1
|
Kato M, Horiguchi G, Ueda T, Fujihara A, Hongo F, Okihara K, Marunaka Y, Teramukai S, Ukimura O. A big data-based prediction model for prostate cancer incidence in Japanese men. Sci Rep 2023; 13:6579. [PMID: 37085532 PMCID: PMC10121595 DOI: 10.1038/s41598-023-33725-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/18/2023] [Indexed: 04/23/2023] Open
Abstract
To define a normal range for PSA values (ng/mL) by age and create a prediction model for prostate cancer incidence. We conducted a retrospective analysis using 263,073 observations of PSA values in Japanese men aged 18-98 years (2007-2017), including healthy men and those diagnosed with prostate cancer. Percentiles for 262,639 PSA observations in healthy men aged 18-70 years were calculated and plotted to elucidate the normal fluctuation range for PSA values by age. Univariable and multivariable logistic regression analyses were performed to develop a predictive model for prostate cancer incidence. PSA levels and PSA velocity increased with age in healthy men. However, there was no difference in PSA velocity with age in men diagnosed with prostate cancer. Logistic regression analysis showed an increased risk of prostate cancer for PSA slopes ranging from 0.5 to 3.5 ng/mL/year. This study provides age-specific normal fluctuation ranges for PSA levels in men aged 18-75 years and presents a novel and personalized prediction model for prostate cancer incidence. We found that PSA slope values of > 3.5 ng/mL/year may indicate a rapid increase in PSA levels caused by pathological condition such as inflammation but are unlikely to indicate cancer risk.
Collapse
Affiliation(s)
- Mineyuki Kato
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto-City, Kyoto, 602-8566, Japan
| | - Go Horiguchi
- Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto-City, Kyoto, Japan
| | - Takashi Ueda
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto-City, Kyoto, 602-8566, Japan.
| | - Atsuko Fujihara
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto-City, Kyoto, 602-8566, Japan
| | - Fumiya Hongo
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto-City, Kyoto, 602-8566, Japan
| | - Koji Okihara
- Department of Urology, North Medical Center Kyoto Prefectural University of Medicine, Yosano-gun, Kyoto, Japan
| | - Yoshinori Marunaka
- Medical Research Institute, Kyoto Industrial Health Association, Kyoto, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto-City, Kyoto, Japan
| | - Osamu Ukimura
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto-City, Kyoto, 602-8566, Japan
| |
Collapse
|
2
|
Carlsson SV, Arnsrud Godtman R, Pihl CG, Vickers A, Lilja H, Hugosson J, Månsson M. Young Age on Starting Prostate-specific Antigen Testing Is Associated with a Greater Reduction in Prostate Cancer Mortality: 24-Year Follow-up of the Göteborg Randomized Population-based Prostate Cancer Screening Trial. Eur Urol 2023; 83:103-109. [PMID: 36334968 PMCID: PMC10481420 DOI: 10.1016/j.eururo.2022.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/15/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The risk of death from prostate cancer (PC) depends on age, but the age at which to start prostate-specific antigen (PSA) screening remains uncertain. OBJECTIVE To study the relationship between risk reduction for PC mortality and age at first PSA screening. DESIGN, SETTING, AND PARTICIPANTS The randomized Göteborg-1 trial invited men for biennial PSA screening between the ages of 50 and 70 yr (screening, n = 10 000) or no invitation but exposure to opportunistic PSA testing (control, n = 10 000). INTERVENTION Regular versus opportunistic PSA screening or no PSA. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We modeled the nonlinear association between starting age and the absolute risk reduction in PC mortality in three settings: (1) intention-to-screen (randomized arms); (2) historical control (screening group and 1990-1994 registry data); and (3) attendees only (screening attendees and matched controls). We tested whether the effect of screening on PC mortality depends on the age at starting screening by comparing survival models with and without an interaction between trial arm and age (intention-to-screen and attendees only). RESULTS AND LIMITATIONS Younger age on starting PSA testing was associated with a greater reduction in PC mortality. Starting screening at age 55 yr approximately halved the risk of PC death compared to first PSA at age 60 yr. The test of association between starting age and the effect of screening on PC mortality was slightly greater than the conventional level of statistical significance (p = 0.052) for the entire cohort, and statistically significant among attendees (p = 0.002). This study is limited by the low number of disease-specific deaths for men starting screening before age 55 yr and the difficulty in discriminating between the effect of starting age and screening duration. CONCLUSIONS Given that prior screening trials included men aged up to 70 yr on starting screening, our results suggest that the effect size reported in prior trials underestimates that of currently recommended programs starting at age 50-55 yr. PATIENT SUMMARY In this study from the Göteborg-1 trial, we looked at the effect of prostate-specific antigen (PSA) screening in reducing men's risk of dying from prostate cancer given the age at which they begin testing. Starting at a younger age reduced the risk of prostate cancer death by a greater amount. We recommend that PSA screening should start no later than at age 55 yr.
Collapse
Affiliation(s)
- Sigrid V Carlsson
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Rebecka Arnsrud Godtman
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden
| | | | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hans Lilja
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Jonas Hugosson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Marianne Månsson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
| |
Collapse
|
3
|
Ye C, Ho JN, Kim DH, Song SH, Kim H, Lee H, Jeong SJ, Hong SK, Byun SS, Ahn H, Hwang SI, Lee HJ, Lee S. The Prostate Health Index and multi-parametric MRI improve diagnostic accuracy of detecting prostate cancer in Asian populations. Investig Clin Urol 2022; 63:631-638. [PMID: 36347552 PMCID: PMC9643725 DOI: 10.4111/icu.20220056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/31/2022] [Accepted: 08/10/2022] [Indexed: 10/05/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate the effectiveness of the Prostate Health Index (PHI) and prostate multi-parametric magnetic resonance imaging (mpMRI) in predicting prostate cancer (PCa) and clinically significant prostate cancer (csPCa) during initial prostate biopsy. MATERIALS AND METHODS In total, 343 patients underwent initial prostate biopsy and were screened by use of PHI and prostate-specific antigen (PSA) levels between April 2019 and July 2021. A subgroup of 232 patients also underwent prostate mpMRI. Logistic regression analysis was performed to evaluate the accuracies of PSA, PHI, and mpMRI as predictors of PCa or csPCa. These predictive accuracies were quantified by using the area under the receiver operating characteristic curve. The different predictive models were compared using the DeLong test. RESULTS Logistic regression showed that age, PSA, PHI, and prostate volume were significant predictors of both PCa and csPCa. In the mpMRI subgroup, age, PSA level, PHI, prostate volume, and mpMRI were predictors of both PCa and csPCa. The PHI (area under the curve [AUC]=0.693) was superior to the PSA level (AUC=0.615) as a predictor of PCa (p=0.038). Combining PHI and mpMRI showed the most accurate prediction of both PCa and csPCa (AUC=0.833, 0.881, respectively). CONCLUSIONS The most accurate prediction of both PCa and csPCa can be performed by combining PHI and mpMRI. In the absence of mpMRI, PHI is superior to PSA alone as a predictor of PCa, and adding PHI to PSA can increase the detection rate of both PCa and csPCa.
Collapse
Affiliation(s)
- Changhee Ye
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin-Nyoung Ho
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dan Hyo Kim
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Hun Song
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hwanik Kim
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hakmin Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seong Jin Jeong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyungwoo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Il Hwang
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hak Jong Lee
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sangchul Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
| |
Collapse
|
4
|
Makau-Barasa LK, Manirakiza A, Carvalho AL, Rebbeck TR. Prostate Cancer Screening, Diagnostic, Treatment Procedures and Costs in Sub-Saharan Africa: A Situational Analysis. Cancer Control 2022; 29:10732748221084932. [PMID: 35350915 PMCID: PMC8973068 DOI: 10.1177/10732748221084932] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Prostate cancer mortality is predicted to nearly double by 2040 in Sub-Saharan Africa (SSA). The lack of prostate cancer screening in SSA contributes to late-stage diagnosis, treatment delays, and poor survival among patients. We analyzed the availability and use of prostate cancer screening, diagnostic and treatment guidelines, procedures, and costs in few SSA countries to determine factors for consideration in the development of prostate cancer screening guidelines for SSA. METHODS We applied mixed methods approaches to collect data through an electronic survey administered to clinicians (oncologists, urologists, pathologists, nurses, and radiation oncologists) providing prostate cancer screening, diagnosis, and treatment services in multiple sub-Saharan countries. RESULTS Inconsistencies in respondents' understanding of the availability and use of prostate cancer screening guidelines in their countries were noted. Prostate Specific Antigen (PSA) and Digital Rectal Examination (DRE) were the most commonly available screening modalities. Available diagnostic procedures included a combination of prostate biopsies, transrectal ultrasonography, and DRE. Our study's data suggest that PSA and DRE exams are available for early diagnosis and screening procedures. Availability of treatment modalities with curative intent and costs for prostate cancer related procedures varied between and within countries. CONCLUSIONS PSA and DRE are available for detecting prostate cancer and may detect aggressive cancers early, leading to improved outcomes. However, PSA screening is also associated with overdiagnosis and over-treatment. National prostate cancer policies should consider health systems, evidence-based guidelines, population characteristics and healthcare financing to ensure access to clinically relevant and safe prostate cancer related care.
Collapse
Affiliation(s)
- Louise K Makau-Barasa
- 8510West Chester University of Pennsylvania, West Chester, PA, USA.,1855Harvard TH Chan School of Public Health and Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | - Timothy R Rebbeck
- 1855Harvard TH Chan School of Public Health and Dana-Farber Cancer Institute, Boston, MA, USA
| |
Collapse
|
5
|
Berg RNWV, Basourakos SP, Shoag J, Scherr D, Awamlh BAHA. Prostate Cancer Screening for Gay Men in the United States. Urology 2021; 163:119-125. [PMID: 34380053 DOI: 10.1016/j.urology.2021.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/27/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To elucidate trends of prostate-cancer (PCa) screening in gay and bisexual men and assess the association of sexual orientation with PCa screening in the US. METHODS Data for men ≥ 40 years-old with no history of PCa were collected from the National Health Interview Survey for the years 2013, 2015, and 2018. Multivariable logistic regression models were created to determine the associations between sexual orientation and PCa screening and the discussion of advantages and disadvantages prior to PCa screening. RESULTS Gay men screened for prostate cancer were younger than their straight counterparts with a median age (IQR) of 58 years (52-66) versus 64 years (56-71). Gay men were more likely to have undergone a screening PSA test (OR 1.56; 95%CI 1.20-2.02) and discuss the advantages of PSA testing with the physician prior to the test (OR 1.64; 95% CI 1.22 - 2.21) when compared to straight men. In yearly analysis, gay men were more likely to have undergone screening in 2013 (OR 1.65, 95%CI 1.01-2.68) and 2015 OR 1.95, 95CI% 1.30-2.91), however, there was no difference when compared to straight men in 2018 (OR 1.32, 95%CI 0.85-2.04). CONCLUSIONS Gay men were screened for PCa at a younger age comparted to straight men. They were also more likely to have undergone PCa cancer screening than straight men between 2013-18. Further study is needed to better understand the role of sexual orientation in PCa screening and management.
Collapse
Affiliation(s)
- Rand N Wilcox Vanden Berg
- Department of Urology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Spyridon P Basourakos
- Department of Urology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Jonathan Shoag
- University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH, USA; Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Douglas Scherr
- Department of Urology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | | |
Collapse
|
6
|
Heijnsdijk EAM, Gulati R, Tsodikov A, Lange JM, Mariotto AB, Vickers AJ, Carlsson SV, Etzioni R. Lifetime Benefits and Harms of Prostate-Specific Antigen-Based Risk-Stratified Screening for Prostate Cancer. J Natl Cancer Inst 2021; 112:1013-1020. [PMID: 32067047 PMCID: PMC7566340 DOI: 10.1093/jnci/djaa001] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/03/2019] [Accepted: 12/12/2019] [Indexed: 12/23/2022] Open
Abstract
Background Studies conducted in Swedish populations have shown that men with lowest prostate-specific antigen (PSA) levels at ages 44–50 years and 60 years have very low risk of future distant metastasis or death from prostate cancer. This study investigates benefits and harms of screening strategies stratified by PSA levels. Methods PSA levels and diagnosis patterns from two microsimulation models of prostate cancer progression, detection, and mortality were compared against results of the Malmö Preventive Project, which stored serum and tracked subsequent prostate cancer diagnoses for 25 years. The models predicted the harms (tests and overdiagnoses) and benefits (lives saved and life-years gained) of PSA-stratified screening strategies compared with biennial screening from age 45 years to age 69 years. Results Compared with biennial screening for ages 45–69 years, lengthening screening intervals for men with PSA less than 1.0 ng/mL at age 45 years led to 46.8–47.0% fewer tests (range between models), 0.9–2.1% fewer overdiagnoses, and 3.1–3.8% fewer lives saved. Stopping screening when PSA was less than 1.0 ng/mL at age 60 years and older led to 12.8–16.0% fewer tests, 5.0–24.0% fewer overdiagnoses, and 5.0–13.1% fewer lives saved. Differences in model results can be partially explained by differences in assumptions about the link between PSA growth and the risk of disease progression. Conclusion Relative to a biennial screening strategy, PSA-stratified screening strategies investigated in this study substantially reduced the testing burden and modestly reduced overdiagnosis while preserving most lives saved. Further research is needed to clarify the link between PSA growth and disease progression.
Collapse
Affiliation(s)
- Eveline A M Heijnsdijk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Roman Gulati
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Institute, Seattle, WA, USA
| | - Alex Tsodikov
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Jane M Lange
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Institute, Seattle, WA, USA
| | - Angela B Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sigrid V Carlsson
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Institute, Seattle, WA, USA
| |
Collapse
|
7
|
Borque-Fernando A, Espílez R, Miramar D, Corbatón D, Rodríguez A, Castro E, Mateo J, Rello L, Méndez A, Gil Sanz MJ. Genetic counseling in prostate cancer: How to implement it in daily clinical practice? Actas Urol Esp 2021; 45:8-20. [PMID: 33059945 DOI: 10.1016/j.acuro.2020.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/22/2020] [Indexed: 11/16/2022]
Abstract
Prostate cancer plays an undeniably prominent role in public health in our days and health systems. Its epidemiological impact is quantitatively very close to that of other tumors such as colon cancer and breast cancer, in which genetic counseling is part of their routine clinical practice, both in the initial evaluation and in the selection of therapeutic strategies. Hereditary cancer syndromes, breast/ovarian and Lynch syndrome are part of genetic counseling in these tumors. Currently, we also know that they can be associated to prostate cancer. The time has come to implement genetic counseling in prostate cancer from the earliest stages of its approach, from initial suspicion to the most advanced tumors. We present an updated review carried out by our interdisciplinary working group on scientific literature, clinical practice guidelines and consensus documents, aimed at the creation and drafting of a'Protocol for genetic counseling in prostate cancer' for the study of germline, with easy application in different healthcare settings. This protocol is currently being implemented in our routine practice and provides answers to 3 specific questions: Who should receive genetic counseling for prostate cancer? Which gene panel should be analyzed? How should counseling be done according to the results obtained? Other aspects about who should perform genetic counseling, ethical considerations and regulations are also collected.
