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Kokori E, Olatunji G, Isarinade DT, Aboje JE, Ogieuhi IJ, Lawal ZD, Woldehana NA, Nazar MW, Scott GY, Aderinto N. Ejaculation Frequency and Prostate Cancer Risk: A Narrative Review of Current Evidence. Clin Genitourin Cancer 2024; 22:102043. [PMID: 38430857 DOI: 10.1016/j.clgc.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 03/05/2024]
Abstract
Prostate cancer, constituting a substantial portion of global cancer incidence and mortality, prompts a critical examination of potential modifiers, notably ejaculation frequency. This narrative review explores the complex relationship between ejaculation frequency and prostate cancer risk, addressing the paucity of consensus and the intricate interplay of factors. The evidence drawn from eleven studies with diverse methodologies reveals a complex understanding of this association. While some studies suggest an inverse correlation between ejaculation frequency and prostate cancer risk, signifying a potential protective effect, others present conflicting findings, necessitating a comprehensive exploration. Evidence synthesis underscores the importance of considering age, urinary health, and lifestyle factors in elucidating the ejaculation frequency-prostate cancer relationship. Notably, technological advancements, including machine learning models and genetic markers, enhance the precision of patient counselling and individualized care. In a clinical context, the findings emphasize the clinical relevance of incorporating sexual behavior into preventive strategies. Public health campaigns emerge as influential tools, breaking taboos, raising awareness, and empowering men to prioritize their well-being. The paradigm shift in prostate cancer understanding, fueled by technology and personalized medicine, holds promise for more accurate risk assessments. Liquid biopsies, multiparametric MRI, and considerations of the gut microbiome present avenues for tailored preventive strategies. However, methodological challenges and study variations necessitate further research, emphasizing consistency, exploring underlying mechanisms, and a life course perspective.
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Affiliation(s)
- Emmanuel Kokori
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | - Gbolahan Olatunji
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | | | - John Ehi Aboje
- Department of Medicine, College of Health Sciences, Benue State University, Benue, Nigeria
| | | | | | | | | | - Godfred Yawson Scott
- Department of Medical Diagnostics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Nicholas Aderinto
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria.
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Braga R, Araújo N, Costa A, Lopes C, Silva I, Correia R, Carneiro F, Braga I, Pacheco-Figueiredo L, Oliveira J, Morais S, Tedim Cruz V, Pereira S, Lunet N. Association between sociodemographic and clinical features, health behaviors, and health literacy of patients with prostate cancer and prostate cancer prognostic stage. Eur J Cancer Prev 2024; 33:243-251. [PMID: 37997910 DOI: 10.1097/cej.0000000000000854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Patient characteristics may influence access and acceptance of Prostate Specific Antigen test, and therefore, the timing of prostate cancer (PCa) diagnosis. A group of 361 patients from a cohort (n = 451) diagnosed with PCa in 2018-2020 at the Portuguese Institute of Oncology of Porto was evaluated before treatment, using a structured interview, the Medical Term Recognition Test, and the EORTC Quality of Life Questionnaire QLQ-PR25. PCa prognostic stages (I, II, III, IV) were attributed according to the American Joint Committee on Cancer eighth edition. Multinomial logistic regression was used to compute the odds ratio and 95% confidence interval (OR [95% CI]), considering PCa stage II, the most frequent, as reference. Older age (OR = 4.21 [2.24-7.93]), living outside the Porto Metropolitan Area while having low income (OR = 6.25 [1.53-25.62]), and erectile dysfunction (OR = 2.22 [0.99-4.99]) were associated with stage III, while urination during the night (OR = 3.02 [1.42-6.41]) was associated with stage IV. Urine leakage was less frequent in stage III (OR = 0.23 [0.08-0.68]), and living with a partner (OR = 0.41 [0.19-0.88]) and family history of cancer (OR = 0.25 [0.07-0.86]) in stage IV. Health literacy was not associated with PCa stage but lower education was less frequent in stage I (OR = 0.27 [0.11-0.69]). Patient sociodemographic and clinical characteristics should be considered as targets to improve PCa early detection and prognosis.
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Affiliation(s)
- Raquel Braga
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto
- Unidade de Saúde Familiar Lagoa, Unidade Local de Saúde de Matosinhos, Matosinhos
| | - Natália Araújo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto
| | - Adriana Costa
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto
| | - Catarina Lopes
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto
| | - Isa Silva
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto
| | - Rita Correia
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto
| | | | - Isaac Braga
- Instituto Português de Oncologia do Porto, Porto
| | | | | | - Samantha Morais
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto
| | - Vítor Tedim Cruz
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto
- Escola de Medicina, Universidade do Minho, Braga
| | - Susana Pereira
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto
- Instituto Português de Oncologia do Porto, Porto
| | - Nuno Lunet
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto
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Isola M, Maxia C, Murtas D, Ekström J, Isola R, Loy F. Prostate-specific antigen: An unfamiliar protein in the human salivary glands. J Anat 2024; 244:873-881. [PMID: 38111134 PMCID: PMC11021670 DOI: 10.1111/joa.13996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/09/2023] [Accepted: 12/04/2023] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVES The presence of prostate-specific antigen (PSA) in saliva and salivary glands has been reported. Nevertheless, its release pathway in these glands remains to be elucidated. Here, we showed PSA subcellular distribution focusing on its plausible route in human salivary parenchyma. MATERIALS AND METHODS Sections of parotid and submandibular glands were subjected to the immunohistochemical demonstration of PSA by the streptavidin-biotin method revealed by alkaline phosphatase. Moreover, ultrathin sections were collected on nickel grids and processed for immunocytochemical analysis, to visualize the intracellular distribution pattern of PSA through the observation by transmission electron microscopy. RESULTS By immunohistochemistry, in both parotid and submandibular glands PSA expression was detected in serous secretory acini and striated ducts. By immunocytochemistry, immunoreactivity was retrieved in the cytoplasmic compartment of acinar and ductal cells, often associated with small cytoplasmic vesicles. PSA labeling appeared also on rough endoplasmic reticulum and in the acini's lumen. A negligible PSA labeling appeared in most of the secretory granules of both glands. CONCLUSIONS Our findings clearly support that human parotid and submandibular glands are involved in PSA secretion. Moreover, based on the immunoreactivity pattern, its release in oral cavity would probably occur by minor regulated secretory or constitutive-like secretory pathways.
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Affiliation(s)
- Michela Isola
- Department of Biomedical SciencesUniversity of CagliariCagliariItaly
| | - Cristina Maxia
- Department of Biomedical SciencesUniversity of CagliariCagliariItaly
| | - Daniela Murtas
- Department of Biomedical SciencesUniversity of CagliariCagliariItaly
| | - Jörgen Ekström
- Division of Pharmacology, Institute of Neuroscience and PhysiologySahlgrenska Academy at the University of GothenburgGöteborgSweden
| | - Raffaella Isola
- Department of Biomedical SciencesUniversity of CagliariCagliariItaly
| | - Francesco Loy
- Department of Biomedical SciencesUniversity of CagliariCagliariItaly
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Dalela D, Corsi NJ, Bronkema C, Sood A, Arora S, Majdalany SE, Butaney M, Jamil M, Li P, Palma-Zamora I, Rakic N, Kovacevic N, Jeong W, Menon M, Rogers CG, Schonberg MA, Abdollah F. Prostate Specific Antigen Screening on a Nationwide Level: Featuring the Contribution of Race and Life Expectancy in Decision Making. Clin Genitourin Cancer 2024; 22:269-280.e2. [PMID: 38233279 DOI: 10.1016/j.clgc.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Estimation of life expectancy (LE) is important for the relative benefit of prostate specific antigen (PSA) screening. Limited data exists regarding screening for Black men with extended LE. The aim of the current study was to assess temporal trends in screening in United States (US) Black men with limited vs. extended LE, using a nationally representative dataset. MATERIALS AND METHODS Using the National Health Institution Survey (NHIS) 2000 to 2018, men aged ≥40 without prior history of prostate cancer (PCa) who underwent PSA screening in the last 12 months were stratified into limited LE (ie, LE <15 years) and extended LE (ie, LE≥15 years) using the validated Schonberg index. LE-stratified temporal trends in PSA screening were analyzed for all men, and then in Black men. Weighted multivariable analyses and dominance analyses identified the predictors of PSA screening. RESULTS PSA screening declined over the study period both for all eligible men with limited and extended LE, particularly between NHIS 2008 and 2013 (27.9%-20.7% in the extended). Screening increased significantly in Black men with extended LE (17.6% in 2010-25.7% in 2018). However, LE was not an independent predictor of screening in the Black cohort. Prior recipient of colonoscopy (55%-57%) and visit to health care provider (24%-32%) were the most important determinants for screening. CONCLUSION For US men with extended LE, only 1 in 4 receive PSA screening, with a decline over the study-period. Screening rates increased for Black men. However, these changes were not driven by LE consideration itself, but participation in other screenings and access to a provider.
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Affiliation(s)
- Deepansh Dalela
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; University of Texas Southwestern Medical Center, Dallas, TX; Wayne State University School of Medicine, Detroit, MI
| | - Nicholas J Corsi
- Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; University of Texas Southwestern Medical Center, Dallas, TX; Wayne State University School of Medicine, Detroit, MI
| | - Chandler Bronkema
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Akshay Sood
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sohrab Arora
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | - Sami E Majdalany
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | - Mohit Butaney
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | - Marcus Jamil
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | - Pin Li
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Mi
| | - Isaac Palma-Zamora
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | - Nikola Rakic
- Department of Urology, Baylor College of Medicine, Houston, TX
| | - Natalija Kovacevic
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | - Wooju Jeong
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Mani Menon
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Craig G Rogers
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | - Mara A Schonberg
- Division of General Medicine, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
| | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI.
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Kaneko M, Kanatani Y, Sato H, Sano M, Teramura E, Imai J, Fujisawa M, Matsushima M, Suzuki H. Prognostic Factors in Prostate Cancer Associated with Ulcerative Colitis. J Clin Med 2024; 13:1392. [PMID: 38592255 PMCID: PMC10932459 DOI: 10.3390/jcm13051392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/17/2024] [Accepted: 02/27/2024] [Indexed: 04/10/2024] Open
Abstract
Ulcerative colitis (UC) has been associated with increased prostate cancer (PCa) risk. However, the mechanisms underlying UC and increased PCa risk remain unclear, and research on this topic is scarce in Japan. We have investigated whether UC is associated with PCa risk in the Japanese population and the risk factors related to PCa among older UC patients. This retrospective single-center cohort study was conducted between January 2010 and April 2022. A total of 68 cases were analyzed, and 9 cases of PCa were observed (13.2%). PCa occurred more frequently in the adult-onset group (8/40, 20.0%) than in the older-onset group with UC (1/28; 3.57%). No significant differences were observed between immunosuppressive therapies and PCa in patients, excluding those with pancolitis-type UC. PCa occurred more frequently in the pancolitis type, and the biologics group had no PCa cases, but the difference was not statistically significant (p = 0.07). This study suggests that pancolitis type and UC onset in middle-aged patients may be risk factors and found that biologics potentially suppress PCa development.
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Affiliation(s)
- Motoki Kaneko
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Tokai University, 143 Shimokasuya, Isehara 259-1193, Japan; (M.K.); (H.S.); (M.S.)
| | - Yasuhiro Kanatani
- Department of Clinical Pharmacology, School of Medicine, Tokai University, 143 Shimokasuya, Isehara 259-1193, Japan
| | - Hirohiko Sato
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Tokai University, 143 Shimokasuya, Isehara 259-1193, Japan; (M.K.); (H.S.); (M.S.)
| | - Masaya Sano
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Tokai University, 143 Shimokasuya, Isehara 259-1193, Japan; (M.K.); (H.S.); (M.S.)
| | - Erika Teramura
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Tokai University, 143 Shimokasuya, Isehara 259-1193, Japan; (M.K.); (H.S.); (M.S.)
| | - Jin Imai
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Tokai University, 143 Shimokasuya, Isehara 259-1193, Japan; (M.K.); (H.S.); (M.S.)
- Department of Clinical Health Science, School of Medicine, Tokai University, 143 Shimokasuya, Isehara 259-1193, Japan
| | - Mia Fujisawa
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Tokai University, 143 Shimokasuya, Isehara 259-1193, Japan; (M.K.); (H.S.); (M.S.)
| | - Masashi Matsushima
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Tokai University, 143 Shimokasuya, Isehara 259-1193, Japan; (M.K.); (H.S.); (M.S.)
| | - Hidekazu Suzuki
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Tokai University, 143 Shimokasuya, Isehara 259-1193, Japan; (M.K.); (H.S.); (M.S.)
