1
|
Sundaresan VM, Smani S, Rajwa P, Renzulli J, Sprenkle PC, Kim IY, Leapman MS. Prostate-specific antigen screening for prostate cancer: Diagnostic performance, clinical thresholds, and strategies for refinement. Urol Oncol 2024:S1078-1439(24)00505-2. [PMID: 39019723 DOI: 10.1016/j.urolonc.2024.06.003] [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: 11/12/2023] [Revised: 03/27/2024] [Accepted: 06/02/2024] [Indexed: 07/19/2024]
Abstract
Prostate specific antigen (PSA) has transformed the diagnosis and treatment of prostate cancer by enabling early detection at global scale. Due to expression in both benign and malignant cells, PSA-based prostate cancer screening using single cut-points yields imperfect diagnostic performance and has led to the detection and over-treatment of low-grade prostate cancer. Additional challenges in the interpretation of PSA include substantial inter and intrapersonal variation, differences with age and prostate volume, and selection of standardized PSA value cutoffs for clinical application. In response, refinements to PSA including risk and age-based thresholds, age and genetic adjustments, PSA density, percentage free PSA, and PSA velocity have been proposed and extensively studied. In this review, we focus on the clinical role of PSA as a screening biomarker with a particular emphasis on its test characteristics, clinically actionable thresholds, and strategies to refine its clinical interpretation.
Collapse
Affiliation(s)
| | - Shayan Smani
- Department of Urology, Yale School of Medicine, New Haven, CT
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Joseph Renzulli
- Department of Urology, Yale School of Medicine, New Haven, CT
| | | | - Isaac Y Kim
- Department of Urology, Yale School of Medicine, New Haven, CT
| | - Michael S Leapman
- Department of Urology, Yale School of Medicine, New Haven, CT; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT.
| |
Collapse
|
2
|
Šimánek V, Vrzáková R, Viták R, Jirásko M, Fürst T, Topolčan O, Pecen L, Vurm V, Kučera R. Preanalytical stability of molecular forms of prostate-specific antigen in serum samples (PSA, free PSA, [-2]proPSA) and their impact on fPSA/tPSA ratio and PHI. Prostate 2024; 84:656-665. [PMID: 38414098 DOI: 10.1002/pros.24681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/04/2024] [Accepted: 02/14/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Prostate cancer is a common cancer in men. Detection methods include the measurement of biomarkers: prostate-specific antigen (PSA), free PSA, [-2]proPSA, and the calculated indices: fPSA/tPSA ratio and Prostate Health Index (PHI). Proper preanalytical conditions are crucial for precise measurement and failure to adhere to protocols or regulations can influence the diagnostic algorithm. We assessed the stability of the above-mentioned biomarkers, fPSA/tPSA ratio and PHI, under various pre-analytical conditions. METHODS Serum samples from 45 males were collected and stored under specific conditions before tPSA, fPSA, and [-2]proPSA were measured. Subsequently, the fPSA/tPSA and PHI were calculated. RESULTS tPSA, fPSA, and [-2]proPSA remained stable during the two freeze-thaw cycles. Storage at 4°C and 22°C resulted in stable tPSA concentrations. However, fPSA levels decreased and [-2]proPSA levels increased over time. The fPSA/tPSA ratio remained stable for 72 h, at which point a decrease was observed in the samples kept at 4°C and 22°C. A gradual increase in PHI was observed in the samples kept at 4°C and 22°C. CONCLUSIONS All biomarkers remained stable during two freeze-thaw cycles. tPSA was the most stable analyte when stored at 4°C, as well as at RT. A gradual increase of [-2]proPSA and a slight decrease in fPSA were observed during the storage test. This led to a decrease in the fPSA/tPSA ratio and an elevation in the PHI. We therefore recommend measuring prostate biomarkers promptly following blood collection. IMPACT Understanding the pre-analytical stability of prostate biomarkers helps prevent false positive results and improve the accuracy of diagnostics for prostate cancer.
Collapse
Affiliation(s)
- Václav Šimánek
- Department of Immunochemistry Diagnostics, University Hospital and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Radana Vrzáková
- Department of Medical Chemistry and Biochemistry, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Roman Viták
- Department of Pharmacology and Toxicology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Michal Jirásko
- Department of Immunochemistry Diagnostics, University Hospital and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Department of Pharmacology and Toxicology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Tomáš Fürst
- Faculty of Science, c, Palacky University in Olomou, Olomouc, Czech Republic
| | - Ondřej Topolčan
- Department of Immunochemistry Diagnostics, University Hospital and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Ladislav Pecen
- Department of Immunochemistry Diagnostics, University Hospital and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Vladimír Vurm
- Department of Immunochemistry Diagnostics, University Hospital and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Radek Kučera
- Department of Immunochemistry Diagnostics, University Hospital and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Department of Pharmacology and Toxicology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| |
Collapse
|
3
|
Emmett L, John N, Pathmanandavel S, Counter W, Ayers M, Sharma S, Agrawal S, Poole A, Hovey E, Pranavan G, Gedye C, Mallesara G, Guminski A, Lee A, Stockler MR, Hickey A, Eu P, Joshua AM, Crumbaker M, Nguyen A. Patient outcomes following a response biomarker-guided approach to treatment using 177Lu-PSMA-I&T in men with metastatic castrate-resistant prostate cancer (Re-SPECT). Ther Adv Med Oncol 2023; 15:17588359231156392. [PMID: 36872949 PMCID: PMC9983078 DOI: 10.1177/17588359231156392] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/25/2023] [Indexed: 03/06/2023] Open
Abstract
Background 177LuPSMA is an effective treatment in metastatic castrate-resistant prostate cancer with trials adopting a standardised dose interval. Adjusting treatment intervals utilising early response biomarkers may improve patient outcomes. Objective This study evaluated progression-free survival (PFS) and overall survival (OS) based on treatment interval adjustment utilising 177LuPSMA 24-h SPECT/CT (177Lu-SPECT) and early prostate-specific antigen (PSA) response. Design Retrospective analysis of a clinical 177Lu-PSMA-I&T treatment programme. Methods In all, 125 men were treated with 6-weekly 177LuPSMA-I&T [median 3 cycles, interquartile range (IQR): 2-4], median dose 8.0 GBq [95% confidence interval (CI): 7.5-8.0]. Imaging screening involved 68GaPSMA-11 PET/diagnostic CT. 177Lu-SPECT/diagnostic CT was acquired following each therapy, and clinical assessments 3-weekly. Following dose 2 (week 6), a composite PSA and 177Lu-SPECT/CT imaging response [partial response (PR), stable disease (SD), and progressive disease (PD)] determined ongoing management. Response group (RG) 1 (marked reduction in PSA/imaging PR) break in treatment until subsequent PSA rise, then re-treatment. RG 2 (stable or reduced PSA and/or imaging SD) 6-weekly treatments until six doses, or no longer clinically benefitting. RG 3 (rise in PSA and/or imaging PD) recommended for an alternative treatment. Results Overall PSA50% response rate (PSARR) was 60% (75/125), median PSA-PFS 6.1 months (95%CI: 5.5-6.7), and median OS 16.8 months (95%CI: 13.5-20.1). 35% (41/116) were classified as RG 1, 34% (39/116) RG 2, and 31% (36/116) RG 3. PSARRs by RG were 95% (38/41), 74% (29/39), and 8% (3/36); median PSA-PFS rates were 12.1 months (95%CI: 9.3-17.4), 6.1 months (95%CI: 5.8-9.0), and 2.6 months (95%CI: 1.6-3.1); and OS rates were 19.2 months (95%CI: 16.8-20.7), 13.2 months (95%CI: 12.0-18.8), and 11.2 months (95%CI: 8.7-15.6) for RG 1, 2, and 3, respectively. The median months of 'treatment holiday' for RG 1 was 6.1 months (IQR: 3.4-8.7). Nine men had received prior 177LuPSMA-617 and were retreated with 177LuPSMA-I&T, with a PSARR of 56% on re-treatment. Conclusion Personalising dosing regimens using early response biomarkers with 177LuPSMA has the potential to achieve similar treatment responses to continuous dosing while allowing treatment breaks or intensification. Further evaluation of early response biomarker-guided treatment regimens in prospective trials is warranted. Plain Language Summary Lutetium-PSMA therapy is a new therapy for metastatic prostate cancer that is well tolerated and effective. However, not all men respond equally, with some responding very well and others progressing early. Personalising treatments require tools that can accurately measure treatment responses, preferably early in the treatment course, so adjustments to treatment can be made. Lutetium-PSMA can measure tumour sites after each therapy by taking whole body 3D images at 24 h using a small radiation wave from the treatment itself. This is called a SPECT scan. Previous work has shown that both prostate-specific antigen (PSA) response and changes in tumour volume on a SPECT scan can predict how patients will respond to treatment as early as dose 2. This study demonstrates that stratifying how men are treated based on the results of the 6-week SPECT scan and PSA response potentially allows a third of men to have break in treatment and that these men have both longer time to disease progression and OS. Men with an increase in tumour volume and increase in PSA early in treatment (6 weeks) had shorter time to disease progression and OS. Men with early biomarker disease progression were offered alternative treatments early in an attempt to allow the opportunity to allow a more effective potential therapy, if one was available. The study is an analysis of a clinical programme, and was not a prospective trial. As such, there are potential biases that could influence results. Hence, while the study is encouraging for the use of early response biomarkers to guide better treatment decisions, this must be validated in a well-designed clinical trial.
