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Kohjimoto Y, Uemura H, Yoshida M, Hinotsu S, Takahashi S, Takeuchi T, Suzuki K, Shinmoto H, Tamada T, Inoue T, Sugimoto M, Takenaka A, Habuchi T, Ishikawa H, Mizowaki T, Saito S, Miyake H, Matsubara N, Nonomura N, Sakai H, Ito A, Ukimura O, Matsuyama H, Hara I. Japanese clinical practice guidelines for prostate cancer 2023. Int J Urol 2024. [PMID: 39078210 DOI: 10.1111/iju.15545] [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: 06/24/2024] [Accepted: 07/09/2024] [Indexed: 07/31/2024]
Abstract
This fourth edition of the Japanese Clinical Practice Guidelines for Prostate Cancer 2023 is compiled. It was revised under the leadership of the Japanese Urological Association, with members selected from multiple academic societies and related organizations (Japan Radiological Society, Japanese Society for Radiation Oncology, the Department of EBM and guidelines, Japan Council for Quality Health Care (Minds), Japanese Society of Pathology, and the patient group (NPO Prostate Cancer Patients Association)), in accordance with the Minds Manual for Guideline Development (2020 ver. 3.0). The most important feature of this revision is the adoption of systematic reviews (SRs) in determining recommendations for 14 clinical questions (CQs). Qualitative SRs for these questions were conducted, and the final recommendations were made based on the results through the votes of 24 members of the guideline development group. Five algorithms based on these results were also created. Contents not covered by the SRs, which are considered textbook material, have been described in the general statement. In the general statement, a literature search for 14 areas was conducted; then, based on the general statement and CQs of the Japanese Clinical Practice Guidelines for Prostate Cancer 2016, the findings revealed after the 2016 guidelines were mainly described. This article provides an overview of these guidelines.
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Affiliation(s)
- Yasuo Kohjimoto
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Hiroji Uemura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, School of Medicine, International University of Health and Welfare, Narita, Chiba, Japan
- Department of EBM and Guidelines, Japan Council for Quality Health Care (Minds), Tokyo, Japan
| | - Shiro Hinotsu
- Department of Biostatistics and Data Management, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
| | - Tsutomu Takeuchi
- NPO Prostate Cancer Patients Association, Takarazuka, Hyogo, Japan
| | - Kazuhiro Suzuki
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroshi Shinmoto
- Department of Radiology, National Defense Medical College, Tokorozawa, Tochigi, Japan
| | - Tsutomu Tamada
- Department of Radiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Takahiro Inoue
- Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Mikio Sugimoto
- Department of Urology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Tomonori Habuchi
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Hitoshi Ishikawa
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shiro Saito
- Department of Urology, Prostate Cancer Center Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan
| | - Hideaki Miyake
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Nobuaki Matsubara
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideki Sakai
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Nagasaki Rosai Hospital, Sasebo, Nagasaki, Japan
| | - Akihiro Ito
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Osamu Ukimura
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hideyasu Matsuyama
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
- Department of Urology, JA Yamaguchi Kouseiren Nagato General Hospital, Yamaguchi, Japan
| | - Isao Hara
- Department of Urology, Wakayama Medical University, Wakayama, Japan
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Chiu PKF, Liu AQ, Lau SY, Teoh JYC, Ho CC, Yee CH, Hou SM, Chan CK, Tang WL, Bangma CH, Chu PSK, Poon WT, Ng CF, Roobol MJ. A 2-year prospective evaluation of the Prostate Health Index in guiding biopsy decisions in a large cohort. BJU Int 2024. [PMID: 38961793 DOI: 10.1111/bju.16457] [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: 07/05/2024]
Abstract
OBJECTIVES To prospectively evaluate how the Prostate Health Index (PHI) impacts on clinical decision in a real-life setting for men with a prostate-specific antigen (PSA) level between 4 and 10 ng/mL and normal digital rectal examination. PATIENTS AND METHODS Since 2016, the PHI has been available at no cost to eligible men in all Hong Kong public hospitals. All eligible patients who received PHI testing in all public Urology units (n = 16) in Hong Kong between May 2016 and August 2017 were prospectively included and followed up. All included men had a PHI test, with its result and implications explained; the subsequent follow-up plan was then decided via shared decision-making with urologists. Patients were followed up for 2 years, with outcomes including prostate biopsy rates and biopsy findings analysed in relation to the initial PHI measurements. RESULTS A total of 2828 patients were followed up for 2 years. The majority (82%) had PHI results in the lower risk range (score <35). Knowing the PHI findings, 83% of the patients with elevated PSA decided not to undergo biopsy. In all, 11% and 45% opted for biopsy in the PHI score <35 and ≥35 groups, respectively. The initial detection rate of International Society of Urological Pathology (ISUP) Grade Group (GG) ≥2 cancer was higher in the PHI score ≥35 group (23%) than in the PHI score <35 group (7.9%). Amongst patients with no initial positive biopsy findings, the subsequent positive biopsy rate for ISUP GG ≥2 cancer was higher in the PHI score ≥35 group (34%) than the PHI score <35 group (13%) with a median follow-up of 2.4 years. CONCLUSION In a real-life setting, with the PHI incorporated into the routine clinical pathway, 83% of the patients with elevated PSA level decided not to undergo prostate biopsy. The PHI pathway also improved the high-grade prostate cancer detection rate when compared to PSA-driven strategies. Higher baseline PHI predicted subsequent biopsy outcome at 2 years. The PHI can serve as a tool to individualise biopsy decisions and frequency of follow-up visits.
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Affiliation(s)
- Peter Ka-Fung Chiu
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Alex Qinyang Liu
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Sui-Yan Lau
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Chun Ho
- Department of Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Chi-Hang Yee
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - See-Ming Hou
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Kwok Chan
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Wai-Lun Tang
- Department of Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Chris H Bangma
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peggy Sau-Kwan Chu
- Division of Urology, Department of Surgery, Tuen Mun Hospital, Hong Kong, China
| | - Wing-Tat Poon
- Department of Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Chi-Fai Ng
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Monique J Roobol
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Hyndman ME, Paproski RJ, Kinnaird A, Fairey A, Marks L, Pavlovich CP, Fletcher SA, Zachoval R, Adamcova V, Stejskal J, Aprikian A, Wallis CJD, Pink D, Vasquez C, Beatty PH, Lewis JD. Development of an effective predictive screening tool for prostate cancer using the ClarityDX machine learning platform. NPJ Digit Med 2024; 7:163. [PMID: 38902526 PMCID: PMC11190196 DOI: 10.1038/s41746-024-01167-9] [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: 03/08/2024] [Accepted: 06/12/2024] [Indexed: 06/22/2024] Open
Abstract
The current prostate cancer (PCa) screen test, prostate-specific antigen (PSA), has a high sensitivity for PCa but low specificity for high-risk, clinically significant PCa (csPCa), resulting in overdiagnosis and overtreatment of non-csPCa. Early identification of csPCa while avoiding unnecessary biopsies in men with non-csPCa is challenging. We built an optimized machine learning platform (ClarityDX) and showed its utility in generating models predicting csPCa. Integrating the ClarityDX platform with blood-based biomarkers for clinically significant PCa and clinical biomarker data from a 3448-patient cohort, we developed a test to stratify patients' risk of csPCa; called ClarityDX Prostate. When predicting high risk cancer in the validation cohort, ClarityDX Prostate showed 95% sensitivity, 35% specificity, 54% positive predictive value, and 91% negative predictive value, at a ≥ 25% threshold. Using ClarityDX Prostate at this threshold could avoid up to 35% of unnecessary prostate biopsies. ClarityDX Prostate showed higher accuracy for predicting the risk of csPCa than PSA alone and the tested model-based risk calculators. Using this test as a reflex test in men with elevated PSA levels may help patients and their healthcare providers decide if a prostate biopsy is necessary.
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Affiliation(s)
- M Eric Hyndman
- Department of Surgical Oncology, University of Calgary, Prostate Cancer Centre, Calgary, T2P 1P9, AB, Canada
- Nanostics Inc., 4550 10230 Jasper Avenue, Edmonton, T5J 4P6, AB, Canada
| | - Robert J Paproski
- Nanostics Inc., 4550 10230 Jasper Avenue, Edmonton, T5J 4P6, AB, Canada
| | - Adam Kinnaird
- Division of Urology, Department of Surgery, University of Alberta, Kipnes Urology Centre, Edmonton, T6G 1Z1, AB, Canada
- Department of Oncology, University of Alberta, Edmonton, T6G 2E1, AB, Canada
| | - Adrian Fairey
- Nanostics Inc., 4550 10230 Jasper Avenue, Edmonton, T5J 4P6, AB, Canada
- Division of Urology, Department of Surgery, University of Alberta, Kipnes Urology Centre, Edmonton, T6G 1Z1, AB, Canada
| | - Leonard Marks
- UCLA Health, Westwood Urology 200 Medical Plaza, Suite 140, Los Angeles, CA, 90095, USA
| | - Christian P Pavlovich
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, 21287, MD, USA
| | - Sean A Fletcher
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, 21287, MD, USA
| | - Roman Zachoval
- Department of Urology, 3rd Faculty of Medicine of Charles University and Thomayer University Hospital, Prague, Czech Republic
| | - Vanda Adamcova
- Department of Urology, 3rd Faculty of Medicine of Charles University and Thomayer University Hospital, Prague, Czech Republic
| | - Jiri Stejskal
- Department of Urology, 3rd Faculty of Medicine of Charles University and Thomayer University Hospital, Prague, Czech Republic
| | - Armen Aprikian
- Nanostics Inc., 4550 10230 Jasper Avenue, Edmonton, T5J 4P6, AB, Canada
- Department of Surgery, McGill University, Montreal, H3G 2M1, QC, Canada
| | - Christopher J D Wallis
- Division of Urology, Department of Surgery, University of Toronto, Toronto, M5T 1P5, ON, Canada
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, M5G 1X5, ON, Canada
- Department of Surgical Oncology, University Health Network, Toronto, ON, Canada
| | - Desmond Pink
- Nanostics Inc., 4550 10230 Jasper Avenue, Edmonton, T5J 4P6, AB, Canada
| | - Catalina Vasquez
- Nanostics Inc., 4550 10230 Jasper Avenue, Edmonton, T5J 4P6, AB, Canada
| | - Perrin H Beatty
- Nanostics Inc., 4550 10230 Jasper Avenue, Edmonton, T5J 4P6, AB, Canada
| | - John D Lewis
- Nanostics Inc., 4550 10230 Jasper Avenue, Edmonton, T5J 4P6, AB, Canada.
- Department of Oncology, University of Alberta, Edmonton, T6G 2E1, AB, Canada.