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Avolio PP, Lughezzani G, Anidjar M, Hassan T, Rompré-Brodeur A, Buffi NM, Lazzeri M, Sanchez-Salas R. The diagnostic accuracy of micro-ultrasound for prostate cancer diagnosis: a review. World J Urol 2023; 41:3267-3276. [PMID: 37555985 DOI: 10.1007/s00345-023-04521-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/02/2023] [Indexed: 08/10/2023] Open
Abstract
PURPOSE Micro-UltraSound (microUS) is a new imaging modality capable of identifying and targeting suspicious areas, which might further increase the diagnostic yield of prostate biopsy (PBx). Aim of this review is to provide insights into the usefulness of microUS for the sub-stratification of prostate cancer (PCa), clinically significant PCa (i.e., any Gleason score ≥ 7 PCa; csPCa) along with non-organ-confined disease in patients undergoing PBx. METHODS A PubMed literature search was performed using keywords: prostate cancer diagnosis, prostate cancer diagnosis surveillance, systematic biopsy, target biopsy, micro-ultrasound, and prostate risk identification using micro-ultrasound. RESULTS MicroUS could significantly improve multiparametric magnetic resonance imaging (mpMRI) findings by adding valuable anatomical and pathological information provided by real-time examination. Furthermore, microUS target biopsy could replace systematic biopsy in clinical practice by reducing the detection of clinically insignificant (ciPCa) and increasing that of csPCa. Finally, microUS may be useful in predicting the presence of non-organ confined PCa before radical prostatectomy and it could also be an effective add-on tool for patient monitoring within the active surveillance program. CONCLUSION MicroUS may represent an attractive step forward for the management of csPCa as a complementary or alternative tool to mpMRI. Nevertheless, further longitudinal studies are warranted, and the strength of the evidence is still suboptimal to provide clear recommendations for daily clinical practice.
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Affiliation(s)
- Pier Paolo Avolio
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Maurice Anidjar
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Toufic Hassan
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Alexis Rompré-Brodeur
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Nicolò Maria Buffi
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Rafael Sanchez-Salas
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada.
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Mumuni S, O’Donnell C, Doody O. The Risk Factors and Screening Uptake for Prostate Cancer: A Scoping Review. Healthcare (Basel) 2023; 11:2780. [PMID: 37893854 PMCID: PMC10606491 DOI: 10.3390/healthcare11202780] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVES The purpose of this scoping review was to identify the risk factors and screening uptake for prostate cancer. DESIGN Scoping review. METHODS Arksey and O'Malley's framework guided this review; five databases (Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PsycINFO, Academic Search Complete and Cochrane Library) and grey literature were searched. Screening was undertaken against predetermined inclusion criteria for articles published before July 2023 and written in English. This review is reported in line with PRISMA-Sc. RESULTS 10,899 database results were identified; 3676 papers were removed as duplicates and 7115 papers were excluded at title and abstract review. A total of 108 papers were full-text reviewed and 67 were included in the review. Grey literature searching yielded no results. Age, family history/genetics, hormones, race/ethnicity, exposure to hazards, geographical location and diet were identified as risk factors. Prostatic antigen test (PSA), digital rectal examination (DRE), transrectal ultrasound (TRUS), magnetic resonance imaging (MRI), magnetic resonance spectroscopic imaging (MRSI) and prostate biopsy were identified as screening/diagnostic methods. The evidence reviewed highlights moderate knowledge and screening uptake of prostate cancer with less than half of men reporting for PSA screening. On the other hand, there is a year-to-year increase in PSA and DRE screening, but factors such as poverty, religion, culture, communication barriers, language and costs affect men's uptake of prostate cancer screening. CONCLUSION As prostate cancer rates increase globally, there is a need for greater uptake of prostate cancer screening and improved health literacy among men and health workers. There is a need to develop a comprehensive prostate cancer awareness and screening programme that targets men and addresses uptake issues so as to provide safe, quality care. STRENGTHS AND LIMITATIONS OF THIS STUDY (1) A broad search strategy was utilised incorporating both databases and grey literature. (2) The PRISMA reporting guidelines were utilised. (3) Only English language papers were included, and this may have resulted in relevant articles being omitted.
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Affiliation(s)
- Seidu Mumuni
- Department of Nursing and Midwifery, University of Limerick, V94 T9PX Limerick, Ireland; (S.M.); (C.O.)
| | - Claire O’Donnell
- Department of Nursing and Midwifery, University of Limerick, V94 T9PX Limerick, Ireland; (S.M.); (C.O.)
- Health Research Institute, Department of Nursing and Midwifery, University of Limerick, V94 T9PX Limerick, Ireland
| | - Owen Doody
- Health Research Institute, Department of Nursing and Midwifery, University of Limerick, V94 T9PX Limerick, Ireland
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Scherer TP, Saba K, Wettstein MS, Lucca I, Mortezavi A, Waisbrod S, Aujesky D, Capaul R, Strebel RT. Do Swiss urologists and Swiss internists screen themselves and their relatives for prostate cancer? A questionnaire study. Swiss Med Wkly 2023; 153:40115. [PMID: 37774392 DOI: 10.57187/smw.2023.40115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023] Open
Abstract
PURPOSE Prostate-specific antigen (PSA) screening for men at risk of prostate cancer is controversial. The current recommendation is to raise awareness of prostate cancer and offer PSA screening in accordance with shared decision- making. Whether the possibility of a PSA screen is discussed with the patient depends on the treating physician, but data on physicians' attitudes towards PSA screening are scarce. This study aimed to examine internists' and urologists' personal PSA screening activity as an indicator of their attitude towards PSA screening. MATERIALS AND METHODS Members of the Swiss Society of Urology and the Swiss Society of General Internal Medicine were asked in 08/2020 to anonymously complete an online survey about personal PSA screening behaviour for themselves, their fathers, brothers and partners. Categorical and continuous variables were compared by chi-squared tests and t-tests, respectively. RESULTS In total, 190/295 (response rate: 64%) urologists and 893/7400 (response rate: 12%) internists participated in the survey. Of the participants, 297/1083 (27.4%) were female. Male urologists >50 years of age screened themselves more often than male internists >50 years of age (89% vs 70%, p <0.05). Furthermore, urologists reported recommending screening statistically significantly more often than internists to their brother, father or partner regardless of their sex (men: 38.1% vs 18.5%; p <0.05; women: 81.8% vs 32.2%; p <0.05). CONCLUSIONS: Most participating male physicians >50 years of age have screened themselves for prostate cancer. Furthermore, PSA screening of relatives was significantly associated with the urology specialty. The reasons physicians screen themselves substantially more often than the public and why male and female urologists as well as male internists perform PSA screening more frequently in their private environment than female internists should be further examined.
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Affiliation(s)
- Thomas P Scherer
- Department of Urology, Cantonal Hospital Grisons, Chur, Switzerland
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Karim Saba
- Department of Urology, Cantonal Hospital Grisons, Chur, Switzerland
- Urology Centre, Hirslanden Klinik Aarau, Aarau, Switzerland
| | - Marian S Wettstein
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Ilaria Lucca
- Department of Urology, University Hospital Lausanne, Lausanne, Switzerland
| | - Ashkan Mortezavi
- University of Zurich, Zurich, Switzerland
- Department of Urology, University Hospital Basel, Basel, Switzerland
| | | | - Drahomir Aujesky
- Department of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
- Swiss Society of General Internal Medicine, SGAIM, Berne, Switzerland
| | - Regula Capaul
- Swiss Society of General Internal Medicine, SGAIM, Berne, Switzerland
| | - Raeto T Strebel
- Department of Urology, Cantonal Hospital Grisons, Chur, Switzerland
- University of Zurich, Zurich, Switzerland
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Sandúa A, Sanmamed MF, Rodríguez M, Ancizu-Marckert J, Gúrpide A, Perez-Gracia JL, Alegre E, González Á. PSA reactivity in extracellular microvesicles to commercial immunoassays. Clin Chim Acta 2023; 543:117303. [PMID: 36948237 DOI: 10.1016/j.cca.2023.117303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 03/24/2023]
Abstract
AIMS Characterization of PSA in extracellular microvesicles (EVs) and its reactivity to commercial methods. MATERIALS AND METHODS EVs derived from serum of 47 prostate cancer (PCa) patients, 27 benign prostatic hyperplasia (BPH) patients and 42 healthy controls were analyzed. EVs isolation and quantification of PSA immunoreactive to total (ev-T-PSA) or free (ev-F-PSA) PSA immunoassays, were performed using commercial assays. PSA in CD81+ or CD63+ EVs was determined directly in serum by an immunocapture-ELISA (IC-ELISA). RESULTS Ev-T-PSA immunoreactive to Elecsys assay was detected in all samples. Median T-PSA ev/srm ratio was 2.20% (Q1-Q3: 0.80-4.00%), although in some samples this ratio reached 59%. T-PSA ev/srm ratio was higher in those samples with serum T-PSA below 4 µg/L than in those exceeding that cut-off (p<0.001). T-PSA ev/srm ratio was lower in PCa patients compared to healthy controls and BPH patients (p<0.001). Elecsys immunoassays detected higher concentrations of ev-T-PSA and ev-F-PSA than Immulite (p<0.001). PSA was detected by IC-ELISA more intensely in CD81+ EVs than in CD63+ EVs, and ev-T-PSA correlated with PSA+CD63+ (p<0.001) but not with PSA+CD81+. CONCLUSION EVs-bound PSA is another form of circulating PSA whose measurement could be easily performed in clinical laboratories by automated immunoassays.
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Affiliation(s)
- Amaia Sandúa
- Service of Biochemistry. Clínica Universidad de Navarra, Av. Pío XII 36, 31008, Pamplona, Spain.
| | - Miguel F Sanmamed
- Oncology Department. Clínica Universidad de Navarra, Av. Pío XII 36, 31008, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Calle Irunlarrea 3, 31008, Pamplona, Spain
| | - María Rodríguez
- Oncology Department. Clínica Universidad de Navarra, Av. Pío XII 36, 31008, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Calle Irunlarrea 3, 31008, Pamplona, Spain
| | - Javier Ancizu-Marckert
- Urology Department. Clínica Universidad de Navarra, Av. Pío XII 36, 31008, Pamplona, Spain
| | - Alfonso Gúrpide
- Oncology Department. Clínica Universidad de Navarra, Av. Pío XII 36, 31008, Pamplona, Spain
| | - José L Perez-Gracia
- Oncology Department. Clínica Universidad de Navarra, Av. Pío XII 36, 31008, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Calle Irunlarrea 3, 31008, Pamplona, Spain
| | - Estibaliz Alegre
- Service of Biochemistry. Clínica Universidad de Navarra, Av. Pío XII 36, 31008, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Calle Irunlarrea 3, 31008, Pamplona, Spain
| | - Álvaro González
- Service of Biochemistry. Clínica Universidad de Navarra, Av. Pío XII 36, 31008, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Calle Irunlarrea 3, 31008, Pamplona, Spain
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10
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Rius Bilbao L, Valladares Gomez C, Aguirre Larracoechea U, Pereira Arias JG, Arredondo Calvo P, Urdaneta Salegui LF, Escobal Tamayo V, Sanz Jaka JP, Recio Ayesa A, Mar Medina J, Mar Medina C. Do PHI and PHI density improve detection of clinically significant prostate cancer only in the PSA gray zone? Clin Chim Acta 2023; 542:117270. [PMID: 36893880 DOI: 10.1016/j.cca.2023.117270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES Prostate health index (PHI) is a predictive biomarker of positive prostate biopsy. The majority of evidence refers to its use in the PSA gray zone (4-10 ng/mL) and negative digital rectal exam (DRE). We aim to evaluate and compare the predictive accuracy of PHI and PHI density (PHId) with PSA, percentage of free PSA and PSA density, in a wider range of patients for the detection of clinically significant prostate cancer (csPCa). METHODS Multicenter prospective study that included patients suspicious of harboring prostate cancer. Non-probabilistic convenience sampling, where men who attended the urology consultation were tested for PHI before prostate biopsy. To evaluate and compare diagnostic accuracy AUC and decision curve analysis (DCA) were calculated. All these procedures were performed for the overall sample and the following subsamples: PSA < 4 ng/ml; PSA 4-10 ng/ml; PSA 4-10 ng/ml plus negative DRE and PSA > 10 ng/ml. RESULTS Among the 559 men included, 194 (34.7%) were diagnosed of csPCa. PHI and PHId outperfomed PSA in all subgroups. PHI best diagnostic performance was found in PSA 4-10 ng/ml with negative DRE (sensitivity 93.33, NPV 96.04). Regarding AUC, significant differences were found between PHId and PSA in the subgroup of PSA 4-10 ng/ml, whatever DRE status. In DCA, PHI density shows the highest net benefit. CONCLUSIONS PHI and PHId outperfom PSA in csPCa detection, not only in the PSA grey zone with negative DRE, but also in a wider range of PSA values. There is an urgent need of prospective studies to established a validated threshold and its incorporation in risk calculators.