Collapse
Affiliation(s)
- Louise Emmett
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital, 390 Victoria Street, Sydney, NSW 2010, Australia.,Department of Theranostics and Nuclear Medicine, St Vincent's Hospital, Sydney, NSW, Australia.,Garvan Institute of Medical Research, Sydney, NSW, Australia.,St. Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Nikeith John
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital, Sydney, NSW, Australia
| | - Sarennya Pathmanandavel
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital, Sydney, NSW, Australia.,Garvan Institute of Medical Research, Sydney, NSW, Australia.,St. Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - William Counter
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital, Sydney, NSW, Australia
| | - Maria Ayers
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital, Sydney, NSW, Australia
| | - Shikha Sharma
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital, Sydney, NSW, Australia
| | - Shikha Agrawal
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital, Sydney, NSW, Australia
| | - Aron Poole
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital, Sydney, NSW, Australia
| | - Elizabeth Hovey
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Ganes Pranavan
- Department of Medical Oncology, The Canberra Hospital, Garran, ACT, Australia
| | - Craig Gedye
- Calvary Mater Hospital, Newcastle, NSW, Australia
| | | | - Alex Guminski
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Adrian Lee
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Martin R Stockler
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Adam Hickey
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital, Sydney, NSW, Australia
| | - Peter Eu
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital, Sydney, NSW, Australia
| | - Anthony M Joshua
- The Kinghorn Cancer Centre, St Vincent's Hospital, Sydney, NSW, Australia
| | - Megan Crumbaker
- Garvan Institute of Medical Research, Sydney, NSW, Australia.,St. Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia.,The Kinghorn Cancer Centre, St Vincent's Hospital, Sydney, NSW, Australia
| | - Andrew Nguyen
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital, Sydney, NSW, Australia.,St. Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
4
|
The Diagnostic Value of PI-RADS v2.1 in Patients with a History of Transurethral Resection of the Prostate (TURP). Curr Oncol 2022; 29:6373-6382. [PMID: 36135071 PMCID: PMC9497547 DOI: 10.3390/curroncol29090502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/28/2022] [Accepted: 09/01/2022] [Indexed: 11/24/2022] Open
Abstract
To explore the diagnostic value of the Prostate Imaging−Reporting and Data System version 2.1 (PI-RADS v2.1) for clinically significant prostate cancer (CSPCa) in patients with a history of transurethral resection of the prostate (TURP), we conducted a retrospective study of 102 patients who underwent systematic prostate biopsies with TURP history. ROC analyses and logistic regression analyses were performed to demonstrate the diagnostic value of PI-RADS v2.1 and other clinical characteristics, including PSA and free/total PSA (F/T PSA). Of 102 patients, 43 were diagnosed with CSPCa. In ROC analysis, PSA, F/T PSA, and PI-RADS v2.1 demonstrated significant diagnostic value in detecting CSPCa in our cohort (AUC 0.710 (95%CI 0.608−0.812), AUC 0.768 (95%CI 0.676−0.860), AUC 0.777 (95%CI 0.688−0.867), respectively). Further, PI-RADS v2.1 scores of the peripheral and transitional zones were analyzed separately. In ROC analysis, PI-RADS v2.1 remained valuable in identifying peripheral-zone CSPCa (AUC 0.780 (95%CI 0.665−0.854; p < 0.001)) while having limited capability in distinguishing transitional zone lesions (AUC 0.533 (95%CI 0.410−0.557; p = 0.594)). PSA and F/T PSA retain significant diagnostic value for CSPCa in patients with TURP history. PI-RADS v2.1 is reliable for detecting peripheral-zone CSPCa but has limited diagnostic value when assessing transitional zone lesions.
Collapse
|
5
|
Garrido MM, Bernardino RM, Marta JC, Holdenrieder S, Guimarães JT. Tumour markers of prostate cancer: The post-PSA era. Ann Clin Biochem 2021; 59:46-58. [PMID: 34463154 DOI: 10.1177/00045632211041890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Although PSA-based prostate cancer (PCa) screening had a positive impact in reducing PCa mortality, it also led to overdiagnosis, overtreatment and to a significant number of unnecessary biopsies. In the post-PSA era, new biomarkers have emerged that can complement the information given by PSA, towards a better cancer diagnostic specificity, and also allow a better estimate of the aggressiveness of the disease and its clinical outcome. That means those markers have the potential to assist the clinician in the decision-making processes, such as whether or not to perform a biopsy, and to make the best treatment choice among the new therapeutic options available, including active surveillance (AS) in lower risk disease. In this article, we will review several of those more recent diagnostic markers (4Kscore®, [-2]proPSA and Prostate Health Index (PHI), SelectMDx®, ConfirmMDx®, Progensa® Prostate Cancer Antigen 3, Mi-Prostate Score, ExoDx™ Prostate Test, the Stockholm-3 test and ERSPC risk calculators) and prognostic markers (OncotypeDX® Genomic Prostate Score, Prolaris®, Decipher® and ProMark®). We will also address some new liquid biopsy approaches - circulating tumour cells and cell-free DNA (cfDNA) - with a potential role in metastatic castration-resistant PCa and will briefly give some future perspectives, mostly outlooking epigenetic markers.
Collapse
Affiliation(s)
- Manuel M Garrido
- Department of Clinical Pathology, 90463Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,Department of Laboratory Medicine, 37811Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Rui M Bernardino
- Department of Urology, 90463Centro Hospitalar Universitário de Lisboa central, Lisbon, Portugal
| | - José C Marta
- Department of Clinical Pathology, 90463Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Stefan Holdenrieder
- Institute of Laboratory Medicine, Munich Biomarker Research Center, 14924Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - João T Guimarães
- Department of Clinical Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Biomedicine, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| |
Collapse
|
6
|
Garrido MM, Marta JC, Bernardino RM, Guerra J, Fernandes F, Pereira MH, Ribeiro R, Holdenrieder S, Pinheiro LC, Guimarães JT. The Percentage of [-2]Pro-Prostate-Specific Antigen and the Prostate Health Index Outperform Prostate-Specific Antigen and the Percentage of Free Prostate-Specific Antigen in the Detection of Clinically Significant Prostate Cancer and Can Be Used as Reflex Tests. Arch Pathol Lab Med 2021; 146:691-700. [PMID: 34343237 DOI: 10.5858/arpa.2021-0079-oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— There is a need to avoid the overdiagnosis of prostate cancer (PCa) and to find more specific biomarkers. OBJECTIVE.— To evaluate the clinical utility of [-2]pro-prostate-specific antigen ([-2]proPSA) derivatives in detecting clinically significant PCa (csPCa) and to compare it with prostate-specific antigen (PSA) and with the percentage of free PSA (%fPSA). DESIGN.— Two hundred thirty-seven men (PSA: 2-10 ng/mL) scheduled for a prostate biopsy were enrolled. Parametric and nonparametric tests, receiver operating characteristic (ROC) curves, and logistic regression analysis were applied. Outcomes were csPCa and overall PCa. RESULTS.— Both [-2]proPSA derivatives were significantly higher in csPCa and overall PCa (P < .001). The areas under the curves for the prediction of csPCa were higher for the percentage of [-2]proPSA (%[-2]proPSA) (0.781) and the prostate health index (PHI) (0.814) than for PSA (0.651) and %fPSA (0.724). There was a gain of 11% in diagnostic accuracy when %[-2]proPSA or PHI were added to a base model with PSA and %fPSA. Twenty-five percent to 29% of biopsies could have been spared with %[-2]proPSA (cutoff: ≥1.25%) and PHI (cutoff: ≥27), missing 10% of csPCa's. The same results could have been achieved by using [-2]proPSA as a reflex test, when %fPSA was 25% or less (cutoffs: ≥1.12% and ≥24 for %[-2]proPSA and PHI, respectively). CONCLUSIONS.— The [-2]proPSA derivatives improve the diagnostic accuracy of csPCa, when the PSA value is between 2 and 10 ng/mL, allowing to spare unnecessary biopsies and to select patients for active surveillance. [-2]proPSA can be used as a reflex test when %fPSA is 25% or less, without reducing the diagnostic accuracy for csPCa and the number of spared biopsies.
Collapse
Affiliation(s)
- Manuel M Garrido
- From the Department of Clinical Pathology (Garrido, Marta), Universidade do Porto, Porto, Portugal.,The Department of Laboratory Medicine (Garrido), Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - José C Marta
- From the Department of Clinical Pathology (Garrido, Marta), Universidade do Porto, Porto, Portugal
| | - Rui M Bernardino
- Department of Urology (Bernardino, Guerra, Fernandes, Pinheiro), Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - João Guerra
- Department of Urology (Bernardino, Guerra, Fernandes, Pinheiro), Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Francisco Fernandes
- Department of Urology (Bernardino, Guerra, Fernandes, Pinheiro), Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Maria H Pereira
- Department of Pathologic Anatomy (Pereira), Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,The Department of Pathologic Anatomy (Pereira), Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ruy Ribeiro
- Biomathematics Laboratory (Ribeiro), Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Stefan Holdenrieder
- Institute of Laboratory Medicine, Munich Biomarker Research Center, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (Holdenrieder)
| | - Luís C Pinheiro
- Department of Urology (Bernardino, Guerra, Fernandes, Pinheiro), Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,The Department of Urology (Pinheiro), Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Portugal
| | - João T Guimarães
- The Department of Biomedicine, Faculdade de Medicina & EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal (Guimarães).,the Department of Clinical Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal (Guimarães)
| |
Collapse
|
7
|
Garrido MM, Ribeiro R, Pinheiro LC, Holdenrieder S, Guimarães JT. The prostate health index and the percentage of [-2]proPSA maintain their diagnostic performance when calculated with total and free PSA from different manufacturers. Clin Chem Lab Med 2021; 59:1869-1877. [PMID: 34318651 DOI: 10.1515/cclm-2021-0554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/15/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the diagnostic performance of the prostate health index (PHI) and of the percentage of [-2]proPSA (%[-2]proPSA) calculated with total and free PSA from non-Beckman Coulter manufacturers (Roche and Abbott), and compare it with the fully Beckman Coulter [-2]proPSA derivatives. METHODS In this study, 237 men (PSA: 2-10 μg/L) scheduled for prostate biopsy were enrolled. %[-2]proPSA and PHI were calculated with total and free PSA from three manufacturers. Beckman Coulter PSA and [-2]proPSA were performed on the Access 2 analyzer (Hybritech calibration). Roche PSA was performed on the cobas e411 and the Abbott PSA on the Architect i2000sr. Statistical analysis was performed, considering prostate cancer (PCa) as the outcome. RESULTS Univariate analysis showed that all indices were predictors of cancer, irrespective of the manufacturer (p<0.001). The AUC was similar for all manufacturers, both for %[-2]proPSA (Beckman Coulter: 0.756; Roche: 0.770; Abbott: 0.756) and PHI (Beckman Coulter: 0.776; Roche: 0.785; Abbott: 0.778). When considering the cutoffs that allowed 90% sensitivity, [-2]proPSA derivatives calculated with Roche and Abbott PSA had similar specificities and predictive values when compared to Beckman Coulter. The percentage of missed cancers (8-9%) was the same between manufacturers. The percentage of spared biopsies was significantly higher with Roche's PHI (21.0%) and Abbott's PHI (20.6%) than with Beckman Coulter's PHI (17.2%). CONCLUSIONS In the PSA range between 2 and 10 μg/L, [-2]proPSA derivatives maintain their diagnostic performance in PCa detection when calculated with PSA from Roche and Abbott. This can lead to a broader implementation of these indices in clinical laboratories worldwide.