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Olson P, Wagner J. Established and emerging liquid biomarkers for prostate cancer detection: A review. Urol Oncol 2024:S1078-1439(24)00486-1. [PMID: 38871601 DOI: 10.1016/j.urolonc.2024.05.011] [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: 11/06/2023] [Revised: 03/03/2024] [Accepted: 05/18/2024] [Indexed: 06/15/2024]
Abstract
Prostate cancer remains one of the most frequently diagnosed cancers among men in the world today. Since its introduction in 1987 and FDA approval in 1994, prostate specific antigen (PSA) has reduced prostate cancer specific mortality considerably. However, the positive and negative predictive value of PSA is less than ideal and can lead to the over-detection of clinically insignificant prostate cancer. In the search for better screening measures to identify this cohort, liquid biomarkers for prostate cancer have emerged. In this review we will explore the commonly used urine and blood based prostate cancer liquid biomarkers. We detail the mechanism of each test and the validation studies that underscore their efficacy. Additionally, we will examine each test's effect on shared decision making as well as their cost efficacy in clinical practice.
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Affiliation(s)
- Philip Olson
- Division of Urology, University of Connecticut Health Center, Farmington, CT.
| | - Joseph Wagner
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT
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Vynckier P, Annemans L, Raes S, Amrouch C, Lindgren P, Májek O, Beyer K, Leenen RCA, Venderbos LDF, Denijs F, van Harten MJ, Helleman J, Chloupková R, Briers E, Vasilyeva V, Rivas JG, Basu P, Chandran A, van den Bergh RCN, Collen S, Van Poppel H, Roobol MJ. Systematic Review on the Cost Effectiveness of Prostate Cancer Screening in Europe. Eur Urol 2024:S0302-2838(24)02378-9. [PMID: 38789306 DOI: 10.1016/j.eururo.2024.04.036] [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: 01/30/2024] [Revised: 04/02/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND AND OBJECTIVE In Europe, prostate cancer (PCa) is the most common cancer in men. Screening may therefore be crucial to lower health care costs, morbidity, and mortality. This systematic review aimed to provide a contemporary overview of the costs and benefits of PCa screening programmes. METHODS A peer-reviewed literature search was conducted, using the PICO method. A detailed search strategy was developed in four databases based on the following key search terms: "PCa", "screening", and "cost effectiveness". Any type of economic evaluation was included. The search strategy was restricted to European countries, but no restrictions were set on the year of publication. KEY FINDINGS AND LIMITATIONS A total of 7484 studies were identified initially. Of these, 19 studies described the cost effectiveness of PCa screening in Europe. Among the studies using an initially healthy study population, most focussed on risk- and/or age- and/or magnetic resonance imaging (MRI)-based screening in addition to prostate-specific antigen (PSA) testing and compared this with no screening. Incremental cost ratios (ICERs) varied from €5872 per quality-adjusted life year (QALY) to €372 948/QALY, with a median of €56 487/QALY. Risk-based screening followed by MRI testing seemed to be a more cost-effective strategy than no screening. CONCLUSIONS AND CLINICAL IMPLICATIONS This systematic review indicates that screening programmes incorporating a risk-based approach and MRI have the potential to be cost effective. PATIENT SUMMARY In this review, we looked at the cost effectiveness of prostate cancer screening in Europe. We found that a risk-based approach and incorporation of magnetic resonance imaging has the potential to be cost effective. However, there remains a knowledge gap regarding cost effectiveness of prostate cancer screening. Therefore, determinants of cost effectiveness require further investigation.
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Affiliation(s)
- Pieter Vynckier
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Lieven Annemans
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sarah Raes
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Cheïma Amrouch
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | | | - Ondřej Májek
- National Screening Centre, Institute of Health Information and Statistics of the Czech Republic, Prague, Czechia; Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Katharina Beyer
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Renée C A Leenen
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Lionne D F Venderbos
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Frederique Denijs
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Meike J van Harten
- Cancer Center, Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jozien Helleman
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Renata Chloupková
- National Screening Centre, Institute of Health Information and Statistics of the Czech Republic, Prague, Czechia; Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czechia
| | | | - Vera Vasilyeva
- European Association of Urology, Policy Office, Arnhem, The Netherlands
| | - Juan Gomez Rivas
- Department of Urology, Clínico San Carlos University Hospital, Madrid, Spain
| | - Partha Basu
- International Agency for Research on Cancer/World Health Organization, Lyon, France
| | - Arunah Chandran
- International Agency for Research on Cancer/World Health Organization, Lyon, France
| | | | - Sarah Collen
- European Association of Urology, Policy Office, Arnhem, The Netherlands
| | - Hein Van Poppel
- European Association of Urology, Policy Office, Arnhem, The Netherlands; Department of Urology, KU Leuven, Leuven, Belgium
| | - Monique J Roobol
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, The Netherlands
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Mohammadi T, Guh DP, Tam ACT, Pataky RE, Black PC, So A, Lynd LD, Zhang W, Conklin AI. Economic evaluation of prostate cancer risk assessment methods: A cost-effectiveness analysis using population data. Cancer Med 2023; 12:20106-20118. [PMID: 37740609 PMCID: PMC10587968 DOI: 10.1002/cam4.6587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND The current prostate cancer (PCa) screening standard of care (SOC) leads to unnecessary biopsies and overtreatment because decisions are guided by prostate-specific antigen (PSA) levels, which have low specificity in the gray zone (3-10 ng/mL). New risk assessment tools (RATs) aim to improve biopsy decision-making. We constructed a modeling framework to assess new RATs in men with gray zone PSA from the British Columbia healthcare system's perspective. METHODS We evaluated the cost-effectiveness of a new RAT used in biopsy-naïve men aged 50+ with a PSA of 3-10 ng/mL using a time-dependent state-transition model. The model was informed by engaging patient partners and using linked administrative health data, supplemented with published literature. The incremental cost-effectiveness ratio and the probability of the RAT being cost-effective were calculated. Probabilistic analysis was used to assess parameter uncertainty. RESULTS In the base case, a RAT based on an existing biomarker's characteristics was a dominant strategy associated with a cost savings of $44 and a quality-adjusted life years (QALY) gain of 0.00253 over 18 years of follow-up. At a cost-effectiveness threshold of $50,000/QALY, the probability that using a RAT is cost-effective relative to the SOC was 73%. Outcomes were sensitive to RAT costs and accuracy, especially the detection rate of high-grade PCa. Results were also impacted by PCa prevalence and assumptions about undetected PCa survival. CONCLUSIONS Our findings showed that a more accurate RAT to guide biopsy can be cost-effective. Our proposed general model can be used to analyze the cost-effectiveness of any novel RAT.
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Affiliation(s)
- Tima Mohammadi
- Centre for Advancing Health Outcomes (formerly Centre for Health Evaluation and Outcome Sciences), Providence Health Care Research InstituteSt. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Daphne P. Guh
- Centre for Advancing Health Outcomes (formerly Centre for Health Evaluation and Outcome Sciences), Providence Health Care Research InstituteSt. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Alexander C. T. Tam
- Centre for Advancing Health Outcomes (formerly Centre for Health Evaluation and Outcome Sciences), Providence Health Care Research InstituteSt. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Reka E. Pataky
- Canadian Centre for Applied Research in Cancer Control, BC CancerVancouverBritish ColumbiaCanada
| | - Peter C. Black
- Department of Urologic Sciences, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Alan So
- Department of Urologic Sciences, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Larry D. Lynd
- Centre for Advancing Health Outcomes (formerly Centre for Health Evaluation and Outcome Sciences), Providence Health Care Research InstituteSt. Paul's HospitalVancouverBritish ColumbiaCanada
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Wei Zhang
- Centre for Advancing Health Outcomes (formerly Centre for Health Evaluation and Outcome Sciences), Providence Health Care Research InstituteSt. Paul's HospitalVancouverBritish ColumbiaCanada
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Annalijn I. Conklin
- Centre for Advancing Health Outcomes (formerly Centre for Health Evaluation and Outcome Sciences), Providence Health Care Research InstituteSt. Paul's HospitalVancouverBritish ColumbiaCanada
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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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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Keeney E, Thom H, Turner E, Martin RM, Morley J, Sanghera S. Systematic Review of Cost-Effectiveness Models in Prostate Cancer: Exploring New Developments in Testing and Diagnosis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:133-146. [PMID: 35031092 PMCID: PMC8752463 DOI: 10.1016/j.jval.2021.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Recent innovations in prostate cancer diagnosis include new biomarkers and more accurate biopsy methods. This study assesses the evidence base on cost-effectiveness of these developments (eg, Prostate Health Index and magnetic resonance imaging [MRI]-guided biopsy) and identifies areas of improvement for future cost-effectiveness models. METHODS A systematic review using the National Health Service Economic Evaluation Database, MEDLINE, Embase, Health Technology Assessment databases, National Institute for Health and Care Excellence guidelines, and United Kingdom National Screening Committee guidance was performed, between 2009 and 2021. Relevant data were extracted on study type, model inputs, modeling methods and cost-effectiveness conclusions, and results narratively synthesized. RESULTS A total of 22 model-based economic evaluations were included. A total of 11 compared the cost-effectiveness of new biomarkers to prostate-specific antigen testing alone and all found biomarkers to be cost saving. A total of 8 compared MRI-guided biopsy methods to transrectal ultrasound-guided methods and found MRI-guided methods to be most cost-effective. Newer detection methods showed a reduction in unnecessary biopsies and overtreatment. The most cost-effective follow-up strategy in men with a negative initial biopsy was uncertain. Many studies did not model for stage or grade of cancer, cancer progression, or the entire testing and treatment pathway. Few fully accounted for uncertainty. CONCLUSIONS This review brings together the cost-effectiveness literature for novel diagnostic methods in prostate cancer, showing that most studies have found new methods to be more cost-effective than standard of care. Several limitations of the models were identified, however, limiting the reliability of the results. Areas for further development include accurately modeling the impact of early diagnostic tests on long-term outcomes of prostate cancer and fully accounting for uncertainty.