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Affiliation(s)
- Leire Rius Bilbao
- Osakidetza Basque Health Service, Barrualde-Galdakao Integrated Health Organisation, Department of Urology, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.
| | - Carmen Valladares Gomez
- Osakidetza Basque Health Service, Barrualde-Galdakao Integrated Health Organisation, Department of Clinical Laboratory Medicine, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Urko Aguirre Larracoechea
- Osakidetza Basque Health Service, Barrualde-Galdakao Integrated Health Organisation, Research Unit, Spain
| | | | - Pablo Arredondo Calvo
- Osakidetza Basque Health Service, Barrualde-Galdakao Integrated Health Organisation, Department of Urology, Spain
| | | | - Victor Escobal Tamayo
- Osakidetza Basque Health Service, Barakaldo-Sestao Integrated Health Organisation, Department of Urology, Spain
| | - Juan Pablo Sanz Jaka
- Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Department of Urology, Spain
| | - Adrian Recio Ayesa
- Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Department of Urology, Spain
| | - Javier Mar Medina
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Research Unit, Spain; Biodonostia Health Research Institute, Donostia-San Sebastián, Spain; Kronikgune Institute for Health Services Research, Barakaldo, Spain
| | - Carmen Mar Medina
- Osakidetza Basque Health Service, Barrualde-Galdakao Integrated Health Organisation, Department of Clinical Laboratory Medicine, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
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11
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Alwadi D, Felty Q, Yoo C, Roy D, Deoraj A. Endocrine Disrupting Chemicals Influence Hub Genes Associated with Aggressive Prostate Cancer. Int J Mol Sci 2023; 24:ijms24043191. [PMID: 36834602 PMCID: PMC9959535 DOI: 10.3390/ijms24043191] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/08/2023] Open
Abstract
Prostate cancer (PCa) is one of the most frequently diagnosed cancers among men in the world. Its prevention has been limited because of an incomplete understanding of how environmental exposures to chemicals contribute to the molecular pathogenesis of aggressive PCa. Environmental exposures to endocrine-disrupting chemicals (EDCs) may mimic hormones involved in PCa development. This research aims to identify EDCs associated with PCa hub genes and/or transcription factors (TF) of these hub genes in addition to their protein-protein interaction (PPI) network. We are expanding upon the scope of our previous work, using six PCa microarray datasets, namely, GSE46602, GSE38241, GSE69223, GSE32571, GSE55945, and GSE26126, from the NCBI/GEO, to select differentially expressed genes based on |log2FC| (fold change) ≥ 1 and an adjusted p-value < 0.05. An integrated bioinformatics analysis was used for enrichment analysis (using DAVID.6.8, GO, KEGG, STRING, MCODE, CytoHubba, and GeneMANIA). Next, we validated the association of these PCa hub genes in RNA-seq PCa cases and controls from TCGA. The influence of environmental chemical exposures, including EDCs, was extrapolated using the chemical toxicogenomic database (CTD). A total of 369 overlapping DEGs were identified associated with biological processes, such as cancer pathways, cell division, response to estradiol, peptide hormone processing, and the p53 signaling pathway. Enrichment analysis revealed five up-regulated (NCAPG, MKI67, TPX2, CCNA2, CCNB1) and seven down-regulated (CDK1, CCNB2, AURKA, UBE2C, BUB1B, CENPF, RRM2) hub gene expressions. Expression levels of these hub genes were significant in PCa tissues with high Gleason scores ≥ 7. These identified hub genes influenced disease-free survival and overall survival of patients 60-80 years of age. The CTD studies showed 17 recognized EDCs that affect TFs (NFY, CETS1P54, OLF1, SRF, COMP1) that are known to bind to our PCa hub genes, namely, NCAPG, MKI67, CCNA2, CDK1, UBE2C, and CENPF. These validated differentially expressed hub genes can be potentially developed as molecular biomarkers with a systems perspective for risk assessment of a wide-ranging list of EDCs that may play overlapping and important role(s) in the prognosis of aggressive PCa.
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Affiliation(s)
- Diaaidden Alwadi
- Department of Environmental Health Sciences, Florida International University, Miami, FL 33199, USA
| | - Quentin Felty
- Department of Environmental Health Sciences, Florida International University, Miami, FL 33199, USA
| | - Changwon Yoo
- Department of Biostatistics, Florida International University, Miami, FL 33199, USA
| | - Deodutta Roy
- Department of Environmental Health Sciences, Florida International University, Miami, FL 33199, USA
| | - Alok Deoraj
- Department of Environmental Health Sciences, Florida International University, Miami, FL 33199, USA
- Correspondence:
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12
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Ferraro S, Biganzoli G, Bussetti M, Castaldi S, Biganzoli EM, Plebani M. Managing the impact of inter-method bias of prostate specific antigen assays on biopsy referral: the key to move towards precision health in prostate cancer management. Clin Chem Lab Med 2023; 61:142-153. [PMID: 36322977 DOI: 10.1515/cclm-2022-0874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/23/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES We assessed the inter-method bias of total (tPSA) and free (fPSA) prostate-specific antigen (PSA) immunoassays to establish if tPSA-based risk thresholds for advanced prostate cancer (PCa), obtained from one method (Roche) can be converted into the corresponding concentrations assayed by other methods. Then we evaluated the impact of the bias of tPSA and fPSA on the estimation of the %f/tPSA ratio and performed a re-calibration of the proposed thresholds for the %f/tPSA ratio according to the assay used. METHODS tPSA and fPSA were measured in 135 and 137 serum samples, respectively by Abbott Alinity i, Beckman Access Dxl, Roche Cobas e801, and Siemens Atellica IM analytical platforms. Scatterplots, Bland-Altman diagrams, Passing-Bablok (PB) were used to inspect and estimate the systematic and proportional bias between the methods. The linear equations with confidence intervals of the parameter estimates were used to transform the tPSA risk thresholds for advanced PCa into the corresponding concentrations measurable by the other analytical methods. To construct a correction coefficient for converting the %f/tPSA ratio from one method to the other, PB and non-parametric boostrapping were used. RESULTS The inter-method bias is not constant but strictly linear allowing the conversion of PSA results obtained from Roche into the other assays, which underestimate tPSA vs. Roche. Siemens and Abbott vs. Roche and Beckman assays, being characterized by a positive and a negative proportional bias for tPSA and fPSA measurements, tend to overestimate the %f/tPSA ratio. CONCLUSIONS There is a consistent risk to miss advanced PCa, if appropriate conversion factors are not applied.
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Affiliation(s)
- Simona Ferraro
- Endocrinology Laboratory Unit, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy.,Newborn Screening and Genetic Metabolic Diseases Unit, "V. Buzzi" Children's Hospital, Milan, Italy
| | - Giacomo Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Marco Bussetti
- Immunoematologia e Medicina trasfusionale Ospedale Castelli, Verbania, Italy
| | - Silvana Castaldi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Elia Mario Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Mario Plebani
- Department of Medicine-DIMED, University of Padova, Padova, Italy
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13
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Nik-Ahd F, Jarjour A, Figueiredo J, Anger JT, Garcia M, Carroll PR, Cooperberg MR, Vidal AC, Freedland SJ. Prostate-Specific Antigen Screening in Transgender Patients. Eur Urol 2023; 83:48-54. [PMID: 36344317 DOI: 10.1016/j.eururo.2022.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/05/2022] [Accepted: 09/06/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT Approximately 0.4-1.3% of the worldwide population is transgender. Although the exact prevalence is unknown, there is an increase in open identification as transgender. Among transgender women (TW), the prostate is retained even after gender-affirmation surgery, thus necessitating ongoing screening for prostate cancer (CaP). However, little is known about CaP screening in this population. OBJECTIVE To assess our current understanding of CaP incidence and prostate-specific antigen (PSA) screening in TW. EVIDENCE ACQUISITION We performed a nonsystematic narrative review of all PubMed publications through June 2022 according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. Given the limited primary research on this subject, case reports were also included. Studies were reviewed to understand PSA screening practices and reports of CaP in this population, as applicable. EVIDENCE SYNTHESIS There is no consensus regarding PSA screening in TW from any of the major societies, and TW are largely absent from guidelines. Case report data suggest that TW with CaP may have more aggressive disease, and these cancers may have been pre-existing prior to present before gender-affirming hormone therapy (GAHT) or be castrate-resistant. CONCLUSIONS We are in the infancy of our understanding of PSA screening in TW. Important avenues for future research include understanding the risks/benefits of PSA screening in TW, how best to mitigate potential negative psychological effects of PSA screening in TW, establishing baseline PSA values for those on GAHT (and determining what values should be considered "elevated"), establishing when to initiate PSA screening for those on GAHT, and establishing the accuracy of biomarkers for those undergoing GAHT. PATIENT SUMMARY We examined patterns of prostate cancer screening for transgender women. Little is known about prostate cancer incidence or screening in this population. Additional research is needed to establish guidelines for screening in this population.
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Affiliation(s)
- Farnoosh Nik-Ahd
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA.
| | - Andrew Jarjour
- College of Osteopathic Medicine of the Pacific, Western University, Pomona, CA, USA
| | - Jane Figueiredo
- Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jennifer T Anger
- Department of Urology, University of California-San Diego Health System, La Jolla, CA, USA
| | - Maurice Garcia
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Peter R Carroll
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Matthew R Cooperberg
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Adriana C Vidal
- Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Stephen J Freedland
- Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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14
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Filella X, Rodríguez-Garcia M, Fernández-Galán E. Clinical usefulness of circulating tumor markers. Clin Chem Lab Med 2022; 61:895-905. [PMID: 36394981 DOI: 10.1515/cclm-2022-1090] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022]
Abstract
Abstract
Tumor markers are a heterogeneous group of substances released by cancer cells into bloodstream, but also expressed by healthy tissues. Thus, very small concentrations can be present in plasma and serum from healthy subjects. Cancer patients tend to show increased levels correlating with tumor bulk, but false positive results could be present in patients with benign conditions. The correct interpretation of TM results could be challenging and many factors should be considered, from pre-analytical conditions to patient concomitant diseases. In this line, the Clinical Chemistry and Laboratory Medicine journal has made important contributions though several publications promoting the adequate use of TM and therefore improving patient safety. TM measurement offers valuable information for cancer patient management in different clinical contexts, such as helping diagnosis, estimating prognosis, facilitating early detection of relapse and monitoring therapy response. Our review analyzes the clinical usefulness of tumor markers applied in most frequent epithelial tumors, based on recent evidence and guidelines.
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Affiliation(s)
- Xavier Filella
- Department of Biochemistry and Molecular Genetics (CDB) , Hospital Clínic de Barcelona, IDIBAPS , Barcelona , Catalonia , Spain
| | - María Rodríguez-Garcia
- Department of Biochemistry and Molecular Genetics (CDB) , Hospital Clínic de Barcelona, IDIBAPS , Barcelona , Catalonia , Spain
| | - Esther Fernández-Galán
- Department of Biochemistry and Molecular Genetics (CDB) , Hospital Clínic de Barcelona, IDIBAPS , Barcelona , Catalonia , Spain
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15
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French AFU Cancer Committee Guidelines - Update 2022-2024: prostate cancer - Diagnosis and management of localised disease. Prog Urol 2022; 32:1275-1372. [DOI: 10.1016/j.purol.2022.07.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022]
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16
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Madendere S, Türkkan G, Arda E, Yürüt Çaloğlu V, Kuyumcuoğlu U. Evaluation of Risk Groups for the Prediction of Biochemical Progression in Patients Undergoing Radical Prostatectomy. JOURNAL OF UROLOGICAL SURGERY 2022. [DOI: 10.4274/jus.galenos.2021.2021.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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17
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Dias AB, O’Brien C, Correas JM, Ghai S. Multiparametric ultrasound and micro-ultrasound in prostate cancer: a comprehensive review. Br J Radiol 2022; 95:20210633. [PMID: 34752132 PMCID: PMC8978255 DOI: 10.1259/bjr.20210633] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Prostate cancer (PCa) is the most common non-cutaneous cancer diagnosed in males. Traditional tools for screening and diagnosis, such as prostate-specific antigen, digital rectal examination and conventional transrectal ultrasound (TRUS), present low accuracy for PCa detection. Multiparametric MRI has become a game changer in the PCa diagnosis pathway and MRI-targeted biopsies are currently recommended for males at risk of clinically significant PCa, even in biopsy-naïve patients. Recent advances in ultrasound have also emerged with the goal to provide a readily accessible and cost-effective tool for detection of PCa. These newer techniques include elastography and contrast-enhanced ultrasound, as well as improved B-mode and Doppler techniques. These modalities can be combined to define a novel ultrasound approach, multiparametric ultrasound. High frequency Micro-ultrasound has emerged as a promising imaging technology for PCa diagnosis. Initial results have shown high sensitivity of Micro-ultrasound in detecting PCa in addition to its potential in improving the accuracy of targeted biopsies, based on targeting under real-time visualization, rather than relying on cognitive/fusion software MRI-transrectal ultrasound-guided biopsy.
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Affiliation(s)
- Adriano Basso Dias
- Joint Department of Medical Imaging, University Health Network–Mount Sinai Hospital–Women’s College Hospital, University of Toronto, Toronto, Canada
| | - Ciara O’Brien
- Joint Department of Medical Imaging, University Health Network–Mount Sinai Hospital–Women’s College Hospital, University of Toronto, Toronto, Canada
| | - Jean-Michel Correas
- Department of Adult Radiology, Paris University and Necker University Hospital, Paris, France
| | - Sangeet Ghai
- Joint Department of Medical Imaging, University Health Network–Mount Sinai Hospital–Women’s College Hospital, University of Toronto, Toronto, Canada
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18
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Würnschimmel C, Chandrasekar T, Hahn L, Esen T, Shariat SF, Tilki D. MRI as a screening tool for prostate cancer: current evidence and future challenges. World J Urol 2022; 41:921-928. [PMID: 35226140 PMCID: PMC10160206 DOI: 10.1007/s00345-022-03947-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/19/2022] [Indexed: 10/19/2022] Open
Abstract
Abstract
Purpose
Prostate cancer (PCa) screening, which relies on prostate-specific antigen (PSA) testing, is a contentious topic that received negative attention due to the low sensitivity and specificity of PSA to detect clinically significant PCa. In this context, due to the higher sensitivity and specificity of magnetic resonance imaging (MRI), several trials investigate the feasibility of “MRI-only” screening approaches, and question if PSA testing may be replaced within prostate cancer screening programs.
Methods
This narrative review discusses the current literature and the outlook on the potential of MRI-based PCa screening.
