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Alizadeh LS, Radek D, Booz C, Verloh N, Yel I, Koch V, Martin S, Gruenewald LD, Dimitrova M, Vogl TJ. Prostatic Artery Embolization: Lessons From 551 Procedures at a Single-Center. Acad Radiol 2024:S1076-6332(24)00350-7. [PMID: 38862346 DOI: 10.1016/j.acra.2024.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/21/2024] [Accepted: 05/21/2024] [Indexed: 06/13/2024]
Abstract
RATIONALE AND OBJECTIVES This retrospective study evaluates the efficacy and safety of Prostatic Artery Embolization (PAE) for the treatment of benign prostatic hyperplasia (BPH) over five years at a single center, conducted by an experienced interventional radiologist. MATERIALS AND METHODS We analyzed 551 PAE interventions from January 2019 to July 2023. Key metrics included patient demographics, procedural details (radiation exposure, particle size), complication rates, pre- and post-interventional prostatic volume (PV), Prostate-specific Antigen (PSA) levels, International Prostate Symptom Score (IPSS), Quality of Life (QoL) scores and International Index of Erectile Function (IIEF) scores. We assessed data normality, performed group and paired sample comparisons, and evaluated correlations. RESULTS For 551 men, the average patient age was 68.81 ± 8.61 years undergoing bilateral embolization. The particle size predominantly used was 100-300 µm (n = 441). PAE lead to significant (p < .001) reduction of both PV (-9.67 ± 14.52 mL) and PSA level (-2,65 ± 1.56 ng/mL) between pre- and three months after PAE. Substantial improvement were observed for IPSS (-9 points) and QoL scores (-2 points), with stable IIEF scores. Only minor complications (n = 16) were reported, and no major complications were observed. Between the first PAE in 2019 and the routinely performed PAE in 2023 significant (p < .0001) reductions in fluoroscopy (-25.2%), and procedural times (-26.1%) were observed. CONCLUSION In conclusion, PAE is a safe and effective treatment for BPH, offering significant improvements in lower urinary tract symptoms (LUTS) and QoL while maintaining sexual function.
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Affiliation(s)
- Leona S Alizadeh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany; Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany.
| | - David Radek
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany; Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Niklas Verloh
- Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Germany
| | - Ibrahim Yel
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany; Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany; Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Simon Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany; Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Leon D Gruenewald
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany; Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Mirela Dimitrova
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany; Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
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Vogl TJ, Booz C, Koch V, Nour-Eldin NEA, Emara EH, Chun F, El Nemr S, Alizadeh LS. Potential of pre-interventional magnetic resonance angiography for optimization of workflow and clinical outcome of prostatic arterial embolization. Eur J Radiol 2022; 150:110236. [DOI: 10.1016/j.ejrad.2022.110236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/27/2022] [Accepted: 03/03/2022] [Indexed: 11/03/2022]
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[Intelligent early prostate cancer detection in 2021: more benefit than harm]. Urologe A 2021; 60:602-609. [PMID: 33881554 DOI: 10.1007/s00120-021-01519-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
Prostate-specific antigen (PSA) is used for early detection of prostate cancer which represents the most frequent cancer diagnosed in men in Germany and Europe. Results of the largest screening trials revealed that PSA testing reduces the incidence of locally advanced and metastatic prostate cancer and shows an effect on cancer-specific mortality. However, since early diagnosis also results in overdiagnosis and overtreatment of insignificant cancers with associated morbidities, there is a need for a more individualized and risk-tailored modern strategy. The PSA at baseline is an important part of this strategy although the German Federal Joint Committee declined its financial coverage by health insurances. Available validated instruments should accompany the baseline PSA to optimize detection of clinically significant prostate cancer.
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Javaeed A, Ghauri SK, Ibrahim A, Doheim MF. Prostate-specific antigen velocity in diagnosis and prognosis of prostate cancer - a systematic review. Oncol Rev 2020; 14:449. [PMID: 32399138 PMCID: PMC7212205 DOI: 10.4081/oncol.2020.449] [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: 08/25/2019] [Accepted: 04/14/2020] [Indexed: 01/01/2023] Open
Abstract
Prostate-specific antigen velocity (PSAV) is widely used to detect PC and predict its progression. In this study, we qualitatively synthesized the currently available evidence from published studies regarding the PSAV role in PC. Electronic databases were searched to find relevant articles published until January 2019. Inclusion and exclusion criteria were applied to identify related papers. Eventually, data extraction followed by evidence synthesis was conducted. Full-text screening resulted in 42 included studies. Multiple definitions and intervals were used for PSAV calculation across studies. Results from the included studies were conflicting regarding the role of PSAV in detecting PC and predicting progression in active surveillance cases. However, there is evidence that PSAV may have a predictive role in post-treated men. There is no clear-cut evidence from the published literature to support the use of PSAV in clinical practice.