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Affiliation(s)
- Edna Keeney
- Health Economics Bristol, Bristol Medical School, University of Bristol, Bristol, England, UK.
| | - Howard Thom
- Health Economics Bristol, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - Emma Turner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - Richard M Martin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK; MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - Josie Morley
- Health Economics Bristol, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - Sabina Sanghera
- Health Economics Bristol, Bristol Medical School, University of Bristol, Bristol, England, UK
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9
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Chiu ST, Cheng YT, Pu YS, Lu YC, Hong JH, Chung SD, Chiang CH, Huang CY. Prostate Health Index Density Outperforms Prostate Health Index in Clinically Significant Prostate Cancer Detection. Front Oncol 2021; 11:772182. [PMID: 34869007 PMCID: PMC8640459 DOI: 10.3389/fonc.2021.772182] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/29/2021] [Indexed: 12/11/2022] Open
Abstract
Background Prostate-specific antigen (PSA) is considered neither sensitive nor specific for prostate cancer (PCa). We aimed to compare total PSA (tPSA), percentage of free PSA (%fPSA), the PSA density (PSAD), Prostate Health Index (PHI), and the PHI density (PHID) to see which one could best predict clinically significant prostate cancer (csPCa): a potentially lethal disease. Methods A total of 412 men with PSA of 2-20 ng/mL were prospectively included. Serum biomarkers for PCa was collected before transrectal ultrasound guided prostate biopsy. PHI was calculated by the formula: (p2PSA/fPSA) x √tPSA. PHID was calculated as PHI divided by prostate volume measured by transrectal ultrasound. Results Of the 412 men, 134 (32.5%) and 94(22.8%) were diagnosed with PCa and csPCa, respectively. We used the area under the receiver operating characteristic curve (AUC) and decision curve analyses (DCA) to compare the performance of PSA related parameters, PHI and PHID in diagnosing csPCa. AUC for tPSA, %fPSA, %p2PSA, PSAD, PHI and PHID were 0.56、0.63、0.76、0.74、0.77 and 0.82 respectively for csPCa detection. In the univariate analysis, the prostate volume, tPSA, %fPSA, %p2PSA, PHI, PSAD, and PHID were all significantly associated with csPCa, and PHID was the most important predictor (OR 1.41, 95% CI 1.15-1.72). Besides, The AUC of PHID was significantly larger than PHI in csPCa diagnosis (p=0.004). At 90% sensitivity, PHID had the highest specificity (54.1%) for csPCa and could reduce the most unnecessary biopsies (43.7%) and miss the fewest csPCa (8.5%) when PHID ≥ 0.67. In addition to AUC, DCA re-confirmed the clinical benefit of PHID over all PSA-related parameters and PHI in csPCa diagnosis. The PHID cut-off value was positively correlated with the csPCa ratio in the PHID risk table, which is useful for evaluating csPCa risk in a clinical setting. Conclusion The PHID is an excellent predictor of csPCa. The PHID risk table may be used in standard clinical practice to pre-select men at the highest risk of harboring csPCa.
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Affiliation(s)
- Shih-Ting Chiu
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yung-Ting Cheng
- Department of Urology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Yeong-Shiau Pu
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Chuan Lu
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jian-Hua Hong
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shiu-Dong Chung
- Division of Urology, Department of Surgery, Far-Eastern Memorial Hospital, New Taipei City, Taiwan.,Graduate Program in Biomedical Informatics, College of Informatics, Yuan-Ze University, Chung-Li, Taiwan
| | - Chih-Hung Chiang
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Urology, Taipei Veterans General Hospital, Yuan-Shan/Su-Ao Branch, Yi-Lan, Taiwan.,Department of Medical Research and Education, Taipei Veterans General Hospital, Yuan-Shan/Su-Ao Branch, Yi-Lan, Taiwan
| | - Chao-Yuan Huang
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
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10
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Karlsson AA, Hao S, Jauhiainen A, Elfström KM, Egevad L, Nordström T, Heintz E, Clements MS. The cost-effectiveness of prostate cancer screening using the Stockholm3 test. PLoS One 2021; 16:e0246674. [PMID: 33630863 PMCID: PMC7906342 DOI: 10.1371/journal.pone.0246674] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/23/2021] [Indexed: 12/21/2022] Open
Abstract
Objectives The European Randomized Study of Screening for Prostate Cancer found that prostate-specific antigen (PSA) screening reduced prostate cancer mortality, however the costs and harms from screening may outweigh any mortality reduction. Compared with screening using the PSA test alone, using the Stockholm3 Model (S3M) as a reflex test for PSA ≥ 1 ng/mL has the same sensitivity for Gleason score ≥ 7 cancers while the relative positive fractions for Gleason score 6 cancers and no cancer were 0.83 and 0.56, respectively. The cost-effectiveness of the S3M test has not previously been assessed. Methods We undertook a cost-effectiveness analysis from a lifetime societal perspective. Using a microsimulation model, we simulated for: (i) no prostate cancer screening; (ii) screening using the PSA test; and (iii) screening using the S3M test as a reflex test for PSA values ≥ 1, 1.5 and 2 ng/mL. Screening strategies included quadrennial re-testing for ages 55–69 years performed by a general practitioner. Discounted costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. Results Comparing S3M with a reflex threshold of 2 ng/mL with screening using the PSA test, S3M had increased effectiveness, reduced lifetime biopsies by 30%, and increased societal costs by 0.4%. Relative to the PSA test, the S3M reflex thresholds of 1, 1.5 and 2 ng/mL had ICERs of 170,000, 60,000 and 6,000 EUR/QALY, respectively. The S3M test was more cost-effective at higher biopsy costs. Conclusions Prostate cancer screening using the S3M test for men with an initial PSA ≥ 2.0 ng/mL was cost-effective compared with screening using the PSA test alone.
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Affiliation(s)
- Andreas A Karlsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Swedish eScience Research Centre, Stockholm, Sweden
| | - Shuang Hao
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Swedish eScience Research Centre, Stockholm, Sweden
| | - Alexandra Jauhiainen
- BioPharma Early Biometrics and Statistical Innovation, Data Science & AI, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - K Miriam Elfström
- Department of Laboratory Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Egevad
- Department of Oncology-Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Tobias Nordström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Emelie Heintz
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Mark S Clements
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Swedish eScience Research Centre, Stockholm, Sweden
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11
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Zhou ZH, Liu F, Wang WJ, Liu X, Sun LJ, Zhu Y, Ye DW, Zhang GM. Development and validation of a nomogram including lymphocyte-to-monocyte ratio for initial prostate biopsy: a double-center retrospective study. Asian J Androl 2021; 23:41-46. [PMID: 32503957 PMCID: PMC7831838 DOI: 10.4103/aja.aja_19_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Here, we developed a prostate cancer (PCa) risk nomogram including lymphocyte-to-monocyte ratio (LMR) for initial prostate biopsy, and internal and external validation were further conducted. A prediction model was developed on a training set. Significant risk factors with P < 0.10 in multivariate logistic regression models were used to generate a nomogram. Discrimination, calibration, and clinical usefulness of the model were assessed using C-index, calibration plot, and decision curve analysis (DCA). The nomogram was re-examined with the internal and external validation set. A nomogram predicting PCa risk in patients with prostate-specific antigen (PSA) 4–10 ng ml−1 was also developed. The model displayed good discrimination with C-index of 0.830 (95% confidence interval [CI]: 0.812–0.852). High C-index of 0.864 (95% CI: 0.840–0.888) and 0.871 (95% CI: 0.861–0.881) was still reached in the internal and external validation sets, respectively. The nomogram exhibited better performance compared to the nomogram with PSA only (C-index: 0.763, 95% CI: 0.746–0.780, P < 0.001) and the nomogram with LMR excluded (C-index: 0.824, 95% CI: 0.804–0.844, P < 0.010). The calibration curve demonstrated good agreement in the internal and external validation sets. DCA showed that the nomogram was useful at the threshold probability of >4% and <99%. The nomogram predicting PCa risk in patients with PSA 4–10 ng ml−1 also displayed good calibration and discrimination performance (C-index: 0.734, 95% CI: 0.708–0.760). This nomogram incorporating age, PSA, digital rectal examination, abnormal imaging signals, PSA density, and LMR could be used to facilitate individual PCa risk prediction in initial prostate biopsy.
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Affiliation(s)
- Zhong-Han Zhou
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Feng Liu
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Wen-Jie Wang
- Department of Special Inspection, Qingdao Eighth People's Hospital, Qingdao 266003, China
| | - Xue Liu
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Li-Jiang Sun
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Yao Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Ding-Wei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Gui-Ming Zhang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
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12
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Jatho A, Mugisha NM, Kafeero J, Holoya G, Okuku F, Niyonzima N, Orem J. Capacity building for cancer prevention and early detection in the Ugandan primary healthcare facilities: Working toward reducing the unmet needs of cancer control services. Cancer Med 2020; 10:745-756. [PMID: 33319508 PMCID: PMC7877353 DOI: 10.1002/cam4.3659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/25/2022] Open
Abstract
Background In 2018, approximately 60,000 Ugandans were estimated to be suffering from cancer. It was also reported that only 5% of cancer patients access cancer care and 77% present with late‐stage cancer coupled with low level of cancer health literacy in the population despite a wide coverage of primary healthcare facilities in Uganda. We aimed to contribute to reducing the unmet needs of cancer prevention and early detection services in Uganda through capacity building. Methods In 2017, we conducted two national and six regional cancer control stakeholders’ consultative meetings. In 2017 and 2018, we trained district primary healthcare teams on cancer prevention and early detection. We also developed cancer information materials for health workers and communities and conducted a follow‐up after the training. Results A total of 488 primary healthcare workers from 118 districts were trained. Forty‐six health workers in the pilot East‐central subregion were further trained in cervical, breast, and prostate cancer early detection (screening and early diagnosis) techniques. A total of 32,800 cancer information, education and communication materials; breast, cervical, prostate childhood and general cancer information booklets; health education guide, community cancer information flipcharts for village health teams and referral guidelines for suspected cancer were developed and distributed to 122 districts. Also, 16 public and private‐not‐for‐profit regional hospitals, and one training institution received these materials. Audiovisual clips on breast, cervical, and prostate cancer were developed for mass and social media dissemination. A follow‐up after six months to one year indicated that 75% of the districts had implemented at least one of the agreed actions proposed during the training. Conclusions In Uganda, the unmet needs for cancer control services are enormous. However, building the capacity of primary healthcare workers to integrate prevention and early detection of cancer into primary health care based on low‐cost options for low‐income countries could contribute to reducing the unmet needs of cancer prevention and early detection in Uganda. In Uganda, the unmet needs for cancer control services are enormous. We engaged district leaders and healthcare managers, developed cancer information materials, and trained the district PHC workers to integrate prevention and early detection of cancer into the primary healthcare system. This could contribute to reducing the unmet needs of cancer control services in Uganda.