Results
Several prospective randomized population-based trials are ongoing. Preliminary study results appear to favor the “MRI-only” approach. However, MRI-based PCa screening programs face a variety of obstacles that have yet to be fully addressed. These include the increased cost of MRI, lack of broad availability, differences in MRI acquisition and interpretation protocols, and lack of long-term impact on cancer-specific mortality. Partly, these issues are being addressed by shorter and simpler MRI approaches (5–20 min bi-parametric MRI), novel quality indicators (PI-QUAL) and the implementation of radiomics (deep learning, machine learning).
Conclusion
Although promising preliminary results were reported, MRI-based PCa screening still lack long-term data on crucial endpoints such as the impact of MRI screening on mortality. Furthermore, the issues of availability, cost-effectiveness, and differences in MRI acquisition and interpretation still need to be addressed.
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19
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Jiang M, Lei S, Zhang J, Hou L, Zhang M, Luo Y. Multimodal Imaging of Target Detection Algorithm under Artificial Intelligence in the Diagnosis of Early Breast Cancer. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:9322937. [PMID: 35047160 PMCID: PMC8763565 DOI: 10.1155/2022/9322937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 01/31/2023]
Abstract
This study aimed to analyze the diagnostic value of multimodal images based on artificial intelligence target detection algorithms for early breast cancer, so as to provide help for clinical imaging examinations of breast cancer. This article combined residual block with inception block, constructed a new target detection algorithm to detect breast lumps, used deep convolutional neural network and ultrasound imaging in diagnosing benign and malignant breast lumps, took breast density grading with mammography, compared the convolutional neural network (CNN) algorithm with the proposed algorithm, and then applied the proposed algorithm to the diagnosis of 120 female patients with breast lumps. According to the results, accuracy rates of breast lump detection (94.76%), benign and malignant breast lumps diagnosis (98.22%), and breast grading (93.65%) with the algorithm applied in this study were significantly higher than those (75.67%, 87.23%, and 79.54%) with CNN algorithm, and the difference was statistically significant (P < 0.05); among 62 patients with malignant breast lumps of the 120 patients with breast lumps, 37 were patients with invasive ductal carcinoma, 8 with lobular carcinoma in situ, 16 with intraductal carcinoma, and 4 with mucinous carcinoma; among the remaining 58 patients with benign breast lumps, 28 were patients with fibrocystic breast disease, 17 with intraductal papilloma, 4 with breast hyperplasia, and 9 with adenopathy; the differences in shape, growth direction, edge, and internal echo of multimodal ultrasound imaging of patients with benign and malignant breast lumps had statistical significance (P < 0.05); the malignant constituent ratios of patients with breast density grades I to IV were 0%, 7.10%, 80.40%, and 100%, respectively. In short, the multimodal imaging diagnosis under the algorithm in this article was superior to CNN algorithm in all aspects; according to the judgment on benign and malignant breast lumps and breast density with multimodal imaging features, the higher the breast density, the higher the probability of breast cancer.
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Affiliation(s)
- Meiping Jiang
- Department of Ultrasonography, Hunan Province Maternal and Child Health Care Hospital, Changsha 410008, Hunan, China
| | - Sanlin Lei
- Department of Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan, China
| | - Junhui Zhang
- Department of Ultrasonography, Hunan Province Maternal and Child Health Care Hospital, Changsha 410008, Hunan, China
| | - Liqiong Hou
- Department of Ultrasonography, Hunan Province Maternal and Child Health Care Hospital, Changsha 410008, Hunan, China
| | - Meixiang Zhang
- Department of Ultrasonography, Hunan Province Maternal and Child Health Care Hospital, Changsha 410008, Hunan, China
| | - Yingchun Luo
- Department of Ultrasonography, Hunan Province Maternal and Child Health Care Hospital, Changsha 410008, Hunan, China
- NHC Key Laboratory of Birth Defect for Research and Prevention (Hunan Provincial Maternal and Child Health Care Hospital), Changsha 410100, Hunan, China
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20
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Çolak S, Vural F. Effect of
nurse‐led
interventions on patient outcomes in patients with prostate cancer: A systematic review. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2021. [DOI: 10.1111/ijun.12310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sevgi Çolak
- Department of Surgical Nursing Health Sciences Institute, Dokuz Eylul University Izmir Turkey
| | - Fatma Vural
- Department of Surgical Nursing, Faculty of Nursing Dokuz Eylul University Izmir Turkey
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21
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Gandaglia G, Leni R, Bray F, Fleshner N, Freedland SJ, Kibel A, Stattin P, Van Poppel H, La Vecchia C. Epidemiology and Prevention of Prostate Cancer. Eur Urol Oncol 2021; 4:877-892. [PMID: 34716119 DOI: 10.1016/j.euo.2021.09.006] [Citation(s) in RCA: 171] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/10/2021] [Accepted: 09/28/2021] [Indexed: 01/04/2023]
Abstract
CONTEXT Worldwide, prostate cancer (PCa) represents the second most common solid tumor in men. OBJECTIVE To assess the geographical distribution of PCa, epidemiological differences, and the most relevant risk factors for the disease. EVIDENCE ACQUISITION Estimated incidence, mortality, and prevalence of PCa for the year 2020 in 185 countries were derived from the IARC GLOBOCAN database. A review of English-language articles published between 2010 and 2020 was conducted using MEDLINE, EMBASE, and Scopus to identify risk factors for PCa. EVIDENCE SYNTHESIS In the year 2020, there were over 1414000 estimated new cases of PCa worldwide, with an age-standardized rate (ASR) incidence of 31 per 100000 (lifetime cumulative risk: 3.9%). Northern Europe has the highest all-age incidence ASR (83), while the lowest ASR was in South-Central Asia (6.3). In the year 2020, there were over 375000 estimated deaths worldwide, and the overall mortality ASR was 7.7 per 100000, with the highest ASR in the Caribbean (28) and the lowest in South-Central Asia (3.1). Family history, hereditary syndromes, and race are the strongest risk factors for PCa. Metabolic syndrome was associated with the risk of developing PCa, high-grade disease, and adverse pathology. Diabetes and exposure to ultraviolet rays were found to be inversely associated to PCa incidence. Cigarette smoking and obesity may increase PCa-specific mortality, while regular physical activity may reduce disease progression. Although 5-alpha reductase inhibitors are known to be associated with a reduced incidence of PCa, available studies failed to show an effect on overall mortality. CONCLUSIONS Family history, race, and hereditary syndromes are well-established risk factors for PCa. Modifiable risk factors may impact the risk of developing PCa and that of dying from the disease, but little evidence exist for any clear indication for prevention other than early diagnosis to reduce PCa mortality. PATIENT SUMMARY Prostate cancer (PCa) rates vary profoundly worldwide, with incidence and mortality rates being highest in Northern Europe and Caribbean, respectively. South-Central Asia has the lowest epidemiological burden. Family history, race, and hereditary syndromes are well-established risk factors for PCa. Modifiable risk factors may impact the risk of developing PCa and that of dying from the disease itself, but little evidence exist for any clear indication for prevention other than early diagnosis to reduce PCa mortality.
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Affiliation(s)
- Giorgio Gandaglia
- Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Riccardo Leni
- Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Neil Fleshner
- Division or Urology, University of Toronto, Toronto, Ontario, Canada
| | - Stephen J Freedland
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Section of Urology, Durham VA Medical Center, Durham, NC, USA
| | - Adam Kibel
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Hendrick Van Poppel
- Department of Urology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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22
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Xue C, Li G, Lu J, Li L. Crosstalk between circRNAs and the PI3K/AKT signaling pathway in cancer progression. Signal Transduct Target Ther 2021; 6:400. [PMID: 34815385 PMCID: PMC8611092 DOI: 10.1038/s41392-021-00788-w] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/30/2021] [Accepted: 10/08/2021] [Indexed: 02/06/2023] Open
Abstract
Circular RNAs (circRNAs), covalently closed noncoding RNAs, are widely expressed in eukaryotes and viruses. They can function by regulating target gene expression, linear RNA transcription and protein generation. The phosphoinositide 3-kinase (PI3K)/AKT signaling pathway plays key roles in many biological and cellular processes, such as cell proliferation, growth, invasion, migration, and angiogenesis. It also plays a pivotal role in cancer progression. Emerging data suggest that the circRNA/PI3K/AKT axis modulates the expression of cancer-associated genes and thus regulates tumor progression. Aberrant regulation of the expression of circRNAs in the circRNA/PI3K/AKT axis is significantly associated with clinicopathological characteristics and plays an important role in the regulation of biological functions. In this review, we summarized the expression and biological functions of PI3K-AKT-related circRNAs in vitro and in vivo and assessed their associations with clinicopathological characteristics. We also further discussed the important role of circRNAs in the diagnosis, prognostication, and treatment of cancers.
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Affiliation(s)
- Chen Xue
- grid.452661.20000 0004 1803 6319State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003 China
| | - Ganglei Li
- grid.452661.20000 0004 1803 6319Department of Neurosurgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003 China
| | - Juan Lu
- grid.452661.20000 0004 1803 6319State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003 China
| | - Lanjuan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China.
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23
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Gandaglia G, Briganti A, Montorsi F. Reimagining prostate cancer screening: the IMPACT of germline mutations. Lancet Oncol 2021; 22:1491-1492. [PMID: 34678157 DOI: 10.1016/s1470-2045(21)00571-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 01/17/2023]
Affiliation(s)
- Giorgio Gandaglia
- Unit of Urology and Division of Oncology, IRCCS Ospedale San Raffaele, Via Olgettina 58,20132, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Unit of Urology and Division of Oncology, IRCCS Ospedale San Raffaele, Via Olgettina 58,20132, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology and Division of Oncology, IRCCS Ospedale San Raffaele, Via Olgettina 58,20132, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
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24
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Re: Andrew J. Vickers. Effects of Magnetic Resonance Imaging Targeting on Overdiagnosis and Overtreatment of Prostate Cancer. Eur Urol 2021;80:567-72. Eur Urol 2021; 80:e147-e148. [PMID: 34598832 DOI: 10.1016/j.eururo.2021.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/19/2021] [Indexed: 11/21/2022]
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25
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Matsugasumi T, Okihara K, Tsujimoto M, Sato O, Imura T, Yamada Y, Fujihara A, Shiraishi T, Hongo F, Ukimura O. Impact of prostate-specific antigen screening on tumor size in patients with prostate cancer in a super-aging district in Kyoto, Japan. Int J Clin Oncol 2021; 26:2303-2309. [PMID: 34537890 DOI: 10.1007/s10147-021-02016-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Population-based prostate-specific antigen (PSA) screening is effective for reducing prostate cancer (PCa)-related mortality rates. In this study, we assessed biopsy-proven maximum cancer core length (MCCL) and maximum cancer diameter on magnetic resonance imaging (MRI; MCDM) in prostate biopsy and multiparametric MRI (mp-MRI) by PCa detection. METHODS We retrospectively assessed 214 male PCa patients and 187 PCa patients with Prostate Imaging Reporting and Data System version 2 (PI-RADS) category 3-5 lesions in pre-biopsy mp-MRI and targeted biopsy characteristics. The mean biopsy-proven MCCL and MCDM were compared among three PSA screening groups, namely the population-based PSA screening (PBS), opportunistic PSA screening (OPS), and symptomatic outpatient PSA examination (SOP) groups. RESULTS The median age and PSA value of the 214 participants were 75 years and 7.9 ng/mL, respectively. In the PBS, OPS, and SOP groups, the median ages were 73, 76, and 76 years, respectively (p = 0.046); PSA values were 7.2, 9.5, and 11.5 ng/mL, respectively (p < 0.001); and biopsy-proven MCCL and MCDM were significantly increased to 7, 10, and 14 mm (p < 0.001) and to 11, 15, and 17 mm (p < 0.001), respectively. In the 187 PCa patients with PI-RADS category 3-5 lesions on mp-MRI, MCDM were 11, 14, and 17 mm (p < 0.001), respectively. CONCLUSIONS The biopsy-proven MCCL and MCDM were significantly smaller in the PBS and OPS groups than in the SOP group, which suggests that PSA screening detected PCa earlier than in symptomatic patients. PSA screening with MRI could objectively lead to earlier diagnosis based on tumor size.
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Affiliation(s)
- Toru Matsugasumi
- Department of Urology, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.,Department of Urology, North Medical Center, Kyoto Prefectural University of Medicine, 481 Otokoyama, Yosano-cho, Kyoto, 629-2261, Japan
| | - Koji Okihara
- Department of Urology, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.,Department of Urology, North Medical Center, Kyoto Prefectural University of Medicine, 481 Otokoyama, Yosano-cho, Kyoto, 629-2261, Japan
| | - Masashi Tsujimoto
- Department of Urology, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.,Department of Urology, North Medical Center, Kyoto Prefectural University of Medicine, 481 Otokoyama, Yosano-cho, Kyoto, 629-2261, Japan
| | - Osamu Sato
- Department of Radiology, North Medical Center, Kyoto Prefectural University of Medicine, 481 Otokoyama, Yosano-cho, Kyoto, 629-2261, Japan
| | - Tetsuya Imura
- Department of Pathology, North Medical Center, Kyoto Prefectural University of Medicine, 481 Otokoyama, Yosano-cho, Kyoto, 629-2261, Japan
| | - Yasuhiro Yamada
- Department of Urology, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Atsuko Fujihara
- Department of Urology, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takumi Shiraishi
- Department of Urology, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Fumiya Hongo
- Department of Urology, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Osamu Ukimura
- Department of Urology, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
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26
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Sandhu S, Moore CM, Chiong E, Beltran H, Bristow RG, Williams SG. Prostate cancer. Lancet 2021; 398:1075-1090. [PMID: 34370973 DOI: 10.1016/s0140-6736(21)00950-8] [Citation(s) in RCA: 233] [Impact Index Per Article: 77.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 12/12/2022]
Abstract
The management of prostate cancer continues to evolve rapidly, with substantial advances being made in understanding the genomic landscape and biology underpinning both primary and metastatic prostate cancer. Similarly, the emergence of more sensitive imaging methods has improved diagnostic and staging accuracy and refined surveillance strategies. These advances have introduced personalised therapeutics to clinical practice, with treatments targeting genomic alterations in DNA repair pathways now clinically validated. An important shift in the therapeutic framework for metastatic disease has taken place, with metastatic-directed therapies being evaluated for oligometastatic disease, aggressive management of the primary lesion shown to benefit patients with low-volume metastatic disease, and with several novel androgen pathway inhibitors significantly improving survival when used as a first-line therapy for metastatic disease. Research into the molecular characterisation of localised, recurrent, and progressive disease will undoubtedly have an impact on clinical management. Similarly, emerging research into novel therapeutics, such as targeted radioisotopes and immunotherapy, holds much promise for improving the lives of patients with prostate cancer.