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Shen H, Zhang L, Zhou J, Chen Z, Yang G, Liao Y, Zhu M. Epidermal Growth Factor-Containing Fibulin-Like Extracellular Matrix Protein 1 (EFEMP1) Acts as a Potential Diagnostic Biomarker for Prostate Cancer. Med Sci Monit 2017; 23:216-222. [PMID: 28085790 PMCID: PMC5256367 DOI: 10.12659/msm.898809] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The aim of this study was to detect the expression of epidermal growth factor-containing fibulin-like extracellular matrix protein 1 (EFEMP1) and estimate its diagnostic value in prostate cancer (PCa). Material/Methods EFEMP1 expression in serum and urine of patients with PCa, benign controls and healthy controls at mRNA and protein level were measured by quantitative reverse transcription polymerase chain reaction (qRT-PCR) and enzyme-linked immunosorbent assay (ELISA) analysis, respectively. The chi-square test was used to analyze the relationship between EFEMP1 expression and clinical factors of patients with PCa. A receiver operating characteristic (ROC) curve was established to evaluate the potential values of EFEMP1 for the diagnosis of PCa. Results The relative expression of EFEMP1 was significantly decreased in patients with PCa compared with that in the benign controls and healthy individuals, both at mRNA and protein levels (P<0.05). In the postoperative serum, the EFEMP1 expression was significantly higher than that in preoperative serum at 2 levels. Urine EFEMP1 expression was also down-regulated in patients with PCa compared to that in the other 2 control groups. The low expression of EFEMP1 was obviously affected by Gleason’s score, serum PSA, pathological stage, and lymph node metastasis. Moreover, there was a significant inverse correlation between EFEMP1 expression and PSA levels. The ROC curve revealed that EFEMP1 distinguished PCa patients from healthy controls, with a high AUC of 0.908, corresponding with high sensitivity and specificity, which was significantly higher than the PSA value. Conclusions Serum EFEMP1 is down-regulated and involved in the progression of PCa. It may serve as a useful diagnostic biomarker, with better diagnostic accuracy than PSA in PCa.
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Affiliation(s)
- Hao Shen
- Department of Urology, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei, China (mainland)
| | - Ling Zhang
- Department of Pathology, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei, China (mainland)
| | - Jiajie Zhou
- Department of Urology, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei, China (mainland)
| | - Zhongjun Chen
- Department of Urology, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei, China (mainland)
| | - Guanghua Yang
- Department of Urology, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei, China (mainland)
| | - Yixiang Liao
- Department of Urology, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei, China (mainland)
| | - Min Zhu
- Department of Urology, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei, China (mainland)
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Machtens S, Roosen A, Stief CG, Truß MC. [Prostate biopsy. Update for indication, procedure, and future developments]. Urologe A 2014; 53:1046-51. [PMID: 25023240 DOI: 10.1007/s00120-014-3536-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Transrectal ultrasound-guided prostate biopsy is considered the gold standard in the primary investigation of a suspicious prostate-related finding. The procedure can be carried out with ten probes or more on the lateral side of the prostate, after administering antibiotic prophylaxis and applying local anesthesia. The indication for a biopsy depends on the results of the digitorectal examination, on the serum prostate-specific antigen level, on the individual patient's wish and on his comorbidities. Whether multiparametric imaging should be used before or during the course of a primary or repeated biopsy in order to identify suspicious prostate lesions is the subject of current investigations. Extended biopsy protocols require further clinical investigations before they can become the new standard in the diagnostic work-up. This review delivers an update on the indication for, and technique of, prostate biopsies.
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Affiliation(s)
- S Machtens
- Klinik für Urologie und Kinderurologie, Marienkrankenhaus Bergisch Gladbach, Dr.-Robert-Koch-Straße 16, 51465, Bergisch Gladbach, Deutschland,
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Stephan C, Miller K, Jung K. Is there an optimal prostate-specific antigen threshold for prostate biopsy? Expert Rev Anticancer Ther 2014; 11:1215-21. [DOI: 10.1586/era.11.46] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Effect of alpha linolenic acid supplementation on serum prostate specific antigen (PSA): results from the alpha omega trial. PLoS One 2013; 8:e81519. [PMID: 24349086 PMCID: PMC3859488 DOI: 10.1371/journal.pone.0081519] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 10/12/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Alpha linolenic acid (ALA) is the major omega-3 fatty acid in the diet. Evidence on health effects of ALA is not conclusive, but some observational studies found an increased risk of prostate cancer with higher intake of ALA. We examined the effect of ALA supplementation on serum concentrations of prostate-specific antigen (PSA), a biomarker for prostate cancer. METHODS The Alpha Omega Trial (ClinicalTrials.gov Identifier: NCT00127452) was a double-blind, placebo-controlled trial of ALA and the fish fatty acids eicosapentanoic acid (EPA) and docosahexanoic acid (DHA) on the recurrence of cardiovascular disease, using a 2×2 factorial design. Blood was collected at the start and the end of the intervention period. The present analysis included 1622 patients with a history of a myocardial infarction, aged 60-80 years with an initial PSA concentration <4 ng/mL. They received either 2 g per day of ALA or placebo in margarine spreads for 40 months. T-tests and logistic regression were used to assess the effects of ALA supplementation on changes in serum PSA (both continuously and as a dichotomous outcome, cut-off point: >4 ng/mL). FINDINGS Mean serum PSA increased by 0.42 ng/mL on placebo (n = 815) and by 0.52 ng/mL on ALA (n = 807), a difference of 0.10 (95% confidence interval: -0.02 to 0.22) ng/mL (P = 0·12). The odds ratio for PSA rising above 4 ng/mL on ALA versus placebo was 1.15 (95% CI: 0.84-1.58). INTERPRETATION An additional amount of 2 g of ALA per day increased PSA by 0.10 ng/mL, but the confidence interval ranged from -0.02 to 0.22 ng/mL and included no effect. Therefore, more studies are needed to establish whether or not ALA intake has a clinically significant effect on PSA or prostate cancer. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov; Identifier: NCT00127452. URL: http://www.clinicaltrials.gov/ct2/show/NCT00127452.