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Affiliation(s)
- Alfred Jatho
- National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea.,Uganda Cancer Institute, Kampala, Uganda
| | | | | | | | - Fred Okuku
- Uganda Cancer Institute, Kampala, Uganda
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13
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Huang D, Yang X, Wu Y, Lin X, Xu D, Na R, Xu J. Cost-Effectiveness Analysis of Prostate Health Index in Decision Making for Initial Prostate Biopsy. Front Oncol 2020; 10:565382. [PMID: 33330035 PMCID: PMC7732507 DOI: 10.3389/fonc.2020.565382] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/27/2020] [Indexed: 12/23/2022] Open
Abstract
Background Clinical studies have suggested that prostate health index (phi) outperforms prostate-specific antigen (PSA) tests in prostate cancer detection. The cost-effectiveness of phi with different cutoffs is poorly understood in the context of decision making for prostate biopsy. Methods In a multicenter cohort, 3,348 men with elevated total PSA (tPSA) underwent initial prostate biopsy from August 2013 to May 2019. We constructed a decision model to evaluate the incremental cost-effectiveness ratios of different phi cutoffs. Total costs and reimbursement payments were based on the fee schedule of Shanghai Basic Medical Insurance and converted into United States dollars ($). Two willingness-to-pay thresholds were estimated as one or three times the average gross domestic product per capita of China ($7,760 or $23,279, respectively). Results The total costs of prostate biopsy and PSA tests were estimated at $315 and $19, respectively. The cost of phi test varied between $72 to $130 in different medical centers. Under different phi cutoffs (from 23 to 35), phi test predicted reductions of 420 (21.7%) to 972 (50.2%) in unnecessary biopsies, with a total gain of 23.77-57.58 quality adjusted life-years compared to PSA tests. All the cutoffs would be cost-effective for patients with tPSA levels of 2-10 ng/ml. Applying 27 as the cutoff was cost-effective for each tPSA range, with missing positive cases ranging from 11 (3.4%) to 33 (11.5%). Conclusions Using phi test was cost-effective in the decision-making process for initial prostate biopsy, especially for patients with tPSA values between 2-10 ng/ml. The phi cutoff of 27 was cost-effective regardless of tPSA ranges and should be recommended from a health-economic perspective.
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Affiliation(s)
- Da Huang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoqun Yang
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yishuo Wu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoling Lin
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Danfeng Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Na
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianfeng Xu
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, United States
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14
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King ML, Nittala MR, Gordy XZ, Roberts P, Lirette ST, Thomas TV, Gordy DP, Albert AA, Vijayakumar V, Vijayakumar S. Prostate Cancer Screening Recommendations for General and Specific Populations in the
Western Nations. EUROPEAN MEDICAL JOURNAL 2020. [DOI: 10.33590/emj/20-00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
There is a chaotic scenario that exists in the field of prostate cancer (PCa) screening. To balance goals, such as decreasing mortality, avoiding unnecessary procedures, and decreasing the cost of medical care, the pendulum seems to have swung to the side of more restricted screening. The decrease in PCa screening has led to a slowly creeping decline in the favourable outcomes that existed among patients with PCa. If a potential patient or a family member is trying to get clear guidance about PCa screening by searching the internet, they will end up confused by several recommendations from many organisations. It is even more challenging to obtain any clarity about PCa screening for special populations, such as those with a family history of PCa, those of African descent/African Americans, and the elderly. The advent of genomic medicine and precision medicine is an opportunity to identify those at a very high risk of developing aggressive PCa, so that PCa screening can be more actively undertaken among them. In this paper, the authors review the current recommendations by different entities and summarise emerging molecular markers that may help bring clarity to PCa screening. The authors predict that concrete, consensual guidelines will emerge in less than one decade. Meanwhile, this article suggests intermediary steps that will help save lives from PCa mortality, especially for under-represented populations. This paper is a catalyst to stimulate further discussion and serves as a guide to noncancer-specialists for the near future as precision medicine progresses to better understand risk–benefit and cost–benefit ratios in PCa screening.
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Affiliation(s)
- Maurice L. King
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Mary R. Nittala
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Xiaoshan Z. Gordy
- Department of Health Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Paul Roberts
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Seth T. Lirette
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Toms V. Thomas
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - David P. Gordy
- Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ashley A. Albert
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Vani Vijayakumar
- Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Srinivasan Vijayakumar
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
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15
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Munteanu VC, Munteanu RA, Gulei D, Schitcu VH, Petrut B, Berindan Neagoe I, Achimas Cadariu P, Coman I. PSA Based Biomarkers, Imagistic Techniques and Combined Tests for a Better Diagnostic of Localized Prostate Cancer. Diagnostics (Basel) 2020; 10:E806. [PMID: 33050493 PMCID: PMC7601671 DOI: 10.3390/diagnostics10100806] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 02/07/2023] Open
Abstract
Prostate cancer represents the most encountered urinary malignancy in males over 50 years old, and the second most diagnosed after lung cancer globally. Digital rectal examination and prostatic specific antigen were the long-time standard tools for diagnosis but with a significant risk of overdiagnosis and overtreatment. Magnetic resonance imaging recently entered the diagnosis process, but to this date, there is no specific biomarker that accurately indicates whether to proceed with the prostate biopsy. Research in this area has gone towards this direction, and recently, serum, urine, imagistic, tissue biomarkers, and Risk Calculators promise to help better diagnose and stratify prostate cancer. In order to eliminate the comorbidities that appear along with the diagnosis and treatment of this disease, there is a constant need to implement new diagnostic strategies. Important uro-oncology associations recommend the use of novel biomarkers in the grey area of prostate cancer, to better distinguish the next step in the diagnostic process. Although it is not that simple, they should be integrated according to the clinical policies, and it should be considered that statistical significance does not always equal clinical significance. In this review, we analyzed the contribution of prostate-specific antigen (PSA)-based biomarkers (PHI, PHID, 4Kscore, STHLM3), imagistic techniques (mp-MRI and mp-US), and combined tests in the early diagnosis process of localized prostate cancer.
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Affiliation(s)
- Vlad Cristian Munteanu
- Department of Urology, The Oncology Institute “Prof Dr. Ion Chiricuta”, 400015 Cluj-Napoca, Romania; (V.H.S.); (B.P.)
- Department of Urology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Raluca Andrada Munteanu
- MedFuture—Research Center for Advanced Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania; (R.A.M.); (D.G.)
| | - Diana Gulei
- MedFuture—Research Center for Advanced Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania; (R.A.M.); (D.G.)
| | - Vlad Horia Schitcu
- Department of Urology, The Oncology Institute “Prof Dr. Ion Chiricuta”, 400015 Cluj-Napoca, Romania; (V.H.S.); (B.P.)
| | - Bogdan Petrut
- Department of Urology, The Oncology Institute “Prof Dr. Ion Chiricuta”, 400015 Cluj-Napoca, Romania; (V.H.S.); (B.P.)
- Department of Urology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Ioana Berindan Neagoe
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania;
- Department of Functional Genomics and Experimental Pathology, The Oncology Institute “Prof. Dr. Ion Chiricuta”, 400015 Cluj-Napoca, Romania
| | - Patriciu Achimas Cadariu
- Surgery Department, The Oncology Institute “Prof. Dr. Ion Chiricuţă”, 400015 Cluj-Napoca, Romania;
- Department of Surgery and Gynecological Oncology, the University of Medicine and Pharmacy “Iuliu Hatieganu”, 400337 Cluj-Napoca, Romania
| | - Ioan Coman
- Department of Urology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Urology, Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania
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16
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Gulati R, Morgan TM, A'mar T, Psutka SP, Tosoian JJ, Etzioni R. Overdiagnosis and Lives Saved by Reflex Testing Men With Intermediate Prostate-Specific Antigen Levels. J Natl Cancer Inst 2020; 112:384-390. [PMID: 31225597 DOI: 10.1093/jnci/djz127] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/30/2019] [Accepted: 06/13/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Several prostate cancer (PCa) early-detection biomarkers are available for reflex testing in men with intermediate prostate-specific antigen (PSA) levels. Studies of these biomarkers typically provide information about diagnostic performance but not about overdiagnosis and lives saved, the primary drivers of associated harm and benefit. METHODS We projected overdiagnoses and lives saved using an established microsimulation model of PCa incidence and mortality with screening and treatment efficacy based on randomized trials. We used this framework to evaluate four urinary reflex biomarkers (measured in 1112 men presenting for prostate biopsy at 10 US academic or community clinics) and two hypothetical ideal biomarkers (with 100% sensitivity or specificity for any or for high-grade PCa) at one-time screening tests at ages 55 and 65 years. RESULTS Compared with biopsying all men with elevated PSA, reflex testing reduced overdiagnoses (range across ages and biomarkers = 8.8-60.6%) but also reduced lives saved (by 7.3-64.9%), producing similar overdiagnoses per life saved. The ideal biomarker for high-grade disease improved this ratio (by 35.2% at age 55 years and 42.0% at age 65 years). Results were similar under continued screening for men not diagnosed at age 55 years, but the ideal biomarker for high-grade disease produced smaller incremental improvement. CONCLUSIONS Modeling is a useful tool for projecting the implications of using reflex biomarkers for long-term PCa outcomes. Under simplified conditions, reflex testing with urinary biomarkers is expected to reduce overdiagnoses but also produce commensurate reductions in lives saved. Reflex testing that accurately identifies high-grade PCa could improve the net benefit of screening.
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Affiliation(s)
- Roman Gulati
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Teresa A'mar
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA.,Department of Urology, University of Michigan, Ann Arbor, MI
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA
| | | | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
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17
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Okidi R, Opira C, Sambo VDC, Achola C, Ogwang DM. Prostate hyperplasia in St Mary's Hospital Lacor: utility of prostate specific antigen in screening for prostate malignancy. Afr Health Sci 2020; 20:1259-1263. [PMID: 33402973 PMCID: PMC7751533 DOI: 10.4314/ahs.v20i3.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Prostate cancer is the second commonest cancer in men worldwide. At present, every patient with lower urinary tract symptoms (LUTS) in St. Mary's Hospital Lacor is undergoing prostate biopsy regardless of the prostate specific antigen (PSA) level. We sought to determine the association between PSA and malignant prostate histology. METHODS This was a retrospective study. Data on age, PSA, prostate volume and prostate histology reported between Jan 2012 and Dec 2019 were retrieved from St. Mary's Hospital Lacor archive and analyzed using STATA SE/13.0. RESULTS Records of 97 patients with LUTS was analyzed. The median (range) age of the patients was 71 (43-100) years. Median (range) of prostate volume was 91.8 (8.0-360.0) cc. Overall, PSA ranged from 0.21 to 399.2 ng/ml. Prostate histology showed 3.1% acinar adenocarcinoma, 24.7% adenocarcinoma and 72.2% benign prostatic hyperplasia. The median PSA amongst patients with malignant and non-malignant prostates were 15.8 ng/ml and 6.07 ng/ml respectively. Serum PSA level was significantly higher in patients with malignant prostate histology (Difference of mean= 9.7; p=0.001). CONCLUSION Patients with LUTS and PSA levels of 15ng/ml or more were more likely to have malignant prostate histology.