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Affiliation(s)
- Shahneen Sandhu
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | | | - Edmund Chiong
- Department of Urology and Department of Surgery, National University of Singapore, Singapore
| | | | - Robert G Bristow
- Manchester Cancer Research Centre and University of Manchester, Manchester, UK
| | - Scott G Williams
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.
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27
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Israël B, Immerzeel J, van der Leest M, Hannink G, Zámecnik P, Bomers J, Schoots IG, van Basten JP, Debruyne F, van Oort I, Sedelaar M, Barentsz J. Clinical implementation of pre-biopsy magnetic resonance imaging pathways for the diagnosis of prostate cancer. BJU Int 2021; 129:480-490. [PMID: 34358388 PMCID: PMC9291303 DOI: 10.1111/bju.15562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective To assess the outcomes of pre‐biopsy magnetic resonance imaging (MRI) pathways, as a tool in biopsy‐naïve men with suspicion of prostate cancer, in routine clinical practice. Secondary outcomes included a comparison of transrectal MRI‐directed biopsy (TR‐MRDB) and transperineal (TP)‐MRDB in men with suspicious MRI. Patients and Methods We retrospectively assessed a two‐centre cohort of consecutive biopsy‐naïve men with suspicion of prostate cancer who underwent a Prostate Imaging‐Reporting and Data System version 2 (PI‐RADS v2) compliant pre‐biopsy MRI in a single, high‐volume centre between 2015 and 2019 (Centre 1). Men with suspicious MRI scans underwent TR‐MRDB in Centre 1 and TP‐MRDB with additional random biopsies (RB) in Centre 2. The MRI and histopathology were assessed in the same institution (Centre 1). Outcomes included: (i) overall detection rates of Grade Group (GG) 1, GG ≥2, and GG ≥3 cancer in men with suspicious MRI; (ii) Biopsy‐avoidance due to non‐suspicious MRI; and (iii) Cancer detection rates and biopsy‐related complications between TR‐ and TP‐MRDB. To reduce confounding bias for MRDB comparisons, inverse probability weighting (IPW) was performed for age, digital rectal examination, prostate‐specific antigen (PSA), prostate volume, PSA density, and PI‐RADS category. Results Of the 2597 men included, the overall GG 1, GG ≥2, and GG ≥3 prevalence was 8% (210/2597), 27% (697/2597), and 15% (396/2597), respectively. Biopsy was avoided in 57% (1488/2597) of men. After IPW, the GG 1, GG ≥2 and GG ≥3 detection rates after TR‐ and TP‐MRDB were comparable at 24%, 57%, and 32%; and 18%, 64%, and 38%, respectively; with mean differences of −5.7% (95% confidence interval [CI] −13% to 1.4%), 6.1% (95% CI −2.1% to 14%), and 5.7% (95% CI −1.7% to 13%). Complications were similar in TR‐MRDB (0.50%) and TP‐MRDB with RB (0.62%; mean difference 0.11%, 95% CI −0.87% to 1.1%). Conclusion This high‐volume, two‐centre study shows pre‐biopsy MRI as a decision tool is implementable in daily clinical practice. Compared to recent trials, a substantially higher biopsy avoidance rate was achieved without compromising GG ≥2/GG ≥3 detection and coinciding with lower over detection rates of GG 1 cancer. Prostate cancer detection and complication rates were comparable for TR‐ and TP‐MRDB.
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Affiliation(s)
- Bas Israël
- Department of Medical Imaging, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.,Department of Urology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Jos Immerzeel
- Department of Urology, Andros Clinics, Arnhem, the Netherlands
| | - Marloes van der Leest
- Department of Medical Imaging, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Patrik Zámecnik
- Department of Medical Imaging, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Joyce Bomers
- Department of Medical Imaging, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Ivo G Schoots
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Frans Debruyne
- Department of Urology, Andros Clinics, Arnhem, the Netherlands
| | - Inge van Oort
- Department of Urology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Michiel Sedelaar
- Department of Urology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Jelle Barentsz
- Department of Medical Imaging, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
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28
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Wendrich K, Krabbenborg L. The use of molecular biomarker tests: an interview study with healthcare providers about a molecular biomarker test for prostate cancer. Per Med 2021; 18:471-482. [PMID: 34353117 DOI: 10.2217/pme-2020-0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: Investigate why healthcare providers are not always willing to use molecular biomarker tests, even though they promise to personalize disease diagnosis and treatment. Materials & methods: We interviewed 20 Dutch urological healthcare providers to ascertain why they used or did not use SelectMDx, a biomarker test for prostate cancer. Results: Whether and how it was used differed from the developers' expectations, because users and nonusers disagreed about its perceived advantages; the scientific and clinical evidence; the advantages of MRI; and the value of PCA3 testing. Financial issues and the absence of SelectMDx in professional guidelines and hospital care pathways also hampered its use. Conclusion: Eliciting users' and nonusers' views is important to better understand how biomarker tests can be embedded in clinical practice.
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Affiliation(s)
- Karine Wendrich
- Institute for Science in Society, Radboud University, Nijmegen, The Netherlands
| | - Lotte Krabbenborg
- Institute for Science in Society, Radboud University, Nijmegen, The Netherlands
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29
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Meehan J, Gray M, Martínez-Pérez C, Kay C, McLaren D, Turnbull AK. Tissue- and Liquid-Based Biomarkers in Prostate Cancer Precision Medicine. J Pers Med 2021; 11:jpm11070664. [PMID: 34357131 PMCID: PMC8306523 DOI: 10.3390/jpm11070664] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/06/2021] [Accepted: 07/13/2021] [Indexed: 12/24/2022] Open
Abstract
Worldwide, prostate cancer (PC) is the second-most-frequently diagnosed male cancer and the fifth-most-common cause of all cancer-related deaths. Suspicion of PC in a patient is largely based upon clinical signs and the use of prostate-specific antigen (PSA) levels. Although PSA levels have been criticised for a lack of specificity, leading to PC over-diagnosis, it is still the most commonly used biomarker in PC management. Unfortunately, PC is extremely heterogeneous, and it can be difficult to stratify patients whose tumours are unlikely to progress from those that are aggressive and require treatment intensification. Although PC-specific biomarker research has previously focused on disease diagnosis, there is an unmet clinical need for novel prognostic, predictive and treatment response biomarkers that can be used to provide a precision medicine approach to PC management. In particular, the identification of biomarkers at the time of screening/diagnosis that can provide an indication of disease aggressiveness is perhaps the greatest current unmet clinical need in PC management. Largely through advances in genomic and proteomic techniques, exciting pre-clinical and clinical research is continuing to identify potential tissue, blood and urine-based PC-specific biomarkers that may in the future supplement or replace current standard practices. In this review, we describe how PC-specific biomarker research is progressing, including the evolution of PSA-based tests and those novel assays that have gained clinical approval. We also describe alternative diagnostic biomarkers to PSA, in addition to biomarkers that can predict PC aggressiveness and biomarkers that can predict response to certain therapies. We believe that novel biomarker research has the potential to make significant improvements to the clinical management of this disease in the near future.
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Affiliation(s)
- James Meehan
- Translational Oncology Research Group, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Edinburgh EH4 2XU, UK; (C.M.-P.); (C.K.); (A.K.T.)
- Correspondence:
| | - Mark Gray
- The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Midlothian EH25 9RG, UK;
| | - Carlos Martínez-Pérez
- Translational Oncology Research Group, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Edinburgh EH4 2XU, UK; (C.M.-P.); (C.K.); (A.K.T.)
- Breast Cancer Now Edinburgh Research Team, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Charlene Kay
- Translational Oncology Research Group, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Edinburgh EH4 2XU, UK; (C.M.-P.); (C.K.); (A.K.T.)
- Breast Cancer Now Edinburgh Research Team, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Duncan McLaren
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh EH4 2XU, UK;
| | - Arran K. Turnbull
- Translational Oncology Research Group, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Edinburgh EH4 2XU, UK; (C.M.-P.); (C.K.); (A.K.T.)
- Breast Cancer Now Edinburgh Research Team, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Edinburgh EH4 2XU, UK
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30
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Wang NN, Zhou SR, Chen L, Tibshirani R, Fan RE, Ghanouni P, Thong AE, To'o KJ, Amirkhiz K, Nix JW, Gordetsky JB, Sprenkle P, Rais-Bahrami S, Sonn GA. The stanford prostate cancer calculator: Development and external validation of online nomograms incorporating PIRADS scores to predict clinically significant prostate cancer. Urol Oncol 2021; 39:831.e19-831.e27. [PMID: 34247909 DOI: 10.1016/j.urolonc.2021.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/01/2021] [Accepted: 06/07/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND While multiparametric MRI (mpMRI) has high sensitivity for detection of clinically significant prostate cancer (CSC), false positives and negatives remain common. Calculators that combine mpMRI with clinical variables can improve cancer risk assessment, while providing more accurate predictions for individual patients. We sought to create and externally validate nomograms incorporating Prostate Imaging Reporting and Data System (PIRADS) scores and clinical data to predict the presence of CSC in men of all biopsy backgrounds. METHODS Data from 2125 men undergoing mpMRI and MR fusion biopsy from 2014 to 2018 at Stanford, Yale, and UAB were prospectively collected. Clinical data included age, race, PSA, biopsy status, PIRADS scores, and prostate volume. A nomogram predicting detection of CSC on targeted or systematic biopsy was created. RESULTS Biopsy history, Prostate Specific Antigen (PSA) density, PIRADS score of 4 or 5, Caucasian race, and age were significant independent predictors. Our nomogram-the Stanford Prostate Cancer Calculator (SPCC)-combined these factors in a logistic regression to provide stronger predictive accuracy than PSA density or PIRADS alone. Validation of the SPCC using data from Yale and UAB yielded robust AUC values. CONCLUSIONS The SPCC combines pre-biopsy mpMRI with clinical data to more accurately predict the probability of CSC in men of all biopsy backgrounds. The SPCC demonstrates strong external generalizability with successful validation in two separate institutions. The calculator is available as a free web-based tool that can direct real-time clinical decision-making.
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Affiliation(s)
- Nancy N Wang
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Steve R Zhou
- Department of Urology, Stanford University School of Medicine, Stanford, CA.
| | - Leo Chen
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Robert Tibshirani
- Departments of Biomedical Data Science and Statistics, Stanford University, Stanford, CA
| | - Richard E Fan
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Pejman Ghanouni
- Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Alan E Thong
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Katherine J To'o
- Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Kamyar Amirkhiz
- Department of Urology, Yale School of Medicine, New Haven, CT
| | - Jeffrey W Nix
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL; O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL
| | - Jennifer B Gordetsky
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL; Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
| | | | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL; O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL; Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Geoffrey A Sonn
- Department of Urology, Stanford University School of Medicine, Stanford, CA; Department of Radiology, Stanford University School of Medicine, Stanford, CA
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31
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Ferraro S, Bussetti M, Bassani N, Rossi RS, Incarbone GP, Bianchi F, Maggioni M, Runza L, Ceriotti F, Panteghini M. Definition of Outcome-Based Prostate-Specific Antigen (PSA) Thresholds for Advanced Prostate Cancer Risk Prediction. Cancers (Basel) 2021; 13:cancers13143381. [PMID: 34298597 PMCID: PMC8305281 DOI: 10.3390/cancers13143381] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary In this study, we used a well calibrated risk prediction model to define prostate-specific antigen (PSA) thresholds for identifying or excluding advanced prostate cancer (PCa) as an aid to personalize management of the diagnostic workup. PSA concentrations ≤ 4.1 (<65 years old) and ≤3.7 μg/L (≥65 years old) excluded an advanced PCa in patients without glandular inflammation, while PSA > 5.7 (<65) and >6.1 μg/L (≥65) suggested a biopsy referral. In the presence of glandular inflammation, PSA does not provide a valid estimate for risk of advanced cancer since the marker variability is higher and the pre-test probability of PCa is low in this group. The proposed PSA thresholds may allow an individualized approach to the diagnostic workup, assisting patients in making an informed decision. However, patients with asymptomatic prostatitis cannot benefit from the use of this model since they cannot be pre-biopsy identified. Abstract We defined prostate-specific antigen (PSA) thresholds from a well calibrated risk prediction model for identifying and excluding advanced prostate cancer (PCa). We retrieved 902 biopsied patients with a pre-biopsy PSA determination (Roche assay). A logistic regression model predictive for PCa including the main effects [i.e., PSA, age, histological evidence of glandular inflammation (GI)] was built after testing the accuracy by calibration plots and Hosmer-Lemeshow test for goodness of fit. PSA thresholds were derived by assuming a diagnostic sensitivity of 95% (rule-out) and 80% (rule-in) for overall and advanced/poorly differentiated PCa. In patients without GI, serum PSA concentrations ≤ 4.1 (<65 years old) and ≤3.7 μg/L (≥65 years old) excluded an advanced PCa (defined as Gleason score ≥ 7 at biopsy), with a negative predictive value of 95.1% [95% confidence interval (CI): 83.0–98.7] and 88.8% (CI: 80.2–93.9), respectively, while PSA > 5.7 (<65) and >6.1 μg/L (≥65) should address biopsy referral. In presence of GI, PSA did not provide a valid estimate for risk of advanced cancer because of its higher variability and the low pre-test probability of PCa. The proposed PSA thresholds may support biopsy decision except for patients with asymptomatic prostatitis who cannot be pre-biopsy identified.