Collapse
Affiliation(s)
- A Borque-Fernando
- Servicio de Urología, Hospital Universitario Miguel Servet, IIS-Aragón, Zaragoza, España.
| | - R Espílez
- Servicio de Urología, Hospital Universitario Miguel Servet, IIS-Aragón, Zaragoza, España
| | - D Miramar
- Servicio de Bioquímica, Unidad de Genética, Hospital Universitario Miguel Servet, Zaragoza, España
| | - D Corbatón
- Servicio de Urología, Hospital Universitario Miguel Servet, IIS-Aragón, Zaragoza, España
| | - A Rodríguez
- Servicio de Bioquímica, Unidad de Genética, Hospital Universitario Miguel Servet, Zaragoza, España
| | - E Castro
- Departamento de Oncología Médica, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Málaga, España
| | - J Mateo
- Instituto de Oncología Vall d'Hebron y Hospital Universitario Vall d'Hebron, Barcelona, España
| | - L Rello
- Servicio de Bioquímica, Unidad de Genética, Hospital Universitario Miguel Servet, Zaragoza, España
| | - A Méndez
- Servicio de Oncología Radioterápica, Hospital Universitario Miguel Servet, Zaragoza, España
| | - M J Gil Sanz
- Servicio de Urología, Hospital Universitario Miguel Servet, IIS-Aragón, Zaragoza, España
| |
Collapse
|
8
|
Press DJ, Pierce B, Lauderdale DS, Aschebrook-Kilfoy B, Lin Gomez S, Hedeker D, Wright NE, Fantus RJ, Bettencourt L, Ahsan H, Eggener S. Tobacco and marijuana use and their association with serum prostate-specific antigen levels among African American men in Chicago. Prev Med Rep 2020; 20:101174. [PMID: 33088675 PMCID: PMC7566952 DOI: 10.1016/j.pmedr.2020.101174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/05/2020] [Accepted: 08/05/2020] [Indexed: 11/30/2022] Open
Abstract
AA men are under-represented in PSA research, a biomarker of prostate cancer aggresiveness. Cigarette smoking was associated with an increase in PSA among older AA men. Tobacco use was associated with an increase in PSA among older AA men. Marijuana use was associated with a decrease in PSA among older AA men. Future behavioral risk factor studies linked to biopsy outcomes are warranted.
African American (AA) men experience more than twice the prostate cancer mortality as White men yet are under-represented in academic research involving prostate-specific antigen (PSA), a biomarker of prostate cancer aggressiveness. We examined the impact of self-reported tobacco (cigarette pack-years and current tobacco use including e-cigarettes) and current regular marijuana use on serum PSA level based on clinical laboratory testing among 928 AA men interviewed 2013–2018 in Chicago. We defined outcome of elevated PSA ≥ 4.0 ng/mL for logistic regression models and continuous PSA increases for general linear models. All models were adjusted for age, sociodemographic characteristics, healthcare utilization, body mass index, and self-reported health. Among 431 AA men age ≥ 55 years, we observed ∼ 5 times the odds of elevated PSA among those with > 1 pack-years of cigarette smoking vs. never-smokers (odds ratio [OR] = 5.09; 95% confidence interval [CI] = 1.57–16.6) and a quarter the odds of elevated PSA among current marijuana users vs. non-users (OR = 0.27; 95% CI = 0.08–0.96). PSA increased on average 1.20 ng/mL among other current tobacco users vs. non-users. Among older AA men, cigarette smoking history and current tobacco use were positively associated with an increase in PSA levels and current marijuana use were inversely associated with PSA levels. Future work with studies of diverse patient populations with cancer outcomes are needed to assess whether these behavioral characteristics contribute to racial/ ethnic disparities in prostate cancer outcomes. Our study provides novel evidence regarding potential differences in PSA levels among older AA men according to behavioral characteristics.
Collapse
Affiliation(s)
- David J. Press
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- The Center for Health Information Partnerships (CHiP), Institute of Public Health & Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Corresponding author at: Department of Public Health Sciences, The University of Chicago Biological Sciences, 5841 S. Maryland Ave., Chicago, IL 60637, USA.
| | - Brandon Pierce
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
- Department of Human Genetics, University of Chicago, Chicago, IL, USA
| | - Diane S. Lauderdale
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Briseis Aschebrook-Kilfoy
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, School of Medicine, San Francisco, CA, USA
| | - Donald Hedeker
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Nathaniel E. Wright
- Medical Scientist Training Program, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Luís Bettencourt
- Mansueto Institute for Urban Innovation, University of Chicago, Chicago, IL, USA
- Department of Ecology and Evolution, University of Chicago, Chicago, IL, USA
- Department of Sociology, University of Chicago, Chicago, IL, USA
- Santa Fe Institute, Santa Fe, NM, USA
| | - Habibul Ahsan
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
- Department of Human Genetics, University of Chicago, Chicago, IL, USA
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Scott Eggener
- Department of Surgery, University of Chicago, Chicago, IL, USA
| |
Collapse
|
9
|
Getaneh AM, Heijnsdijk EAM, Roobol MJ, de Koning HJ. Assessment of harms, benefits, and cost-effectiveness of prostate cancer screening: A micro-simulation study of 230 scenarios. Cancer Med 2020; 9:7742-7750. [PMID: 32813910 PMCID: PMC7571827 DOI: 10.1002/cam4.3395] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 12/15/2022] Open
Abstract
Background Prostate cancer screening incurs a high risk of overdiagnosis and overtreatment. An organized and age‐targeted screening strategy may reduce the associated harms while retaining or enhancing the benefits. Methods Using a micro‐simulation analysis (MISCAN) model, we assessed the harms, benefits, and cost‐effectiveness of 230 prostate‐specific antigen (PSA) screening strategies in a Dutch population. Screening strategies were varied by screening start age (50, 51, 52, 53, 54, and 55), stop age (51‐69), and intervals (1, 2, 3, 4, 8, and single test). Costs and effects of each screening strategy were compared with a no‐screening scenario. Results The most optimum strategy would be screening with 3‐year intervals at ages 55–64 resulting in an incremental cost‐effectiveness ratio (ICER) of €19 733 per QALY. This strategy predicted a 27% prostate cancer mortality reduction and 28 life years gained (LYG) per 1000 men; 36% of screen‐detected men were overdiagnosed. Sensitivity analyses did not substantially alter the optimal screening strategy. Conclusions PSA screening beyond age 64 is not cost‐effective and associated with a higher risk of overdiagnosis. Similarly, starting screening before age 55 is not a favored strategy based on our cost‐effectiveness analysis.
Collapse
Affiliation(s)
- Abraham M Getaneh
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Eveline A M Heijnsdijk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
10
|
Kovac E, Carlsson SV, Lilja H, Hugosson J, Kattan MW, Holmberg E, Stephenson AJ. Association of Baseline Prostate-Specific Antigen Level With Long-term Diagnosis of Clinically Significant Prostate Cancer Among Patients Aged 55 to 60 Years: A Secondary Analysis of a Cohort in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. JAMA Netw Open 2020; 3:e1919284. [PMID: 31940039 PMCID: PMC6991265 DOI: 10.1001/jamanetworkopen.2019.19284] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
IMPORTANCE The use of prostate-specific antigen (PSA) screening for prostate cancer is controversial because of the risk of overdiagnosis and overtreatment of indolent cancers. Optimal screening strategies are highly sought. OBJECTIVE To estimate the long-term risk of any prostate cancer and clinically significant prostate cancer based on baseline PSA levels among men aged 55 to 60 years. DESIGN, SETTING, AND PARTICIPANTS This secondary analysis of a cohort in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial uses actuarial analysis to analyze the association of baseline PSA levels with long-term risk of any prostate cancer and of clinically significant prostate cancer among men aged 55 to 60 years enrolled in the screening group of the trial between 1993 and 2001. EXPOSURE Single PSA measurement at study entry. MAIN OUTCOMES AND MEASURES Long-term risk of any prostate cancer and clinically significant prostate cancer diagnoses. RESULTS There were 10 968 men aged 55 to 60 years (median [interquartile range] age, 57 [55-58] years) at study enrollment in the screening group of the PLCO Cancer Screening Trial who had long-term follow-up. Actuarial 13-year incidences of clinically significant prostate cancer diagnosis among participants with a baseline PSA of 0.49 ng/mL or less was 0.4% (95% CI, 0%-0.8%); 0.50-0.99 ng/mL, 1.5% (95% CI, 1.1%-1.9%); 1.00-1.99 ng/mL, 5.4% (95% CI, 4.4%-6.4%); 2.00-2.99 ng/mL, 10.6% (95% CI, 8.3%-12.9%); 3.00-3.99 ng/mL, 15.3% (95% CI, 11.4%-19.2%); and 4.00 ng/mL and greater, 29.5% (95% CI, 24.2%-34.8%) (all pairwise log-rank P ≤ .004). Only 15 prostate cancer-specific deaths occurred during 13 years of follow-up, and 9 (60.0%) were among men with a baseline PSA level of 2.00 ng/mL or higher. CONCLUSIONS AND RELEVANCE In this secondary analysis of a cohort from the PLCO Cancer Screening Trial, baseline PSA levels among men aged 55 to 60 years were associated with long-term risk of clinically significant prostate cancer. These findings suggest that repeated screening can be less frequent among men aged 55 to 60 years with a low baseline PSA level (ie, <2.00 ng/mL) and possibly discontinued among those with baseline PSA levels of less than 1.00 ng/mL.
Collapse
Affiliation(s)
- Evan Kovac
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio
- Department of Urology, Montefiore Medical Center, Bronx, New York
| | - Sigrid V. Carlsson
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Hans Lilja
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Jonas Hugosson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Michael W. Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Erik Holmberg
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Andrew J. Stephenson
- Department of Surgery, Division of Urology, Rush Medical College, Chicago, Illinois
| |
Collapse
|
11
|
Toprak B, Colak A, Yalcin H, Yildirim M. No association of serum PSA with vitamin D or total oxidant-antioxidant capacity in healthy men. Aging Male 2019; 22:214-217. [PMID: 30084276 DOI: 10.1080/13685538.2018.1491026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background and aim: Vitamin D deficiency and oxidative stress were suggested to be related to prostate cancer risk. We aimed to investigate the association of serum PSA concentration with vitamin D and total oxidant/antioxidant levels. Materials and methods: A total of 95 healthy men were enrolled for the cross sectional study. Serum PSA, 25(OH)D, serum total oxidant status, and total antioxidant status were measured. Results: Serum PSA was significantly negatively correlated with serum total oxidant status (r= -0.309, p = .003) but there was no significant correlation between PSA and 25(OH)D (p = .383) or total antioxidant levels (p = .233). After adjustment for age BMI and smoking status with multiple regression analysis, there was no significant association between serum PSA and total oxidant status. Conclusion: We find no evidence for an association between PSA and vitamin D levels or serum total oxidant/antioxidant levels.
Collapse
Affiliation(s)
- Burak Toprak
- a Department of Clinical Biochemistry , Sivas State hospital , Sivas , Turkey
| | - Ayfer Colak
- b Department of Clinical Biochemistry , Tepecik Teaching and Research Hospital , Izmir , Turkey
| | - Hulya Yalcin
- b Department of Clinical Biochemistry , Tepecik Teaching and Research Hospital , Izmir , Turkey
| | - Mustafa Yildirim
- c Department of Internal Medicine , Tepecik Teaching and Research Hospital , Izmir , Turkey
| |
Collapse
|
12
|
Magers MJ, Cheng L. Practical Molecular Testing in a Clinical Genitourinary Service. Arch Pathol Lab Med 2019; 144:277-289. [PMID: 31373513 DOI: 10.5858/arpa.2019-0134-ra] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Molecular testing is increasingly playing a key role in the diagnosis, prognosis, and treatment of neoplasms of the genitourinary system. OBJECTIVE.— To provide a general overview of the clinically relevant molecular tests available for neoplasms of the genitourinary tract. DATA SOURCES.— Relevant medical literature indexed on PubMed. CONCLUSIONS.— Understanding of the molecular oncology of genitourinary neoplasms is rapidly advancing, and the pathologist must be aware of the practical implications of molecular testing. While many genomic abnormalities are not yet clinically relevant, there is an increasing library of ancillary tests that may guide diagnosis, prognosis, and/or treatment of many neoplasms. Recurrent genomic abnormalities have been identified in many types of renal cell carcinoma, and some types of renal cell carcinoma are specifically defined by the molecular abnormality. Two major routes of developing urothelial carcinoma have been molecularly described. Recurrent translocations involving ETS family genes are found in approximately half of prostate cancer cases. Testicular germ cell tumors typically harbor i(12p). Penile neoplasms are often high-risk human papillomavirus-driven cancers. Nonetheless, even as genitourinary neoplasms are increasingly better understood at the molecular level, further research with eventual clinical validation is needed for optimal diagnosis, prognosis, and treatment of aggressive malignancies in the genitourinary tract.