Collapse
Affiliation(s)
- Manuel M Garrido
- Department of Clinical Pathology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,Department of Laboratory Medicine,Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Ruy Ribeiro
- Biomathematics Laboratory, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Luís C Pinheiro
- Department of Urology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,Department of Urology, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Portugal
| | - Stefan Holdenrieder
- Institute of Laboratory Medicine, Munich Biomarker Research Center, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - João T Guimarães
- Department of Clinical Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Biomedicine, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| |
Collapse
|
8
|
Garrido MM, Ribeiro RM, Pinheiro LC, Holdenrieder S, Guimarães JT. The prostate health index (PHI) density: Are there advantages over PHI or over the prostate-specific antigen density? Clin Chim Acta 2021; 520:133-138. [PMID: 34097882 DOI: 10.1016/j.cca.2021.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Overdiagnosis of prostate cancer (PCa) should be minimized. We wanted to evaluate the diagnostic performance of the prostate health index density (PHID) and compare it with that of the prostate health index (PHI) alone and of the prostate-specific antigen density (PSAD). MATERIALS AND METHODS 232 men scheduled for a prostate biopsy (prostate-specific antigen level: 2-10 µg/L), were enrolled. PHI, PHID and PSAD were evaluated considering PCa and clinically significant PCa (csPCa) as the outcomes. RESULTS For PCa, the area under the curve (AUC) was higher for PHID (0.823) than for PHI (0.779) and PSAD (0.776). For csPCa, the AUC was also higher for PHID (0.851) but closer to that of PSAD (0.819) and PHI (0.813). For equal sensitivities (90%) for PCa, PHID and PSAD offered the highest specificities (37%), missing the same number of cancers (n = 11). Considering csPCa, PHI and PHID had similar specificities. PSAD reached the highest specificity (50.0%), sparing 32.8% of biopsies, while missing 9 cases of csPCa. CONCLUSIONS PHID has a better diagnostic performance than PHI for overall PCa detection, but very close to the PSAD performance. Considering csPCa, PHI and PHID perform almost equally, but PSAD has a better diagnostic performance.
Collapse
Affiliation(s)
- Manuel M Garrido
- Department of Clinical Pathology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal; Department of Laboratory Medicine, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.
| | - Ruy M Ribeiro
- Biomathematics Laboratory, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Luís C Pinheiro
- Department of Urology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal; Department of Urology, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Portugal
| | - Stefan Holdenrieder
- Institute of Laboratory Medicine, Munich Biomarker Research Center, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - João T Guimarães
- Department of Clinical Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Biomedicine, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| |
Collapse
|
9
|
Balázs K, Antal L, Sáfrány G, Lumniczky K. Blood-Derived Biomarkers of Diagnosis, Prognosis and Therapy Response in Prostate Cancer Patients. J Pers Med 2021; 11:296. [PMID: 33924671 PMCID: PMC8070149 DOI: 10.3390/jpm11040296] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 03/31/2021] [Accepted: 04/03/2021] [Indexed: 12/11/2022] Open
Abstract
Prostate cancer is among the most frequent cancers in men worldwide. Despite the fact that multiple therapeutic alternatives are available for its treatment, it is often discovered in an advanced stage as a metastatic disease. Prostate cancer screening is based on physical examination of prostate size and prostate-specific antigen (PSA) level in the blood as well as biopsy in suspect cases. However, these markers often fail to correctly identify the presence of cancer, or their positivity might lead to overdiagnosis and consequent overtreatment of an otherwise silent non-progressing disease. Moreover, these markers have very limited if any predictive value regarding therapy response or individual risk for therapy-related toxicities. Therefore, novel, optimally liquid biopsy-based (blood-derived) markers or marker panels are needed, which have better prognostic and predictive value than the ones currently used in the everyday routine. In this review the role of circulating tumour cells, extracellular vesicles and their microRNA content, as well as cellular and soluble immunological and inflammation- related blood markers for prostate cancer diagnosis, prognosis and prediction of therapy response is discussed. A special emphasis is placed on markers predicting response to radiotherapy and radiotherapy-related late side effects.
Collapse
Affiliation(s)
| | | | | | - Katalin Lumniczky
- Unit of Radiation Medicine, Department of Radiobiology and Radiohygiene, National Public Health Centre, 1221 Budapest, Hungary; (K.B.); (L.A.); (G.S.)
| |
Collapse
|
10
|
Akdogan N, Aridogan IA, Izol V, Deger M, Gokalp F, Bayazit Y, Tansug MZ. Use of the prostate health index in the detection of prostate cancer at all PSA levels (use of prostate health index in prostate cancer). Int J Clin Pract 2021; 75:e13922. [PMID: 33300224 DOI: 10.1111/ijcp.13922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/06/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To determine the efficiency of prostate health index (PHI) calculated simultaneously during an ultrasound-guided fine-needle prostate biopsy in prostate cancer diagnosis. METHODS The present study included 258 subsequent patients who underwent a TRUS-guided biopsy in our clinic between August 2015 and March 2016 due to elevated blood levels of PSA and suspicion of prostate cancer. The total PSA, free PSA and pro-PSA were analysed in all patients before the procedure. RESULTS The average age of 258 patients was 63.5 (36-91) years, and the mean PSA level and mean PHI values were 40.1 (0.12-2170) and 118 (0.41-1308), respectively. According to the PSA data, the patients were divided into two groups: the low PSA (<4 ng/mL) group containing ten patients with adenocancer (31.2%) and 22 patients with BPH (68.8%) and the high PSA (>4 ng/mL) group consisting of 86 patients with adenocancer (42.2%) and 118 (57.8%) with BPH. The sensitivity and specificity of PSA in detecting prostate adenocancer were calculated as 89.6% and 15.7%, respectively. Similarly, when a PHI level below 55 was accepted as low, and a PHI level at or above 55 was accepted as high, PHI's sensitivity and specificity were determined as 71.9% and 67.9%, respectively. CONCLUSIONS The overall findings indicate that the specificity of PHI is higher than PSA in terms of prostate cancer detection.
Collapse
Affiliation(s)
- Nebil Akdogan
- Department of Urology, Faculty of Medicine, University of Cukurova, Adana, Turkey
| | - I Atilla Aridogan
- Department of Urology, Faculty of Medicine, University of Cukurova, Adana, Turkey
| | - Volkan Izol
- Department of Urology, Faculty of Medicine, University of Cukurova, Adana, Turkey
| | - Mutlu Deger
- Department of Urology, Faculty of Medicine, University of Cukurova, Adana, Turkey
| | - Fatih Gokalp
- Department of Urology, Faculty of Medicine, University of Cukurova, Adana, Turkey
| | - Yildirim Bayazit
- Department of Urology, Faculty of Medicine, University of Cukurova, Adana, Turkey
| | - M Zuhtu Tansug
- Department of Urology, Faculty of Medicine, University of Cukurova, Adana, Turkey
| |
Collapse
|
11
|
Moran AB, Domínguez-Vega E, Nouta J, Pongracz T, de Reijke TM, Wuhrer M, Lageveen-Kammeijer GSM. Profiling the proteoforms of urinary prostate-specific antigen by capillary electrophoresis - mass spectrometry. J Proteomics 2021; 238:104148. [PMID: 33618028 DOI: 10.1016/j.jprot.2021.104148] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/26/2021] [Accepted: 01/31/2021] [Indexed: 01/07/2023]
Abstract
Early detection of prostate cancer may lead to the overdiagnosis and overtreatment of patients as well as missing significant cancers. The current diagnostic approach uses elevated serum concentrations of prostate-specific antigen (PSA) as an indicator of risk. However, this test has been widely criticized as it shows poor specificity and sensitivity. In order to improve early detection and diagnosis, several studies have investigated whether different PSA proteoforms are correlated to prostate cancer. Until now, studies and methodologies for the comprehensive characterization of PSA proteoforms from biofluids are scarce. For this purpose, we developed an intact protein assay to analyze PSA by capillary electrophoresis-electrospray ionization-mass spectrometry after affinity purification from patients' urine. Here, we determined six proteolytic cleavage variants. In regard to glycosylation, tri-, di-, mono- and non-sialylated complex-type N-glycans were found on non-cleaved PSA, as well as the non-glycosylated variant. The performance of the intact protein assay was assessed using a pooled sample, obtaining an inter-day variability of 15%. Furthermore, urinary patient samples were analyzed by intact protein analysis and a bottom-up approach (glycopeptide analysis). This combined approach revealed complimentary information on both levels, demonstrating the benefit of using two orthogonal techniques to provide a thorough profile of urinary PSA. SIGNIFICANCE: The detection of clinically relevant prostate cancer requires a more specific and sensitive biomarker and, in this case, several PSA proteoforms may be able to aid or improve the current PSA test. However, a comprehensive analysis of the intact PSA proteoform profile is still lacking. This study investigated the PSA proteoforms present in urine and, in particular, determined the relative contribution of cleaved PSA and non-cleaved PSA forms to the total glycosylation profile. Importantly, intact protein analysis did not require further sample treatment before being measured by CE-ESI-MS. Furthermore, its glycosylation was also assessed in a bottom-up approach to provide complementary information. Overall, these results represent an important basis for future characterization and biomarker studies.