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Affiliation(s)
- Simona Ferraro
- Unità Operativa Patologia Clinica, ASST Fatebenefratelli-Sacco, Ospedale ‘Luigi Sacco’, Via GB Grassi 74, 20157 Milano, Italy; (M.B.); (M.P.)
- Correspondence:
| | - Marco Bussetti
- Unità Operativa Patologia Clinica, ASST Fatebenefratelli-Sacco, Ospedale ‘Luigi Sacco’, Via GB Grassi 74, 20157 Milano, Italy; (M.B.); (M.P.)
| | - Niccolò Bassani
- Statistical Consultant, Flat 5 Hazel Court Avenue, Hitchin SG4 9SJ, UK;
| | - Roberta Simona Rossi
- Unità Operativa Anatomia Patologica, ASST Fatebenefratelli-Sacco, Ospedale ‘Luigi Sacco’, Via GB Grassi 74, 20157 Milano, Italy; (R.S.R.); (F.B.)
| | - Giacomo Piero Incarbone
- Urologia, ASST Fatebenefratelli-Sacco, Ospedale ‘Luigi Sacco’, Via GB Grassi 74, 20157 Milano, Italy;
| | - Filippo Bianchi
- Unità Operativa Anatomia Patologica, ASST Fatebenefratelli-Sacco, Ospedale ‘Luigi Sacco’, Via GB Grassi 74, 20157 Milano, Italy; (R.S.R.); (F.B.)
| | - Marco Maggioni
- Unità Operativa Anatomia Patologica, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Via F. Sforza 35, 20122 Milano, Italy; (M.M.); (L.R.)
| | - Letterio Runza
- Unità Operativa Anatomia Patologica, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Via F. Sforza 35, 20122 Milano, Italy; (M.M.); (L.R.)
| | - Ferruccio Ceriotti
- Laboratorio Analisi, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Via F. Sforza 35, 20122 Milano, Italy;
| | - Mauro Panteghini
- Unità Operativa Patologia Clinica, ASST Fatebenefratelli-Sacco, Ospedale ‘Luigi Sacco’, Via GB Grassi 74, 20157 Milano, Italy; (M.B.); (M.P.)
- Dipartimento di Scienze Biomediche e Cliniche ‘Luigi Sacco’, Università Degli Studi di Milano, 20157 Milano, Italy
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Getaneh AM, Heijnsdijk EA, de Koning HJ. Cost-effectiveness of multiparametric magnetic resonance imaging and MRI-guided biopsy in a population-based prostate cancer screening setting using a micro-simulation model. Cancer Med 2021; 10:4046-4053. [PMID: 33991077 PMCID: PMC8209626 DOI: 10.1002/cam4.3932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/29/2021] [Accepted: 04/12/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The introduction of multiparametric magnetic resonance imaging (mpMRI) and MRI-guided biopsy has improved the diagnosis of prostate cancer. However, it remains uncertain whether it is cost-effective, especially in a population-based screening strategy. METHODS We used a micro-simulation model to assess the cost-effectiveness of an MRI-based prostate cancer screening in comparison to the classical prostate-specific antigen (PSA) screening, at a population level. The test sensitivity parameters for the mpMRI and MRI-guided biopsy, grade misclassification rates, utility estimates, and the unit costs of different interventions were obtained from literature. We assumed the same screening attendance rate and biopsy compliance rate for both strategies. A probabilistic sensitivity analysis, consisting of 1000 model runs, was performed to estimate a mean incremental cost-effectiveness ratio (ICER) and assess uncertainty. A €20,000 willingness-to-pay (WTP) threshold per quality-adjusted life year (QALY) gained, and a discounting rate of 3.5% was considered in the analysis. RESULTS The MRI-based screening improved the life-years (LY) and QALYs gained by 3.5 and 3, respectively, in comparison to the classical screening pathway. Based on the probabilistic sensitivity analyses, the MRI screening pathway leads to total discounted mean incremental costs of €15,413 (95% confidence interval (CI) of €14,556-€16,272) compared to the classical screening pathway. The corresponding discounted mean incremental QALYs gained was 1.36 (95% CI of 1.31-1.40), resulting in a mean ICER of €11,355 per QALY gained. At a WTP threshold of €20,000, the MRI screening pathway has about 84% chance to be more cost-effective than the classical screening pathway. CONCLUSIONS For triennial screening from age 55-64, incorporation of mpMRI as a reflex test after a positive PSA test result with a subsequent MRI-guided biopsy has a high probability to be more cost-effective as compared with the classical prostate cancer screening pathway.
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Affiliation(s)
- Abraham M Getaneh
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Eveline Am Heijnsdijk
- Department of Public Health, 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
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Abstract
Prostate cancer is a global health problem, but incidence varies considerably across different continents. Asia is traditionally considered a low-incidence area, but the incidence and mortality of prostate cancer have rapidly increased across the continent. Substantial differences in epidemiological features have been observed among different Asian regions, and incidence, as well as mortality-to-incidence ratio, is associated with the human development index. Prostate cancer mortality decreased in Japan and Israel from 2007 to 2016, but mortality has increased in Thailand, Kyrgyzstan and Uzbekistan over the same period. Genomic analyses have shown a low prevalence of ERG oncoprotein in the East Asian population, alongside a low rate of PTEN loss, high CHD1 enrichments and high FOXA1 alterations. Contributions from single-nucleotide polymorphisms to prostate cancer risk vary with ethnicity, but germline mutation rates of DNA damage repair genes in metastatic prostate cancer are comparable in Chinese and white patients from the USA and UK. Pharmacogenomic features of testosterone metabolism might contribute to disparities seen in the response to androgen deprivation between East Asian men and white American and European men. Overall, considerable diversity in epidemiology and genomics of prostate cancer across Asia defines disease characteristics in these populations, but studies in this area are under-represented in the literature. Taking into account this intracontinental and intercontinental heterogeneity, translational studies are required in order to develop ethnicity-specific treatment strategies.
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Duffy MJ. Biomarkers for prostate cancer: prostate-specific antigen and beyond. Clin Chem Lab Med 2021; 58:326-339. [PMID: 31714881 DOI: 10.1515/cclm-2019-0693] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/19/2019] [Indexed: 12/21/2022]
Abstract
In recent years, several new biomarkers supplementing the role of prostate-specific antigen (PSA) have become available for men with prostate cancer. Although widely used in an ad hoc manner, the role of PSA in screening asymptomatic men for prostate cancer is controversial. Several expert panels, however, have recently recommended limited PSA screening following informed consent in average-risk men, aged 55-69 years. As a screening test for prostate cancer however, PSA has limited specificity and leads to overdiagnosis which in turn results in overtreatment. To increase specificity and reduce the number of unnecessary biopsies, biomarkers such as percent free PSA, prostate health index (PHI) or the 4K score may be used, while Progensa PCA3 may be measured to reduce the number of repeat biopsies in men with a previously negative biopsy. In addition to its role in screening, PSA is also widely used in the management of patients with diagnosed prostate cancer such as in surveillance following diagnosis, monitoring response to therapy and in combination with both clinical and histological criteria in risk stratification for recurrence. For determining aggressiveness and predicting outcome, especially in low- or intermediate-risk men, tissue-based multigene tests such as Decipher, Oncotype DX (Prostate), Prolaris and ProMark, may be used. Emerging therapy predictive biomarkers include AR-V7 for predicting lack of response to specific anti-androgens (enzalutamide, abiraterone), BRAC1/2 mutations for predicting benefit from PARP inhibitor and PORTOS for predicting benefit from radiotherapy. With the increased availability of multiple biomarkers, personalised treatment for men with prostate cancer is finally on the horizon.
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Affiliation(s)
- Michael J Duffy
- UCD Clinical Research Centre, St. Vincent's University Hospital, Dublin 4, Ireland.,UCD School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
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Álvarez-Maestro M, Eguibar A, Chanca P, Klett-Mingo M, Gómez Rivas J, Buño-Soto A, de Bethencourt FR, Ferrer M. Androgen Deprivation Therapy in Patients With Prostate Cancer Increases Serum Levels of Thromboxane A 2: Cardiovascular Implications. Front Cardiovasc Med 2021; 8:653126. [PMID: 33928136 PMCID: PMC8076684 DOI: 10.3389/fcvm.2021.653126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/15/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Androgens have been described as important players in the regulation of vascular function/structure through their action on the release and effect of vasoactive factors, such as prostanoids. Patients with prostate cancer (PCa) under androgen deprivation therapies (ADTs) present increased risk of cardiovascular mortality. Since thromboxane A2 (TXA2) is one of the most studied prostanoids and its involvement in different cardiovascular diseases has been described, the aim of this study was to investigate: (i) the effect of ADT on the serum levels of TXA2 in PCa patients and its possible link to the redox status and (ii) the effect of the non-hydrolyzable TXA2 analog U-46619 on the function of the aorta of male rats. Methods: The levels of TXA2 and total antioxidant status in 50 healthy subjects, 54 PCa patients, and 57 PCa under ADT were evaluated. These determinations were accompanied by levels of testosterone and C-reactive protein as an inflammation marker. In aortic segments from male rats, the U46619-induced effects on: (i) the vasomotor responses to acetylcholine (ACh), to the NO donor sodium nitroprusside (SNP), to the carbon monoxide-releasing molecule-3 (CORM-3), and to noradrenaline (NA) and (ii) the expression of cyclooxygenase-2 (COX-2), heme oxygenase-1 (HO-1), and phosphorylated ERK1/2 were analyzed. Results: The serum level of TXA2 in patients with PCa was increased with respect to healthy subjects, which was further increased by ADT. There was no modification in the total antioxidant status among the three experimental groups. In aortic segments from male rats, the TXA2 analog decreased the endothelium-dependent relaxation and the sensitivity of smooth muscle cells to NO, while it increased the vasoconstriction induced by NA; the expression of COX-2, HO-1, and pERK1/2 was also increased. Conclusions: ADT increased, along with other inflammatory/oxidative markers, the serum levels of TXA2. The fact that TXA2 negatively impacts the vascular function of the aorta of healthy male rats suggests that inhibition of TXA2-mediated events could be considered a potential strategy to protect the cardiovascular system.
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Affiliation(s)
- Mario Álvarez-Maestro
- Servicio de Urología, Hospital Universitario La Paz, Madrid, Spain.,Grupo de Investigación en Urología, IdiPAZ, Madrid, Spain
| | - Aritz Eguibar
- Servicio de Urología, Hospital Universitario La Paz, Madrid, Spain
| | - Patricia Chanca
- Servicio de Análisis Clínicos, Hospital Universitario La Paz, Madrid, Spain
| | | | - Juan Gómez Rivas
- Departamento de Urología, Hospital Clínico San Carlos, Madrid, Spain
| | - Antonio Buño-Soto
- Servicio de Análisis Clínicos, Hospital Universitario La Paz, Madrid, Spain.,Grupo de Investigación en Neonatología, IdiPAZ, Madrid, Spain
| | - Fermín R de Bethencourt
- Servicio de Urología, Hospital Universitario La Paz, Madrid, Spain.,Grupo de Investigación en Urología, IdiPAZ, Madrid, Spain
| | - Mercedes Ferrer
- Grupo de Investigación en Urología, IdiPAZ, Madrid, Spain.,Departamento de Fisiología, Facultad de Medicina, UAM, Madrid, Spain
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Ferraro S, Bussetti M, Rizzardi S, Braga F, Panteghini M. Verification of Harmonization of Serum Total and Free Prostate-Specific Antigen (PSA) Measurements and Implications for Medical Decisions. Clin Chem 2021; 67:543-553. [PMID: 33674839 DOI: 10.1093/clinchem/hvaa268] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/08/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Previous studies have shown that the harmonization of prostate-specific antigen (PSA) assays remained limited even after the introduction of WHO International Standards. This information needs updating for current measuring systems (MS) and reevaluation according to established analytical performance specifications (APS) and the characteristics of antibodies used. METHODS Total (tPSA) and free (fPSA) PSA were measured in 135 and 137 native serum samples, respectively, by Abbott Alinity i, Beckman Access Dxl, Roche Cobas e801, and Siemens Atellica IM MSs. Passing-Bablok regression and difference plots were used to compare results from each MS to the all-method median values. Agreement among methods was evaluated against APS for bias derived from biological variation of the 2 measurands. RESULTS The median interassay CV for tPSA MSs (11.5%; 25-75th percentiles, 9.2-13.4) fulfilled the minimum APS goal for intermethod bias (15.9%), while the interassay CV for fPSA did not [20.4% (25-75th percentiles, 18.4-22.7) vs goal 17.6%]. Considering the all-method median value of each sample as reference, all tPSA MSs exhibited a mean percentage bias within the minimum goal. On the other hand, Alinity (+21.3%) and Access (-24.2%) were out of the minimum bias goal for fPSA, the disagreement explained only in minimal part by the heterogeneity of employed antibodies. CONCLUSIONS The harmonization among tPSA MSs is acceptable only when minimum APS are applied and necessitates further improvement. The marked disagreement among fPSA MSs questions the use of fPSA as a second-level test for biopsy referral.