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Getaneh AM, Heijnsdijk EAM, Roobol MJ, de Koning HJ. Assessment of harms, benefits, and cost-effectiveness of prostate cancer screening: A micro-simulation study of 230 scenarios. Cancer Med 2020; 9:7742-7750. [PMID: 32813910 PMCID: PMC7571827 DOI: 10.1002/cam4.3395] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 12/15/2022] Open
Abstract
Background Prostate cancer screening incurs a high risk of overdiagnosis and overtreatment. An organized and age‐targeted screening strategy may reduce the associated harms while retaining or enhancing the benefits. Methods Using a micro‐simulation analysis (MISCAN) model, we assessed the harms, benefits, and cost‐effectiveness of 230 prostate‐specific antigen (PSA) screening strategies in a Dutch population. Screening strategies were varied by screening start age (50, 51, 52, 53, 54, and 55), stop age (51‐69), and intervals (1, 2, 3, 4, 8, and single test). Costs and effects of each screening strategy were compared with a no‐screening scenario. Results The most optimum strategy would be screening with 3‐year intervals at ages 55–64 resulting in an incremental cost‐effectiveness ratio (ICER) of €19 733 per QALY. This strategy predicted a 27% prostate cancer mortality reduction and 28 life years gained (LYG) per 1000 men; 36% of screen‐detected men were overdiagnosed. Sensitivity analyses did not substantially alter the optimal screening strategy. Conclusions PSA screening beyond age 64 is not cost‐effective and associated with a higher risk of overdiagnosis. Similarly, starting screening before age 55 is not a favored strategy based on our cost‐effectiveness analysis.
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Affiliation(s)
- Abraham M Getaneh
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Eveline A M Heijnsdijk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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19
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Filella X, Albaladejo MD, Allué JA, Castaño MA, Morell-Garcia D, Ruiz MÀ, Santamaría M, Torrejón MJ, Giménez N. Prostate cancer screening: guidelines review and laboratory issues. Clin Chem Lab Med 2020; 57:1474-1487. [PMID: 31120856 DOI: 10.1515/cclm-2018-1252] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/21/2019] [Indexed: 12/19/2022]
Abstract
Background Prostate-specific antigen (PSA) remains as the most used biomarker in the detection of early prostate cancer (PCa). Clinical practice guidelines (CPGs) are produced to facilitate incorporation of evidence into clinical practice. This is particularly useful when PCa screening remains controversial and guidelines diverge among different medical institutions, although opportunistic screening is not recommended. Methods We performed a systematic review of guidelines about PCa screening using PSA. Guidelines published since 2008 were included in this study. The most updated version of these CPGs was used for the evaluation. Results Twenty-two guidelines were selected for review. In 59% of these guidelines, recommendations were graded according to level of evidence (n = 13), but only 18% of the guidelines provided clear algorithms (n = 4). Each CPG was assessed using a checklist of laboratory issues, including pre-analytical, analytical, and post-analytical factors. We found that laboratory medicine specialists participate in 9% of the guidelines reviewed (n = 2) and laboratory issues were frequently omitted. We remarked that information concerning the consequences of World Health Organization (WHO) standard in PSA testing was considered by only two of 22 CPGs evaluated in this study. Conclusions We concluded that the quality of PCa early detection guidelines could be improved properly considering the laboratory issues in their development.
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Affiliation(s)
- Xavier Filella
- Evidence Based Laboratory Medicine Commission and Biological Markers of Cancer Commission, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain.,Department of Biochemistry and Molecular Genetics (CDB), Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - María Dolores Albaladejo
- Evidence Based Laboratory Medicine Commission, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain.,Department of Clinical Analysis and Biochemistry, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - Juan Antonio Allué
- Evidence Based Laboratory Medicine Commission, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain.,Synlab Diagnosticos Globales, Sevilla, Spain
| | - Miguel Angel Castaño
- Evidence Based Laboratory Medicine Commission, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain.,Department of Biochemistry, Hospital Clínico Universitario Juan Ramón Jiménez, Huelva, Spain
| | - Daniel Morell-Garcia
- Evidence Based Laboratory Medicine Commission, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain.,Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Maria Àngels Ruiz
- Evidence Based Laboratory Medicine Commission, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain.,Department of Laboratory Medicine, Fundació Hospital de l'Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain
| | - María Santamaría
- Evidence Based Laboratory Medicine Commission, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain.,Department of Biochemistry, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - María José Torrejón
- Evidence Based Laboratory Medicine Commission, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain.,UGC of Clinical Analysis, Hospital Clínico San Carlos, Madrid, Spain
| | - Nuria Giménez
- Evidence Based Laboratory Medicine Commission, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain.,Committee of Evidence-Based Laboratory Medicine (C-EBLM), International Federation of Clinical Chemistry and Laboratory Medicine (IFCC), Milano, Italy.,Research Unit, Research Foundation Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain.,Laboratory of Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
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20
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Teoh JYC, Leung CH, Wang MH, Chiu PKF, Yee CH, Ng CF, Wong MCS. The cost-effectiveness of prostate health index for prostate cancer detection in Chinese men. Prostate Cancer Prostatic Dis 2020; 23:615-621. [PMID: 32606435 DOI: 10.1038/s41391-020-0243-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/16/2020] [Accepted: 06/17/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Prostate-specific antigen (PSA) and prostate health index (PHI) have been used as biomarkers for prostate cancer detection. In this study, we aimed to evaluate the cost-effectiveness of PHI for prostate cancer detection in Chinese men. METHOD We developed a Markov model for Chinese male patient aged 50-75 years old. The PSA strategy was to offer TRUS-PB for all patients with elevated PSA of 4-10 ng/mL. The PHI strategy was to offer PHI for patients with elevated PSA of 4-10 ng/mL. TRUS-PB would only be offered for patients with PHI >35.0. Model inputs were extracted from local data when available. The cost per quality-adjusted life years gained for both strategies were calculated. The incremental cost-effectiveness ratios in relation to the willingness-to-pay (WTP) threshold were compared. One-way sensitivity analysis and probabilistic sensitivity analysis were performed. Cost-effectiveness acceptability curves were also constructed. RESULTS With a Markov model of 25 screening cycles from age 50 to 75 years, the mean total costs per man were estimated to be USD 27,439 in the PSA strategy and USD 22,877 in the PHI strategy. The estimated effects were estimated to be 15.70 in the PSA strategy and 16.05 in the PHI strategy. The PHI strategy was associated with an expected decrease in cost of USD 4562 and an expected gain of 0.35 QALY, resulting in an ICER of USD -13056.56. The results were shown to be robust upon one-way sensitivity analysis. Upon Monte Carlo simulation, the PHI strategy was more cost-effective for 100% of the iterations. The PHI strategy demonstrated dominance over the PSA strategy regardless of what WTP threshold we use. CONCLUSIONS A PHI-based screening strategy may be more cost-effective than a PSA-based strategy for prostate cancer detection in Chinese men. These results support consideration of a PHI-based approach for prostate cancer in Hong Kong.
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Affiliation(s)
- Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
| | - Chi-Ho Leung
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Maggie Haitian Wang
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Peter Ka-Fung Chiu
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Hang Yee
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Martin Chi-Sang Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
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21
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Brönimann S, Pradere B, Karakiewicz P, Abufaraj M, Briganti A, Shariat SF. An overview of current and emerging diagnostic, staging and prognostic markers for prostate cancer. Expert Rev Mol Diagn 2020; 20:841-850. [DOI: 10.1080/14737159.2020.1785288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Stephan Brönimann
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, CHRU Tours, Francois Rabelais University, Tours, France
| | - Pierre Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada
| | - Mohammad Abufaraj
- Division of Urology, Department of Special Surgery, Jordan University Hospital, the 2 University of Jordan, Amman, Jordan
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Shahrokh F. Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Departments of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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22
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Kim L, Boxall N, George A, Burling K, Acher P, Aning J, McCracken S, Page T, Gnanapragasam VJ. Clinical utility and cost modelling of the phi test to triage referrals into image-based diagnostic services for suspected prostate cancer: the PRIM (Phi to RefIne Mri) study. BMC Med 2020; 18:95. [PMID: 32299423 PMCID: PMC7164355 DOI: 10.1186/s12916-020-01548-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/03/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The clinical pathway to detect and diagnose prostate cancer has been revolutionised by the use of multiparametric MRI (mpMRI pre-biopsy). mpMRI however remains a resource-intensive test and is highly operator dependent with variable effectiveness with regard to its negative predictive value. Here we tested the use of the phi assay in standard clinical practice to pre-select men at the highest risk of harbouring significant cancer and hence refine the use of mpMRI and biopsies. METHODS A prospective five-centre study recruited men being investigated through an mpMRI-based prostate cancer diagnostic pathway. Test statistics for PSA, PSA density (PSAd) and phi were assessed for detecting significant cancers using 2 definitions: ≥ Grade Group (GG2) and ≥ Cambridge Prognostic Groups (CPG) 3. Cost modelling and decision curve analysis (DCA) was simultaneously performed. RESULTS A total of 545 men were recruited and studied with a median age, PSA and phi of 66 years, 8.0 ng/ml and 44 respectively. Overall, ≥ GG2 and ≥ CPG3 cancer detection rates were 64% (349/545), 47% (256/545) and 32% (174/545) respectively. There was no difference across centres for patient demographics or cancer detection rates. The overall area under the curve (AUC) for predicting ≥ GG2 cancers was 0.70 for PSA and 0.82 for phi. AUCs for ≥ CPG3 cancers were 0.81 and 0.87 for PSA and phi respectively. AUC values for phi did not differ between centres suggesting reliability of the test in different diagnostic settings. Pre-referral phi cut-offs between 20 and 30 had NPVs of 0.85-0.90 for ≥ GG2 cancers and 0.94-1.0 for ≥ CPG3 cancers. A strategy of mpMRI in all and biopsy only positive lesions reduced unnecessary biopsies by 35% but missed 9% of ≥ GG2 and 5% of ≥ CPG3 cancers. Using PH ≥ 30 to rule out referrals missed 8% and 5% of ≥ GG2 and ≥ CPG3 cancers (and reduced unnecessary biopsies by 40%). This was achieved however with 25% fewer mpMRI. Pathways incorporating PSAd missed fewer cancers but necessitated more unnecessary biopsies. The phi strategy had the lowest mean costs with DCA demonstrating net clinical benefit over a range of thresholds. CONCLUSION phi as a triaging test may be an effective way to reduce mpMRI and biopsies without compromising detection of significant prostate cancers.
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Affiliation(s)
- Lois Kim
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Nicholas Boxall
- Department of Urology, Cambridge University Hospitals Trust, Cambridge, UK
| | - Anne George
- Urological Malignancies Programme CRUK & Cambridge Urology Translational Research and Clinical Trials Office, University of Cambridge Box 193, Cambridge Biomedical Campus Cambridge CB20QQ, Cambridge, UK
| | - Keith Burling
- NIHR Cambridge Biomedical Research Centre, Core Biochemical Assay Laboratory, University of Cambridge, Cambridge, UK
| | - Pete Acher
- Department of Urology, Southend Hospital, Essex, UK
| | - Jonathan Aning
- Department of Urology, North Bristol NHS Trust, Bristol, UK
| | - Stuart McCracken
- Department of Urology, South Tyneside and Sunderland NHS Trust, Sunderland, UK
| | - Toby Page
- Department of Urology, Newcastle Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Vincent J Gnanapragasam
- Department of Urology, Cambridge University Hospitals Trust, Cambridge, UK. .,Urological Malignancies Programme CRUK & Cambridge Urology Translational Research and Clinical Trials Office, University of Cambridge Box 193, Cambridge Biomedical Campus Cambridge CB20QQ, Cambridge, UK. .,Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK.