Collapse
Affiliation(s)
- Alan B Moran
- Leiden University Medical Center, Center for Proteomics and Metabolomics, 2300 RC Leiden, the Netherlands
| | - Elena Domínguez-Vega
- Leiden University Medical Center, Center for Proteomics and Metabolomics, 2300 RC Leiden, the Netherlands
| | - Jan Nouta
- Leiden University Medical Center, Center for Proteomics and Metabolomics, 2300 RC Leiden, the Netherlands
| | - Tamas Pongracz
- Leiden University Medical Center, Center for Proteomics and Metabolomics, 2300 RC Leiden, the Netherlands
| | - Theo M de Reijke
- Amsterdam UMC, location Academic Medical Center, Department of Urology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Manfred Wuhrer
- Leiden University Medical Center, Center for Proteomics and Metabolomics, 2300 RC Leiden, the Netherlands
| | | |
Collapse
|
12
|
Noh TI, Hyun CW, Kang HE, Jin HJ, Tae JH, Shim JS, Kang SG, Sung DJ, Cheon J, Lee JG, Kang SH. A Predictive Model Based on Bi-parametric Magnetic Resonance Imaging and Clinical Parameters for Clinically Significant Prostate Cancer in the Korean Population. Cancer Res Treat 2021; 53:1148-1155. [PMID: 33421975 PMCID: PMC8524004 DOI: 10.4143/crt.2020.1068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/31/2020] [Indexed: 01/01/2023] Open
Abstract
PURPOSE This study aimed to develop and validate a predictive model for the assessment of clinically significant prostate cancer (csPCa) in men, prior to prostate biopsies, based on bi-parametric magnetic resonance imaging (bpMRI) and clinical parameters. Materials and Methods We retrospectively analyzed 300 men with clinical suspicion of prostate cancer (prostate-specific antigen [PSA] ≥ 4.0 ng/mL and/or abnormal findings in a digital rectal examination), who underwent bpMRI-ultrasound fusion transperineal targeted and systematic biopsies in the same session, at a Korean university hospital. Predictive models, based on Prostate Imaging Reporting and Data Systems scores of bpMRI and clinical parameters, were developed to detect csPCa (intermediate/high grade [Gleason score ≥ 3+4]) and compared by analyzing the areas under the curves and decision curves. RESULTS A predictive model defined by the combination of bpMRI and clinical parameters (age, PSA density) showed high discriminatory power (area under the curve, 0.861) and resulted in a significant net benefit on decision curve analysis. Applying a probability threshold of 7.5%, 21.6% of men could avoid unnecessary prostate biopsy, while only 1.0% of significant prostate cancers were missed. CONCLUSION This predictive model provided a reliable and measurable means of risk stratification of csPCa, with high discriminatory power and great net benefit. It could be a useful tool for clinical decision-making prior to prostate biopsies.
Collapse
Affiliation(s)
- Tae Il Noh
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chang Wan Hyun
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ha Eun Kang
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyun Jung Jin
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jong Hyun Tae
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ji Sung Shim
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Gu Kang
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Deuk Jae Sung
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.,Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jun Cheon
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jeong Gu Lee
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
13
|
Kim JH, Hong SK. Clinical utility of current biomarkers for prostate cancer detection. Investig Clin Urol 2021; 62:1-13. [PMID: 33381926 PMCID: PMC7801171 DOI: 10.4111/icu.20200395] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/09/2020] [Accepted: 10/22/2020] [Indexed: 12/14/2022] Open
Abstract
Although prostate-specific antigen (PSA) remains the most used test to detect prostate cancer (PCa), the limited specificity and an elevated rate of overdiagnosis are the main problems associated with PSA testing. Over the last three decades, a large body of evidence has indicated that PSA screening methods for PCa are problematic, although PSA screening significantly reduces PCa-specific mortality. A number of novel biomarkers have been introduced to overcome these limitations of PSA in the clinical setting. These biomarkers have demonstrated an increased ability to select patients for biopsy and identify men at risk for clinically significant PCa. Although a number of assays require further validation, initial data are promising. Forthcoming results will ultimately determine the clinical utility and commercial availability of these assays. Extensive efforts have recently been made to identify and commercialize novel PCa biomarkers for more effective detection of PCa, either alone or in combination with currently available clinical tools. This review highlights the role of existing and promising serum and urinary biomarkers for the detection and prognostication of PCa before prostate biopsy.
Collapse
Affiliation(s)
- Jeong Hyun Kim
- Department of Urology, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
| |
Collapse
|
14
|
Hu Q, Gan S, Bao Y, Zhang Y, Han D, Niu L. Electrochemically Controlled ATRP for Cleavage-Based Electrochemical Detection of the Prostate-Specific Antigen at Femtomolar Level Concentrations. Anal Chem 2020; 92:15982-15988. [PMID: 33225684 DOI: 10.1021/acs.analchem.0c03467] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
As a single-chain glycoprotein with endopeptidase activity, the prostate-specific antigen (PSA) is valuable as an informative serum marker in diagnosing, staging, and prognosis of prostate cancer. In this report, an electrochemical biosensor based on the target-induced cleavage of a specific peptide substrate (PSA peptide) is designed for the highly selective detection of PSA at the femtomolar level, using electrochemically controlled atom transfer radical polymerization (eATRP) as a method for signal amplification. The PSA peptides, without free carboxyl sites, are attached to the gold surface via the N-terminal cysteine residue. The target-induced cleavage of PSA peptides results in the generation of carboxyl sites, to which the alkyl halide initiator α-bromophenylacetic acid (BPAA) is linked via the Zr(IV) linkers. Subsequently, the potentiostatic eATRP of ferrocenylmethyl methacrylate (FcMMA, as the monomer) leads to the surface-initiated grafting of high-density ferrocenyl polymers. As a result, a large amount of Fc redox tags can be recruited for signal amplification, through which the limit of detection (LOD) for PSA can be down to 3.2 fM. As the recognition element, the PSA peptide is easy to synthesize, chemically and thermally stable, and low-cost. Without the necessity of enzyme or nanoparticle labels, the eATRP-based amplification method is easy to operate and low-cost. Results also show that the cleavage-based electrochemical PSA biosensor is highly selective and applicable to PSA detection in complex biological samples. In view of these merits, the integration of the eATRP-based amplification method into cleavage-based recognition is believed to hold great promise for the electrochemical detection of PSA in clinical applications.
Collapse
Affiliation(s)
- Qiong Hu
- Center for Advanced Analytical Science, School of Chemistry and Chemical Engineering, Guangzhou University, Guangzhou 510006, P. R. China
| | - Shiyu Gan
- Center for Advanced Analytical Science, School of Chemistry and Chemical Engineering, Guangzhou University, Guangzhou 510006, P. R. China
| | - Yu Bao
- Center for Advanced Analytical Science, School of Chemistry and Chemical Engineering, Guangzhou University, Guangzhou 510006, P. R. China
| | - Yuwei Zhang
- Center for Advanced Analytical Science, School of Chemistry and Chemical Engineering, Guangzhou University, Guangzhou 510006, P. R. China
| | - Dongxue Han
- Center for Advanced Analytical Science, School of Chemistry and Chemical Engineering, Guangzhou University, Guangzhou 510006, P. R. China
| | - Li Niu
- Center for Advanced Analytical Science, School of Chemistry and Chemical Engineering, Guangzhou University, Guangzhou 510006, P. R. China
| |
Collapse
|
15
|
Characterisation of the main PSA glycoforms in aggressive prostate cancer. Sci Rep 2020; 10:18974. [PMID: 33149259 PMCID: PMC7643140 DOI: 10.1038/s41598-020-75526-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/12/2020] [Indexed: 12/16/2022] Open
Abstract
Serum levels of prostate specific antigen (PSA) are commonly used for prostate cancer (PCa) detection. However, their lack of specificity to distinguish benign prostate pathologies from PCa, or indolent from aggressive PCa have prompted the study of new non-invasive PCa biomarkers. Aberrant glycosylation is involved in neoplastic progression and specific changes in PSA glycosylation pattern, as the reduction in the percentage of α2,6-sialic acid (SA) are associated with PCa aggressiveness. In this study, we have characterised the main sialylated PSA glycoforms from blood serum of aggressive PCa patients and have compared with those of standard PSA from healthy individuals’ seminal plasma. PSA was immunoprecipitated and α2,6-SA were separated from α2,3-SA glycoforms using SNA affinity chromatography. PSA N-glycans were released, labelled and analysed by hydrophilic interaction liquid chromatography combined with exoglycosidase digestions. The results showed that blood serum PSA sialylated glycoforms containing GalNAc residues were largely increased in aggressive PCa patients, whereas the disialylated core fucosylated biantennary structures with α2,6-SA, which are the major PSA glycoforms in standard PSA from healthy individuals, were markedly reduced in aggressive PCa. The identification of these main PSA glycoforms altered in aggressive PCa opens the way to design specific strategies to target them, which will be useful to improve PCa risk stratification.