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Affiliation(s)
- Simona Ferraro
- Unità Operativa Complessa di Patologia Clinica, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Marco Bussetti
- Unità Operativa Complessa di Patologia Clinica, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Sara Rizzardi
- Unità Operativa Laboratorio Analisi Chimico Cliniche e Microbiologiche, ASST Cremona, Cremona, Italy
| | - Federica Braga
- Unità Operativa Complessa di Patologia Clinica, ASST Fatebenefratelli-Sacco, Milano, Italy.,Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Mauro Panteghini
- Unità Operativa Complessa di Patologia Clinica, ASST Fatebenefratelli-Sacco, Milano, Italy.,Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
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Ferraro S, Bussetti M, Panteghini M. Serum Prostate-Specific Antigen Testing for Early Detection of Prostate Cancer: Managing the Gap between Clinical and Laboratory Practice. Clin Chem 2021; 67:602-609. [PMID: 33619518 DOI: 10.1093/clinchem/hvab002] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/21/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Current clinical practice guidelines (CPGs) for early detection of prostate cancer recommend for clinical decision-making a personalized prostate-specific antigen (PSA)-based management to improve the risk-benefit ratio of the screening strategy. Some important critical issues regarding the PSA determination in the clinical framework are, however, still neglected in current guidelines and a major focus of recommendations on those aspects would be needed to improve their effectiveness. CONTENT Evidence sources in the available literature concerning the interchangeability of total PSA results measured with different commercial methods were critically appraised. We discuss how the heterogeneity of the measurand, the intermethod bias, and the design and selectivity of immunoassays may affect the diagnostic accuracy of selected PSA thresholds, and how knowledge of the analytical characteristics of assays in service, such as the recognized PSA circulating forms and the cross-reactivity with PSA homologs, is basic for improving both clinical decision-making in cancer screening and the reliability of the clinical interpretation of results at the individual level. SUMMARY Current CPGs ignore the poor interchangeability of PSA results obtained from different assays and the substantial role of laboratory issues in clinical performance of PSA testing. Involved stakeholders should contribute to fill the existing gap by: (a) preparing commutable reference materials for immunoassay calibration; (b) providing analytical characteristics that may explain the different performance of assays; (c) deriving outcome-based analytical performance specifications for PSA measurement; and (d) giving more focus on laboratory items when CPGs are prepared.
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Affiliation(s)
- Simona Ferraro
- Department of Biomedical and Clinical Sciences, 'Luigi Sacco', University of Milan, and Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Marco Bussetti
- Department of Biomedical and Clinical Sciences, 'Luigi Sacco', University of Milan, and Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Mauro Panteghini
- Department of Biomedical and Clinical Sciences, 'Luigi Sacco', University of Milan, and Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
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Moris L, Devos G, Van den Broeck T, Milonas D, Albersen M, Berghen C, De Meerleer G, Devlies W, Everaerts W, Gevaert T, Van Poppel H, Claessens F, Joniau S. Current and emerging therapies for localized high-risk prostate cancer. Expert Rev Anticancer Ther 2020; 21:267-282. [PMID: 33225759 DOI: 10.1080/14737140.2021.1852932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Despite progress in the field of high-risk localized prostate cancer (HRPCa) treatments, high-risk patients treated with curative intent are at increased risk of biochemical recurrence, metastatic progression and cancer-related death. The optimal treatment strategy remains a topic of debate. This review provides an overview of the current and investigational therapeutic options for HRPCa.Areas covered: A PubMed search was performed for papers on the current perspectives on the multimodality treatment of HRPCa. We focus on both primary local treatment as well as systemic treatment options. Finally, relevant ongoing trials focusing on systemic treatments (including [neo]adjuvant treatments) enrolling at least 50 patients were retrieved, to highlight ongoing research and treatment optimization.Expert opinion: Disease progression in HRPCa patients is driven by local tumor extension and subclinical metastases. Therefore, the main treatment concept is a multimodal approach targeting the primary tumor with extended surgery or RT with long-term ADT and simultaneously targeting micro-metastatic deposits. However, there is still room for optimization. Upcoming clinical trials comparing surgery versus RT as local treatment, trials with (neo)adjuvant chemotherapy or androgen receptor signaling inhibitors will likely change the treatment landscape. However, a multimodal treatment strategy will stay as the cornerstone in the treatment of HRPCa.
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Affiliation(s)
- Lisa Moris
- Department of Urology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Department of Cellular and Molecular Medicine, Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium
| | - Gaëtan Devos
- Department of Urology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | | | - Daimantas Milonas
- Department of Urology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Department of Urology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Charlien Berghen
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Gert De Meerleer
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Wout Devlies
- Department of Urology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Department of Cellular and Molecular Medicine, Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium
| | - Wouter Everaerts
- Department of Urology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Thomas Gevaert
- Department of Pathology, Catholic University Leuven, Belgium
| | - Hendrik Van Poppel
- Department of Urology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Frank Claessens
- Department of Cellular and Molecular Medicine, Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
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Prostate Cancer Screening with PSA: Ten Years' Experience of Population Based Early Prostate Cancer Detection Programme in Lithuania. J Clin Med 2020; 9:jcm9123826. [PMID: 33255919 PMCID: PMC7760278 DOI: 10.3390/jcm9123826] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 11/24/2022] Open
Abstract
The aim of this study is to report key performance estimates from the ten years of a population-based prostate cancer screening programme in Lithuania. Retrospective analysis of screening activities recorded in 2006–2015 among men aged 50–74 years was performed. We estimated screening coverage, cancer detection rate, compliance to biopsy, and positive predictive values in each screening round inside and outside the target population. In the first 10 years of screening, 16,061 prostate cancer cases were registered within the screening programme, 10,202 were observed among screened men but reported outside the screening programme, and 1455 prostate cancers were observed in a screening-naïve population. Screening cover reached up to 45.5% of the target population in the recent rounds. The proportion of prostate specific antigen (PSA) test-positive men decreased from 16.9% in 2006 to 10.7% in 2014–2015. Up to 40.0% of PSA test-positive men received a biopsy, of whom 42.0% were positive for prostate cancer. The cancer detection rate was 10.4−15.0% among PSA test-positives and 1.4–1.9% among screened individuals. Screening participants were more likely to be diagnosed with organ-confined disease as compared to non-participants. Despite the unorganized screening practices being employed and low coverage per screening round, 70% of the target population were screened at least once in the first 10 years of screening.
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40
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Meyers TJ, Weiner AB, Graff RE, Desai AS, Cooley LF, Catalona WJ, Hanauer SB, Wu JD, Schaeffer EM, Abdulkadir SA, Kundu SD, Witte JS. Association between inflammatory bowel disease and prostate cancer: A large-scale, prospective, population-based study. Int J Cancer 2020; 147:2735-2742. [PMID: 32399975 DOI: 10.1002/ijc.33048] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/14/2020] [Accepted: 04/28/2020] [Indexed: 12/24/2022]
Abstract
Inflammatory bowel disease (IBD) is an established risk factor for colorectal cancer. Recent reports suggesting IBD is also a risk factor for prostate cancer (PC) require further investigation. We studied 218 084 men in the population-based UK Biobank cohort, aged 40 to 69 at study entry between 2006 and 2010, with follow-up through mid-2015. We assessed the association between IBD and subsequent PC using multivariable Cox regression analyses, adjusting for age at assessment, ethnic group, UK region, smoking status, alcohol drinking frequency, body mass index, Townsend Deprivation Index, family history of PC and previous prostate-specific antigen testing. Mean age at study entry was 56 years, 94% of the men were white, and 1.1% (n = 2311) had a diagnosis of IBD. After a median follow-up of 78 months, men with IBD had an increased risk of PC (adjusted hazard ratio [aHR] = 1.31, 95% confidence interval [CI] = 1.03-1.67, P = .029). The association with PC was only among men with the ulcerative colitis (UC; aHR = 1.47, 95% CI = 1.11-1.95, P = .0070), and not Crohn's disease (aHR 1.06, 95% CI = 0.63-1.80, P = .82). Results are limited by lack of data on frequency of health care interactions. In a large-scale, prospective cohort study, we detected an association between IBD, and UC specifically, with incident PC diagnosis.
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Affiliation(s)
- Travis J Meyers
- Department of Epidemiology and Biostatistics, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Adam B Weiner
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rebecca E Graff
- Department of Epidemiology and Biostatistics, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Anuj S Desai
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lauren Folgosa Cooley
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - William J Catalona
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Stephen B Hanauer
- Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jennifer D Wu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Edward M Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sarki A Abdulkadir
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Shilajit D Kundu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - John S Witte
- Department of Epidemiology and Biostatistics, University of California San Francisco (UCSF), San Francisco, California, USA
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41
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Recommandations françaises du Comité de cancérologie de l’AFU – actualisation 2020–2022 : cancer de la prostate. Prog Urol 2020; 30:S136-S251. [DOI: 10.1016/s1166-7087(20)30752-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Ghayad T, Mekhael M, Gebara N, Eid R, Kourié HR, Haddad F, Nemr E. [Lebanese physicians' attitude towards prostate cancer screening]. Bull Cancer 2020; 107:1199-1201. [PMID: 32977939 DOI: 10.1016/j.bulcan.2020.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/29/2020] [Accepted: 07/14/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Toni Ghayad
- Université Saint-Joseph de Beyrouth, faculté de médecine, Beyrouth, Liban
| | - Mario Mekhael
- Université Saint-Joseph de Beyrouth, faculté de médecine, Beyrouth, Liban
| | - Nicole Gebara
- Université Saint-Joseph de Beyrouth, faculté de médecine, département de médecine de famille, Beyrouth, Liban.
| | - Roland Eid
- Université Saint-Joseph de Beyrouth, département d'hématologie et d'oncologie médicale, faculté de médecine, Beyrouth, Liban
| | - Hampig Raphael Kourié
- Université Saint-Joseph de Beyrouth, département d'hématologie et d'oncologie médicale, faculté de médecine, Beyrouth, Liban
| | - Fady Haddad
- Université Saint-Joseph de Beyrouth, département de médecine interne, Beyrouth, Liban
| | - Elie Nemr
- Université Saint-Joseph de Beyrouth, faculté de médecine, département d'urologie, Beyrouth, Liban
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Taljaard M, Lovric GT, Makenzi AM, Kawinga P. Information Needs of Black Prostate Cancer Patients Receiving Treatment Within the South African Public Healthcare System. Oncol Ther 2020; 8:285-298. [PMID: 32856279 PMCID: PMC7683621 DOI: 10.1007/s40487-020-00125-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction Prostate cancer is the leading cancer type in black South African men. The South African public healthcare sector serves more than 84% of the population, which includes many of these men. Previous evidence suggests that patients’ information needs are influenced by culture. No studies could be found that explored the information needs of black men diagnosed with prostate cancer in a developing country from the patients’ perspectives. Therefore, this study set out to investigate the information needs of black men diagnosed with prostate cancer in a South African public healthcare setting. Methods Nine participants who had completed a radical course of external beam radiation therapy for prostate cancer were interviewed. These participants had gained experience from their cancer journey in this setting and could therefore provide information-rich perspectives about their information needs from the time of diagnosis to end of treatment. Interviews were conducted in the participants’ preferred language, with three interviews conducted in Zulu with an English translator. Results Important themes that emerged included patients' desire to receive more information regarding what was happening in the diagnosis stage, the implications of having prostate cancer and the origin of their symptoms. The participants expressed a need to understand the potential side effects of radiation therapy, the reason for bladder filling and on-treatment set-up imaging verification. Participants also wanted to know how they should care for themselves and adjust their lifestyles, and required more information about follow-up tests and appointments. Conclusion In South Africa, black men with prostate cancer expressed the need for more information about the implications of a prostate cancer diagnosis, the reasons for these treatments and what they were expected to do. They also require information about where to go and what will happen in the different parts of the healthcare system with regard to the diagnosis and treatment of the prostate cancer. Communities should also be educated about cancer to avoid misconceptions. In South Africa, healthcare workers should consider the life-worlds of black men in the public healthcare system when attending to their information needs.