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A longitudinal study of PSA and its influential factors in a cohort of Chinese men with initial PSA levels less than 4 ng ml(-1). Asian J Androl 2013; 15:483-6. [PMID: 23749004 DOI: 10.1038/aja.2013.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 02/20/2013] [Accepted: 03/11/2013] [Indexed: 11/08/2022] Open
Abstract
To evaluate the longitudinal change in prostate-specific antigen (PSA) and the influence of initial PSA on the PSA change. We retrospectively analysed health examination data collected at Beijing Hospital from March 2007 to November 2011. Men with an initial PSA levels less than 4 ng ml(-1) and an annual PSA test for 5 years were enrolled into the study. The men were separated into four groups by the initial PSA level (0-0.99, 1-1.99, 2-2.99 and 3-3.99 ng ml(-1)), and the difference in PSA change among the four groups was analysed. A total of 1330 men were enrolled into the study. The mean age, initial PSA and PSA velocity (PSAV) were 58.17 ± 14.63 (range 24-91) years, 1.18 ± 0.79 (range 0-4) ng ml(-1) and 0.04 ± 0.25 (range -1.34-2.02) ng ml(-1) year(-1). Pearson's correlation analysis showed no correlation between initial PSA and PSAV (r=-0.036, P=0.189). The PSAV of the 0-0.99, 1-1.99, 2-2.99 and 3-3.99 ng ml(-1) initial PSA groups was 0.03 ± 0.11, 0.07 ± 0.32, 0.03 ± 0.34 and -0.01 ± 0.43 ng ml(-1) year(-1), respectively (P=0.06). As the initial PSA increased, the percentage of having a PSAV over 0.75 ng ml(-1) year(-1) and a negative PSAV both significantly increased. Males with a baseline PSA of 0-0.99, 1-1.99, 2-2.99 and 3-3.99 ng ml(-1) had a 1.88%, 6.16%, 16.30% and 57.81% chance, respectively, that their PSA would increase above 4.0 ng ml(-1) over the following 4 years (P<0.0001). The PSAV has no correlation with the initial PSA level. However, as the initial PSA increases, the chance that males will have an abnormal PSA or PSAV in the future increases.
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Agarwal M, He C, Siddiqui J, Wei J, Macoska JA. CCL11 (eotaxin-1): a new diagnostic serum marker for prostate cancer. Prostate 2013; 73:573-81. [PMID: 23059958 PMCID: PMC3594486 DOI: 10.1002/pros.22597] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 09/10/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND The recent recommendation of the U.S. Preventive Services Task Force against PSA-based screening for prostate cancer was based, in part, on the lack of demonstrated diagnostic utility of serum PSA values in the low, but detectable range to successfully predict prostate cancer. Though controversial, this recommendation reinforced the critical need to develop, validate, and determine the utility of other serum and/or urine transcript and protein markers as diagnostic markers for PCa. The studies described here were intended to determine whether inflammatory cytokines might augment serum PSA as a diagnostic marker for prostate cancer. METHODS Multiplex ELISA assays were performed to quantify CCL1, CCL2, CCL5, CCL8, CCL11, CCL17, CXCL1, CXCL5, CXCL8, CXCL10, CXCL12, and IL-6 protein levels in the serum of 272 men demonstrating serum PSA values of <10 ng/ml and undergoing a 12 core diagnostic needle biopsy for detection of prostate cancer. Logistic regression was used to identify the associations between specific chemokines and prostate cancer status adjusted for prostate volume, and baseline PSA. RESULTS Serum levels for CCL1 (I-309) were significantly elevated among all men with enlarged prostates (P < 0.04). Serum levels for CCL11 (Eotaxin-1) were significantly elevated among men with prostate cancer regardless of prostate size (P < 0.01). The remaining 10 cytokines examined in this study did not exhibit significant correlations with either prostate volume or cancer status. CONCLUSIONS Serum CCL11 values may provide a useful diagnostic tool to help distinguish between prostatic enlargement and prostate cancer among men demonstrating low, but detectable, serum PSA values.