Collapse
|
16
|
French WW, Wallen EM. Advances in the diagnostic options for prostate cancer. Postgrad Med 2020; 132:52-62. [PMID: 32900250 DOI: 10.1080/00325481.2020.1822067] [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: 10/23/2022]
Abstract
Over the past decade, despite the controversies surrounding prostate cancer screening, significant refinements have improved its application. PSA screening, although it has been questioned, appears to confer a mortality benefit and remains the most effective way to identify the possible presence of prostate cancer. Methods to improve the specificity of PSA screening and limit overdiagnosis of indolent cancers, including risk-stratified screening regimens, are currently being utilized. Certain imaging modalities, such as multiparametric MRI, have proven to be excellent adjuncts providing improved risk stratification and the ability for targeted biopsies; however, concerns over variability in interpretation and generalizability persist. A number of novel biomarkers have become available with nearly all demonstrating the ability to improve upon the specificity of PSA screening; however, optimal timing, direct comparisons, and usefulness in conjunction with imaging modalities remain to be elucidated. With the improvement in testing options and recognition of the risk/benefit ratio for men undergoing screening for prostate cancer, the increasing role of shared decision making in the process is emphasized.
Collapse
Affiliation(s)
- William W French
- Department of Urology, University of North Carolina Medical Center , Chapel Hill, NC, United States
| | - Eric M Wallen
- Department of Urology, University of North Carolina Medical Center , Chapel Hill, NC, United States
| |
Collapse
|
17
|
Andrews JR, Ahmed ME, Motterle G, Albadri ST, Haloi R, Karnes RJ, Kwon ED, Price KA. A Rare Case of Prostate-Specific Antigen-Producing Metastatic Parotid Adenocarcinoma Developing Androgen Receptor Resistance. Mayo Clin Proc Innov Qual Outcomes 2020; 4:601-607. [PMID: 33083709 PMCID: PMC7557195 DOI: 10.1016/j.mayocpiqo.2020.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 62-year-old man presented with a rising serum concentration of prostate-specific antigen (PSA) to 53.3 ng/mL (to convert to μg/L, multiply by 1) and a PSA doubling time of 2.6 months. Computed tomography, fluorodeoxyglucose–positron emission tomography, and C-11 choline positron emission tomography demonstrated a parotid mass with innumerable lytic bone lesions and diffuse metastatic disease to the neck and mediastinal lymph nodes. Mediastinal lymph node biopsy revealed salivary ductal adenocarcinoma that produced PSA and demonstrated androgen receptor sensitivity. The patient had a prolonged clinical benefit to first- and second-line hormone therapy, and his PSA levels correlated with treatment response, development of hormone resistance, and progression. In summary, urologists, pathologists, and primary care providers should be aware that a rising PSA level in the setting of a head and neck mass in a patient without a history of prostate cancer does not constitute a diagnosis of metastatic prostate adenocarcinoma and that other primary tumors should be considered and a broader imaging and pathologic evaluation is indicated.
Collapse
Affiliation(s)
| | | | | | - Sam T Albadri
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Rimki Haloi
- Department of Urology, Mayo Clinic, Rochester, MN
| | | | | | | |
Collapse
|
18
|
Zheng Z, Zhou Z, Yan W, Zhou Y, Chen C, Li H, Ji Z. Tumor characteristics, treatments, and survival outcomes in prostate cancer patients with a PSA level < 4 ng/ml: a population-based study. BMC Cancer 2020; 20:340. [PMID: 32321456 PMCID: PMC7178745 DOI: 10.1186/s12885-020-06827-z] [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: 11/18/2019] [Accepted: 04/05/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND To examine the tumor characteristics, treatments and survival outcomes of prostate cancer (PCa) patients with a prostate-specific antigen (PSA) level < 4 ng/ml. METHODS Of 205,913 men with primary prostate adenocarcinoma in the Surveillance, Epidemiology and End Results (SEER) database (2010 to 2015), 24,054 (11.68%) patients were diagnosed with a PSA level < 4 ng/ml. Comparisons of categorical variables among different groups were performed by using the Chi square test. Multivariate Cox regression analysis was adjusted for age, ethnicity, marital status, insurance status, TNM stage, Gleason grade, treatment and survival. Kaplan-Meier survival curves were constructed for overall mortality and tested by the log-rank test. RESULTS PCa patients with a PSA level < 4 ng/ml generally had more favorable tumor characteristics: younger, lower T stage, lower Gleason grade and lower lymph node metastasis rate. However, there were more patients in stage M1 in the group of PSA level < 4 ng/ml than that in the groups of PSA level of 4-10 ng/ml, 10-20 ng/ml and > 20 ng/ml. The multivariate Cox regression model revealed that overall mortality was associated with age, marital status, race, Gleason grade, M stage and treatment approach. CONCLUSIONS In conclusion, PCa patients with a PSA level < 4 ng/ml have more favorable tumor characteristics at diagnosis and receive more benefit from active treatment. However, those patients with advanced TNM stage and high Gleason grade should be paid more attention in clinical application.
Collapse
Affiliation(s)
- Zhibo Zheng
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing, Dong Cheng District, Beijing, 100730, China.,Department of International Medical Services, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhien Zhou
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing, Dong Cheng District, Beijing, 100730, China
| | - Weigang Yan
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing, Dong Cheng District, Beijing, 100730, China.
| | - Yi Zhou
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing, Dong Cheng District, Beijing, 100730, China
| | - Chuyan Chen
- Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Hanzhong Li
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing, Dong Cheng District, Beijing, 100730, China
| | - Zhigang Ji
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing, Dong Cheng District, Beijing, 100730, China
| |
Collapse
|
19
|
Nassir AM. A piece in prostate cancer puzzle: Future perspective of novel molecular signatures. Saudi J Biol Sci 2020; 27:1148-1154. [PMID: 32256177 PMCID: PMC7105665 DOI: 10.1016/j.sjbs.2020.02.003] [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: 11/03/2019] [Revised: 01/26/2020] [Accepted: 02/01/2020] [Indexed: 12/24/2022] Open
Abstract
Prostate cancer (PCa) has a variable biological potential. It constitutes the second most common cancer amongst men worldwide and the fifth most common cancer in Saudi Arabia. Identifying men at higher risk of developing PCa, differentiating indolent from aggressive disease and predicting the likelihood of progression will improve decision-making and selection for active surveillance protocols. Biomarkers have been utilized for PCa screening and predicting cancer behavior and response to treatment. The prostate specific antigen (PSA) screening helps detect PCa in early stages, while implementing a plan for management and outcome. However, PSA screening is still controversial, due to the risks of over diagnosis and treatment, and its inability to detect a good proportion of advanced tumors. Alternatively, a new era of PCa biomarkers has emerged with higher PCa specificity than PSA and its isoforms hopefully improving screening methods, such as Prostate Health Index (PHI) score, Progensa Prostate Cancer Antigen 3 (PCA3), Mi-Prostate Score (MiPS), Prostate Stem Cell Antigen (PSCA), 4Kscore test, and Urokinase Plasminogen Activation (uPA and uPAR). Few novel biomarkers have shown promise in preliminary results. This review will display promising biomarkers including some important FDA approved ones, highlighting their clinical implication and future place in the PCa puzzle, along with addressing their current limitations.
Collapse
Affiliation(s)
- Anmar M Nassir
- Department of Surgery, Umm Al-Qura University, Makkah, Saudi Arabia.,Department of Urology, King Abdullah Medical City, Makkah, Saudi Arabia
| |
Collapse
|
20
|
Affiliation(s)
- Mehwish Saba Aslam
- Department of Microbiology and Immunology, School of Medicine, Southeast University, Nanjing, China
| | - Liudi Yuan
- Department of Microbiology and Immunology, School of Medicine, Southeast University, Nanjing, China
| |
Collapse
|
21
|
Skakić A, Ignjatović I, Bašić D, Veljković A, Kocić G. PROSTATE-SPECIFIC ANTIGEN DYNAMICS IN DIAGNOSIS OF PROSTATE CANCER. ACTA MEDICA MEDIANAE 2019. [DOI: 10.5633/amm.2019.0317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
22
|
In silico analysis of non-synonymous single nucleotide polymorphism in a human KLK-2 gene associated with prostate cancer. Meta Gene 2019. [DOI: 10.1016/j.mgene.2019.100578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
|
23
|
Lang R, Rolny V, Leinenbach A, Karl J, Swiatek-de Lange M, Kobold U, Schrader M, Krause H, Mueller M, Vogeser M. Investigation on core-fucosylated prostate-specific antigen as a refined biomarker for differentiation of benign prostate hyperplasia and prostate cancer of different aggressiveness. Tumour Biol 2019; 41:1010428319827223. [PMID: 30907281 DOI: 10.1177/1010428319827223] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Prostate cancer represents a major cause of cancer death in men worldwide. Novel non-invasive methods are still required for differentiation of non-aggressive from aggressive tumors. Recently, changes in prostate-specific antigen glycosylation pattern, such as core-fucosylation, have been described in prostate cancer. The objective of this study was to evaluate whether the core-fucosylation determinant of serum prostate-specific antigen may serve as refined marker for differentiation between benign prostate hyperplasia and prostate cancer or identification of aggressive prostate cancer. A previously developed liquid chromatography-mass spectrometry/mass spectrometry-based strategy was used for multiplex analysis of core-fucosylated prostate-specific antigen (fuc-PSA) and total prostate-specific antigen levels in sera from 50 benign prostate hyperplasia and 100 prostate cancer patients of different aggressiveness (Gleason scores, 5-10) covering the critical gray area (2-10 ng/mL). For identification of aggressive prostate cancer, the ratio of fuc-PSA to total prostate-specific antigen (%-fuc-PSA) yielded a 5%-8% increase in the area under the curve (0.60) compared to the currently used total prostate-specific antigen (area under the curve = 0.52) and %-free prostate-specific antigen (area under the curve = 0.55) tests. However, our data showed that aggressive prostate cancer (Gleason score > 6) and non-aggressive prostate cancer (Gleason score ≤ 6) could not significantly (p-value = 0.08) be differentiated by usage of %-fuc-PSA. In addition, both non-standardized fuc-PSA and standardized %-fuc-PSA had no diagnostic value for differentiation of benign prostate hyperplasia from prostate cancer. The %-fuc-PSA serum levels could not improve the differentiation of non-aggressive and aggressive prostate cancer compared to conventional diagnostic prostate cancer markers. Still, it is unclear whether these limitations come from the biomarker, the used patient cohort, or the imprecision of the applied method itself. Therefore, %-fuc-PSA should be further investigated, especially by more precise methods whether it could be clinically used in prostate cancer diagnosis.