Collapse
Affiliation(s)
- Martin J Magers
- From the Departments of Pathology and Laboratory Medicine (Drs Magers and Cheng) and Urology (Dr Cheng), Indiana University School of Medicine, Indianapolis, Indiana
| | - Liang Cheng
- From the Departments of Pathology and Laboratory Medicine (Drs Magers and Cheng) and Urology (Dr Cheng), Indiana University School of Medicine, Indianapolis, Indiana
| |
Collapse
|
13
|
Jeong B, Kim YJ, Jeong JY, Kim YJ. Label-free electrochemical quantification of microRNA-375 in prostate cancer cells. J Electroanal Chem (Lausanne) 2019. [DOI: 10.1016/j.jelechem.2019.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
14
|
Cheng HH, Sokolova AO, Schaeffer EM, Small EJ, Higano CS. Germline and Somatic Mutations in Prostate Cancer for the Clinician. J Natl Compr Canc Netw 2019; 17:515-521. [DOI: 10.6004/jnccn.2019.7307] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/02/2019] [Indexed: 11/17/2022]
Abstract
It is increasingly important for clinicians involved in the management of prostate cancer to understand the relevance of heritable (germline) mutations that, for select patients, affect prostate cancer risk and cancer biology, and acquired (somatic) mutations that occur in prostate cancer cells. In the advanced disease setting, mutations in homologous recombination repair genes (eg, BRCA1, BRCA2, ATM, CHEK2, PALB2) suggest candidacy for platinum chemotherapy and PARP inhibitor trials. Similarly, microsatellite instability and mismatch repair deficiency, which may arise in the setting of MLH1, MSH2, MSH6, and PMS2 mutations, suggest potential vulnerability to PD-1 inhibitors. Germline genetic testing has potential importance in the treatment and assessment of familial risk, and tumor-directed somatic sequencing may guide treatment decision-making. This review provides clinicians with knowledge of basic genetic terminology, awareness of the importance of family history of cancer (not limited to prostate cancer), contrasts between the different but potentially related objectives of germline versus somatic testing of tumor tissue, and indications for genetic counseling. Specific clinical scenarios, objectives of testing, and nature of the assays are reviewed. Germline and somatic mutations of known and potential relevance to prostate cancer are discussed in the context of treatment options, and algorithms to assist clinicians in approaching this area are proposed.
Collapse
Affiliation(s)
- Heather H. Cheng
- aDivision of Medical Oncology, University of Washington, and
- bDivision of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Alexandra O. Sokolova
- aDivision of Medical Oncology, University of Washington, and
- bDivision of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Edward M. Schaeffer
- cRobert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois; and
| | - Eric J. Small
- dHelen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
| | - Celestia S. Higano
- aDivision of Medical Oncology, University of Washington, and
- bDivision of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| |
Collapse
|
15
|
Preston MA, Gerke T, Carlsson SV, Signorello L, Sjoberg DD, Markt SC, Kibel AS, Trinh QD, Steinwandel M, Blot W, Vickers AJ, Lilja H, Mucci LA, Wilson KM. Baseline Prostate-specific Antigen Level in Midlife and Aggressive Prostate Cancer in Black Men. Eur Urol 2018; 75:399-407. [PMID: 30237027 DOI: 10.1016/j.eururo.2018.08.032] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 08/23/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Prostate-specific antigen (PSA) measurement in midlife predicts long-term prostate cancer (PCa) mortality among white men. OBJECTIVE To determine whether baseline PSA level during midlife predicts risk of aggressive PCa in black men. DESIGN, SETTING, AND PARTICIPANTS Nested case-control study among black men in the Southern Community Cohort Study recruited between 2002 and 2009. A prospective cohort in the southeastern USA with recruitment from community health centers. A total of 197 incident PCa patients aged 40-64 yr at study entry and 569 controls matched on age, date of blood draw, and site of enrollment. Total PSA was measured in blood collected and stored at enrollment. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Total and aggressive PCa (91 aggressive: Gleason ≥7, American Joint Committee on Cancer stage III/IV, or PCa-specific death). Exact conditional logistic regression estimated odds ratios (ORs) with 95% confidence intervals (CIs) for PCa by category of baseline PSA. RESULTS AND LIMITATIONS Median PSA among controls was 0.72, 0.80, 0.94, and 1.03ng/ml for age groups 40-49, 50-54, 55-59, and 60-64 yr, respectively; 90th percentile levels were 1.68, 1.85, 2.73, and 3.33ng/ml. Furthermore, 95% of total and 97% of aggressive cases had baseline PSA above the age-specific median. Median follow-up was 9 yr. The OR for total PCa comparing PSA >90th percentile versus ≤median was 83.6 (95% CI, 21.2-539) for 40-54 yr and 71.7 (95% CI, 23.3-288) for 55-64 yr. For aggressive cancer, ORs were 174 (95% CI, 32.3-infinity) for 40-54 yr and 51.8 (95% CI, 11.0-519) for 55-64 yr. A composite endpoint of aggressive PCa based on stage, grade, and mortality was used and is a limitation. CONCLUSIONS PSA levels in midlife strongly predicted total and aggressive PCa among black men. PSA levels among controls were similar to those among white controls in prior studies. PATIENT SUMMARY Prostate-specific antigen (PSA) level during midlife strongly predicted future development of aggressive prostate cancer among black men. Targeted screening based on a midlife PSA might identify men at high risk while minimizing screening in those men at low risk.
Collapse
Affiliation(s)
- Mark A Preston
- Division of Urology, Brigham and Women's Hospital, Boston, MA, USA.
| | - Travis Gerke
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Sigrid V Carlsson
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Lisa Signorello
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Sarah C Markt
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Adam S Kibel
- Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
| | - Quoc-Dien Trinh
- Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
| | - Mark Steinwandel
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William Blot
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Hans Lilja
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA; Departments of Laboratory Medicine and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Lorelei A Mucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kathryn M Wilson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
16
|
L
ong‐term longitudinal changes in baseline
PSA
distribution and estimated prevalence of prostate cancer in male Japanese participants of population‐based
PSA
screening. Int J Cancer 2018; 143:1611-1619. [DOI: 10.1002/ijc.31560] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/19/2018] [Accepted: 04/16/2018] [Indexed: 11/07/2022]
|
17
|
Sjoberg DD, Vickers AJ, Assel M, Dahlin A, Poon BY, Ulmert D, Lilja H. Twenty-year Risk of Prostate Cancer Death by Midlife Prostate-specific Antigen and a Panel of Four Kallikrein Markers in a Large Population-based Cohort of Healthy Men. Eur Urol 2018. [PMID: 29519548 DOI: 10.1016/j.eururo.2018.02.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Prostate-specific antigen (PSA) screening reduces prostate cancer deaths but leads to harm from overdiagnosis and overtreatment. OBJECTIVE To determine the long-term risk of prostate cancer mortality using kallikrein blood markers measured at baseline in a large population of healthy men to identify men with low risk for prostate cancer death. DESIGN, SETTING, PARTICIPANTS Study based on the Malmö Diet and Cancer cohort enrolling 11 506 unscreened men aged 45-73 yr during 1991-1996, providing cryopreserved blood at enrollment and followed without PSA screening to December 31, 2014. We measured four kallikrein markers in the blood of 1223 prostate cancer cases and 3028 controls. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Prostate cancer death (n=317) by PSA and a prespecified statistical model based on the levels of four kallikrein markers. RESULTS AND LIMITATIONS Baseline PSA predicted prostate cancer death with a concordance index of 0.86. In men with elevated PSA (≥2.0ng/ml), predictive accuracy was enhanced by the four-kallikrein panel compared with PSA (0.80 vs 0.73; improvement 0.07; 95% confidence interval 0.04, 0.10). Nearly half of men aged 60+ yr with elevated PSA had a four-kallikrein panel score of <7.5%, translating into 1.7% risk of prostate cancer death at 15 yr-a similar estimate to that of a man with a PSA of 1.6ng/ml. Men with a four-kallikrein panel score of ≥7.5% had a 13% risk of prostate cancer death at 15 yr. CONCLUSIONS A prespecified statistical model based on four kallikrein markers (commercially available as the 4Kscore) reclassified many men with modestly elevated PSA, to have a low long-term risk of prostate cancer death. Men with elevated PSA but low scores from the four-kallikrein panel can be monitored rather than being subject to biopsy. PATIENT SUMMARY Men with elevated prostate-specific antigen (PSA) are often referred for prostate biopsy. However, men with elevated PSA but low scores from the four-kallikrein panel can be monitored rather than being subject to biopsy.
Collapse
Affiliation(s)
- Daniel D Sjoberg
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Vickers
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Melissa Assel
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anders Dahlin
- Department of Clinical Microbiology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Bing Ying Poon
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David Ulmert
- Molecular Pharmacology Program, Sloan Kettering Institute, New York, NY, USA; Division of Urological Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Hans Lilja
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Department of Translational Medicine, Lund University, Malmö, Sweden.
| |
Collapse
|
18
|
Seibert TM, Fan CC, Wang Y, Zuber V, Karunamuni R, Parsons JK, Eeles RA, Easton DF, Kote-Jarai ZS, Al Olama AA, Garcia SB, Muir K, Grönberg H, Wiklund F, Aly M, Schleutker J, Sipeky C, Tammela TL, Nordestgaard BG, Nielsen SF, Weischer M, Bisbjerg R, Røder MA, Iversen P, Key TJ, Travis RC, Neal DE, Donovan JL, Hamdy FC, Pharoah P, Pashayan N, Khaw KT, Maier C, Vogel W, Luedeke M, Herkommer K, Kibel AS, Cybulski C, Wokolorczyk D, Kluzniak W, Cannon-Albright L, Brenner H, Cuk K, Saum KU, Park JY, Sellers TA, Slavov C, Kaneva R, Mitev V, Batra J, Clements JA, Spurdle A, Teixeira MR, Paulo P, Maia S, Pandha H, Michael A, Kierzek A, Karow DS, Mills IG, Andreassen OA, Dale AM. Polygenic hazard score to guide screening for aggressive prostate cancer: development and validation in large scale cohorts. BMJ 2018; 360:j5757. [PMID: 29321194 PMCID: PMC5759091 DOI: 10.1136/bmj.j5757] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To develop and validate a genetic tool to predict age of onset of aggressive prostate cancer (PCa) and to guide decisions of who to screen and at what age. DESIGN Analysis of genotype, PCa status, and age to select single nucleotide polymorphisms (SNPs) associated with diagnosis. These polymorphisms were incorporated into a survival analysis to estimate their effects on age at diagnosis of aggressive PCa (that is, not eligible for surveillance according to National Comprehensive Cancer Network guidelines; any of Gleason score ≥7, stage T3-T4, PSA (prostate specific antigen) concentration ≥10 ng/L, nodal metastasis, distant metastasis). The resulting polygenic hazard score is an assessment of individual genetic risk. The final model was applied to an independent dataset containing genotype and PSA screening data. The hazard score was calculated for these men to test prediction of survival free from PCa. SETTING Multiple institutions that were members of international PRACTICAL consortium. PARTICIPANTS All consortium participants of European ancestry with known age, PCa status, and quality assured custom (iCOGS) array genotype data. The development dataset comprised 31 747 men; the validation dataset comprised 6411 men. MAIN OUTCOME MEASURES Prediction with hazard score of age of onset of aggressive cancer in validation set. RESULTS In the independent validation set, the hazard score calculated from 54 single nucleotide polymorphisms was a highly significant predictor of age at diagnosis of aggressive cancer (z=11.2, P<10-16). When men in the validation set with high scores (>98th centile) were compared with those with average scores (30th-70th centile), the hazard ratio for aggressive cancer was 2.9 (95% confidence interval 2.4 to 3.4). Inclusion of family history in a combined model did not improve prediction of onset of aggressive PCa (P=0.59), and polygenic hazard score performance remained high when family history was accounted for. Additionally, the positive predictive value of PSA screening for aggressive PCa was increased with increasing polygenic hazard score. CONCLUSIONS Polygenic hazard scores can be used for personalised genetic risk estimates that can predict for age at onset of aggressive PCa.