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Affiliation(s)
- Manisha Agarwal
- Department of Urology, The University of Michigan School of Medicine, Ann Arbor, MI
| | - Chang He
- Department of Urology, The University of Michigan School of Medicine, Ann Arbor, MI
| | - Javed Siddiqui
- Center for Translational Pathology, The University of Michigan School of Medicine, Ann Arbor, MI
| | - John Wei
- Department of Urology, The University of Michigan School of Medicine, Ann Arbor, MI
- Center for Translational Pathology, The University of Michigan School of Medicine, Ann Arbor, MI
| | - Jill A. Macoska
- Department of Urology, The University of Michigan School of Medicine, Ann Arbor, MI
- Address Correspondence To: Jill A. Macoska, Ph.D., Department of Urology, The University of Michigan, 6217 Cancer Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0944, (734) 647-8121 TEL, (734) 647-9271 FAX,
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Prostate specific antigen testing: age-related interpretation in early prostate cancer detection. Pathology 2013; 45:343-5. [PMID: 23619589 DOI: 10.1097/pat.0b013e3283619a77] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wu H, Liu T, Ma C, Xue R, Deng C, Zeng H, Shen X. GC/MS-based metabolomic approach to validate the role of urinary sarcosine and target biomarkers for human prostate cancer by microwave-assisted derivatization. Anal Bioanal Chem 2011; 401:635-46. [PMID: 21626193 DOI: 10.1007/s00216-011-5098-9] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Revised: 05/09/2011] [Accepted: 05/10/2011] [Indexed: 12/11/2022]
Abstract
A recent study showed that sarcosine may be potentially useful for the diagnosis and prognosis of prostate cancer (PCa). The aim of this study was to validate diagnostic value of sarcosine for PCa, to evaluate urine metabolomic profiles in patients with PCa in comparison of non-cancerous control, and to further explore the other potential metabolic biomarkers for PCa. Isotope dilution gas chromatography/mass spectrometry (ID GC/MS) metabolomic approach was applied to evaluate sarcosine using [methyl-D(3)]-sarcosine as an internal standard. Microwave-assisted derivatization (MAD) together with GC/MS was utilized to obtain the urinary metabolomic information in 20 PCa patients compared with eight patients with benign prostate hypertrophy and 20 healthy men. Acquired metabolomic data were analyzed using a two-sample t test. Diagnostic models for PCa were constructed using principal component analysis and were assessed with receiver-operating characteristic curves. Results showed that the urinary sarcosine level has no statistical difference between the PCa group and the control group. In addition, nine metabolomic markers between the PCa group and the healthy male group were selected, which constructed a diagnostic model with a high area under the curve value of 0.9425. We conclude that although urinary sarcosine value has limited potential in the diagnostic algorithm of PCa, urinary metabolomic panel based on GC/MS assay following MAD may potentially become a diagnostic tool for PCa.
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Affiliation(s)
- Hao Wu
- Department of Gastroenterology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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Loeb S, Carvalhal GF, Catalona WJ. Reply. Urology 2010. [DOI: 10.1016/j.urology.2009.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Börgermann C, vom Dorp F, Breuer G, Kliner S, Rübben H. Früherkennung von Prostatakarzinomen. Urologe A 2010; 49:1351-5. [DOI: 10.1007/s00120-010-2394-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rodríguez-Alonso A, González-Blanco A, Pita-Fernández S, Bonelli-Martín C, Pértega-Díaz S, Cuerpo-Pérez M. Relación de la velocidad preoperatoria de PSA con los hallazgos histopatológicos de la pieza quirúrgica y la supervivencia tras prostatectomía radical. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2010.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Thanigasalam R, Mancuso P, Tsao K, Rashid P. Prostate-specific antigen velocity (PSAV): apracticalrole for PSA? ANZ J Surg 2009; 79:703-6. [DOI: 10.1111/j.1445-2197.2009.05055.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Börgermann C, Loertzer H, Luboldt HJ, Hammerer P, Fornara P, Graefen M, Rübben H. [PSA--Quo vadis?]. Urologe A 2009; 48:1008, 1010, 1012-4, passim. [PMID: 19680620 DOI: 10.1007/s00120-009-2076-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Prostate cancer is the most frequent cancer in males. Because of the high cure rates, early detection of prostate cancer should identify organ-confined prostate cancers. An early detection examination should be performed annually starting at the age of 50 years and ending when life expectancy is less than 10 years. Digital rectal examination is supplemented by determination of prostate-specific antigen (PSA). Before the first PSA test, the patient must be informed of possible consequences such as biopsy recommendation and treatment options. A threshold of 4 ng/ml is defined as the indication for prostate biopsy. Imaging methods do not play a major role in early detection of prostate cancer today. Early detection identifies many latent prostate cancers, and patients may receive overtreatment. A possible solution is to change the early detection paradigm from detection of all prostate cancers to identification of aggressive ones. In this article, early detection is discussed based on the recent literature.
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Affiliation(s)
- C Börgermann
- Klinik und Poliklinik für Urologie, Uroonkologie und Kinderurologie, Universitätsklinik, Hufelandstrasse 55, 45122, Essen, Germany.