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23
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Filella X. Towards personalized prostate cancer screening. ADVANCES IN LABORATORY MEDICINE 2020; 1:20190027. [PMID: 37362554 PMCID: PMC10197357 DOI: 10.1515/almed-2019-0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 09/26/2019] [Indexed: 06/28/2023]
Abstract
The value of the prostate-specific antigen (PSA) in prostate cancer (PCa) screening is controversial. Contradictory results have been reported in the literature as to whether PSA-based screening reduces mortality. Also, some of the studies published are methodologically flawed. However, evidence consistently demonstrates that screening programs results in the identification of patients with indolent prostatic tumors which rate has increased. Controversy is not only about the value of PSA-based screening, but also about the age range for screening, risk groups based on baseline PSA, PSA ranges, or the use of other biomarkers (PHI, 4Kscore). At present, PCa screening in the general population is not recommended by most scientific societies, although it can be used after discussing the risks and benefits with the patient. When discussing the need to perform a screening, the risks of using screening (lack of specificity of PSA, overdiagnosis) must be weighed against the risks of not performing it (increased rate of patients with initial diagnosis of metastasis). In the recent years, a number of authors have advocated the use of personalized screening, which could change the risk/benefit evaluation, thereby making screening necessary on the basis of a set of individual factors.
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Affiliation(s)
- Xavier Filella
- Department of Biochemistry and Molecular Genetics (CDB), IDIBAPS, Hospital Clínic, Barcelona, Catalonia, Spain
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24
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Ferro M, De Cobelli O, Lucarelli G, Porreca A, Busetto GM, Cantiello F, Damiano R, Autorino R, Musi G, Vartolomei MD, Muto M, Terracciano D. Beyond PSA: The Role of Prostate Health Index (phi). Int J Mol Sci 2020; 21:ijms21041184. [PMID: 32053990 PMCID: PMC7072791 DOI: 10.3390/ijms21041184] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/05/2020] [Accepted: 02/07/2020] [Indexed: 01/03/2023] Open
Abstract
Background: Widespread use of prostate specific antigen (PSA) in screening procedures allowed early identification of an increasing number of prostate cancers (PCas), mainly including indolent cancer. Availability of different therapeutic strategies which have a very different impact on the patient’s quality of life suggested a strong need for tools able to identify clinically significant cancer at diagnosis. Multi-parametric magnetic resonance showed very good performance in pre-biopsy diagnosis. However, it is an expensive tool and requires an experienced radiologist. In this context, a simple blood-based test is worth investigating. In this context, researchers focused their attention on the development of a laboratory test able to minimize overdiagnosis without losing the identification of aggressive tumors. Results: Recent literature data on PCa biomarkers revealed a clear tendency towards the use of panels of biomarkers or a combination of biomarkers and clinical variables. Phi, the 4Kscore, and Stockholm3 as circulating biomarkers and the Mi-prostate score, Exo DX Prostate, and Select MD-X as urinary biomarker-based tests have been developed. In this scenario, phi is worthy of attention as a noninvasive test significantly associated with aggressive PCa. Conclusions: Literature data showed that phi had good diagnostic performance to identify clinically significant (cs) PCa, suggesting that it could be a useful tool for personalized treatment decision-making. In this review, phi potentialities, limitations, and comparisons with other blood- and urinary-based tests were explored.
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Affiliation(s)
- Matteo Ferro
- Division of Urology, European Institute of Oncology, 20141 Milan, Italy; (M.F.); (O.D.C.); (G.M.)
| | - Ottavio De Cobelli
- Division of Urology, European Institute of Oncology, 20141 Milan, Italy; (M.F.); (O.D.C.); (G.M.)
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation—Urology, Andrology and Kidney Transplantation Unit, University of Bari, 70124 Bari, Italy;
| | - Angelo Porreca
- Department of Urology, Abano Terme Hospital, 35031 Padua, Italy;
| | | | - Francesco Cantiello
- Department of Urology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (F.C.); (R.D.)
| | - Rocco Damiano
- Department of Urology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (F.C.); (R.D.)
| | | | - Gennaro Musi
- Division of Urology, European Institute of Oncology, 20141 Milan, Italy; (M.F.); (O.D.C.); (G.M.)
| | - Mihai Dorin Vartolomei
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
- Department of Cell and Molecular Biology, University of Medicine, Pharmacy, Sciences and Technology, 540139 Targu Mures, Romania
| | - Matteo Muto
- Radiotherapy Unit, “S. G. Moscati” Hospital, 83100 Avellino, Italy;
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples “Federico II”, 8031 Naples, Italy
- Correspondence: ; Tel.: +39-8174-6361-7
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A Trial-Based Cost-Utility Analysis of Metastasis-Directed Therapy for Oligorecurrent Prostate Cancer. Cancers (Basel) 2020; 12:cancers12010132. [PMID: 31947974 PMCID: PMC7016808 DOI: 10.3390/cancers12010132] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/18/2019] [Accepted: 01/02/2020] [Indexed: 01/08/2023] Open
Abstract
The optimal management of patients with oligorecurrent prostate cancer (PCa) is unknown. There is growing interest in metastasis-directed therapy (MDT) for this population. The objective was to assess cost-utility from a Belgian healthcare payer’s perspective of MDT and delayed androgen deprivation therapy (ADT) in comparison with surveillance and delayed ADT, and with immediate ADT. A Markov decision-analytic trial-based model was developed, projecting the results over a 5-year time horizon with one-month cycles. Clinical data were derived from the STOMP trial and literature. Treatment costs were derived from official government documents. Probabilistic sensitivity analyses showed that MDT is cost-effective compared to surveillance (ICER: €8393/quality adjusted life year (QALY)) and immediate ADT (dominant strategy). The ICER is most sensitive to utilities in the different health states and the first month MDT cost. At a willingness-to-pay threshold of €40,000 per QALY, the cost of the first month MDT should not exceed €8136 to be cost-effective compared to surveillance. The Markov-model suggests that MDT for oligorecurrent PCa is potentially cost-effective in comparison with surveillance and delayed ADT, and in comparison with immediate ADT.
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Mei XL, Zheng QF. Role of Cellular Biomolecules in Screening, Diagnosis and Treatment of Colorectal Cancer. Curr Drug Metab 2019; 20:880-888. [PMID: 31656148 DOI: 10.2174/1389200220666191018153428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/19/2019] [Accepted: 10/01/2019] [Indexed: 12/24/2022]
Abstract
Background:
Prevention is the primary strategy to avoid the occurrence and mortality of colorectal cancer.
Generally, the concentrations of tumor markers tested during the diagnosis and believed to assist the detection of
disease in the early stages of cancer. Some of the biomarkers are also important during treatment and real-time monitoring
of the progress of treatment.
Methods:
We considered a rationale search of key references from the database of peer-reviewed research and review
literatures of colorectal cancer. The topic of search was focused on the novel methods and modern techniques
of Screening, Diagnosis, and Treatment of colorectal cancer. The screened publications were critically analysed
using a deductive content analysis and the matter was put in separate headings and sub headings.
Results:
It was found that endoscopic examination, early detection, and surgery are some of the common strategies to
manage colorectal cancer because late stages are difficult to treat due to the high-cost requirement and fewer chances
of survival. As far as chemotherapy is concerned, systemic chemotherapy has been shown to offer the maximum
benefit to patients with cancer metastasis. Among different chemotherapy measures, primary colorectal cancer prevention
agents involve pharmaceuticals, phytochemicals, and dietary supplements are some of the standard options.
Conclusion:
In this review article, we have provided a comprehensive analysis of different biomarkers for the detection
of colorectal cancer as well as different formulations developed for efficient treatment of the disease. The use of
dietary supplements, the combinatorial approach, and nanotechnology-based strategies for colorectal cancer diagnosis
and treatment are some of the recent and modern methods of cancer management.
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Affiliation(s)
- Xiang-Lin Mei
- Department of Pathology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Qing-Fan Zheng
- Department of Endoscopy Center, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
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Eggener SE, Rumble RB, Armstrong AJ, Morgan TM, Crispino T, Cornford P, van der Kwast T, Grignon DJ, Rai AJ, Agarwal N, Klein EA, Den RB, Beltran H. Molecular Biomarkers in Localized Prostate Cancer: ASCO Guideline. J Clin Oncol 2019; 38:1474-1494. [PMID: 31829902 DOI: 10.1200/jco.19.02768] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE This guideline provides recommendations for available tissue-based prostate cancer biomarkers geared toward patient selection for active surveillance, identification of clinically significant disease, choice of postprostatectomy adjuvant versus salvage radiotherapy, and to address emerging questions such as the relative value of tissue biomarkers compared with magnetic resonance imaging. METHODS An ASCO multidisciplinary Expert Panel, with representatives from the European Association of Urology, American Urological Association, and the College of American Pathologists, conducted a systematic literature review of localized prostate cancer biomarker studies between January 2013 and January 2019. Numerous tissue-based molecular biomarkers were evaluated for their prognostic capabilities and potential for improving management decisions. Here, the Panel makes recommendations regarding the clinical use and indications of these biomarkers. RESULTS Of 555 studies identified, 77 were selected for inclusion plus 32 additional references selected by the Expert Panel. Few biomarkers had rigorous testing involving multiple cohorts and only 5 of these tests are commercially available currently: Oncotype Dx Prostate, Prolaris, Decipher, Decipher PORTOS, and ProMark. With various degrees of value and validation, multiple biomarkers have been shown to refine risk stratification and can be considered for select men to improve management decisions. There is a paucity of prospective studies assessing short- and long-term outcomes of patients when these markers are integrated into clinical decision making. RECOMMENDATIONS Tissue-based molecular biomarkers (evaluating the sample with the highest volume of the highest Gleason pattern) may improve risk stratification when added to standard clinical parameters, but the Expert Panel endorses their use only in situations in which the assay results, when considered as a whole with routine clinical factors, are likely to affect a clinical decision. These assays are not recommended for routine use as they have not been prospectively tested or shown to improve long-term outcomes-for example, quality of life, need for treatment, or survival. Additional information is available at www.asco.org/genitourinary-cancer-guidelines.