Collapse
Affiliation(s)
| | | | | | | | | | - Uwe Kobold
- 1 Roche Diagnostics GmbH, Penzberg, Germany
| | | | - Hans Krause
- 3 Urologische Klinik, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Mueller
- 4 Klinikum der Stadt Ludwigshafen am Rhein gGmbH, Ludwigshafen, Germany
| | - Michael Vogeser
- 5 Institute of Laboratory Medicine, Hospital of the Ludwig-Maximilians University, Munich, Germany
| |
Collapse
|
24
|
Osses DF, Roobol MJ, Schoots IG. Prediction Medicine: Biomarkers, Risk Calculators and Magnetic Resonance Imaging as Risk Stratification Tools in Prostate Cancer Diagnosis. Int J Mol Sci 2019; 20:E1637. [PMID: 30986955 PMCID: PMC6480079 DOI: 10.3390/ijms20071637] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/27/2019] [Accepted: 03/29/2019] [Indexed: 12/11/2022] Open
Abstract
This review discusses the most recent evidence for currently available risk stratification tools in the detection of clinically significant prostate cancer (csPCa), and evaluates diagnostic strategies that combine these tools. Novel blood biomarkers, such as the Prostate Health Index (PHI) and 4Kscore, show similar ability to predict csPCa. Prostate cancer antigen 3 (PCA3) is a urinary biomarker that has inferior prediction of csPCa compared to PHI, but may be combined with other markers like TMPRSS2-ERG to improve its performance. Original risk calculators (RCs) have the advantage of incorporating easy to retrieve clinical variables and being freely accessible as a web tool/mobile application. RCs perform similarly well as most novel biomarkers. New promising risk models including novel (genetic) markers are the SelectMDx and Stockholm-3 model (S3M). Prostate magnetic resonance imaging (MRI) has evolved as an appealing tool in the diagnostic arsenal with even stratifying abilities, including in the initial biopsy setting. Merging biomarkers, RCs and MRI results in higher performances than their use as standalone tests. In the current era of prostate MRI, the way forward seems to be multivariable risk assessment based on blood and clinical parameters, potentially extended with information from urine samples, as a triaging test for the selection of candidates for MRI and biopsy.
Collapse
Affiliation(s)
- Daniël F Osses
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands.
- Department of Urology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands.
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands.
| | - Ivo G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands.
| |
Collapse
|
25
|
Li J, Ma J, Zhang Y, Zhang Z, He G. An amperometric biosensor for the assay of sarcosine based on the cross coupled chemical and electrochemical reactions with practical applications. J Electroanal Chem (Lausanne) 2019. [DOI: 10.1016/j.jelechem.2018.12.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
26
|
Sokoll LJ, Mangold L, Mohr P, Dua R, Partin AW. High "phi"ve. J Appl Lab Med 2018; 3:333-335. [PMID: 33636944 DOI: 10.1373/jalm.2018.027482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 06/28/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Lori J Sokoll
- Departments of Pathology and.,Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Leslie Mangold
- Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | | | | | - Alan W Partin
- Departments of Pathology and.,Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| |
Collapse
|
27
|
The prostate health index PHI predicts oncological outcome and biochemical recurrence after radical prostatectomy - analysis in 437 patients. Oncotarget 2017; 8:79279-79288. [PMID: 29108306 PMCID: PMC5668039 DOI: 10.18632/oncotarget.17476] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/15/2017] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to investigate the Prostate-Health-Index (PHI) for pathological outcome prediction following radical prostatectomy and also for biochemical recurrence prediction in comparison to established parameters such as Gleason-score, pathological tumor stage, resection status (R0/1) and prostate-specific antigen (PSA). Out of a cohort of 460 cases with preoperative PHI-measurements (World Health Organization calibration: Beckman Coulter Access-2-Immunoassay) between 2001 and 2014, 437 patients with complete follow up data were included. From these 437 patients, 87 (19.9%) developed a biochemical recurrence. Patient characteristics were compared by using chi-square test. Predictors were analyzed by multivariate adjusted logistic and Cox regression. The median follow up for a biochemical recurrence was 65 (range 3-161) months. PHI, PSA, [-2]proPSA, PHI- and PSA-density performed as significant variables (p < 0.05) for cancer aggressiveness: Gleason-score <7 or ≥7 (ISUP grade 1 or ≥2) . Concerning pathological tumor stage discrimination and prediction, variables as PHI, PSA, %fPSA, [-2]proPSA, PHI- and PSA-density significantly discriminated between stages <pT3 and ≥pT3 with the highest AUC (0.7) for PHI. In biochemical recurrence prediction PHI, PSA, [-2]proPSA, PHI- and PSA-density were the strongest predictors. In conclusion, due to heterogeneity of time spans to biochemical recurrence, longer follow up periods are crucial. This study with a median follow up of more than 5 years, confirmed a clinical value for PHI as an independent biomarker essential for biochemical recurrence prediction.
Collapse
|
28
|
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.
Collapse
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.
| |
Collapse
|
29
|
Schlack K, Krabbe LM, Fobker M, Schrader AJ, Semjonow A, Boegemann M. Early Prediction of Therapy Response to Abiraterone Acetate Using PSA Subforms in Patients with Castration Resistant Prostate Cancer. Int J Mol Sci 2016; 17:ijms17091520. [PMID: 27618028 PMCID: PMC5037797 DOI: 10.3390/ijms17091520] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 12/02/2022] Open
Abstract
The purpose of this study was to evaluate the prognostic ability of early changes of total prostate specific antigen (tPSA), free PSA (fPSA), [−2]proPSA and the Prostate Health Index (PHI) following initiation of Abiraterone-therapy in men with castration resistant prostate cancer (mCRPC). In 25 patients, PSA-subforms were analyzed before and at 8–12 weeks under therapy as prognosticators of progression-free-survival (PFS) and overall survival (OS). Comparing patients with a PFS < vs. ≥12 months by using Mann–Whitney–Wilcoxon Tests, the relative-median-change of tPSA (−0.1% vs. −86.8%; p = 0.02), fPSA (12.1% vs. −55.3%; p = 0.03) and [−2]proPSA (8.1% vs. −59.3%; p = 0.05) differed significantly. For men with ≤ vs. >15 months of OS there was a non-significant trend for a difference in the relative-median-change of fPSA (17.0% vs. −46.3%; p = 0.06). In Kaplan–Meier analyses, declining fPSA and [−2]proPSA were associated with a longer median PFS (13 months, 95% confidence interval (CI): 9.6–16.4 vs. 10 months, 95% CI: 3.5–16.5; p = 0.11), respectively. Correspondingly, decreasing fPSA and [−2]proPSA values indicated an OS of 32 months (95% CI: not reached (NR)) compared to 21 months in men with rising values (95% CI: 7.7–34.3; p = 0.14), respectively. We concluded that the addition of fPSA- and [−2]proPSA-changes to tPSA-information might be further studied as potential markers of early Abiraterone response in mCRPC patients.
Collapse
Affiliation(s)
- Katrin Schlack
- Department of Urology, Prostate Center, University Hospital Muenster, Albert-Schweitzer-Campus 1, GB A1, Muenster D-48149, Germany.
| | - Laura-Maria Krabbe
- Department of Urology, Prostate Center, University Hospital Muenster, Albert-Schweitzer-Campus 1, GB A1, Muenster D-48149, Germany.
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9110, USA.
| | - Manfred Fobker
- Center for Laboratory Medicine, University Hospital Muenster, Albert-Schweitzer-Campus 1, GB A1, Muenster D-48149, Germany.
| | - Andres Jan Schrader
- Department of Urology, Prostate Center, University Hospital Muenster, Albert-Schweitzer-Campus 1, GB A1, Muenster D-48149, Germany.
| | - Axel Semjonow
- Department of Urology, Prostate Center, University Hospital Muenster, Albert-Schweitzer-Campus 1, GB A1, Muenster D-48149, Germany.
| | - Martin Boegemann
- Department of Urology, Prostate Center, University Hospital Muenster, Albert-Schweitzer-Campus 1, GB A1, Muenster D-48149, Germany.
| |
Collapse
|
30
|
Pecoraro V, Roli L, Plebani M, Trenti T. Clinical utility of the (-2)proPSA and evaluation of the evidence: a systematic review. ACTA ACUST UNITED AC 2016; 54:1123-32. [DOI: 10.1515/cclm-2015-0876] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 10/19/2015] [Indexed: 11/15/2022]
Abstract
AbstractDiagnostic studies usually provide important information about the analytical and diagnostic performances. We investigated the clinical utility of (-2)proPSA in identifying patients with prostate cancer (PCa).We performed electronic searches in five databases as well as a list of reference literature. Studies were included if they evaluated the diagnostic accuracy of (-2)proPSA in men with PSA value ranged from 2.0 to 10 μg/L. We also analyzed data about total PSA (tPSA), %(-2)proPSa, freePSA (fPSA), its percentage (%fPSA) and the prostate health index (phi). The selection of the studies, the screening of the full texts and the data extraction, as well as the assessment of risk of bias using the QUADAS-2 tool were conducted independently by two authors. Grading the quality of the evidence was carried out according to the GRADE method. The random effects model was used for the meta-analyses.We included 17 studies, including 6912 patients. The pooled sensitivity of (-2)proPSA was 90% and the summary specificity was 13%. The tPSA sensitivity and specificity were 89% and 25%, respectively. Considering (-2)proPSA, 225 men out of 1000 have been identified having PCa true positives (TP). However, 652 persons have been incorrectly identified and undergo biopsy. The majority of studies were judged to carry a moderate risk of bias. Therefore, the overall quality of evidences was deemed to be low.The (-2)proPSA could be useful to identify men at risk of PCa, but its accuracy still remains uncertain and the level of evidence does not support an improved clinical utility.