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van Renterghem K, Van Koeveringe G, Achten R, van Kerrebroeck P. A new algorithm in patients with elevated and/or rising prostate-specific antigen level, minor lower urinary tract symptoms, and negative multisite prostate biopsies. Int Urol Nephrol 2009; 42:29-38. [PMID: 19496018 PMCID: PMC2844972 DOI: 10.1007/s11255-009-9596-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 05/17/2009] [Indexed: 01/21/2023]
Abstract
Patients with elevated and/or rising prostate-specific antigen (PSA), minor lower urinary tract symptoms (LUTS), and no evidence for prostate cancer on (multiple) extended prostate biopsies are a regularly encountered problem in urological practice. Even now, patients are seen with no objective explanation of this persistent elevated and/or rising PSA. So far, many strategic proposals have been elaborated and published to deal with this specific population including the use of different PSA derivates; applying different biopsy schemes—strategies—biopsy target imaging; diagnostic use of prostate cancer genes; and many more. In this review, we propose a new algorithm in which an urodynamic evaluation should be included since bladder outlet obstruction (BOO) can be expected. Once BOO is confirmed, a transurethral resection of the prostate (TURP) can be offered to these patients. This procedure will result in subjective and biochemical improvement and allows extensive histological examination. Current literature was reviewed with regard to this specific population. This research was performed using the commercially available Medline online search tools and applying the following search terms: “diagnostic TURP”; “elevated PSA”; and “prostate biopsy”. Furthermore, subsequent reference search was executed on retrieved articles.
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Sighinolfi MC, Micali S, De Stefani S, Cicero A, Cianci F, Giacometti M, Bianchi G. Retrospective descriptive analysis of the physiological kinetics of prostate-specific antigen in men older than 75 years. Asian J Androl 2009; 11:493-7. [PMID: 19448643 DOI: 10.1038/aja.2008.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Several studies have compared prostate-specific antigen (PSA) kinetics in men with and without cancer, but there has been no adequate analysis of the longitudinal variation in PSA. The aim of this study was to assess the fluctuations in PSA in a cohort of elderly men in an attempt to define a physiological pattern of PSA kinetics. We searched a specific cohort of patients aged > 75 years and with PSA value < 2.0 ng mL(-1). A history of all PSA values over the past 10 years was compiled for each patient to create a database of patients fitting the following criteria: (1) minimum of five PSA measurements, (2) over at least 5 years. Exclusion criteria were: (1) PSA < 0.2 ng mL(-1) at each measurement and (2) having had more than one PSA test per year. In all, 1 327 patients (mean age: 78.52 years) fit the inclusion criteria. The mean variation from the first to the last PSA test was 0.05 +/- 0.43, with a mean follow-up of 6.79 +/- 1.71 years. Over the same period, the mean fluctuation from the lowest to the highest PSA value was 0.04 +/- 0.55 (P = 0.925). The mean annual PSA velocity (PSAV) was calculated by dividing the mean variation from the first to the last PSA test by the number of years of observation for each patient and was set at 0.0104 +/- 0.1050. Concluding, in a large-scale cohort of elderly individuals considered healthy and evaluated for a considerable follow-up, the average annual PSAV as well as the average fluctuation from the lowest to the highest PSA value are insignificant.
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Walz J, Haese A, Scattoni V, Steuber T, Chun FKH, Briganti A, Montorsi F, Graefen M, Huland H, Karakiewicz PI. Percent free prostate-specific antigen (PSA) is an accurate predictor of prostate cancer risk in men with serum PSA 2.5 ng/mL and lower. Cancer 2008; 113:2695-703. [PMID: 18853417 DOI: 10.1002/cncr.23885] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Up to 17% of men with a prostate-specific antigen (PSA) level below the accepted prostate biopsy cutoff of 2.5 ng/mL may have prostate cancer. Because identification of these patients represents a difficult task, we assessed the ability of percent free PSA to discriminate between benign and malignant prostate biopsy outcomes in men with PSA < or =2.5 ng/mL. METHODS Between 1999 and 2006, 543 men with a PSA < or =2.5 ng/mL were referred for initial prostate biopsy. Age, total PSA, percent free PSA, and digital rectal examination findings represented predictors of prostate cancer at biopsy in logistic regression models. The area under the receiver operating characteristics curve (AUC) quantified the discriminative ability of the predictors. The pathological characteristics of the detected cancers were assessed in individuals treated with radical prostatectomy. RESULTS Of all, 23% had prostate cancer on biopsy, 16.5% of patients treated with radical prostatectomy had pT3 stage, and 35.6% had a pathological Gleason score of 3 + 4 or higher. The most accurate predictor of prostate cancer on biopsy was percent free PSA (0.68) versus age (0.50), total PSA (0.57), or rectal examination findings (0.58). Of patients with percent free PSA below 14%, 59% had prostate cancer. In multivariate models, percent free PSA (P < .001) and rectal examination findings (P = .001) were the only independent predictors of prostate cancer. The combined AUC of all predictors (0.69) was not significantly (P = .7) higher than that of percentage of free PSA alone (0.68). CONCLUSIONS The risk of prostate cancer is clearly non-negligible in patients with PSA < or =2.5 ng/mL. The percent free PSA can accurately predict the prevalence of prostate cancer at prostate biopsy in these individuals.