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Affiliation(s)
| | | | | | - Todd M Morgan
- University of Michigan School of Medicine, Ann Arbor, MI
| | | | - Philip Cornford
- Royal Liverpool University Hospital, Liverpool, United Kingdom
| | | | | | - Alex J Rai
- Columbia University Irving Medical Center, New York, NY
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28
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McAllister BJ. The association between ethnic background and prostate cancer. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2019; 28:S4-S10. [PMID: 31597062 DOI: 10.12968/bjon.2019.28.18.s4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Prostate cancer is a complex disease which is more prevalent among men of black and minority ethnic (BME) background than their Caucasian counterparts, with men of African-Caribbean background experiencing higher levels of incidence and mortality than any other ethnic group. The reasons behind this health inequality are poorly understood and likely to be multifactorial. Several theories have been posited, including genetic disposition, poorer access to health care, a lack of understanding of the risks posed by prostate cancer and an unwillingness to access mainstream health care. There is, however, a notable disparity between the amount of literature focusing on prostate cancer as it affects those with a BME background and on prostate cancer in general. This further compounds the difficulties encountered by BME men, who rely on health professionals being aware of the greater risk they face. More knowledge and understanding is required by both the general population and medical practitioners to address this health inequality.
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Affiliation(s)
- Bría J McAllister
- Urology Nurse Practitioner, Department of Urology, Nottingham University Hospitals NHS Trust
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Bouttell J, Teoh J, Chiu PK, Chan KS, Ng CF, Heggie R, Hawkins N. Economic evaluation of the introduction of the Prostate Health Index as a rule-out test to avoid unnecessary biopsies in men with prostate specific antigen levels of 4-10 in Hong Kong. PLoS One 2019; 14:e0215279. [PMID: 30990840 PMCID: PMC6467402 DOI: 10.1371/journal.pone.0215279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 03/31/2019] [Indexed: 11/18/2022] Open
Abstract
A recent study showed that the Prostate Health Index may avoid unnecessary biopsies in men with prostate specific antigen 4-10ng/ml and normal digital rectal examination in the diagnosis of prostate cancer in Hong Kong. This study aimed to conduct an economic evaluation of the impact of adopting this commercially-available test in the Hong Kong public health service to determine whether further research is justified. A cost-consequence analysis was undertaken comparing the current diagnostic pathway with a proposed diagnostic pathway using the Prostate Health Index. Data for the model was taken from a prospective cohort study recruited at a single-institution and micro-costing studies. Using a cut off PHI score of 35 to avoid biopsy would cost HK$3,000 and save HK$7,988 per patient in biopsy costs and HK$511 from a reduction in biopsy-related adverse events. The net cost impact of the change was estimated to be HK$5,500 under base case assumptions. At the base case sensitivity and specificity for all grades of cancer (61.3% and 77.5% respectively) all grade cancer could be missed in 4.22% of the population and high grade cancer in 0.53%. The introduction of the prostate health index into the diagnostic pathway for prostate cancer in Hong Kong has the potential to reduce biopsies, biopsy costs and biopsy-related adverse events. Policy makers should consider the clinical and economic impact of this proposal.
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Affiliation(s)
- Janet Bouttell
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Jeremy Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Peter K. Chiu
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kevin S. Chan
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Robert Heggie
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Neil Hawkins
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Jedinak A, Loughlin KR, Moses MA. Approaches to the discovery of non-invasive urinary biomarkers of prostate cancer. Oncotarget 2018; 9:32534-32550. [PMID: 30197761 PMCID: PMC6126692 DOI: 10.18632/oncotarget.25946] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/23/2018] [Indexed: 02/07/2023] Open
Abstract
Prostate cancer (PCa) continues to be one of the most common cancers in men worldwide. Prostate specific antigen (PSA) measured in blood has been used for decades as an aid for physicians to detect the presence of prostate cancer. However, the PSA test has limited sensitivity and specificity, leading to unnecessary biopsies, overdiagnosis and overtreatment of patients. For these reasons, there is an urgent need for more accurate PCa biomarkers that can detect PCa with high sensitivity and specificity. Urine is a unique source of potential protein biomarkers that can be measured in a non-invasive way. This review comprehensively summarizes state of the art approaches used in the discovery and validation of urinary biomarkers for PCa. Numerous strategies are currently being used in the discovery of urinary biomarkers for prostate cancer including gel-based separation techniques, mass spectrometry, activity-based proteomic assays and software approaches. Antibody-based approaches remain preferred method for validation of candidate biomarkers with rapidly advancing multiplex immunoassays and MS-based targeted approaches. In the last decade, there has been a dramatic acceleration in the development of new techniques and approaches in the discovery of protein biomarkers for prostate cancer including computational, statistical and data mining methods. Many urinary-based protein biomarkers have been identified and have shown significant promise in initial studies. Examples of these potential biomarkers and the methods utilized in their discovery are also discussed in this review.
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Affiliation(s)
- Andrej Jedinak
- Vascular Biology Program and Department of Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Kevin R Loughlin
- Department of Surgery, Harvard Medical School, Boston, MA, USA.,Department of Urology, Brigham and Women's Hospital, Boston, MA, USA
| | - Marsha A Moses
- Vascular Biology Program and Department of Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA
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Mathieu R, Castelli C, Fardoun T, Peyronnet B, Shariat SF, Bensalah K, Vincendeau S. Cost analysis of prostate cancer detection including the prostate health index (phi). World J Urol 2018; 37:481-487. [PMID: 29980838 DOI: 10.1007/s00345-018-2362-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 05/29/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To assess the economic impact of introducing the prostate health index (phi) for prostate cancer (PCa) detection. METHODS A total of 177 patients who presented in an academic institution with a tPSA between 2 and 10 ng/ml and underwent prostate biopsies within the 3 months were enrolled. With phi and tPSA thresholds of 43 and 4 ng/ml, respectively, probability for each branch of a decision tree model for PCa diagnosis and corresponding mean cost were estimated with "Monte Carlo" simulations. A sensitivity analysis was performed. RESULTS With a similar sensitivity, phi strategy increased positive predictive value by 13.9 points and negative predictive value by 31.6 points in comparison to tPSA strategy. Mean costs per patient with tPSA and phi strategies were €514 and €528, respectively, for a phi test price at 50€. One-way sensitivity analysis showed that phi strategy was less expensive (508€/patient) than tPSA strategy with a phi test price below 30€. In multi-criteria sensitivity analysis, PPV and the rates of positive phi and tPSA were the parameters with the largest impact on the final cost as opposed to the cost of the biopsy or imaging which have less influence. With an expected rate of positive phi test < 60%, tPSA strategy was more expensive than phi strategy. CONCLUSIONS The introduction of phi index in PCa detection would result in a significant clinical benefit compared to tPSA strategy. In our economic model, the phi strategy was equivalent or slightly more expensive than the current tPSA strategy.
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Affiliation(s)
- Romain Mathieu
- Department of Urology, Service D'urologie, Rennes University Hospital, Hôpital Pontchaillou, 2, rue Henri Le Guillou, 35000, Rennes, France.
| | | | - Tarek Fardoun
- Department of Urology, Service D'urologie, Rennes University Hospital, Hôpital Pontchaillou, 2, rue Henri Le Guillou, 35000, Rennes, France
| | - Benoit Peyronnet
- Department of Urology, Service D'urologie, Rennes University Hospital, Hôpital Pontchaillou, 2, rue Henri Le Guillou, 35000, Rennes, France
| | - Shahrokh F Shariat
- Department of Urology, General Hospital, Medical University Vienna, Vienna, Austria.,Department of Urology, University of Texas, Southwestern Medical Center, Dallas, TX, USA.,Department of Urology, Weill Cornell Medical College, New York, NY, USA.,Karl Landsteiner Institute, Vienna, Austria
| | - Karim Bensalah
- Department of Urology, Service D'urologie, Rennes University Hospital, Hôpital Pontchaillou, 2, rue Henri Le Guillou, 35000, Rennes, France
| | - Sébastien Vincendeau
- Department of Urology, Service D'urologie, Rennes University Hospital, Hôpital Pontchaillou, 2, rue Henri Le Guillou, 35000, Rennes, France
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Sathianathen NJ, Kuntz KM, Alarid-Escudero F, Lawrentschuk NL, Bolton DM, Murphy DG, Weight CJ, Konety BR. Incorporating Biomarkers into the Primary Prostate Biopsy Setting: A Cost-Effectiveness Analysis. J Urol 2018; 200:1215-1220. [PMID: 29906434 DOI: 10.1016/j.juro.2018.06.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE We performed a cost-effectiveness analysis using the PHI (Prostate Health Index), 4Kscore®, SelectMDx™ and the EPI (ExoDx™ Prostate [IntelliScore]) in men with elevated prostate specific antigen to determine the need for biopsy. MATERIALS AND METHODS We developed a decision analytical model in men with elevated prostate specific antigen (3 ng/ml or greater) in which 1 biomarker test was used to determine which hypothetical individuals required biopsy. In the current standard of care strategy all individuals underwent biopsy. Model parameters were derived from a comprehensive review of the literature. Costs were calculated from a health sector perspective and converted into 2017 United States dollars. RESULTS The cost and QALYs (quality adjusted life-years) of the current standard of care, which was transrectal ultrasound guided biopsy, was $3,863 and 18.085, respectively. Applying any of the 3 biomarkers improved quality adjusted survival compared to the current standard of care. The cost of SelectMDx, the PHI and the EPI was lower than performing prostate biopsy in all patients. However, the PHI was more costly and less effective than the SelectMDx strategy. The EPI provided the highest QALY with an incremental cost-effectiveness ratio of $58,404 per QALY. The use of biomarkers could reduce the number of unnecessary biopsies by 24% to 34% compared to the current standard of care. CONCLUSIONS Applying biomarkers in men with elevated prostate specific antigen to determine the need for biopsy improved quality adjusted survival by decreasing the number of biopsies performed and the treatment of indolent disease. Using SelectMDx or the EPI following elevated prostate specific antigen but before proceeding to biopsy is a cost-effective strategy in this setting.
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Affiliation(s)
- Niranjan J Sathianathen
- Department of Urology, University of Minnesota, Minneapolis, Minnesota; Department of Surgery, Urology Unit and Olivia Newton-John Cancer Research Institute Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
| | - Karen M Kuntz
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Fernando Alarid-Escudero
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Nathan L Lawrentschuk
- Department of Surgery, Urology Unit and Olivia Newton-John Cancer Research Institute Austin Health, University of Melbourne, Melbourne, Victoria, Australia; Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Damien M Bolton
- Department of Surgery, Urology Unit and Olivia Newton-John Cancer Research Institute Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Declan G Murphy
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Loeb S, Dani H. Whom to Biopsy: Prediagnostic Risk Stratification with Biomarkers, Nomograms, and Risk Calculators. Urol Clin North Am 2017; 44:517-524. [PMID: 29107268 PMCID: PMC6004126 DOI: 10.1016/j.ucl.2017.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article describes markers used for prostate biopsy decisions, including prostrate-specific antigen (PSA), free PSA, the prostate health index, 4Kscore, PCA3, and ConfirmMDx. It also summarizes the use of nomograms combining multiple variables for prostate cancer detection.