Collapse
Affiliation(s)
- Tyler M Seibert
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, USA
| | - Chun Chieh Fan
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, USA
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, USA
| | - Yunpeng Wang
- NORMENT, KG Jebsen Centre, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Verena Zuber
- NORMENT, KG Jebsen Centre, Oslo University Hospital and University of Oslo, Oslo, Norway
- MRC Biostatistics Unit, Cambridge Biomedical Campus, Cambridge CB2 0SR, UK
| | - Roshan Karunamuni
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, USA
| | - J Kellogg Parsons
- Department of Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Rosalind A Eeles
- Institute of Cancer Research, London, SM2 5NG, UK
- Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
| | | | - Ali Amin Al Olama
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
- Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, R3, Box 83, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Sara Benlloch Garcia
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
| | - Kenneth Muir
- Institute of Population Health, University of Manchester, Manchester, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Henrik Grönberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Wiklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Markus Aly
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Solna, 171 76 Stockholm, Sweden
- Department of Urology, Karolinska University Hospital, Solna, 171 76 Stockholm, Sweden
| | - Johanna Schleutker
- Department of Medical Biochemistry and Genetics, Institute of Biomedicine, Kiinamyllynkatu 10, FI-20014 University of Turku, Finland
- Tyks Microbiology and Genetics, Department of Medical Genetics, Turku University Hospital, Turku, Finland
- BioMediTech, 30014 University of Tampere, Tampere, Finland
| | - Csilla Sipeky
- Department of Medical Biochemistry and Genetics, Institute of Biomedicine, Kiinamyllynkatu 10, FI-20014 University of Turku, Finland
- Tyks Microbiology and Genetics, Department of Medical Genetics, Turku University Hospital, Turku, Finland
| | - Teuvo Lj Tammela
- Department of Urology, Tampere University Hospital and Medical School, University of Tampere, Finland
| | - Børge G Nordestgaard
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Sune F Nielsen
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Maren Weischer
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Rasmus Bisbjerg
- Department of Urology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - M Andreas Røder
- Copenhagen Prostate Cancer Centre, Department of Urology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Iversen
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Copenhagen Prostate Cancer Centre, Department of Urology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tim J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health University of Oxford, Oxford OX3 7LF, UK
| | - Ruth C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health University of Oxford, Oxford OX3 7LF, UK
| | - David E Neal
- Nuffield Department of Surgical Sciences, Faculty of Medical Science, University of Oxford, John Radcliffe Hospital, Oxford, UK
- University of Cambridge, Department of Oncology, Box 279, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Jenny L Donovan
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, Faculty of Medical Science, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Paul Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - Nora Pashayan
- University College London, Department of Applied Health Research, London WC1E 7HB, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - Kay-Tee Khaw
- Clinical Gerontology Unit, University of Cambridge, Cambridge UK
| | - Christiane Maier
- Institute of Human Genetics, University Hospital of Ulm, Ulm, Germany
| | - Walther Vogel
- Institute of Human Genetics, University Hospital of Ulm, Ulm, Germany
| | - Manuel Luedeke
- Institute of Human Genetics, University Hospital of Ulm, Ulm, Germany
| | - Kathleen Herkommer
- Department of Urology, Klinikum rechts der Isar der Technischen Universitaet Muenchen, Munich, Germany
| | - Adam S Kibel
- Division of Urologic Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, 75 Francis Street, Boston, MA 02115, USA
| | - Cezary Cybulski
- International Hereditary Cancer Centre, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Dominika Wokolorczyk
- International Hereditary Cancer Centre, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Wojciech Kluzniak
- International Hereditary Cancer Centre, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Lisa Cannon-Albright
- Division of Genetic Epidemiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Katarina Cuk
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kai-Uwe Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jong Y Park
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Thomas A Sellers
- Office of the Center Director, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Chavdar Slavov
- Department of Urology and Alexandrovska University Hospital, Medical University, Sofia, Bulgaria
| | - Radka Kaneva
- Department of Medical Chemistry and Biochemistry, Molecular Medicine Center, Medical University, Sofia, 2 Zdrave Str, 1431 Sofia, Bulgaria
| | - Vanio Mitev
- Department of Medical Chemistry and Biochemistry, Molecular Medicine Center, Medical University, Sofia, 2 Zdrave Str, 1431 Sofia, Bulgaria
| | - Jyotsna Batra
- Australian Prostate Cancer Research Centre-Qld, Institute of Health and Biomedical Innovation and School of Biomedical Science, Queensland University of Technology, Brisbane, Australia
| | - Judith A Clements
- Australian Prostate Cancer Research Centre-Qld, Institute of Health and Biomedical Innovation and School of Biomedical Science, Queensland University of Technology, Brisbane, Australia
| | - Amanda Spurdle
- Molecular Cancer Epidemiology Laboratory, Queensland Institute of Medical Research, Brisbane, Australia
- Australian Prostate Cancer Research Centre-Qld, Institute of Health and Biomedical Innovation and School of Biomedical Science, Queensland University of Technology, Brisbane, Australia
- Australian Prostate Cancer BioResource, Institute of Health and Biomedical Innovation and School of Biomedical Science, Queensland University of Technology, Brisbane, Australia
| | - Manuel R Teixeira
- Department of Genetics, Portuguese Oncology Institute, Porto, Portugal
- Biomedical Sciences Institute (ICBAS), University of Porto, Porto, Portugal
| | - Paula Paulo
- Department of Genetics, Portuguese Oncology Institute, Porto, Portugal
| | - Sofia Maia
- Department of Genetics, Portuguese Oncology Institute, Porto, Portugal
| | | | | | | | - David S Karow
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, USA
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Ian G Mills
- NORMENT, KG Jebsen Centre, Oslo University Hospital and University of Oslo, Oslo, Norway
- Centre for Cancer Research and Cell Biology, Queens University Belfast, Belfast, UK
- Nuffield Department of Surgical Sciences, Faculty of Medical Science, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Ole A Andreassen
- NORMENT, KG Jebsen Centre, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Anders M Dale
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, USA
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| |
Collapse
|
19
|
Chiu PK, Alberts AR, Venderbos LDF, Bangma CH, Roobol MJ. Additional benefit of using a risk-based selection for prostate biopsy: an analysis of biopsy complications in the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer. BJU Int 2017; 120:394-400. [PMID: 28498624 DOI: 10.1111/bju.13913] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To investigate biopsy complications and hospital admissions that could be reduced by the use of European Randomized Study of Screening for Prostate Cancer (ERSPC) risk calculators. MATERIALS AND METHODS All biopsies performed in the Rotterdam section of the ERSPC between 1993 and 2015 were included. Biopsy complications and hospital admission data were prospectively recorded in questionnaires that were completed 2 weeks after biopsy. The ERSPC risk calculators 3 (RC3) and 4 (RC4) were applied to men attending the first and subsequent rounds of screening, respectively. Applying the predefined RC3/4 probability thresholds for prostate cancer (PCa) risk of ≥12.5% and high-grade PCa risk ≥3%, we assessed the number of complications, admissions and costs that could be reduced by avoiding biopsies in men below these thresholds. RESULTS A total of 10 747 biopsies with complete questionnaires were included. For these biopsies a complication rate of 67.9% (7294/10 747), a post-biopsy fever rate of 3.9% (424/10747) and a hospital admission rate of 0.9% (92/10747) were recorded. The fever rate was found to be static over the years, but the hospital admission rate tripled from 0.6% (1993-1996) to 2.1% (2009-2015). Among 7704 biopsies which fit the criteria for RC3 or RC4, 35.8% of biopsies (2757/7704), 37.4% of complications (1972/5268), 39.4% of fever events (128/325) and 42.3% of admissions (30/71) could have been avoided by using one of the risk calculators. More complications could have been avoided if RC4 had been used and for more recent biopsies (2009-2015). Our findings show that 35.9% of the total cost of biopsies and complication treatment could have been avoided. CONCLUSION A significant proportion of biopsy complications, hospital admissions and costs could be reduced if biopsy decisions were based on ERSPC risk calculators instead of PSA only. This effect was most prominent in more recent biopsies and in men with repeated biopsies or screening.
Collapse
Affiliation(s)
- Peter K Chiu
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Arnout R Alberts
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Chris H Bangma
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
20
|
Cheng HH, Pritchard CC, Montgomery B, Lin DW, Nelson PS. Prostate Cancer Screening in a New Era of Genetics. Clin Genitourin Cancer 2017; 15:625-628. [PMID: 28697982 DOI: 10.1016/j.clgc.2017.05.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 05/17/2017] [Accepted: 05/23/2017] [Indexed: 12/24/2022]
Abstract
Men who inherit pathogenic germline mutations in BRCA2 and BRCA1 are at increased risk of developing aggressive prostate cancer, and those with germline mutations in other DNA repair genes such as ATM, CHEK2, and MSH2/MSH6 may also have increased risks. Although clinically important, there is lack of specific guidance regarding management strategies for men at increased risk owing to germline mutation status or family history of aggressive prostate cancer. We review prostate cancer genetic risk factors and the ongoing IMPACT (Identification of Men with a genetic predisposition to ProstAte Cancer: Targeted screening in BRCA1/2 mutation carriers and controls) screening study. Pending results of IMPACT and unified guidelines, there are areas of uncertainty and need for further study. Ongoing and future research will be critical for optimizing prostate cancer screening approaches for men at the highest risk for aggressive prostate cancer. In the interim, we propose a practical approach to prostate cancer screening for men with a germline mutation in a known/suspected moderate to high-penetrance cancer predisposition gene (eg, BRCA1/2), and/or men with a first- or second-degree relative with metastatic prostate cancer (regardless of genetic testing): baseline prostate-specific antigen and digital rectal exam by experienced providers at age 40 years or 5 years earlier than age of diagnosis of the youngest first- or second-degree relative with metastatic prostate cancer, whichever is earlier. Then, based on age, digital rectal exam, and prostate-specific antigen, we suggest consideration of magnetic resonance imaging, biopsy, and/or continued monitoring.
Collapse
Affiliation(s)
- Heather H Cheng
- Department of Medicine, University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA.
| | - Colin C Pritchard
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | | | - Daniel W Lin
- Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Urology, University of Washington, Seattle, WA
| | - Peter S Nelson
- Department of Medicine, University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| |
Collapse
|
21
|
Fujizuka Y, Ito K, Oki R, Suzuki R, Sekine Y, Koike H, Matsui H, Shibata Y, Suzuki K. Predictive value of different prostate-specific antigen-based markers in men with baseline total prostate-specific antigen <2.0 ng/mL. Int J Urol 2017; 24:602-609. [PMID: 28560739 DOI: 10.1111/iju.13381] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 04/16/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the predictive value of various molecular forms of prostate-specific antigen in men with baseline prostate-specific antigen <2.0 ng/mL. METHODS The case cohort comprised 150 men with a baseline prostate-specific antigen level <2.0 ng/mL, and who developed prostate cancer within 10 years. The control cohort was 300 baseline prostate-specific antigen- and age-adjusted men who did not develop prostate cancer. Serum prostate-specific antigen, free prostate-specific antigen, and [-2] proenzyme prostate-specific antigen were measured at baseline and last screening visit. The predictive impact of baseline prostate-specific antigen- and [-2] proenzyme prostate-specific antigen-related indices on developing prostate cancer was investigated. The predictive impact of those indices at last screening visit and velocities from baseline to final screening on tumor aggressiveness were also investigated. RESULTS The baseline free to total prostate-specific antigen ratio was a significant predictor of prostate cancer development. The odds ratio was 6.08 in the lowest quintile baseline free to total prostate-specific antigen ratio subgroup. No serum indices at diagnosis were associated with tumor aggressiveness. The Prostate Health Index velocity and [-2] proenzyme prostate-specific antigen/free prostate-specific antigen velocity significantly increased in patients with higher risk D'Amico risk groups and higher Gleason scores. CONCLUSIONS Free to total prostate-specific antigen ratio in men with low baseline prostate-specific antigen levels seems to predict the risk of developing prostate cancer, and it could be useful for a more effective individualized screening system. Longitudinal changes in [-2] proenzyme prostate-specific antigen-related indices seem to correlate with tumor aggressiveness, and they could be used as prognostic tool before treatment and during active surveillance.
Collapse
Affiliation(s)
- Yuji Fujizuka
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Kazuto Ito
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Ryo Oki
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Rie Suzuki
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yoshitaka Sekine
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hidekazu Koike
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroshi Matsui
- 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
| |
Collapse
|
22
|
Li Y, Khan MS, Tian L, Liu L, Hu L, Fan D, Cao W, Wei Q. An ultrasensitive electrochemical immunosensor for the detection of prostate-specific antigen based on conductivity nanocomposite with halloysite nanotubes. Anal Bioanal Chem 2017; 409:3245-3251. [PMID: 28251291 DOI: 10.1007/s00216-017-0266-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/01/2017] [Accepted: 02/17/2017] [Indexed: 12/25/2022]
Abstract
A sensitive label-free amperometric electrochemical immunosensor for detection of prostate-specific antigen (PSA) was proposed in this work. The nanocomposite of halloysite nanotubes with polypyrrole shell and palladium nanoparticles (HNTs@PPy-Pd) was used as a novel signal label. The HNTs with adequate hydroxyl groups are economically available raw materials. PPy, as an electrically conducting polymer material, can be absorbed to the surface of HNTs by in situ oxidative polymerization of the pyrrole monomer and form a shell on the HNTs. The shell of PPy could not only improve the conductivity of the nanocomposite but also absorb large amounts of Pd nanoparticles (NPs). The Pd NPs with high electrocatalytic activity toward the reduction of H2O2 and the HNTs@PPy-Pd nanocomposite as the analytical signal label could improve the sensitivity of the immunosensor. Under optimal conditions, the immunosensor showed a low detection limit (0.03 pg/mL) and a wide linear range (0.0001 to 25 ng/mL) of PSA. Moreover, its merits such as good selectivity, acceptable reproducibility, and stability indicate that the fabricated immunosensor has a promising application potential in clinical diagnosis. Graphical Abstract A new label-free amperometric electrochemical immunosensor based on HNTs@PPy-Pd nanocomposite for quantitative detection of PSA.
Collapse
Affiliation(s)
- Yueyuan Li
- Key Laboratory of Chemical Sensing & Analysis in Universities of Shandong (University of Jinan), School of Chemistry and Chemical Engineering, University of Jinan, Jinan, Shandong, 250022, China
| | - Malik Saddam Khan
- Key Laboratory of Chemical Sensing & Analysis in Universities of Shandong (University of Jinan), School of Chemistry and Chemical Engineering, University of Jinan, Jinan, Shandong, 250022, China
| | - Lihui Tian
- Key Laboratory of Chemical Sensing & Analysis in Universities of Shandong (University of Jinan), School of Chemistry and Chemical Engineering, University of Jinan, Jinan, Shandong, 250022, China
| | - Li Liu
- Key Laboratory of Chemical Sensing & Analysis in Universities of Shandong (University of Jinan), School of Chemistry and Chemical Engineering, University of Jinan, Jinan, Shandong, 250022, China
| | - Lihua Hu
- Key Laboratory of Chemical Sensing & Analysis in Universities of Shandong (University of Jinan), School of Chemistry and Chemical Engineering, University of Jinan, Jinan, Shandong, 250022, China
| | - Dawei Fan
- Key Laboratory of Chemical Sensing & Analysis in Universities of Shandong (University of Jinan), School of Chemistry and Chemical Engineering, University of Jinan, Jinan, Shandong, 250022, China
| | - Wei Cao
- Key Laboratory of Chemical Sensing & Analysis in Universities of Shandong (University of Jinan), School of Chemistry and Chemical Engineering, University of Jinan, Jinan, Shandong, 250022, China.
| | - Qin Wei
- Key Laboratory of Chemical Sensing & Analysis in Universities of Shandong (University of Jinan), School of Chemistry and Chemical Engineering, University of Jinan, Jinan, Shandong, 250022, China
| |
Collapse
|
23
|
Genome-wide association study of prostate-specific antigen levels identifies novel loci independent of prostate cancer. Nat Commun 2017; 8:14248. [PMID: 28139693 PMCID: PMC5290311 DOI: 10.1038/ncomms14248] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 12/12/2016] [Indexed: 12/22/2022] Open
Abstract
Prostate-specific antigen (PSA) levels have been used for detection and surveillance of prostate cancer (PCa). However, factors other than PCa—such as genetics—can impact PSA. Here we present findings from a genome-wide association study (GWAS) of PSA in 28,503 Kaiser Permanente whites and 17,428 men from replication cohorts. We detect 40 genome-wide significant (P<5 × 10−8) single-nucleotide polymorphisms (SNPs): 19 novel, 15 previously identified for PSA (14 of which were also PCa-associated), and 6 previously identified for PCa only. Further analysis incorporating PCa cases suggests that at least half of the 40 SNPs are PSA-associated independent of PCa. The 40 SNPs explain 9.5% of PSA variation in non-Hispanic whites, and the remaining GWAS SNPs explain an additional 31.7%; this percentage is higher in younger men, supporting the genetic basis of PSA levels. These findings provide important information about genetic markers for PSA that may improve PCa screening, thereby reducing over-diagnosis and over-treatment. Prostate-specific antigen is used as a biomarker of prostate cancer, but levels can be affected by other factors not related to cancer. Here, the authors find genes associated with prostate specific antigen levels in healthy men, which could be used to reduce over-diagnosis and over-treatment.