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Affiliation(s)
- Jochen Walz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada.
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Vickers AJ, Savage C, O'Brien MF, Lilja H. Systematic review of pretreatment prostate-specific antigen velocity and doubling time as predictors for prostate cancer. J Clin Oncol 2008; 27:398-403. [PMID: 19064972 DOI: 10.1200/jco.2008.18.1685] [Citation(s) in RCA: 167] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Pretreatment prostate-specific antigen (PSA) dynamics (PSA velocity and PSA doubling time) are widely advocated as useful prognostic markers in prostate cancer. We aimed to assess the published evidence for the clinical utility of PSA dynamics in this population. METHODS We conducted a systematic review of studies published before March 2007 in which a PSA dynamic (velocity or doubling time) was calculated in patients before definitive treatment, a subsequent event (such as biopsy or recurrence) was ascertained, and the association between the two was analyzed. Our principal end point was the type of analysis reported, particularly whether the predictive accuracy of a statistical model that included both absolute PSA level and a PSA dynamic was compared with that of a model that included only PSA. RESULTS Eighty-seven articles were eligible for analysis. The most common end points were biopsy (42 articles), and either recurrence (14 articles) or metastases or death (14 articles) after definitive therapy. Although PSA dynamics were generally found to be associated with outcome, only one article compared predictive accuracy of models with and without a PSA dynamic: this reported that PSA velocity improved prediction slightly (from 0.81 to 0.83), but was subject to verification bias. No article used decision analytic methods to examine the clinical impact of PSA dynamics. CONCLUSION There is little evidence that calculation of PSA velocity or doubling time in untreated patients provides predictive information beyond that provided by absolute PSA level alone. We see no justification for the use of PSA dynamics in clinical decision making before treatment in early-stage prostate cancer.
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Affiliation(s)
- Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Loeb S, Sutherland DE, D'Amico AV, Roehl KA, Catalona WJ. PSA Velocity Is Associated With Gleason Score in Radical Prostatectomy Specimen: Marker for Prostate Cancer Aggressiveness. Urology 2008; 72:1116-20; discussion 1120. [DOI: 10.1016/j.urology.2008.01.082] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Revised: 12/23/2007] [Accepted: 01/10/2008] [Indexed: 11/15/2022]
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Stephan C, Büker N, Cammann H, Meyer HA, Lein M, Jung K. Artificial neural network (ANN) velocity better identifies benign prostatic hyperplasia but not prostate cancer compared with PSA velocity. BMC Urol 2008; 8:10. [PMID: 18764937 PMCID: PMC2543033 DOI: 10.1186/1471-2490-8-10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Accepted: 09/02/2008] [Indexed: 11/21/2022] Open
Abstract
Background To validate an artificial neural network (ANN) based on the combination of PSA velocity (PSAV) with a %free PSA-based ANN to enhance the discrimination between prostate cancer (PCa) and benign prostate hyperplasia (BPH). Methods The study comprised 199 patients with PCa (n = 49) or BPH (n = 150) with at least three PSA estimations and a minimum of three months intervals between the measurements. Patients were classified into three categories according to PSAV and ANN velocity (ANNV) calculated with the %free based ANN "ProstataClass". Group 1 includes the increasing PSA and ANN values, Group 2 the stable values, and Group 3 the decreasing values. Results 71% of PCa patients typically have an increasing PSAV. In comparison, the ANNV only shows this in 45% of all PCa patients. However, BPH patients benefit from ANNV since the stable values are significantly more (83% vs. 65%) and increasing values are less frequently (11% vs. 21%) if the ANNV is used instead of the PSAV. Conclusion PSAV has only limited usefulness for the detection of PCa with only 71% increasing PSA values, while 29% of all PCa do not have the typical PSAV. The ANNV cannot improve the PCa detection rate but may save 11–17% of unnecessary prostate biopsies in known BPH patients.
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Affiliation(s)
- Carsten Stephan
- Department of Urology, Charité - Universitätsmedizin Berlin, Germany.