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Affiliation(s)
- Stacy Loeb
- Department of Urology, New York University, New York, NY, USA; Department of Population Health, New York University, New York, NY, USA; Department of Urology, Manhattan Veterans Affairs Medical Center, New York, NY, USA.
| | - Hasan Dani
- Department of Urology, SUNY Downstate College of Medicine, Brooklyn, NY, USA
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Abstract
PURPOSE OF REVIEW This article intends to review biomarkers derived from blood, urine, and tissue that can aid in the diagnosis of prostate cancer (PCa). RECENT FINDINGS PCa screening requires tools that complement prostate-specific antigen (PSA) with a higher specificity for clinically significant disease. Novel blood biomarkers, such as the Prostate Health Index (phi) and 4Kscore, utilize isoforms of PSA to more accurately predict high-grade PCa than traditional tools such as PSA and the percentage free-to-total PSA. Several gene products associated with PCa can be detected in the urine through commercially available assays. PCa antigen 3 (PCA3), though approved for repeat biopsy decisions, appears inferior to other biomarkers such as phi for identifying aggressive disease. However, combinations of PCA3 with other urine assays have shown promising results. One tissue-based hypermethylation test, named ConfirmMDx, can also be used to determine the need for repeat biopsy in men with a prior negative biopsy. SUMMARY Several biomarkers have been developed to aid in the screening and diagnosis of PCa. Such tests are often indicated in men with moderately elevated PSA or history of a prior negative biopsy. Their use facilitates reduction of unnecessary biopsies without sacrificing the early diagnosis of clinically significant PCa.
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Affiliation(s)
- Hasan Dani
- Department of Urology, SUNY Downstate College of Medicine, Brooklyn, NY
| | - Stacy Loeb
- Department of Urology, New York University, NY, NY
- Population Health, New York University, NY, NY
- Manhattan Veterans Affairs Medical Center, NY, NY
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Dijkstra S, Govers TM, Hendriks RJ, Schalken JA, Van Criekinge W, Van Neste L, Grutters JPC, Sedelaar JPM, van Oort IM. Cost-effectiveness of a new urinary biomarker-based risk score compared to standard of care in prostate cancer diagnostics - a decision analytical model. BJU Int 2017; 120:659-665. [PMID: 28370948 DOI: 10.1111/bju.13861] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of a new urinary biomarker-based risk score (SelectMDx; MDxHealth, Inc., Irvine, CA, USA) to identify patients for transrectal ultrasonography (TRUS)-guided biopsy and to compare this with the current standard of care (SOC), using only prostate-specific antigen (PSA) to select for TRUS-guided biopsy. MATERIALS AND METHODS A decision tree and Markov model were developed to evaluate the cost-effectiveness of SelectMDx as a reflex test vs SOC in men with a PSA level of >3 ng/mL. Transition probabilities, utilities and costs were derived from the literature and expert opinion. Cost-effectiveness was expressed in quality-adjusted life years (QALYs) and healthcare costs of both diagnostic strategies, simulating the course of patients over a time horizon representing 18 years. Deterministic sensitivity analyses were performed to address uncertainty in assumptions. RESULTS A diagnostic strategy including SelectMDx with a cut-off chosen at a sensitivity of 95.7% for high-grade prostate cancer resulted in savings of €128 and a gain of 0.025 QALY per patient compared to the SOC strategy. The sensitivity analyses showed that the disutility assigned to active surveillance had a high impact on the QALYs gained and the disutility attributed to TRUS-guided biopsy only slightly influenced the outcome of the model. CONCLUSION Based on the currently available evidence, the reduction of over diagnosis and overtreatment due to the use of the SelectMDx test in men with PSA levels of >3 ng/mL may lead to a reduction in total costs per patient and a gain in QALYs.
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Affiliation(s)
- Siebren Dijkstra
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim M Govers
- Department of Operating Rooms, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rianne J Hendriks
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jack A Schalken
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wim Van Criekinge
- Department of Mathematical Modelling, Statistics and Bioinformatics, Ghent University, Ghent, Belgium
| | - Leander Van Neste
- Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Janneke P C Grutters
- Department of Operating Rooms, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Inge M van Oort
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
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Borrebaeck CAK. Precision diagnostics: moving towards protein biomarker signatures of clinical utility in cancer. Nat Rev Cancer 2017; 17:199-204. [PMID: 28154374 DOI: 10.1038/nrc.2016.153] [Citation(s) in RCA: 252] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Interest in precision diagnostics has been fuelled by the concept that early detection of cancer would benefit patients; that is, if detected early, more tumours should be resectable and treatment more efficacious. Serum contains massive amounts of potentially diagnostic information, and affinity proteomics has risen as an accurate approach to decipher this, to generate actionable information that should result in more precise and evidence-based options to manage cancer. To achieve this, we need to move from single to multiplex biomarkers, a so-called signature, that can provide significantly increased diagnostic accuracy. This Opinion article focuses on the progress being made in identifying protein biomarker signatures of clinical utility, using blood-based proteomics.
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Affiliation(s)
- Carl A K Borrebaeck
- Department of Immunotechnology, CREATE Health Translational Cancer Center, Medicon Village (Bldg 406), Lund University, 223 81 Lund, Sweden
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Filella X, Foj L. Prostate Cancer Detection and Prognosis: From Prostate Specific Antigen (PSA) to Exosomal Biomarkers. Int J Mol Sci 2016; 17:ijms17111784. [PMID: 27792187 PMCID: PMC5133785 DOI: 10.3390/ijms17111784] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/04/2016] [Accepted: 10/14/2016] [Indexed: 12/22/2022] Open
Abstract
Prostate specific antigen (PSA) remains the most used biomarker in the management of early prostate cancer (PCa), in spite of the problems related to false positive results and overdiagnosis. New biomarkers have been proposed in recent years with the aim of increasing specificity and distinguishing aggressive from non-aggressive PCa. The emerging role of the prostate health index and the 4Kscore is reviewed in this article. Both are blood-based tests related to the aggressiveness of the tumor, which provide the risk of suffering PCa and avoiding negative biopsies. Furthermore, the use of urine has emerged as a non-invasive way to identify new biomarkers in recent years, including the PCA3 and TMPRSS2:ERG fusion gene. Available results about the PCA3 score showed its usefulness to decide the repetition of biopsy in patients with a previous negative result, although its relationship with the aggressiveness of the tumor is controversial. More recently, aberrant microRNA expression in PCa has been reported by different authors. Preliminary results suggest the utility of circulating and urinary microRNAs in the detection and prognosis of PCa. Although several of these new biomarkers have been recommended by different guidelines, large prospective and comparative studies are necessary to establish their value in PCa detection and prognosis.
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Affiliation(s)
- Xavier Filella
- Department of Biochemistry and Molecular Genetics (CDB), Hospital Clínic, IDIBAPS, C/Villarroel, 170, 08036 Barcelona, Catalonia, Spain.
| | - Laura Foj
- Department of Biochemistry and Molecular Genetics (CDB), Hospital Clínic, IDIBAPS, C/Villarroel, 170, 08036 Barcelona, Catalonia, Spain.
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Leapman MS, Carroll PR. What is the best way not to treat prostate cancer? Urol Oncol 2016; 35:42-50. [PMID: 27746147 DOI: 10.1016/j.urolonc.2016.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 09/08/2016] [Accepted: 09/08/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Selective treatment approaches for prostate cancer (PCa) are warranted given the highly varied nature of the disease and the consequences associated with definitive therapy. MATERIALS AND METHODS We present a stepwise overview of strategies optimized to not treat PCa, ranging from improved screening practices that seek to maximize the yield at initial diagnosis, as well as refinements to clinical risk prediction and the performance of active surveillance. RESULTS Improved adherence to screening guidelines offering simplistic, rational practice recommendations are poised to improve the performance of early detection strategies. In addition, measures to improve the quality of PCa screening would include greater integration of novel markers with higher specificity for clinically significant disease, in an effort to stem the tide of over-diagnosis and consequential overtreatment of low-grade tumors. For men diagnosed with PCa, the use of validated, multi-variable risk stratification stands to offer greater certainty in initial management choices: consideration of active surveillance for those with low-risk status, and definitive therapy for men with intermediate and high-risk features. We review the efficacy and nature of active surveillance protocols, and offer a context for refinements that may be anticipated with future study. CONCLUSIONS The question of how best to not treat prostate cancer is often more complex than policies of universal treatment, yet is integral to minimize morbidity of over-treatment in patients with low-risk tumors. An array of refined risk stratification instruments, biomarkers, and genomic assays seek to improve the confidence both prior to, and following diagnosis.
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Affiliation(s)
- Michael S Leapman
- Department of Urology, Yale University School of Medicine, New Haven, CT.
| | - Peter R Carroll
- Department of Urology, University of California San Francisco, San Francisco, CA
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Abstract
PURPOSE OF REVIEW The aim of this review was to highlight important articles in the field of prostate cancer screening published during 2015 and early 2016. Four major areas were identified for the purpose: screening strategies, post-United States Preventive Services Task Force (USPSTF) 2011-2012, screening trends/patterns, and shared decision making. RECENT FINDINGS Several studies furthered the evidence that screening reduces the risk of metastasis and death from prostate cancer. Multiplex screening strategies are of proven benefit; genetics and MRI need further evaluation. Prostate-specific antigen (PSA) screening rates declined in men above age of 50 years, as did the overall prostate cancer incidence following the USPSTF 2011-2012 recommendation against PSA. The consequences of declining screening rates will become apparent in the next few years. More research is needed to identify the most optimal approach to engage in, and implement, an effective shared decision-making in clinical practice. SUMMARY Data emerging in 2015 provided evidence on the question of how best to screen and brought more steps in the right direction of 'next-generation prostate cancer screening'. Screening is an ongoing process in all men regardless of whether or not they might benefit from early detection and treatment. After the USPSTF 2011-2012 recommendation, the rates of PSA testing are declining; however, this decline is observed in all men and not solely in those who will not benefit from the screening. The long-term effect of this recommendation might not be as anticipated. More studies are needed on how to implement the best available evidence on who, and when, to screen in clinical practice.
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Affiliation(s)
- Sigrid V. Carlsson
- Memorial Sloan Kettering Cancer Center, Department of
Surgery and Epidemiology & Biostatistics, New York, USA
- Institute of Clinical Sciences, Sahlgrenska Academy at
Gothenburg University, Sweden
| | - Monique J. Roobol
- Department of Urology, Erasmus University Medical Center,
Rotterdam, The Netherlands
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