Collapse
|
31
|
Clinical impact of prostate specific antigen (PSA) inter-assay variability on management of prostate cancer. Clin Biochem 2015; 49:79-84. [PMID: 26506115 DOI: 10.1016/j.clinbiochem.2015.10.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/18/2015] [Accepted: 10/20/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the inter-assay variability of six commercially available prostate specific antigen (PSA) assays, its clinical impact in prostate cancer (PCa) and comparison of automated versus manual assays. PATIENTS AND METHODS Sera from 495 patients (425 with PCa and 70 men with Benign Prostatic Hyperplasia (BPH), were measured with six different assays [three automated assays (a-PSA) and three manual ELISA based assay (m-PSA)]. Variability, agreement and bias were measured and compared among assays using Bland Altman plots and Passing and Bablok regression analysis. The possible impact of inter-assay variability on important clinical scenarios was also studied. RESULTS All the assays were well correlated (r: 0.88-0.98); however there was significant disagreement and bias between the systems, which were more pronounced among the a-PSA assays. The Bland Altman plot showed that the variability was high between the m-PSA assays and the standard Abbott system with mean difference of 3.8-5.8ng/ml. In contrast, the a-PSA had better agreement with mean difference of 0.8-2.3ng/ml. Beckman Coulter showed the best agreement to the institutional reference (slope-1.097; 95% CI: 1.06-1.14; p<0.05, and intercept-0.20; 95% CI-0.38-0.58; p<0.05, Passing Bablok). It led to significant variability in PCa risk stratification and failure to detect biochemical failure in more than 50% cases. CONCLUSIONS The discrepancies between the assays lead to significant clinical misinterpretation with risk group migration and detection of biochemical failure post radiotherapy. There are significant discordances between automated and ELISA based assays.
Collapse
|
32
|
Stephan C, Jung K, Ralla B. Current biomarkers for diagnosing of prostate cancer. Future Oncol 2015; 11:2743-55. [DOI: 10.2217/fon.15.203] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Prostate cancer (PCa) is mostly detected by prostate-specific antigen (PSA) as one of the most widely used tumor markers. But PSA is limited with its low specificity. The prostate health index (phi) can improve specificity over percent free and total PSA and correlates with aggressive cancer. The urinary PCA3 also shows its utility to detect PCa but its correlation with aggressiveness and the low sensitivity at high values are limitations. While the detection of alterations of the androgen-regulated TMPRSS2 and ETS transcription factor genes in tissue of ˜50% of all PCa patients was one research milestone, the urinary assay should only be used in combination with PCA3. Both US FDA-approved markers phi and PCA3 perform equally.
Collapse
Affiliation(s)
- Carsten Stephan
- Department of Urology, Charité – Universitätsmedizin Berlin, CCM, Charitéplatz 1, D-10117 Berlin, Germany
- Berlin Institute for Urologic Research, Berlin, Germany
| | - Klaus Jung
- Department of Urology, Charité – Universitätsmedizin Berlin, CCM, Charitéplatz 1, D-10117 Berlin, Germany
- Berlin Institute for Urologic Research, Berlin, Germany
| | - Bernhard Ralla
- Department of Urology, Charité – Universitätsmedizin Berlin, CCM, Charitéplatz 1, D-10117 Berlin, Germany
| |
Collapse
|
33
|
Potential Utility of Novel Biomarkers in Active Surveillance of Low-Risk Prostate Cancer. BIOMED RESEARCH INTERNATIONAL 2015; 2015:475920. [PMID: 26339615 PMCID: PMC4538404 DOI: 10.1155/2015/475920] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 02/13/2015] [Accepted: 02/13/2015] [Indexed: 11/17/2022]
Abstract
Active surveillance (AS) is now an accepted management strategy for men with low-risk localized prostate cancer (PCa). However, detecting disease progression in a patient selected for AS remains a challenge. It is crucial to know what will serve as the best parameter to correctly identify tumors that progress to a more aggressive phenotype so as not to miss the window of curability. Several biomarkers are now being actively investigated as novel tools to improve PCa risk assessments. To date, several serum, urinary, and tissue biomarkers have shown promising prognostic value. %[-2]proPSA and PHI showed improved predictive value for an unfavorable biopsy conversion at annual surveillance biopsy in the AS program. PCA3 and TMPRSS2:ERG had additional independent predictive value for the prediction of PCa detection and progression, although PCA3 was limited in predicting aggressive cancer. Other tissue biomarkers also showed promising ability to predict disease progression. Although several of these novel biomarkers have an improved predictive accuracy that is better than classical parameters, there is still a need for further well-designed, large, multicenter, prospective trials to avoid common bias and clinical validation.
Collapse
|
34
|
Phage display aided improvement of a unique prostate-specific antigen (PSA) antibody unreactive with Lys145–Lys146 internally cleaved forms. J Immunol Methods 2015; 422:72-9. [DOI: 10.1016/j.jim.2015.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 04/07/2015] [Accepted: 04/07/2015] [Indexed: 11/22/2022]
|
35
|
Duskova K, Vesely S. Prostate Specific Antigen. Current clinical application and future prospects. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2015; 159:18-26. [DOI: 10.5507/bp.2014.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 08/29/2014] [Indexed: 11/23/2022] Open
|
36
|
Chen YT, Tuan LP, Chen HW, Wei IA, Chou MY, Chen HM, Tyan YC, Chen SF. Quantitative Analysis of Prostate Specific Antigen Isoforms Using Immunoprecipitation and Stable Isotope Labeling Mass Spectrometry. Anal Chem 2014; 87:545-53. [DOI: 10.1021/ac5033066] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yi-Ting Chen
- Department
of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Molecular
Medicine Research Center, Chang Gung University, Taoyuan 333, Taiwan
| | - Li-Ping Tuan
- Department
of Chemistry, National Taiwan Normal University, Taipei 11677 Taiwan
| | - Hsiao-Wei Chen
- Molecular
Medicine Research Center, Chang Gung University, Taoyuan 333, Taiwan
| | - I-An Wei
- Department
of Chemistry, National Taiwan Normal University, Taipei 11677 Taiwan
| | - Min-Yuan Chou
- Biomedical
Technology and Devices Research Laboratories, Industrial Technology Research Institute, Chutung 31040, Taiwan
| | - Han-Min Chen
- Department
of Life Science, Catholic Fu-Jen University, Taipei 24205, Taiwan
| | - Yu-Chang Tyan
- Department
of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Sung-Fang Chen
- Department
of Chemistry, National Taiwan Normal University, Taipei 11677 Taiwan
| |
Collapse
|
37
|
Bruzzese D, Mazzarella C, Ferro M, Perdonà S, Chiodini P, Perruolo G, Terracciano D. Prostate health index vs percent free prostate-specific antigen for prostate cancer detection in men with "gray" prostate-specific antigen levels at first biopsy: systematic review and meta-analysis. Transl Res 2014; 164:444-51. [PMID: 25035153 DOI: 10.1016/j.trsl.2014.06.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/17/2014] [Accepted: 06/18/2014] [Indexed: 11/28/2022]
Abstract
The most promising approach to improve the specificity of prostate-specific antigen (PSA) test relies on the measurement of different molecular isoforms of PSA in serum. Currently, in men with a total PSA (tPSA) level between 2 and 10 ng/mL, measurement of %fPSA (free to total PSA ratio ×100) is used as reflex testing to better distinguish between malignant and benign prostate disease. Recently, Beckman Coulter developed the prostate health index (PHI) and several studies suggested that this test may improve the diagnostic ability of %fPSA.We performed a meta-analysis to evaluate the usefulness of PHI compared with %fPSA in the detection of prostate cancer (PCa) at first biopsy in men with tPSA "gray" levels of 2-10 ng/mL. Data on sensitivity and specificity were extracted from 8 eligible studies. Only observational studies comparing the diagnostic ability of PHI and %fPSA in tPSA range of 2-10 ng/mL were included. A total of 8 studies involving 2969 patients with a tPSA range of 2-10 ng/mL undergoing first biopsy were included in this meta-analysis. Biopsy-confirmed PCa was detected in 1287 (43.3%) men. Selected studies determined both PHI and %fPSA as a reflex test. The areas under curve (AUCs) of PHI and %fPSA were 0.74 (95% confidence interval [CI], 0.70-0.77) and 0.63 (95% CI, 0.58-0.67), respectively. Meta-regression analysis confirmed the superiority of PHI which showed, compared with %fPSA, a relative diagnostic odds ratio of 2.81 (95% CI, 2.19-3.6; P < 0.0001). In conclusion, PHI instead of %fPSA as a reflex test in men with tPSA "gray" levels is a better predictor of positive first biopsy and can offer a reduction in unnecessary biopsies.