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Affiliation(s)
- Melissa Taljaard
- Department of Radiography, Faculty of Health Sciences, University of Pretoria, Pretoria, 0001, South Africa
| | - Germaine T Lovric
- Department of Radiography, Faculty of Health Sciences, University of Pretoria, Pretoria, 0001, South Africa.
| | - Aviwe M Makenzi
- Department of Radiography, Faculty of Health Sciences, University of Pretoria, Pretoria, 0001, South Africa
| | - Prudence Kawinga
- Department of Radiography, Faculty of Health Sciences, University of Pretoria, Pretoria, 0001, South Africa
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Shaikh F, Dupont-Roettger D, Dehmeshki J, Kubassova O, Quraishi MI. Advanced Imaging of Biochemical Recurrent Prostate Cancer With PET, MRI, and Radiomics. Front Oncol 2020; 10:1359. [PMID: 32974134 PMCID: PMC7466650 DOI: 10.3389/fonc.2020.01359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/29/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Faiq Shaikh
- Image Analysis Group, Philadelphia, PA, United States
| | | | - Jamshid Dehmeshki
- Image Analysis Group, Philadelphia, PA, United States
- Faculty of Science, Engineering and Computing, Kingston University, Kingston-upon-Thames, United Kingdom
| | | | - Mohammed I. Quraishi
- Department of Radiology, University of Tennessee Medical Center, Knoxville, TN, United States
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Rethinking prostate cancer screening: could MRI be an alternative screening test? Nat Rev Urol 2020; 17:526-539. [PMID: 32694594 DOI: 10.1038/s41585-020-0356-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2020] [Indexed: 12/14/2022]
Abstract
In the past decade rigorous debate has taken place about population-based screening for prostate cancer. Although screening by serum PSA levels can reduce prostate cancer-specific mortality, it is unclear whether the benefits outweigh the risks of false-positive results and overdiagnosis of insignificant prostate cancer, and it is not recommended for population-based screening. MRI screening for prostate cancer has the potential to be analogous to mammography for breast cancer or low-dose CT for lung cancer. A number of potential barriers and technical challenges need to be overcome in order to implement such a programme. We discuss different approaches to MRI screening that could address these challenges, including abbreviated MRI protocols, targeted MRI screening, longer rescreening intervals and a multi-modal screening pathway. These approaches need further investigation, and we propose a phased stepwise research framework to ensure proper evaluation of the use of a fast MRI examination as a screening test for prostate cancer.
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Saar M, Linxweiler J, Borkowetz A, Fussek S, Urbanova K, Bellut L, Kristiansen G, Wullich B. Current Role of Multiparametric MRI and MRI Targeted Biopsies for Prostate Cancer Diagnosis in Germany: A Nationwide Survey. Urol Int 2020; 104:731-740. [PMID: 32640460 DOI: 10.1159/000508755] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/03/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Multiparametric MRI (mpMRI) and MRI targeted biopsies (MRtb) are a new standard in prostate cancer (PCa) screening and diagnosis. Guidelines already include this approach for patients at risk. We aimed to gather information from German urologists about their knowledge, routine use, and attitude toward mpMRI and consecutive biopsy methods. MATERIALS AND METHODS An anonymous online questionnaire was sent via Survey Monkey to the members of the German Society of Urology (DGU). Statistical analyses were performed using SPSS version 25.0. RESULTS 496 members with a median age of 48.6 years (±11.7) participated in the survey. The majority rated mpMRI of the prostate as a very useful diagnostic tool (72.7%). MRtb of the prostate was considered as very advantageous (71.5%). MpMRI was used by 95.9%, and 83.2% also recommended MRtb predominantly in clinical institutions. For targeted biopsy, MRI-ultrasound fusion biopsy was clearly favored (75.8%). MpMRI was mostly used in patients with previously negative biopsy (90.9%) and in patients under active surveillance (60.9%). Arguments against the use of prostate mpMRI are costs (84.9%) and/or lack of sufficient radiological infrastructure (17.4%). CONCLUSION Our data illustrate the meanwhile high acceptance and clinical use of the prostate mpMRI and MRtb in Germany.
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Affiliation(s)
- Matthias Saar
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany,
| | - Johannes Linxweiler
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Angelika Borkowetz
- Department of Urology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Sebastian Fussek
- Department of Urology, University Hospital Greifswald, Greifswald, Germany
| | - Katerina Urbanova
- Department of Urology, St. Antonius Hospital Gronau, Gronau, Germany
| | - Laura Bellut
- Department of Urology and Pediatric Urology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Glen Kristiansen
- Institute of Pathology, University of Bonn Medical School, Bonn, Germany
| | - Bernd Wullich
- Department of Urology and Pediatric Urology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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de Pelsemaeker MC, Guiot Y, Vanderveken J, Galant C, Van Bockstal MR. The Impact of the COVID-19 Pandemic and the Associated Belgian Governmental Measures on Cancer Screening, Surgical Pathology and Cytopathology. Pathobiology 2020; 88:46-55. [PMID: 32634799 PMCID: PMC7445376 DOI: 10.1159/000509546] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/19/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction The severe acute respiratory syndrome coronavirus 2 caused a pandemic of coronavirus disease 2019 (COVID-19). Unprecedented public health actions were introduced, including social distancing, travel restrictions and quarantine. The Belgian government announced a national emergency plan, thereby postponing all non-urgent medical consultations and operations. This report analyses the impact of these measures on cancer screening, through assessment of the workload of a laboratory for histopathology and cytopathology. Methods Data on monthly numbers of histological and cytological samples, immunohistochemistry and molecular tests were extracted from the laboratory information management system. Results The global histopathological and cytological workload was substantially reduced. The impact on oncology-related surgical procedures was rather limited. The anti-COVID-19 measures significantly diminished all screening-related samples, such as colon biopsies, breast biopsies and cervical cytology, and strongly reduced the number of samples related to “functional” pathology, such as thyroidectomies and gastric biopsies. Conclusions Since many health care interventions are reflected in the workload of a pathology laboratory, this study enabled us to identify areas for “deconfinement” health care actions. Our findings indicate that various areas in medicine were affected, but the impact seemed largest for cancer screening. Health care professionals should assure that consultations related to cancer screening are postponed instead of cancelled.
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Affiliation(s)
| | - Yves Guiot
- Department of Pathology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | | | - Christine Galant
- Department of Pathology, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium
| | - Mieke Rosalie Van Bockstal
- Department of Pathology, Cliniques universitaires Saint-Luc, Brussels, Belgium, .,Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium,
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Mishra SC. A discussion on controversies and ethical dilemmas in prostate cancer screening. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2019-105979. [PMID: 32631969 DOI: 10.1136/medethics-2019-105979] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 05/17/2020] [Accepted: 05/22/2020] [Indexed: 06/11/2023]
Abstract
Prostate cancer (PCa) is one of the the most common cancers in men. A blood test called prostate-specific antigen (PSA) has a potential to pick up this cancer very early and is used for screening of this disease. However, screening for prostate cancer is a matter of debate. Level 1 evidence from randomised controlled trials suggests a reduction in cancer-specific mortality from PCa screening. However, there could be an associated impact on quality of life due to a high proportion of overdiagnosis and overtreatment as part of the screening. The US Preventive Services Task Force (USPSTF) in 2012 recommended that PSA-based PCa screening should not to be offered at any age. However, considering the current evidence, USPSTF recently revised its recommendation to offer the PSA test to men aged 55-69 years with shared decision-making, in line with earlier guidelines from the American Cancer Society and the American Urological Association. A shared decision making is necessary since the PSA test could potentially harm an individual. However, the literature suggests that clinicians often neglect a discussion on this issue before ordering the test. This narrative discusses the main controversies regarding PCa screening including the PSA threshold for biopsy, the concept of overdiagnosis and overtreatment, the practical difficulties of active surveillance, the current level 1 evidence on the mortality benefit of screening, and the associated pitfalls. It offers a detailed discussion on the ethics involved in the PSA test and highlights the barriers to shared decision-making and possible solutions.
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Affiliation(s)
- Satish Chandra Mishra
- Department of Surgery, WHO Collaboration Centre for Research in Surgical Care Delivery in LMIC, Bhabha Atomic Research Centre Hospital, Mumbai, MH 400094, India
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Luján Galán M, Páez Borda Á, Llanes González L, Romero Cajigal I, Berenguer Sánchez A. Results of the spanish section of the European Randomized Study of Screening for Prostate Cancer (ERSPC). Update after 21 years of follow-up. Actas Urol Esp 2020; 44:430-436. [PMID: 32147352 DOI: 10.1016/j.acuro.2020.01.005] [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: 09/22/2019] [Revised: 01/16/2020] [Accepted: 01/19/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND OBJECTIVE The objective of the European Randomized Study of Screening for Prostate Cancer (ERSPC) is to assess whether prostate cancer (PCa) screening leads to an improvement of cancer-specific survival. This multicenter study (eight European countries) has recruited more than 180,000 asymptomatic men. After a follow-up period of 16 years, it has been shown that PSA screening reduces PCa mortality by 20%, and that it does not affect all-cause mortality. This article provides updated the results of the Spanish arm of the ERSPC after 21 years of follow-up. MATERIALS AND METHODS The study invited 18,612 men (aged 45 - 70) of the Spanish section (Getafe and Parla, Madrid) to participate. They were randomly assigned to the intervention arm (serum PSA-based screening) and to the control arm (follow-up without intervention). The diagnoses of PCa were recorded, as well as the PCa-specific and all-cause mortality rates. A comparison between the survival curves of both arms of the study and detailed analysis of the causes of death were performed. RESULTS The study finally included 4,276 men (2,415 intervention arm, 1,861 control arm). The median age, serum PSA and follow-up time were 57 years, 0.9 ng/ml and 21.1 years, respectively. There were 285 cases with PCa diagnosis, 188 (7.8%) from the intervention arm and 97 (5.2%) from the control arm (p<,001). A total of 216 (75.8%) presented organ-confined disease. There were 994 deaths were recorded; 544 (22.5%) in the intervention arm and 450 (24.2%) in the control arm. No significant differences were detected between the arms of the study in terms of cancer-specific (p=.768) or all-cause (p=.192) mortality rates. The main cause of death was malignant tumors (492 patients, 49.5% of overall mortality), and the most frequent sites were lung and bronchus (29.5%), colon and rectum (14.8%), and hematologic (9.8%). Only 20 patients (0.4% of the patients recruited) died from PCa, with no significant difference between study arms. CONCLUSIONS In this update of the results of the Spanish section of the ERSPC study after 21 years of follow-up, we have not detected a benefit of PCa screening in terms of overall and cancer-specific survival.
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Quintana LM, Fernández Pascual E, Linares Espinós E, Martinez-Ballesteros C, Martin-Vivas C, Rengifo Abbad D, d'Anna Caruso N, Allona A, Martínez-Salamanca JI. Initial experience with SelectMDx® in the diagnosis of prostate cancer in a real-world evidence clinical practice setting. Actas Urol Esp 2020; 44:400-407. [PMID: 32475689 DOI: 10.1016/j.acuro.2020.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 03/04/2020] [Accepted: 03/22/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The use of biomarkers in the detection of prostate cancer (PC) can decrease overdiagnosis and overtreatment of non-significant PC. We analyze the usefulness and applicability of the SelectMDx® marker in a routine clinical practice setting. MATERIAL AND METHODS Retrospective study of 48 patients evaluated by the SelectMDx® test between July 2017 and April 2019. Patients were stratified into two groups according to the risk estimated by the clinically significant CP test (CS-PC): <2% or 'very low risk', and >2%. Results were expressed based on previous prostate biopsy (PB) and multi-parametric magnetic resonance imaging (mpMRI) outcomes. RESULTS Patients with negative PB and normal/doubtful mpMRI had <2% risk in 7/9 cases. Patients without PB and normal/doubtful mpMRI had <2% risk in 12/18 cases, and 2/6 cases with a >2% risk presented CS-PC. Of the 14 patients with no previous PB or mpMRI, 9 had <2% risk, and 2 cases were diagnosed with PC from the group of patients (5) with risk >2%. The number of patients in the remaining subgroups is too small to draw any conclusions. In all cases with pathological digital rectal examination, the test showed a >2% PC risk. CONCLUSION SelectMDx® is a promising test for detecting patients with a very low risk of CS-PC, especially in patients with suspected PC, with or without negative PB, with normal/doubtful mpMRI. The presence of a pathological digital rectal examination may condition the result of the test.
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Affiliation(s)
- L M Quintana
- Servicio de Urología, Hospital Universitario La Paz. Universidad Autónoma de Madrid, Madrid, España
| | - E Fernández Pascual
- Servicio de Urología, Hospital Universitario La Paz. Universidad Autónoma de Madrid, Madrid, España; Instituto Lyx Urología. Universidad Francisco de Vitoria, Madrid, España
| | - E Linares Espinós
- Servicio de Urología, Hospital Universitario La Paz. Universidad Autónoma de Madrid, Madrid, España; Instituto Lyx Urología. Universidad Francisco de Vitoria, Madrid, España.
| | - C Martinez-Ballesteros
- Instituto Lyx Urología. Universidad Francisco de Vitoria, Madrid, España; Servicio de Urología, Hospital Universitario Puerta de Hierro-Majadahonda. Universidad Autónoma de Madrid, Madrid, España
| | - C Martin-Vivas
- Instituto Lyx Urología. Universidad Francisco de Vitoria, Madrid, España
| | - D Rengifo Abbad
- Instituto Lyx Urología. Universidad Francisco de Vitoria, Madrid, España; Servicio de Urología, Hospital Universitario Puerta de Hierro-Majadahonda. Universidad Autónoma de Madrid, Madrid, España
| | - N d'Anna Caruso
- Instituto Lyx Urología. Universidad Francisco de Vitoria, Madrid, España
| | - A Allona
- Servicio de Urología, Hospital Ruber Internacional, Madrid, España
| | - J I Martínez-Salamanca
- Instituto Lyx Urología. Universidad Francisco de Vitoria, Madrid, España; Servicio de Urología, Hospital Universitario Puerta de Hierro-Majadahonda. Universidad Autónoma de Madrid, Madrid, España
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