Collapse
|
24
|
Hillig T, Nielsen TK, Hansen SI, Nygaard AB, Sölétormos G. Elevated prostate specific antigen and reduced 10-year survival among a cohort of Danish men consecutively referred from primary care to an urological department during 2005-2006. Scandinavian Journal of Clinical and Laboratory Investigation 2016; 77:27-35. [PMID: 27762145 DOI: 10.1080/00365513.2016.1242153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
It remains unclear whether total prostate specific antigen (tPSA) or complex PSA (cPSA) has the best diagnostic performance. Additionally, the utility of percentage free PSA (%fPSA) is still debated. Our objectives were to compare the diagnostic performances of tPSA, cPSA, and %fPSA among patients referred from GP to an Urological Specialist and to investigate prognostic factors and survival in the cohort. A total of 1261 consecutive male patients without previously known prostate cancer (PCa) were referred to the same Department of Urology during June 2005 to August 2006. Some 299 patients were diagnosed with PCa and 962 patients were found without PCa. Among the PCa patients, the median age, tPSA, cPSA, and %fPSA levels were 70.8 years, 13.4 μg/L, 10.8 μg/L, and 12.6%. For patients without PCa the results were 67.5 years, 2.5 μg/L, 1.9 μg/L, and 24.9%. The sensitivity, specificity, PVpos, PVneg, and efficiency of tPSA and cPSA were overlapping (p > .05). In the tPSA interval >4 μg/L - ≤20 μg/L, %fPSA excluded PCa with a PVneg of 72.4%; 38.5% of PCa patients had a tPSA concentration >20 μg/L at the time of referral and these patients had a reduced 10-year survival as compared to patients with tPSA concentrations ≤20 μg/L. In conclusion, tPSA and cPSA showed similar diagnostic performances. %fPSA provided additional diagnostic information at tPSA concentrations >4 μg - ≤20 μg/L. The high percentage of patients with tPSA concentrations >20 μg/L indicate delayed use of tPSA resulting in advanced disease at presentation and reduced patient survival.
Collapse
Affiliation(s)
- Thore Hillig
- a Department of Clinical Biochemistry , Nordsjaellands Hospital, University of Copenhagen , Denmark
| | | | - Steen Ingemann Hansen
- a Department of Clinical Biochemistry , Nordsjaellands Hospital, University of Copenhagen , Denmark
| | - Ann-Britt Nygaard
- a Department of Clinical Biochemistry , Nordsjaellands Hospital, University of Copenhagen , Denmark
| | - György Sölétormos
- c Department of Research , , Nordsjaellands Hospital, University of Copenhagen , Denmark
| |
Collapse
|
25
|
Ankerst DP, Gelfond J, Goros M, Herrera J, Strobl A, Thompson IM, Hernandez J, Leach RJ. Serial Percent Free Prostate Specific Antigen in Combination with Prostate Specific Antigen for Population Based Early Detection of Prostate Cancer. J Urol 2016; 196:355-60. [PMID: 26979652 PMCID: PMC4969186 DOI: 10.1016/j.juro.2016.03.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE We characterized the diagnostic properties of serial percent free prostate specific antigen in relation to prostate specific antigen in a multiethnic, multiracial cohort of healthy men. MATERIALS AND METHODS A total of 6,982 percent free prostate specific antigen and prostate specific antigen measurements were obtained from participants in a greater than 12-year Texas screening study comprising 1,625 men who never underwent biopsy, 497 who underwent 1 or more biopsies negative for prostate cancer and 61 diagnosed with prostate cancer. We evaluated the ROC AUC of percent free prostate specific antigen and the proportion of patients with fluctuating values across multiple visits determined according to 2 thresholds (less than 15% vs 25%). The proportion of cancer cases in which percent free prostate specific antigen indicated a positive test before prostate specific antigen greater than 4 ng/ml did and the number of negative biopsies that would have been spared by negative percent free prostate specific antigen test results were calculated. RESULTS Percent free prostate specific antigen fluctuated around its threshold of less than 25% (less than 15%) in 38.3% (78.1%), 42.2% (20.9%), and 11.4% (25.7%) of patients never biopsied, and with negative and positive biopsies, respectively. At the same thresholds, percent free prostate specific antigen tested positive earlier than prostate specific antigen in 71.4% and 34.2% of cancer cases, respectively. Among men with multiple negative biopsies and PSA greater than 4 ng/ml, percent free PSA would have tested negative in 31.6% and 65.8%, respectively. CONCLUSIONS Percent free prostate specific antigen should accompany prostate specific antigen testing to potentially spare unnecessary biopsies or detect cancer earlier. When near the threshold, both tests should be repeated due to commonly observed fluctuation.
Collapse
Affiliation(s)
- Donna Pauler Ankerst
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Mathematics, Technische Universitaet Muenchen, Munich, Germany.
| | - Jonathan Gelfond
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Martin Goros
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Jesus Herrera
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Andreas Strobl
- Department of Mathematics, Technische Universitaet Muenchen, Munich, Germany
| | - Ian M Thompson
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Javier Hernandez
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Robin J Leach
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| |
Collapse
|
26
|
Crawford ED, Rosenberg MT, Partin AW, Cooperberg MR, Maccini M, Loeb S, Pettaway CA, Shore ND, Arangua P, Hoenemeyer J, Leveridge M, Leapman M, Pinto P, Thompson IM, Carroll P, Eastham J, Gomella L, Klein EA. An Approach Using PSA Levels of 1.5 ng/mL as the Cutoff for Prostate Cancer Screening in Primary Care. Urology 2016; 96:116-120. [PMID: 27450937 DOI: 10.1016/j.urology.2016.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 06/22/2016] [Accepted: 07/01/2016] [Indexed: 10/21/2022]
Affiliation(s)
| | | | - Alan W Partin
- Department of Pathology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Matthew R Cooperberg
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | | | - Stacy Loeb
- Department of Urology and Population Health, New York University, New York, NY
| | - Curtis A Pettaway
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Neal D Shore
- Atlantic Urology Clinics, Carolina Urologic Research Center, Myrtle Beach, SC
| | - Paul Arangua
- University of Colorado Health Science Center, Aurora, CO
| | | | - Mike Leveridge
- Department of Urology, Department of Oncology, Kingston General Hospital, Queen's University, Kingston, ON
| | - Michael Leapman
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - Peter Pinto
- National Cancer Institute, Center for Cancer Research, Bethesda, MD
| | - Ian M Thompson
- Department of Urology, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Peter Carroll
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - James Eastham
- Department of Urology, Memorial Sloan Kettering Cancer Institute, New York, NY
| | - Leonard Gomella
- Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Eric A Klein
- Cleveland Clinic, Glickman Urological & Kidney Institute, Cleveland, OH
| |
Collapse
|
27
|
Preston MA, Batista JL, Wilson KM, Carlsson SV, Gerke T, Sjoberg DD, Dahl DM, Sesso HD, Feldman AS, Gann PH, Kibel AS, Vickers AJ, Mucci LA. Baseline Prostate-Specific Antigen Levels in Midlife Predict Lethal Prostate Cancer. J Clin Oncol 2016; 34:2705-11. [PMID: 27298404 DOI: 10.1200/jco.2016.66.7527] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Prostate-specific antigen (PSA) level in midlife predicted future prostate cancer (PCa) mortality in an unscreened Swedish population. Our purpose was to determine if a baseline PSA level during midlife predicts lethal PCa in a US population with opportunistic screening. MATERIALS AND METHODS We conducted a nested case-control study among men age 40 to 59 years who gave blood before random assignment in the Physicians' Health Study, a randomized, placebo-controlled trial of aspirin and β-carotene among 22,071 US male physicians initiated in 1982 and then transitioned into a prospective cohort with 30 years of follow-up. Baseline PSA levels were available for 234 patients with PCa and 711 age-matched controls. Seventy-one participants who developed lethal PCa were rematched to 213 controls. Conditional logistic regression was used to estimate odds ratios and the area under the receiver operating characteristic curve, with 95% CIs, of the association between baseline PSA and risk of lethal PCa. RESULTS Median PSA among controls was 0.68, 0.88, and 0.96 ng/mL for men age 40 to 49, 50 to 54, and 55 to 59 years, respectively. Risk of lethal PCa was strongly associated with baseline PSA in midlife: odds ratios (95% CIs) comparing PSA in the > 90th percentile versus less than or equal to median were 8.7 (1.0 to 78.2) at 40 to 49 years, 12.6 (1.4 to 110.4) at 50 to 54 years, and 6.9 (2.5 to 19.1) at 55 to 59 years. A total of 82%, 71%, and 86% of lethal cases occurred in men with PSA above the median at ages 40 to 49, 50 to 54, and 55 to 59 years, respectively. CONCLUSION PSA levels in midlife strongly predict future lethal PCa in a US cohort subject to opportunistic screening. Risk-stratified screening on the basis of midlife PSA should be considered in men age 45 to 59 years.
Collapse
Affiliation(s)
- Mark A Preston
- Mark A. Preston, Julie L. Batista, Howard D. Sesso, and Adam S. Kibel, Brigham and Women's Hospital; Julie L. Batista, Kathryn M. Wilson, Travis Gerke, Howard D. Sesso, and Lorelei A. Mucci, Harvard T. H. Chan School of Public Health; Julie L. Batista, Harvard Medical School; Douglas M. Dahl and Adam S. Feldman, Massachusetts General Hospital, Boston, MA; Sigrid V. Carlsson, Daniel D. Sjoberg, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Sigrid V. Carlsson, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; and Peter H. Gann, University of Illinois at Chicago, Chicago, IL.
| | - Julie L Batista
- Mark A. Preston, Julie L. Batista, Howard D. Sesso, and Adam S. Kibel, Brigham and Women's Hospital; Julie L. Batista, Kathryn M. Wilson, Travis Gerke, Howard D. Sesso, and Lorelei A. Mucci, Harvard T. H. Chan School of Public Health; Julie L. Batista, Harvard Medical School; Douglas M. Dahl and Adam S. Feldman, Massachusetts General Hospital, Boston, MA; Sigrid V. Carlsson, Daniel D. Sjoberg, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Sigrid V. Carlsson, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; and Peter H. Gann, University of Illinois at Chicago, Chicago, IL
| | - Kathryn M Wilson
- Mark A. Preston, Julie L. Batista, Howard D. Sesso, and Adam S. Kibel, Brigham and Women's Hospital; Julie L. Batista, Kathryn M. Wilson, Travis Gerke, Howard D. Sesso, and Lorelei A. Mucci, Harvard T. H. Chan School of Public Health; Julie L. Batista, Harvard Medical School; Douglas M. Dahl and Adam S. Feldman, Massachusetts General Hospital, Boston, MA; Sigrid V. Carlsson, Daniel D. Sjoberg, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Sigrid V. Carlsson, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; and Peter H. Gann, University of Illinois at Chicago, Chicago, IL
| | - Sigrid V Carlsson
- Mark A. Preston, Julie L. Batista, Howard D. Sesso, and Adam S. Kibel, Brigham and Women's Hospital; Julie L. Batista, Kathryn M. Wilson, Travis Gerke, Howard D. Sesso, and Lorelei A. Mucci, Harvard T. H. Chan School of Public Health; Julie L. Batista, Harvard Medical School; Douglas M. Dahl and Adam S. Feldman, Massachusetts General Hospital, Boston, MA; Sigrid V. Carlsson, Daniel D. Sjoberg, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Sigrid V. Carlsson, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; and Peter H. Gann, University of Illinois at Chicago, Chicago, IL
| | - Travis Gerke
- Mark A. Preston, Julie L. Batista, Howard D. Sesso, and Adam S. Kibel, Brigham and Women's Hospital; Julie L. Batista, Kathryn M. Wilson, Travis Gerke, Howard D. Sesso, and Lorelei A. Mucci, Harvard T. H. Chan School of Public Health; Julie L. Batista, Harvard Medical School; Douglas M. Dahl and Adam S. Feldman, Massachusetts General Hospital, Boston, MA; Sigrid V. Carlsson, Daniel D. Sjoberg, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Sigrid V. Carlsson, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; and Peter H. Gann, University of Illinois at Chicago, Chicago, IL
| | - Daniel D Sjoberg
- Mark A. Preston, Julie L. Batista, Howard D. Sesso, and Adam S. Kibel, Brigham and Women's Hospital; Julie L. Batista, Kathryn M. Wilson, Travis Gerke, Howard D. Sesso, and Lorelei A. Mucci, Harvard T. H. Chan School of Public Health; Julie L. Batista, Harvard Medical School; Douglas M. Dahl and Adam S. Feldman, Massachusetts General Hospital, Boston, MA; Sigrid V. Carlsson, Daniel D. Sjoberg, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Sigrid V. Carlsson, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; and Peter H. Gann, University of Illinois at Chicago, Chicago, IL
| | - Douglas M Dahl
- Mark A. Preston, Julie L. Batista, Howard D. Sesso, and Adam S. Kibel, Brigham and Women's Hospital; Julie L. Batista, Kathryn M. Wilson, Travis Gerke, Howard D. Sesso, and Lorelei A. Mucci, Harvard T. H. Chan School of Public Health; Julie L. Batista, Harvard Medical School; Douglas M. Dahl and Adam S. Feldman, Massachusetts General Hospital, Boston, MA; Sigrid V. Carlsson, Daniel D. Sjoberg, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Sigrid V. Carlsson, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; and Peter H. Gann, University of Illinois at Chicago, Chicago, IL
| | - Howard D Sesso
- Mark A. Preston, Julie L. Batista, Howard D. Sesso, and Adam S. Kibel, Brigham and Women's Hospital; Julie L. Batista, Kathryn M. Wilson, Travis Gerke, Howard D. Sesso, and Lorelei A. Mucci, Harvard T. H. Chan School of Public Health; Julie L. Batista, Harvard Medical School; Douglas M. Dahl and Adam S. Feldman, Massachusetts General Hospital, Boston, MA; Sigrid V. Carlsson, Daniel D. Sjoberg, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Sigrid V. Carlsson, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; and Peter H. Gann, University of Illinois at Chicago, Chicago, IL
| | - Adam S Feldman