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van Renterghem K, Van Koeveringe G, Achten R, van Kerrebroeck P. Prospective study of the role of transurethral resection of the prostate in patients with an elevated prostate-specific antigen level, minor lower urinary tract symptoms, and proven bladder outlet obstruction. Eur Urol 2008; 54:1385-92. [PMID: 18599187 DOI: 10.1016/j.eururo.2008.06.069] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Accepted: 06/16/2008] [Indexed: 12/15/2022]
Abstract
BACKGROUND Deciding on strategy for patients with minor lower urinary tract symptoms (LUTS), elevated prostate-specific antigen (PSA) levels, unsuspicious digital rectal examination (DRE) and/or transrectal ultrasound (TRUS), and multiple negative extended prostate biopsies is complex. OBJECTIVES To define the role and clinical significance of transurethral resection of the prostate (TURP) in these patients. DESIGN, SETTINGS, AND PARTICIPANTS Thirty-three patients with elevated PSA; minor LUTS, as assessed by the International Prostate Symptoms Score (IPSS); no suspicion for prostate cancer on DRE and/or TRUS; and negative extended prostate biopsies were prospectively enrolled in a cohort study at a tertiary care institution. INTERVENTION After full urodynamic investigation showing all patients to be bladder outlet obstructed, TURP was performed. MEASUREMENTS Resected tissue was histologically examined for presence of prostate cancer. Within 6 mo after TURP, patients were clinically reevaluated by means of IPSS and PSA level. RESULTS AND LIMITATIONS Preoperatively, mean PSA and IPSS values were 8.2ng/ml and 6.8, respectively. Mean detrusor pressure at maximum flow was 80.3cm H(2)O. Histological examination after TURP revealed benign prostate hyperplasia in 81.8% (subgroup 1) and aggressive prostate cancer in 6.1% of patients (subgroup 2). In 12.1% of patients, only a few chips of nonaggressive prostate cancer (T1a) were detected. In patients without signs of aggressive prostate cancer (93.9%=12.1%+81.8%, subgroup 3), mean postoperative PSA and IPSS values were 0.6ng/ml and 2.4, respectively, while these values were 0.6ng/ml and 2.5ng/ml in subgroup 1 (p<0.0001). This study is limited in sample size, requiring more research to confirm these results. CONCLUSIONS This prospective study shows that, in patients with minor LUTS and no suspicion for prostate cancer, bladder outlet obstruction can result in elevated PSA levels. These patients will benefit from TURP regarding symptomatology and supernormalisation of PSA levels. Moreover, albeit in few cases, histological examination will reveal aggressive prostate cancer.
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Svatek RS, Shulman MJ, Benaim EA, Rogers TE, Margulis V. Change in Prostate Specific Antigen Following Androgen Stimulation is an Independent Predictor of Prostate Cancer Diagnosis. J Urol 2008; 179:2192-5; discussion 2195-6. [DOI: 10.1016/j.juro.2008.01.142] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Robert S. Svatek
- Departments of Urology and Pathology (TER), Dallas Veterans Administration Hospital, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Michael J. Shulman
- Departments of Urology and Pathology (TER), Dallas Veterans Administration Hospital, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Elie A. Benaim
- Departments of Urology and Pathology (TER), Dallas Veterans Administration Hospital, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Thomas E. Rogers
- Departments of Urology and Pathology (TER), Dallas Veterans Administration Hospital, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Vitaly Margulis
- Departments of Urology and Pathology (TER), Dallas Veterans Administration Hospital, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
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Wolters T, Roobol MJ, Bangma CH, Schröder FH. Is prostate-specific antigen velocity selective for clinically significant prostate cancer in screening? European Randomized Study of Screening for Prostate Cancer (Rotterdam). Eur Urol 2008; 55:385-92. [PMID: 18353529 DOI: 10.1016/j.eururo.2008.02.046] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Accepted: 02/29/2008] [Indexed: 11/16/2022]
Abstract
BACKGROUND The value of prostate-specific antigen velocity (PSAV) in screening for prostate cancer (PCa) and especially for clinically significant PCa is unclear. OBJECTIVE To assess the value of PSAV in screening for PCa. Specifically, the role of PSAV in lowering the number of unnecessary biopsies and reducing the detection rate of indolent PCa was evaluated. DESIGN, SETTING, AND PARTICIPANTS All men included in the study cohort were participants in the European Randomized Study of Screening for Prostate Cancer (ERSPC), Rotterdam section. INTERVENTION During the first and second screening round, a PSA test was performed on 2217 men, and all underwent a biopsy during the second screening round 4 yr later. MEASUREMENTS PSAV was calculated and biopsy outcome was classified as benign, possibly indolent PCa, or clinically significant PCa. RESULTS AND LIMITATIONS A total of 441 cases of PCa were detected, 333 were classified as clinically significant and 108 as possibly indolent. The use of PSAV cut-offs reduced the number of biopsies but led to important numbers of missed (indolent and significant) PCa. PSAV was predictive for PCa (OR: 1.28, p<0.001) and specifically for significant PCa (OR: 1.46, p<0.001) in univariate analyses. However, multivariate analyses using age, PSA, prostate volume, digital rectal examination and transrectal ultrasonography outcome, and previous biopsy (yes/no) showed that PSAV was not an independent predictor of PCa (OR: 1.01, p=0.91) or significant PCa (OR: 0.87, p=0.30). CONCLUSIONS The use of PSAV as a biopsy indicator would miss a large number of clinically significant PCa cases with increasing PSAV cut-offs. In this study, PSAV was not an independent predictor of a positive biopsy in general or significant PCa on biopsy. Therefore, PSAV does not improve the ERSPC screening algorithm.
