternal embryonic leucine zipper kinase (MELK) was identified to be highly correlated with cell cycle genes like UBE2C, TOP2A, CCNB2, and AURKB. Increased MELK gene expression in high-risk prostate cancer was validated by qPCR in an independent patient cohort (p < 0.005, n = 79). Immunohistochemistry analysis using a tissue microarray (n = 94) revealed increased MELK protein expression in prostate cancer tissues of high Gleason scores. RNAi-based inhibition of MELK in PC3 and LNCaP cells suggested putative function in chromatin modification, embryonic development and cell migration. The concerted inhibition of MELK and other cell cycle targets by the antibiotic siomycin A strongly impaired cell viability of prostate cancer cells, and may point to a novel therapy approach for a subset of high-risk prostate cancer patients.
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Kimura T. East meets West: ethnic differences in prostate cancer epidemiology between East Asians and Caucasians. CHINESE JOURNAL OF CANCER 2011; 31:421-9. [PMID: 22085526 PMCID: PMC3777503 DOI: 10.5732/cjc.011.10324] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Prostate cancer is the most prevalent cancer in males in Western countries. The reported incidence in Asia is much lower than that in African Americans and European Caucasians. Although the lack of systematic prostate cancer screening system in Asian countries explains part of the difference, this alone cannot fully explain the lower incidence in Asian immigrants in the United States and west-European countries compared to the black and non-Hispanic white in those countries, nor the somewhat better prognosis in Asian immigrants with prostate cancer in the United States. Soy food consumption, more popular in Asian populations, is associated with a 25% to 30% reduced risk of prostate cancer. Prostate-specific antigen (PSA) is the only established and routinely implemented clinical biomarker for prostate cancer detection and disease status. Other biomarkers, such as urinary prostate cancer antigen 3 RNA, may increase accuracy of prostate cancer screening compared to PSA alone. Several susceptible loci have been identified in genetic linkage analyses in populations of countries in the West, and approximately 30 genetic polymorphisms have been reported to modestly increase the prostate cancer risk in genome-wide association studies. Most of the identified polymorphisms are reproducible regardless of ethnicity. Somatic mutations in the genomes of prostate tumors have been repeatedly reported to include deletion and gain of the 8p and 8q chromosomal regions, respectively; epigenetic gene silencing of glutathione S-transferase Pi (GSTP1); as well as mutations in androgen receptor gene. However, the molecular mechanisms underlying carcinogenesis, aggressiveness, and prognosis of prostate cancer remain largely unknown. Gene-gene and/or gene-environment interactions still need to be learned. In this review, the differences in PSA screening practice, reported incidence and prognosis of prostate cancer, and genetic factors between the populations in East and West factors are discussed.
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Affiliation(s)
- Tomomi Kimura
- Epidemiology, Janssen Pharmaceutical K.K., Tokyo 101-0065, Japan.
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Schröder FH, Zappa M. Prostate-specific antigen testing in Tyrol, Austria: prostate cancer mortality reduction was supported by an update with mortality data up to 2008. Int J Public Health 2011; 57:45-7. [PMID: 22044937 PMCID: PMC3282002 DOI: 10.1007/s00038-011-0316-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 10/12/2011] [Indexed: 11/29/2022] Open
Affiliation(s)
- Fritz H. Schröder
- The Erasmus Medical Center, P.O. Box 2040, Rotterdam, 3000 CA The Netherlands
| | - Marco Zappa
- Unit of Clinical and Descriptive Epidemiology, Institute for Study and Prevention of Cancer (ISPO), Via delle Oblate 2, Pontenuovo, 50143 Florence, Italy
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