- Mark A. Preston, Julie L. Batista, Howard D. Sesso, and Adam S. Kibel, Brigham and Women's Hospital; Julie L. Batista, Kathryn M. Wilson, Travis Gerke, Howard D. Sesso, and Lorelei A. Mucci, Harvard T. H. Chan School of Public Health; Julie L. Batista, Harvard Medical School; Douglas M. Dahl and Adam S. Feldman, Massachusetts General Hospital, Boston, MA; Sigrid V. Carlsson, Daniel D. Sjoberg, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Sigrid V. Carlsson, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; and Peter H. Gann, University of Illinois at Chicago, Chicago, IL
| | - Peter H Gann
- Mark A. Preston, Julie L. Batista, Howard D. Sesso, and Adam S. Kibel, Brigham and Women's Hospital; Julie L. Batista, Kathryn M. Wilson, Travis Gerke, Howard D. Sesso, and Lorelei A. Mucci, Harvard T. H. Chan School of Public Health; Julie L. Batista, Harvard Medical School; Douglas M. Dahl and Adam S. Feldman, Massachusetts General Hospital, Boston, MA; Sigrid V. Carlsson, Daniel D. Sjoberg, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Sigrid V. Carlsson, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; and Peter H. Gann, University of Illinois at Chicago, Chicago, IL
| | - Adam S Kibel
- Mark A. Preston, Julie L. Batista, Howard D. Sesso, and Adam S. Kibel, Brigham and Women's Hospital; Julie L. Batista, Kathryn M. Wilson, Travis Gerke, Howard D. Sesso, and Lorelei A. Mucci, Harvard T. H. Chan School of Public Health; Julie L. Batista, Harvard Medical School; Douglas M. Dahl and Adam S. Feldman, Massachusetts General Hospital, Boston, MA; Sigrid V. Carlsson, Daniel D. Sjoberg, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Sigrid V. Carlsson, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; and Peter H. Gann, University of Illinois at Chicago, Chicago, IL
| | - Andrew J Vickers
- Mark A. Preston, Julie L. Batista, Howard D. Sesso, and Adam S. Kibel, Brigham and Women's Hospital; Julie L. Batista, Kathryn M. Wilson, Travis Gerke, Howard D. Sesso, and Lorelei A. Mucci, Harvard T. H. Chan School of Public Health; Julie L. Batista, Harvard Medical School; Douglas M. Dahl and Adam S. Feldman, Massachusetts General Hospital, Boston, MA; Sigrid V. Carlsson, Daniel D. Sjoberg, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Sigrid V. Carlsson, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; and Peter H. Gann, University of Illinois at Chicago, Chicago, IL
| | - Lorelei A Mucci
- Mark A. Preston, Julie L. Batista, Howard D. Sesso, and Adam S. Kibel, Brigham and Women's Hospital; Julie L. Batista, Kathryn M. Wilson, Travis Gerke, Howard D. Sesso, and Lorelei A. Mucci, Harvard T. H. Chan School of Public Health; Julie L. Batista, Harvard Medical School; Douglas M. Dahl and Adam S. Feldman, Massachusetts General Hospital, Boston, MA; Sigrid V. Carlsson, Daniel D. Sjoberg, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Sigrid V. Carlsson, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; and Peter H. Gann, University of Illinois at Chicago, Chicago, IL
| |
Collapse
|
28
|
Packer JR, Maitland NJ. The molecular and cellular origin of human prostate cancer. BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2016; 1863:1238-60. [DOI: 10.1016/j.bbamcr.2016.02.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/17/2016] [Accepted: 02/22/2016] [Indexed: 01/01/2023]
|
29
|
Endzeliņš E, Melne V, Kalniņa Z, Lietuvietis V, Riekstiņa U, Llorente A, Linē A. Diagnostic, prognostic and predictive value of cell-free miRNAs in prostate cancer: a systematic review. Mol Cancer 2016; 15:41. [PMID: 27189160 PMCID: PMC4870749 DOI: 10.1186/s12943-016-0523-5] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 05/12/2016] [Indexed: 01/01/2023] Open
Abstract
Prostate cancer, the second most frequently diagnosed cancer in males worldwide, is estimated to be diagnosed in 1.1 million men per year. Introduction of PSA testing substantially improved early detection of prostate cancer, however it also led to overdiagnosis and subsequent overtreatment of patients with an indolent disease. Treatment outcome and management of prostate cancer could be improved by the development of non-invasive biomarker assays that aid in increasing the sensitivity and specificity of prostate cancer screening, help to distinguish aggressive from indolent disease and guide therapeutic decisions. Prostate cancer cells release miRNAs into the bloodstream, where they exist incorporated into ribonucleoprotein complexes or extracellular vesicles. Later, cell-free miRNAs have been found in various other biofluids. The initial RNA sequencing studies suggested that most of the circulating cell-free miRNAs in healthy individuals are derived from blood cells, while specific disease-associated miRNA signatures may appear in the circulation of patients affected with various diseases, including cancer. This raised a hope that cell-free miRNAs may serve as non-invasive biomarkers for prostate cancer. Indeed, a number of cell-free miRNAs that potentially may serve as diagnostic, prognostic or predictive biomarkers have been discovered in blood or other biofluids of prostate cancer patients and need to be validated in appropriately designed longitudinal studies and clinical trials. In this review, we systematically summarise studies investigating cell-free miRNAs in biofluids of prostate cancer patients and discuss the utility of the identified biomarkers in various clinical scenarios. Furthermore, we discuss the possible mechanisms of miRNA release into biofluids and outline the biological questions and technical challenges that have arisen from these studies.
Collapse
Affiliation(s)
- Edgars Endzeliņš
- Latvian Biomedical Research and Study Centre, Ratsupites Str 1, k-1, LV-1067, Riga, Latvia
| | - Vita Melne
- Latvian Biomedical Research and Study Centre, Ratsupites Str 1, k-1, LV-1067, Riga, Latvia.,Riga Stradiņš University, Dzirciema Str 16, Riga, LV-1007, Latvia
| | - Zane Kalniņa
- Latvian Biomedical Research and Study Centre, Ratsupites Str 1, k-1, LV-1067, Riga, Latvia
| | - Vilnis Lietuvietis
- Latvian Biomedical Research and Study Centre, Ratsupites Str 1, k-1, LV-1067, Riga, Latvia.,Riga Stradiņš University, Dzirciema Str 16, Riga, LV-1007, Latvia
| | - Una Riekstiņa
- Faculty of Medicine, University of Latvia, 19 Raina blvd., Riga, LV-1586, Latvia
| | - Alicia Llorente
- Department of Molecular Cell Biology, Institute for Cancer Research, Oslo University Hospital-The Norwegian Radium Hospital, 0379, Oslo, Norway
| | - Aija Linē
- Latvian Biomedical Research and Study Centre, Ratsupites Str 1, k-1, LV-1067, Riga, Latvia.
| |
Collapse
|
30
|
Vickers AJ, Eastham JA, Scardino PT, Lilja H. The Memorial Sloan Kettering Cancer Center Recommendations for Prostate Cancer Screening. Urology 2016; 91:12-8. [PMID: 26850815 PMCID: PMC4842100 DOI: 10.1016/j.urology.2015.12.054] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/10/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
Abstract
The Memorial Sloan Kettering Cancer Center (MSKCC) recommendations on prostate cancer screening were developed in response to three limitations of previous screening guidelines: insufficient evidence base, failure to link screening with treatment, and lack of risk stratification. The objective of the recommendations is to provide a schema for prostate cancer screening that maximizes the benefits, in terms of reduction in prostate cancer-specific mortality, and minimizes the harms, in terms of overdiagnosis and overtreatment. We recommend the following schema for men choosing to be screened following informed decision-making: starting at age 45, prostate-specific antigen (PSA) without digital rectal examination. If PSA ≥ 3 ng/mL: consider prostate biopsy; if PSA ≥ 1 but < 3 ng/mL: return for PSA testing every 2-4 years; if PSA < 1 ng/mL: return for PSA testing at 6-10 years. PSA testing should end at age 60 for men with PSA ≤ 1 ng/ mL; at 70, unless a man is very healthy and has a higher than average PSA; at 75 for all men. The decision to biopsy a man with a PSA > 3 ng/mL should be based on a variety of factors including repeat blood draw for confirmatory testing of the PSA level, digital rectal examination results, and workup for benign disease. Additional reflex tests in blood such as a free-to-total PSA ratio, the Prostate Health Index, or 4Kscore, or urinary testing of PCA3, can also be informative in some patients. The best evidence suggests that more restricted indication for prostate biopsy and a more focused approach to pursue screening in men at highest risk of lethal cancer would retain most of the mortality benefits of aggressive screening schema, while importantly reducing harms from overdetection and overtreatment.
Collapse
Affiliation(s)
| | | | | | - Hans Lilja
- Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
31
|
Lazzeri M, Guazzoni G, Montorsi F. Total and Free PSA, PCA3, PSA Density and Velocity. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
32
|
Vázquez-Salas RA, Torres-Sánchez L, López-Carrillo L, Romero-Martínez M, Manzanilla-García HA, Cruz-Ortíz CH, Mendoza-Peña F, Jiménez-Ríos MÁ, Rodríguez-Covarrubias F, Hernández-Toríz N, Moreno-Alcázar O. History of gonorrhea and prostate cancer in a population-based case-control study in Mexico. Cancer Epidemiol 2015; 40:95-101. [PMID: 26706364 DOI: 10.1016/j.canep.2015.12.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 11/18/2015] [Accepted: 12/03/2015] [Indexed: 01/11/2023]
Abstract
UNLABELLED We evaluated the association between a history of sexually transmitted diseases (STDs) and the risk for prostate cancer (PC) among Mexican males. METHODS PC incident cases (n=402) that were identified at six public hospitals in Mexico City were matched by age (±5 years) with 805 population controls with no history of PC. By face-to-face interview, we obtained information about sexual history, previous STDs, sociodemographic characteristics, and familial history of PC. An unconditional logistic regression model was used to estimate the risk for PC. RESULTS A total of 16.6% of men reported having had at least one previous STD, and the most frequently reported STD was gonorrhea (10.5%). After adjusting by PC familial history, the history of STD was associated with a two-fold greater risk of PC: odds ratio (OR)=2.67; 95% confidence interval (95% CI=1.91-3.73). When each STD was evaluated separately, only gonorrhea was associated with a significant increase in PC risk (OR=3.04; 95% CI=1.99-4.64). These associations were similar when we stratified by low-risk PC (Gleason <7) and high-risk PC (Gleason ≥7). CONCLUSION These results confirm that STDs, and particularly gonorrhea, may play an etiological role in PC among Mexican males, which is consistent with a previous report from a multiethnic cohort.
Collapse
Affiliation(s)
- Ruth Argelia Vázquez-Salas
- Instituto Nacional de Salud Pública (INSP), Av. Universidad 655, Col. Sta. María Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico
| | - Luisa Torres-Sánchez
- Instituto Nacional de Salud Pública (INSP), Av. Universidad 655, Col. Sta. María Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico.
| | - Lizbeth López-Carrillo
- Instituto Nacional de Salud Pública (INSP), Av. Universidad 655, Col. Sta. María Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico
| | - Martín Romero-Martínez
- Instituto Nacional de Salud Pública (INSP), Av. Universidad 655, Col. Sta. María Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico
| | - Hugo A Manzanilla-García
- Hospital General de México, Dr. Balmis 148, Col. Doctores, Deleg. Cuauhtémoc, 06726 México, D.F., Mexico
| | - Carlos Humberto Cruz-Ortíz
- Hospital General de México, Dr. Balmis 148, Col. Doctores, Deleg. Cuauhtémoc, 06726 México, D.F., Mexico
| | - Fernando Mendoza-Peña
- Hospital Regional "Lic. Adolfo López Mateos" (ISSSTE), Av. Universidad 1321, Col. Florida Deleg. Álvaro Obregón, 01030 México, D.F., Mexico
| | - Miguel Ángel Jiménez-Ríos
- Instituto Nacional de Cancerología (INCan), Av. San Fernando No. 22, Col. Sección XVI, Deleg. Tlalpan, 14080 México, D.F., Mexico
| | - Francisco Rodríguez-Covarrubias
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Av. Vasco de Quiroga 15, Col. Belisario Domínguez, Col. Sección XVI, Deleg. Tlalpan, 14080 México, D.F, Mexico
| | - Narciso Hernández-Toríz
- Hospital de Oncología, Centro Médico Siglo XXI (CMN-SXXI), Instituto Mexicano del Seguro Social (IMSS), Av. Cuauhtémoc 330, Col. Doctores, Deleg. Cuauhtémoc, México, D.F., 06720, Mexico
| | - Othón Moreno-Alcázar
- Hospital General Regional No. 1. "Carlos MacGregor Sánchez Navarro" (IMSS), Eje 2 Pte 222, Col. Del Valle Centro, Deleg. Benito Juárez, 03100 México, D.F., Mexico
| |
Collapse
|
33
|
Godtman RA, Carlsson S, Holmberg E, Stranne J, Hugosson J. The Effect of Start and Stop Age at Screening on the Risk of Being Diagnosed with Prostate Cancer. J Urol 2015; 195:1390-1396. [PMID: 26678954 DOI: 10.1016/j.juro.2015.11.062] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE We investigated the effect of age and number of screens on the risk of prostate cancer diagnosis. MATERIALS AND METHODS Since 1995 the Göteborg randomized population based prostate cancer screening trial has invited men biennially for prostate specific antigen testing, until the upper age limit of 70 years. Men with a prostate specific antigen above the threshold of 2.5 ng/ml were recommended further evaluation including 10-core biopsy (sextant before 2009). The present study comprises 9,065 men born between 1930 and 1943 (1944 excluded due to different screening algorithm). Complete attendees were defined as men who accepted all screening invitations (maximum 3 to 9 invitations). The cumulative incidence of prostate cancer was calculated using standard methods. RESULTS Of the 3,488 (38%) complete attendees 667 were diagnosed with prostate cancer (followup 1995 to June 30, 2014). At age 70 years there was no significant difference in prostate cancer risk among those who started screening at the age of 52 (9 screens), 55 (7 screens) or 60 (5 screens) years. However, the cumulative risk of prostate cancer diagnosis increased dramatically with age, and was 7.9% at age 60, 15% at age 65 and 21% at age 70 for men who had been screened 4 or more times. CONCLUSIONS There was no clear association between risk of prostate cancer and the number of screens. Starting screening at an early age appears to advance the time of prostate cancer diagnosis but does not seem to increase the risk of being diagnosed with the disease. Age at termination of screening is strongly associated with the risk of being diagnosed with prostate cancer.