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Affiliation(s)
- Tineke Wolters
- Department of Urology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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Macoska JA, Begley LA, Dunn RL, Siddiqui J, Wei JT, Sarma AV. Pilot and feasibility study of serum chemokines as markers to distinguish prostatic disease in men with low total serum PSA. Prostate 2008; 68:442-52. [PMID: 18196514 DOI: 10.1002/pros.20717] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The incidence and prevalence of both benign prostatic hypertrophy (BPH) and prostate cancer (PCa) increase with the aging process. Our laboratory recently showed that the chemokines CXCL5 and CXCL12, which normally function as inflammatory mediators, are secreted at higher levels by aging prostate stromal fibroblasts and elicit proliferative responses from both prostate stromal fibroblast and epithelial cells. Because both CXCL5 and CXCL12 are secreted molecules, we hypothesized that their levels in patient serum might serve as biomarkers to distinguish between BPH and PCa. METHODS Serum CXCL5 and CXCL12 levels were determined using sandwich ELISAs for 51 men demonstrating low serum PSA values of < or =10 ng/ml who underwent diagnostic needle biopsy for the detection of PCa. The bivariate relationship of circulating chemokine levels, age, and disease status in the prostate was tested using the Wilcoxon rank-sum test. RESULTS Total serum CXCL12 levels were significantly higher for men who were biopsy positive compared to those who were biopsy negative for cancer and histological prostatitis (P = 0.050). Among men who were biopsy negative for PCa, total serum CXCL5 levels were inversely associated with prostate volume and were significantly higher in men with concomitant BPH and histological prostatitis compared to those without evidence of prostatic disease (P < 0.003). CONCLUSIONS The results of this pilot and feasibility study suggest that serum or plasma CXCL5 and CXCL12 levels may potentially distinguish between BPH and PCa among patients presenting with low serum PSA, and may be useful toward facilitating decisions to perform diagnostic needle biopsy in this patient population.
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Affiliation(s)
- Jill A Macoska
- Department of Urology, University of Michigan, Ann Arbor, Michigan 48109-0944, USA
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D'Amico AV. Prostate-Specific Antigen (PSA) and PSA Velocity: Competitors or Collaborators in the Prediction of Curable and Clinically Significant Prostate Cancer. J Clin Oncol 2008; 26:823-4. [DOI: 10.1200/jco.2007.15.1902] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anthony V. D'Amico
- Department of Radiation Oncology, Brigham and Women's Hospital, and Dana Farber Cancer Institute, Boston, MA
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Ahyai SA, Graefen M, Steuber T, Haese A, Schlomm T, Walz J, Köllermann J, Briganti A, Zacharias M, Friedrich MG, Karakiewicz PI, Montorsi F, Huland H, Chun FKH. Contemporary prostate cancer prevalence among T1c biopsy-referred men with a prostate-specific antigen level < or = 4.0 ng per milliliter. Eur Urol 2007; 53:750-7. [PMID: 17964070 DOI: 10.1016/j.eururo.2007.10.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Accepted: 10/08/2007] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the prostate cancer (PCa) prevalence and risk factors of men with prostate-specific antigen (PSA) level< or =4.0 ng/ml and an unsuspicious digital rectal examination (DRE) in a large biopsy referral cohort. MATERIALS AND METHODS Between 1997 and 2005, 855 men underwent initial transrectal ultrasound (TRUS)-guided prostate biopsy at the University Hospital Hamburg-Eppendorf. Patients with any previous surgical or medical treatment were excluded from analyses. Logistic regression analyses were performed to determine risk factors of PCa at biopsy and high-grade PCa defined as biopsy Gleason sum> or =7. RESULTS Overall PCa detection rate was 23.1%. The majority had a biopsy Gleason sum of 6 (79.5%) and 20.5% had a biopsy Gleason sum> or =7. Total PSA (tPSA) and percentage of free PSA (%fPSA) were statistically significantly different in men with and without PCa (all p<0.001). In tPSA strata < or = 0.5, 0.6-1.0, 1.1-2.0, 2.1-3.0, and 3.1-4.0 ng/ml, PCa prevalence was 4.0%, 10.6%, 14.8%, 24.5%, and 32.1%, respectively. In logistic regression analyses addressing PCa and Gleason sum > or = 7 at biopsy, %fPSA and prostate volume represented independent and most informative risk factors. CONCLUSION Our data demonstrate that a substantial percentage (23.1%) of men with a PSA< or =4.0 ng/ml and an unsuspicious DRE in a biopsy referral population harbor PCa, with 20.5% being high grade. Low %fPSA and low prostate volume represent important parameters in PCa and in high grade disease detection at biopsy, respectively.
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Affiliation(s)
- Sascha A Ahyai
- Department of Urology, University of Hamburg, Hamburg, Germany
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Puppo P. Repeated negative prostate biopsies with persistently elevated or rising PSA: a modern urologic dilemma. Eur Urol 2007; 52:639-41. [PMID: 17451871 DOI: 10.1016/j.eururo.2007.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Accepted: 04/03/2007] [Indexed: 12/19/2022]
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