Collapse
Affiliation(s)
- Rebecka Arnsrud Godtman
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Göteborg, Sahlgrenska University Hospital, Göteborg, Sweden.
| | - Sigrid Carlsson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Göteborg, Göteborg, Sweden; Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erik Holmberg
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Göteborg, Göteborg, Sweden
| | - Johan Stranne
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Göteborg, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Jonas Hugosson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Göteborg, Göteborg, Sweden
| |
Collapse
|
34
|
Angulo J, Viñas M, Gimbernat H, Fata FRD, Granados R, Luján M. Baseline PSA in a Spanish male population aged 40-49 years anticipates detection of prostate cancer. Actas Urol Esp 2015; 39:605-11. [PMID: 26099906 DOI: 10.1016/j.acuro.2015.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 05/04/2015] [Accepted: 05/05/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION We researched the usefulness of optimizing prostate cancer (PC) screening in our community using baseline PSA readings in men between 40-49 years of age. MATERIAL AND METHOD A retrospective study was performed that analyzed baseline PSA in the fifth decade of life and its ability to predict the development of PC in a population of Madrid (Spain). An ROC curve was created and a cutoff was proposed. We compared the evolution of PSA from baseline in patients with consecutive readings using the Friedman test. We established baseline PSA ranges with different risks of developing cancer and assessed the diagnostic utility of the annual PSA velocity (PSAV) in this population. RESULTS Some 4,304 men aged 40-49 years underwent opportunistic screening over the course of 17 years, with at least one serum PSA reading (6,001 readings) and a mean follow-up of 57.1±36.8 months. Of these, 768 underwent biopsy of some organ, and 104 underwent prostate biopsy. Fourteen patients (.33%) were diagnosed with prostate cancer. The median baseline PSA was .74 (.01-58.5) ng/mL for patients without PC and 4.21 (.76-47.4) ng/mL for those with PC. The median time from the reading to diagnosis was 26.8 (1.5-143.8) months. The optimal cutoff for detecting PC was 1.9ng/mL (sensitivity, 92.86%; specificity, 92.54%; PPV, 3.9%; NPV, 99.97%), and the area under the curve was 92.8%. In terms of the repeated reading, the evolution of the PSA showed no statistically significant differences between the patients without cancer (p=.56) and those with cancer (P=.64). However, a PSAV value >.3ng/mL/year revealed high specificity for detecting cancer in this population. CONCLUSIONS A baseline PSA level ≥1.9ng/mL in Spanish men aged 40-49 years predicted the development of PC. This value could therefore be of use for opportunistic screening at an early age. An appropriate follow-up adapted to the risk of this population needs to be defined, but an annual PSAV ≥.3ng/mL/year appears of use for reaching an early diagnosis.
Collapse
|
35
|
Loeb S. Editorial Comment. Urology 2015; 86:504-5. [PMID: 26282019 DOI: 10.1016/j.urology.2015.04.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Stacy Loeb
- Department of Urology, New York University, New York, NY; Department of Population Health, New York University, New York, NY; Laura and Isaac Perlmutter Cancer Center, New York University, New York, NY; Manhattan Veterans Affairs Medical Center, New York, NY
| |
Collapse
|
36
|
Gondos A, Krilaviciute A, Smailyte G, Ulys A, Brenner H. Cancer surveillance using registry data: Results and recommendations for the Lithuanian national prostate cancer early detection programme. Eur J Cancer 2015; 51:1630-7. [DOI: 10.1016/j.ejca.2015.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 04/12/2015] [Accepted: 04/14/2015] [Indexed: 10/23/2022]
|
37
|
Stattin P, Vickers AJ, Sjoberg DD, Johansson R, Granfors T, Johansson M, Pettersson K, Scardino PT, Hallmans G, Lilja H. Improving the Specificity of Screening for Lethal Prostate Cancer Using Prostate-specific Antigen and a Panel of Kallikrein Markers: A Nested Case-Control Study. Eur Urol 2015; 68:207-13. [PMID: 25682340 PMCID: PMC4496315 DOI: 10.1016/j.eururo.2015.01.009] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/09/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND A disadvantage of prostate-specific antigen (PSA) for the early detection of prostate cancer (PCa) is that many men must be screened, biopsied, and diagnosed to prevent one death. OBJECTIVE To increase the specificity of screening for lethal PCa at an early stage. DESIGN, SETTING, AND PARTICIPANTS We conducted a case-control study nested within a population-based cohort. PSA and three additional kallikreins were measured in cryopreserved blood from a population-based cohort in Västerbotten, Sweden. Of 40379 men providing blood at ages 40, 50, and 60 yr from 1986 to 2009, 12542 men were followed for >15 yr. From this cohort, the Swedish Cancer Registry identified 1423 incident PCa cases, 235 with distant metastasis. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Risk of distant metastasis for different PSA levels and a prespecified statistical model based on the four kallikrein markers. RESULTS AND LIMITATIONS Most metastatic cases occurred in men with PSA in the top quartile at age 50 yr (69%) or 60 yr (74%), whereas 20-yr risk of metastasis for men with PSA below median was low (≤0.6%). Among men with PSA >2 ng/ml, a prespecified model based on four kallikrein markers significantly enhanced the prediction of metastasis compared with PSA alone. About half of all men with PSA >2 ng/ml were defined as low risk by this model and had a ≤1% 15-yr risk of metastasis. CONCLUSIONS Screening at ages 50-60 yr should focus on men with PSA in the top quartile. A marker panel can aid biopsy decision making. PATIENT SUMMARY For men in their fifties, screening should focus on those in the top 10% to 25% of PSA values because the majority of subsequent cases of distant metastasis are found among these men. Testing of four kallikrein markers in men with an elevated PSA could aid biopsy decision making.
Collapse
Affiliation(s)
- Pär Stattin
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert Johansson
- Regional Cancer Centre, Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | | | - Mattias Johansson
- Section of Genetics, The International Agency for Research on Cancer, Lyon, France
| | - Kim Pettersson
- Division of Biotechnology, University of Turku, Turku, Finland
| | - Peter T Scardino
- Department of Surgery (Urology), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Göran Hallmans
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden
| | - Hans Lilja
- Department of Surgery (Urology), Memorial Sloan Kettering Cancer Center, New York, NY, USA; Departments of Laboratory Medicine and Medicine (Genitourinary Oncology), Memorial Sloan Kettering Cancer Center, New York, NY, USA; Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headington, Oxford, UK; Department of Translational Medicine, Lund University, Skåne University Hospital, Malmö, Sweden.
| |
Collapse
|
38
|
Gelfond J, Choate K, Ankerst DP, Hernandez J, Leach RJ, Thompson IM. Intermediate-Term Risk of Prostate Cancer is Directly Related to Baseline Prostate Specific Antigen: Implications for Reducing the Burden of Prostate Specific Antigen Screening. J Urol 2015; 194:46-51. [DOI: 10.1016/j.juro.2015.02.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2015] [Indexed: 10/24/2022]
Affiliation(s)
- Jonathan Gelfond
- Department of Biostatistics and Epidemiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Kara Choate
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Donna P. Ankerst
- Department of Biostatistics and Epidemiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Javier Hernandez
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Robin J. Leach
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Cellular and Structural Biology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Ian M. Thompson
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| |
Collapse
|
39
|
Tsui KH, Chung LC, Feng TH, Lee TY, Chang PL, Chen WT, Juang HH. Divergent effect of liver X receptor agonists on prostate-specific antigen expression is dependent on androgen receptor in prostate carcinoma cells. Prostate 2015; 75:603-15. [PMID: 25560459 DOI: 10.1002/pros.22944] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 11/17/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Liver X receptor (LXR) isoforms, LXRα and LXRβ, have similar protein structures and ligands, but diverse tissue distribution. We used two synthetic, non-steroidal LXR agonists, T0901317 and GW3965, to investigate the effects of LXR agonist modulation on prostate specific antigen (PSA) via the expressions of androgen receptors (AR), LXRα, or LXRβ, in prostate carcinoma cells. METHODS LXRα- or LXRβ-knockdown cells were transduced with specific shRNA lentiviral particles. LXRα and LXRβ expressions were assessed by immunoblotting and RT-qPCR assays. Cell proliferation was determined by (3) H-thymidine incorporation assays. The effects of LXR agonists and epigallocatechin gallate (EGCG) on PSA expression were determined by ELISA, immunoblotting, or transient gene expression assays. RESULTS Treatment with either T0901317 or GW3965 significantly attenuated cell proliferation of LNCaP cells. T0901317 treatment suppressed PSA expression while GW3965 treatment enhanced PSA expression. The increase of PSA promoter activity by GW3965 was dependent on the expression of AR. Either LXRα- or LXRβ-knockdown did not affect the activation of androgen on PSA gene expression. However, as compared with mock knockdown-LNCaP cells, the LXRα-knockdown but not the LXRβ-knockdown attenuated the effects of T0901317 and GW3965 on PSA expressions. The effect of GW3965 on PSA expression was blocked by the addition of EGCG. CONCLUSIONS Our results indicate that T0901317 and GW3965 have divergent effects on PSA expressions. The effects of LXR agonists on PSA expression are LXRα-dependent and AR-dependent. EGCG blocks the inducing effect of GW3965 on PSA expression.
Collapse
Affiliation(s)
- Ke-Hung Tsui
- Department of Urology, Chang Gung Memorial Hospital-Linko, Kwei-Shan, Tao-Yuan, Taiwan; Department of Anatomy, College of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan
| | | | | | | | | | | | | |
Collapse
|
40
|
Prostate Specific Antigen as a Tumor Marker in Prostate Cancer: Biochemical and Clinical Aspects. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 867:93-114. [PMID: 26530362 DOI: 10.1007/978-94-017-7215-0_7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In this chapter the use of prostate specific antigen (PSA) as a tumor marker for prostate cancer is discussed. The chapter provides an overview of biological and clinical aspects of PSA. The main drawback of total PSA (tPSA) is its lack of specificity for prostate cancer which leads to unnecessary biopsies. Moreover, PSA-testing poses a risk of overdiagnosis and subsequent overtreatment. Many PSA-based markers have been developed to improve the performance characteristics of tPSA. As well as different molecular subforms of tPSA, such as proPSA (pPSA) and free PSA (fPSA), and PSA derived kinetics as PSA-velocity (PSAV) and PSA-doubling time (PSADT). The prostate health index (phi), PSA-density (PSAD) and the contribution of non PSA-based markers such as the urinary transcripts of PCA3 and TMPRSS-ERG fusion are also discussed. To enable further risk stratification tumor markers are often combined with clinical data (e.g. outcome of DRE) in so-called nomograms. Currently the role of magnetic resonance imaging (MRI) in the detection and staging of prostate cancer is being explored.
Collapse
|
41
|
Fornara P, Theil G, Schaefer C, Heß J, Rübben H. Benefits and Risks of Prostate Cancer Screening. Oncol Res Treat 2014; 37 Suppl 3:29-37. [DOI: 10.1159/000363756] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
42
|
Chiang KC, Tsui KH, Chung LC, Yeh CN, Feng TH, Chen WT, Chang PL, Chiang HY, Juang HH. Cisplatin modulates B-cell translocation gene 2 to attenuate cell proliferation of prostate carcinoma cells in both p53-dependent and p53-independent pathways. Sci Rep 2014; 4:5511. [PMID: 24981574 PMCID: PMC4076686 DOI: 10.1038/srep05511] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 06/11/2014] [Indexed: 12/29/2022] Open
Abstract
Cisplatin is a widely used anti-cancer drug. The B-cell translocation gene 2 (BTG2) is involved in the cell cycle transition regulation. We evaluated the cisplatin effects on prostate cancer cell proliferation and the expressions of BTG2, p53, androgen receptor (AR) and prostate specific antigen (PSA) in prostate carcinoma, p53 wild-type LNCaP or p53-null PC-3, cells. Cisplatin treatments attenuated cell prostate cancer cell growth through inducing Go/G1 cell cycle arrest in lower concentration and apoptosis at higher dosage. Cisplatin treatments enhanced p53 and BTG2 expression, repressed AR and PSA expression, and blocked the activation of androgen on the PSA secretion in LNCaP cells. BTG2 knockdown in LNCaP cells attenuated cisplatin-mediated growth inhibition. Cisplatin enhanced BTG2 gene expression dependent on the DNA fragment located within -173 to -82 upstream of BTG2 translation initiation site in prostate cancer cells. Mutation of the p53 response element from GGGCAGAGCCC to GGGCACC or mutation of the NFκB response element from GGAAAGTCC to GGAAAGGAA by site-directed mutagenesis abolished the stimulation of cisplatin on the BTG2 promoter activity in LNCaP or PC-3 cells, respectively. Our results indicated that cisplatin attenuates prostate cancer cell proliferation partly mediated by upregulation of BTG2 through the p53-dependent pathway or p53-independent NFκB pathway.
Collapse
Affiliation(s)
- Kun-Chun Chiang
- Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC
- These authors contributed equally to this work
| | - Ke-Hung Tsui
- Department of Urology, Chang Gung Memorial Hospital, Kwei-Shan, Tao-Yuan, Taiwan, ROC
- These authors contributed equally to this work
| | - Li-Chuan Chung
- Department of Anatomy, College of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan, ROC
| | - Chun-Nan Yeh
- Department of General Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Tao-Yuan, Taiwan, ROC
| | - Tsui-Hsia Feng
- School of Nursing, College of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan, ROC
| | - Wen-Tsung Chen
- National Kaohsiung University of Hospitality and Tourism, Hsiao-Kang, Kaohsiung Taiwan R.O.C
| | - Phei-Lang Chang
- Department of Urology, Chang Gung Memorial Hospital, Kwei-Shan, Tao-Yuan, Taiwan, ROC
| | - Hou-Yu Chiang
- Department of Anatomy, College of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan, ROC
| | - Horng-Heng Juang
- Department of Anatomy, College of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan, ROC
| |
Collapse
|
43
|
Auffenberg GB, Meeks JJ. Application of the 2013 American Urological Association early detection of prostate cancer guideline: who will we miss? World J Urol 2014; 32:959-64. [PMID: 24946729 DOI: 10.1007/s00345-014-1341-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 06/04/2014] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The American Urological Association (AUA) published new prostate cancer (CaP) screening guidelines in 2013. We apply the guidelines to a retrospective cohort to compare tumor characteristics of those no longer recommended for screening with those who remain screening candidates. METHODS We identified cases of screening detected CaP (stage cT1c) in the Surveillance Epidemiology and End Results database from October 2005 to December 2010. The 2013 AUA Guidelines were retrospectively applied to the cohort. Men were categorized into three groups for comparison based on whether or not they would now be recommended for CaP screening (Unscreened, Young Unscreened, and Screened). We compared clinical and pathological characteristics of CaP across study groups. RESULTS A total of 142,382 men were identified. Screening would no longer be recommended for 40,160. Those no longer recommended for screening had higher median PSA (6.4 vs. 5.8 ng/mL, p < 0.01), more Gleason 7 and ≥8 CaP on prostate biopsy (36.4 vs. 34.8 %, p < 0.001; 12.4 vs. 9.2 %, p < 0.001, respectively) and slightly more Gleason ≥8 CaP (9.0 vs. 7.5 %, p = 0.03), and T3 tumors (17.3 vs. 16.5 %, p = 0.01) at prostatectomy. Nodal and distant metastasis rates were clinically equivalent among men screened and unscreened. Subgroup analysis of young patients (40-54 years old) no longer recommended for screening identified intermediate or high-risk Gleason scores at prostatectomy 57.6 % of the time. CONCLUSIONS Features of CaP in men no longer recommended for routine screening are largely equivalent to if not worse than those in screened men.
Collapse
Affiliation(s)
- Gregory B Auffenberg
- Department of Urology, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave., Tarry 16-703, Chicago, IL, 60611, USA
| | | |
Collapse
|
44
|
Park HG, Ko OS, Kim YG, Park JK. Efficacy of Repeated Transrectal Prostate Biopsy in Men Younger Than 50 Years With an Elevated Prostate-Specific Antigen Concentration (>3.0 ng/mL): Risks and Benefits Based on Biopsy Results and Follow-up Status. Korean J Urol 2014; 55:249-53. [PMID: 24741413 PMCID: PMC3988435 DOI: 10.4111/kju.2014.55.4.249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 10/14/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Prostate cancer is rare in men younger than 50 years. Digital rectal examination (DRE) and measurement of prostate-specific antigen (PSA) concentrations are standard screening methods for detecting prostate cancer. We retrospectively investigated the risks and benefits of repeated transrectal ultrasonography-guided prostate needle biopsies in relation to the follow-up status of men younger than 50 years with a consistently high PSA concentration (>3.0 ng/mL). MATERIALS AND METHODS During the period from January 2000 through February 2013, we reviewed patient's ages, dates of procedures, DRE results, frequencies of biopsies, results of the biopsies, periods of follow-up, PSA concentrations, and prostate volumes in Chonbuk National University Hospital records. We conducted telephone interviews in patients who did not undergo regular follow-up. RESULTS The mean age of the patients was 44.7 years, and the mean PSA concentration was 8.59 ng/mL (range, 3.04-131 ng/mL) before biopsy. The PSA concentration was significantly different (p<0.001) between the patients with prostate cancer and those with benign prostatic hyperplasia (BPH). Nineteen patients underwent repeated prostate biopsy; however, in only one patient did the pathologic findings indicate a change from BPH to prostate cancer. We identified several complications after transrectal biopsy through an evaluation of follow-up data. CONCLUSIONS All patients with benign prostatic disease based on their first biopsy were shown to have benign disease based on all repeated biopsies (15.83%), except for one patient; however, several complications were noted after biopsy. Therefore, the risks and benefits of repeated biopsy in young patients should be considered because of the low rate of change from benign to malignant disease despite continuously high PSA concentrations (>3.0 ng/mL).
Collapse
Affiliation(s)
- Ho Gyun Park
- Department of Urology, Chonbuk National University Medical School, Jeonju, Korea
| | - Oh Seok Ko
- Department of Urology, Chonbuk National University Medical School, Jeonju, Korea
| | - Young Gon Kim
- Department of Urology, Chonbuk National University Medical School, Jeonju, Korea
| | - Jong Kwan Park
- Department of Urology, Chonbuk National University Medical School, Jeonju, Korea. ; Institute for Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea. ; Biomedical Research Institute, Chonbuk National University Medical School, Jeonju, Korea. ; Clinical Trial Center of Medical Devices, Chonbuk National University Medical School, Jeonju, Korea
| |
Collapse
|
45
|
Stephan C, Ralla B, Jung K. Prostate-specific antigen and other serum and urine markers in prostate cancer. Biochim Biophys Acta Rev Cancer 2014; 1846:99-112. [PMID: 24727384 DOI: 10.1016/j.bbcan.2014.04.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 03/24/2014] [Accepted: 04/01/2014] [Indexed: 11/16/2022]
Abstract
Prostate-specific antigen (PSA) is one of the most widely used tumor markers, and strongly correlates with the risk of harboring from prostate cancer (PCa). This risk is visible already several years in advance but PSA has severe limitations for PCa detection with its low specificity and low negative predictive value. There is an urgent need for new biomarkers especially to detect clinically significant and aggressive PCa. From all PSA-based markers, the FDA-approved Prostate Health Index (phi) shows improved specificity over percent free and total PSA. Other serum kallikreins or sarcosine in serum or urine show more diverging data. In urine, the FDA-approved prostate cancer gene 3 (PCA3) has also proven its utility in the detection and management of early PCa. However, some aspects on its correlation with aggressiveness and the low sensitivity at very high values have to be re-examined. The detection of a fusion of the androgen regulated TMPRSS2 gene with the ERG oncogene (from the ETS family), which acts as transcription factor gene, in tissue of ~50% of all PCa patients was one milestone in PCa research. When combining the urinary assays for TMPRSS2:ERG and PCA3, an improved accuracy for PCa detection is visible. PCA3 and phi as the best available PCa biomarkers show an equal performance in direct comparisons.
Collapse
Affiliation(s)
- Carsten Stephan
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute for Urologic Research, Berlin, Germany.
| | - Bernhard Ralla
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Klaus Jung
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute for Urologic Research, Berlin, Germany
| |
Collapse
|
46
|
Carlsson S, Assel M, Sjoberg D, Ulmert D, Hugosson J, Lilja H, Vickers A. Influence of blood prostate specific antigen levels at age 60 on benefits and harms of prostate cancer screening: population based cohort study. BMJ 2014; 348:g2296. [PMID: 24682399 PMCID: PMC3968958 DOI: 10.1136/bmj.g2296] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the relative risks of prostate cancer incidence, metastasis, and mortality associated with screening by serum prostate specific antigen (PSA) levels at age 60. DESIGN Population based cohort study. SETTING General male population of Sweden taking part in a screening trial in Gothenburg or participating in a cardiovascular study, the Malmö Preventive Project. PARTICIPANTS The screened group consisted of 1756 men aged 57.5-62.5 participating in the screening arm of the Gothenburg randomized prostate cancer screening trial since 1995. The unscreened group consisted of 1162 men, born in 1921, participating in the Malmö Preventive Project, with PSA levels measured retrospectively in stored blood samples from 1981. INTERVENTION PSA screening versus no screening. MAIN OUTCOME MEASURES Incidence rate ratios for the effect of screening on prostate cancer diagnosis, metastasis, and death by PSA levels at age 60. RESULTS The distribution of PSA levels was similar between the two cohorts. Differences in benefits by baseline PSA levels were large. Among men with baseline levels measured, 71.7% (1646/2295) had a PSA level <2 ng/mL. For men aged 60 with PSA level <2 ng/mL, there was an increase in incidence of 767 cases per 10,000 without a decrease in prostate cancer mortality. For men with PSA levels ≥ 2 ng/mL, the reduction in cancer mortality was large, with only 23 men needing to be screened and six diagnosed to avoid one prostate cancer death by 15 years. CONCLUSIONS The ratio of benefits to harms of PSA screening varies noticeably with blood PSA levels at age 60. For men with a PSA level <1 ng/mL at age 60, no further screening is recommended. Continuing to screen men with PSA levels >2 ng/mL at age 60 is beneficial, with the number needed to screen and treat being extremely favourable. Screening men with a PSA level of 1-2 ng/mL is an individual decision to be based on a discussion between patient and doctor.
Collapse
Affiliation(s)
- Sigrid Carlsson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden
| | | | | | | | | | | | | |
Collapse
|
47
|
Vertosick EA, Poon BY, Vickers AJ. Relative value of race, family history and prostate specific antigen as indications for early initiation of prostate cancer screening. J Urol 2014; 192:724-8. [PMID: 24641912 DOI: 10.1016/j.juro.2014.03.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2014] [Indexed: 11/15/2022]
Abstract
PURPOSE Many guidelines suggest earlier screening for prostate cancer in men at high risk, with risk defined in terms of race and family history. Recent evidence suggests that baseline prostate specific antigen is strongly predictive of the long-term risk of aggressive prostate cancer. We compared the usefulness of risk stratifying early screening by race, family history and prostate specific antigen at age 45 years. MATERIALS AND METHODS Using estimates from the literature we calculated the proportion of men targeted for early screening using family history, black race or prostate specific antigen as the criterion for high risk. We calculated the proportion of prostate cancer deaths that would occur in those men by age 75 years. RESULTS Screening based on family history involved 10% of men, accounting for 14% of prostate cancer deaths. Using black race as a risk criterion involved 13% of men, accounting for 28% of deaths. In contrast, 44% of prostate cancer deaths occurred in the 10% of men with the highest prostate specific antigen at age 45 years. In no sensitivity analysis for race and family history did the ratio of risk group size to number of prostate cancer deaths in that risk group approach that of prostate specific antigen. CONCLUSIONS Basing decisions for early screening on prostate specific antigen at age 45 years provided the best ratio between men screened and potential cancer deaths avoided. Given the lack of evidence that race or family history affects the relationship between prostate specific antigen and risk, prostate specific antigen based risk stratification would likely include any black men or men with a family history who are destined to experience aggressive disease. Differential screening based on risk should be informed by baseline prostate specific antigen.
Collapse
Affiliation(s)
- Emily A Vertosick
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Bing Ying Poon
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Andrew J Vickers
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York.
| |
Collapse
|
48
|
Wilt TJ, Scardino PT, Carlsson SV, Basch E. Prostate-specific antigen screening in prostate cancer: perspectives on the evidence. J Natl Cancer Inst 2014; 106:dju010. [PMID: 24594482 DOI: 10.1093/jnci/dju010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Timothy J Wilt
- Affiliations of authors: Minneapolis VA Center for Chronic Disease Outcomes Research and the University of Minnesota School of Medicine, Minneapolis, MN (TJW); Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (PTS, SVC); Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB)
| | | | | | | |
Collapse
|
49
|
Chiang KC, Tsui KH, Chung LC, Yeh CN, Chang PL, Chen WT, Juang HH. Topoisomerase inhibitors modulate gene expression of B-cell translocation gene 2 and prostate specific antigen in prostate carcinoma cells. PLoS One 2014; 9:e89117. [PMID: 24586533 PMCID: PMC3930641 DOI: 10.1371/journal.pone.0089117] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 01/15/2014] [Indexed: 12/02/2022] Open
Abstract
Camptothecin (CPT) and doxorubicin (DOX) have been demonstrated to have potent anti-tumor activity. The B-cell translocation gene 2 (BTG2) is involved in the regulation of cell cycle progression. We evaluated the molecular mechanisms of CPT and DOX on cell proliferation and the expressions of BTG2 and prostate specific antigen (PSA) in prostate carcinoma cells. Our results indicated that CPT or DOX treatments induced Go/G1 cell cycle arrest in LNCaP cells and apoptosis at higher dosage. Immunoblot and transient gene expression assay indicated that CPT or DOX treatments induced p53 and BTG2 gene expression, with the later effect dependent on the p53 response element within BTG2 promoter area since mutation of the p53 response element from GGGAAAGTCC to GGAGTCC or from GGCAGAGCCC to GGCACC by site-directed mutagenesis abolished the stimulation of CPT or DOX on the BTG2 promoter activity, which is also supported by our results that cotreatments of pifithrin-α, an inhibitor of p53 dependent transcriptional activation, blocked the induction of CPT or DOX on BTG2 gene expression. CPT or DOX also downregulated the protein expressions of androgen receptor (AR) and PSA. Transient gene expression assays suggested that CPT or DOX’s attenuation of PSA promoter activity is dependent on both the androgen and p53 response elements within of the PSA promoter. Our results indicated that CPT and DOX attenuate cell proliferation via upregulation of BTG2 gene expression through the p53-dependent pathway. The CPT and DOX block the PSA gene expression by upregulation of p53 activity and downregulation of androgen receptor activity.
Collapse
Affiliation(s)
- Kun-Chun Chiang
- Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC
| | - Ke-Hung Tsui
- Department of Urology, Chang Gung Memorial Hospital, Kwei-Shan, Tao-Yuan, Taiwan, ROC
- Department of Anatomy, College of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan, ROC
| | - Li-Chuan Chung
- Department of Anatomy, College of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan, ROC
| | - Chun-Nan Yeh
- Department of General Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Tao-Yuan, Taiwan, ROC
| | - Phei-Lang Chang
- Department of Urology, Chang Gung Memorial Hospital, Kwei-Shan, Tao-Yuan, Taiwan, ROC
- Department of Anatomy, College of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan, ROC
| | - Wen-Tsung Chen
- National Kaohsiung University of Hospitality and Tourism, Hsiao-Kang, Kaohsiung Taiwan, ROC
| | - Horng-Heng Juang
- Department of Anatomy, College of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan, ROC
- * E-mail:
| |
Collapse
|
50
|
Schnipper LE, Lyman GH, Blayney DW, Hoverman JR, Raghavan D, Wollins DS, Schilsky RL. American Society of Clinical Oncology 2013 Top Five List in Oncology. J Clin Oncol 2013; 31:4362-70. [DOI: 10.1200/jco.2013.53.3943] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Lowell E. Schnipper
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Gary H. Lyman, Duke University and Duke Cancer Institute, Durham; Derek Raghavan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Douglas W. Blayney, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA; J. Russell Hoverman, Texas Oncology, Dallas, TX; and Dana S. Wollins and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA
| | - Gary H. Lyman
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Gary H. Lyman, Duke University and Duke Cancer Institute, Durham; Derek Raghavan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Douglas W. Blayney, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA; J. Russell Hoverman, Texas Oncology, Dallas, TX; and Dana S. Wollins and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA
| | - Douglas W. Blayney
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Gary H. Lyman, Duke University and Duke Cancer Institute, Durham; Derek Raghavan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Douglas W. Blayney, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA; J. Russell Hoverman, Texas Oncology, Dallas, TX; and Dana S. Wollins and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA
| | - J. Russell Hoverman
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Gary H. Lyman, Duke University and Duke Cancer Institute, Durham; Derek Raghavan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Douglas W. Blayney, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA; J. Russell Hoverman, Texas Oncology, Dallas, TX; and Dana S. Wollins and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA
| | - Derek Raghavan
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Gary H. Lyman, Duke University and Duke Cancer Institute, Durham; Derek Raghavan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Douglas W. Blayney, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA; J. Russell Hoverman, Texas Oncology, Dallas, TX; and Dana S. Wollins and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA
| | - Dana S. Wollins
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Gary H. Lyman, Duke University and Duke Cancer Institute, Durham; Derek Raghavan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Douglas W. Blayney, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA; J. Russell Hoverman, Texas Oncology, Dallas, TX; and Dana S. Wollins and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA
| | - Richard L. Schilsky
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Gary H. Lyman, Duke University and Duke Cancer Institute, Durham; Derek Raghavan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Douglas W. Blayney, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA; J. Russell Hoverman, Texas Oncology, Dallas, TX; and Dana S. Wollins and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA
| |
Collapse
|