Collapse
Affiliation(s)
- Dario Bruzzese
- Department of Public Health, University "Federico II", Naples, Italy
| | - Claudia Mazzarella
- Department of Translational Medical Sciences, University "Federico II", Naples, Italy
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Sisto Perdonà
- Urology Unit, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Paolo Chiodini
- Medical Statistics Unit, Second University of Naples, Naples, Italy
| | - Giuseppe Perruolo
- Department of Translational Medical Sciences, University "Federico II", Naples, Italy
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University "Federico II", Naples, Italy.
| |
Collapse
|
38
|
Abstract
OBJECTIVES To provide clarity on the pros and cons of using prostate-specific antigen (PSA) as a screening tool for prostate cancer. METHODS Case scenarios and a literature review of recently published clinical trial data are presented to provide evidence of the controversy. RESULTS PSA is a sensitive biomarker for detecting diseases of the prostate, but it is limited in its ability to distinguish cancerous from noncancerous conditions or aggressive from indolent cancers and has resulted in a considerable amount of overdiagnosis and overtreatment. CONCLUSIONS The analytical methodology for total PSA testing is both reliable and cost-effective, but patients should be encouraged to talk to their providers to understand the benefits and harms associated with this testing.
Collapse
Affiliation(s)
- Jaime H. Noguez
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Corinne R. Fantz
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| |
Collapse
|
39
|
Schmid M, Hansen J, Rink M, Fisch M, Chun F. The development of nomograms for stratification of men at risk of prostate cancer prior to prostate biopsy. Biomark Med 2014; 7:843-50. [PMID: 24266817 DOI: 10.2217/bmm.13.114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A main limitation of early prostate cancer (PCa) detection due to elevated PSA levels is caused by the low specificity of PSA, which is associated with a high proportion of men detected with nonmalignant findings at first or subsequent prostate biopsy (PBX). Multivariate prediction models, such as nomograms, have been developed, providing a more accurate method to prospectively determine the risk of a positive PBX. Combining established clinical risk factors with novel diagnostic markers of PCa appears promising to further improve predictive accuracy estimates. Ideally, these nomograms should be capable of identifying PCa at PBX without missing men with high-grade PCa, and preventing a significant proportion of men without, or with insignificant, PCa from undergoing PBX. The intention is to reduce disease morbidity and mortality by detecting significant PCa at an early stage, and at the same time to avoid overdiagnosis as well as overintervention.
Collapse
Affiliation(s)
- Marianne Schmid
- Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | | | | | | | | |
Collapse
|
40
|
Wang W, Wang M, Wang L, Adams TS, Tian Y, Xu J. Diagnostic ability of %p2PSA and prostate health index for aggressive prostate cancer: a meta-analysis. Sci Rep 2014; 4:5012. [PMID: 24852453 PMCID: PMC5381367 DOI: 10.1038/srep05012] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 05/01/2014] [Indexed: 01/23/2023] Open
Abstract
The role of [-2]proPSA (p2PSA) based diagnostic tests for the detection of aggressive prostate cancer (PCa) has not been fully evaluated. We conducted a meta-analysis to evaluate the diagnostic performance of p2PSA/free PSA (%p2PSA) and prostate health index (Phi) tests for PCa and to evaluate their ability in discriminating between aggressive and non-aggressive PCa. A total of 16 articles were included in this meta-analysis. For the detection of PCa, the pooled sensitivity, specificity, and AUC were 0.86 (95% CI, 0.84-0.87), 0.40 (95% CI, 0.39-042) and 0.72 (95% CI, 0.67-0.77) for %p2PSA respectively, and were 0.85 (95% CI, 0.83-0.86), 0.45 (95% CI, 0.44-0.47) and 0.70 (95% CI=0.65-0.74) for Phi, respectively. In addition, the sensitivity for discriminating PCa between higher Gleason score (≥7) and lower Gleason score (<7) was 0.96 (95% CI, 0.93-0.98) and 0.90 (95% CI, 0.87-0.92) for %p2PSA and Phi respectively, and the specificity was low, only 0.09 (95% CI, 0.06-0.12) and 0.17 (95% CI, 0.14-0.19) for %p2PSA and Phi, respectively. Phi and %p2PSA have a high diagnostic accuracy rates and can be used in PCa diagnosis. Phi and %p2PSA may be useful as tumor markers in predicating patients harboring more aggressive disease and guiding biopsy decisions.
Collapse
Affiliation(s)
- Wenying Wang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
- Center for Cancer Genomics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
- These authors contributed equally to this work
| | - Meilin Wang
- Center for Cancer Genomics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
- These authors contributed equally to this work
| | - Li Wang
- Center for Cancer Genomics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Tamara S. Adams
- Center for Cancer Genomics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Ye Tian
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Jianfeng Xu
- Center for Cancer Genomics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| |
Collapse
|
41
|
Schmid M, Trinh QD, Graefen M, Fisch M, Chun FK, Hansen J. The role of biomarkers in the assessment of prostate cancer risk prior to prostate biopsy: which markers matter and how should they be used? World J Urol 2014; 32:871-80. [PMID: 24825472 DOI: 10.1007/s00345-014-1317-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 05/02/2014] [Indexed: 12/12/2022] Open
Abstract
Prostate cancer (PCa) screening has been substantially influenced by the clinical implementation of serum prostate-specific antigen (PSA). In this context, improvement of early PCa detection and stage migration as well as reduced PCa mortality were achieved, and up-to-date PSA represents the gold standard biomarker of PCa diagnosis together with clinical findings. Nonetheless, PSA shows weakness in discriminating between malign and benign prostatic disease or indolent and aggressive cancers. As a result, the expansion of PSA screening is extensively debated with regard to overdetection and ultimately overtreatment, keeping in mind that PCa is still the third leading cause of cancer-specific mortality in the Western male population. Consequently, today's task is to increase the accuracy of PCa detection and furthermore to allow stratification for indolent PCa that might permit active surveillance and to filter out aggressive cancers necessitating treatment. Thus, novel biomarkers, especially in combination with approved clinical risk factors (e.g., age or family history of PCa), within multivariable prediction models carry the potential to improve many aspects of PCa diagnosis and to enable risk classification in clinical practice. Multivariable models lead to superior accuracy for PCa prediction instead of the use of a single risk factor. The aim of this article was to present an overview of known risk factors for PCa together with new promising blood- and urine-based biomarkers and their application within risk models that may allow risk stratification for PCa prior to prostate biopsy. Risk models may optimize PCa detection and classification with regard to improved PCa risk assessment and avoidance of unnecessary prostate biopsies.
Collapse
Affiliation(s)
- Marianne Schmid
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | | | | | | | | | | |
Collapse
|
42
|
Stephan C, Ralla B, Jung K. Prostate-specific antigen and other serum and urine markers in prostate cancer. Biochim Biophys Acta Rev Cancer 2014; 1846:99-112. [PMID: 24727384 DOI: 10.1016/j.bbcan.2014.04.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 03/24/2014] [Accepted: 04/01/2014] [Indexed: 11/16/2022]
Abstract
Prostate-specific antigen (PSA) is one of the most widely used tumor markers, and strongly correlates with the risk of harboring from prostate cancer (PCa). This risk is visible already several years in advance but PSA has severe limitations for PCa detection with its low specificity and low negative predictive value. There is an urgent need for new biomarkers especially to detect clinically significant and aggressive PCa. From all PSA-based markers, the FDA-approved Prostate Health Index (phi) shows improved specificity over percent free and total PSA. Other serum kallikreins or sarcosine in serum or urine show more diverging data. In urine, the FDA-approved prostate cancer gene 3 (PCA3) has also proven its utility in the detection and management of early PCa. However, some aspects on its correlation with aggressiveness and the low sensitivity at very high values have to be re-examined. The detection of a fusion of the androgen regulated TMPRSS2 gene with the ERG oncogene (from the ETS family), which acts as transcription factor gene, in tissue of ~50% of all PCa patients was one milestone in PCa research. When combining the urinary assays for TMPRSS2:ERG and PCA3, an improved accuracy for PCa detection is visible. PCA3 and phi as the best available PCa biomarkers show an equal performance in direct comparisons.
Collapse
Affiliation(s)
- Carsten Stephan
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute for Urologic Research, Berlin, Germany.
| | - Bernhard Ralla
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Klaus Jung
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute for Urologic Research, Berlin, Germany
| |
Collapse
|
43
|
Kallikreins as biomarkers for prostate cancer. BIOMED RESEARCH INTERNATIONAL 2014; 2014:526341. [PMID: 24809052 PMCID: PMC3997884 DOI: 10.1155/2014/526341] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 03/10/2014] [Indexed: 12/02/2022]
Abstract
The introduction of testing for prostate-specific antigen (PSA), a member of the fifteen-gene family of kallikrein-related peptidases and also known as kallikrein-related peptidase 3 (KLK3), in blood has revolutionized both the detection and management of prostate cancer. Given the similarities between PSA and other KLK gene family members along with limitations of PSA as a biomarker for prostate cancer mainly in reference to diagnostic specificity, the potential roles of other members of this gene family as well as PSA derivatives and isoforms in the management of prostate cancer have been studied extensively. Of these, approaches to measure distinct molecular forms of PSA (free, intact, complexed PSA, and pro-PSA) combined with kallikrein-related peptidase 2 (KLK2), also known as hK2, have been considered holding particular promise in enhancing the diagnosis of prostate cancer. Recently, an integrated approach of applying a panel of four kallikrein markers has been demonstrated to enhance accuracy in predicting the risk of prostate cancer at biopsy. This review presents an overview of kallikreins, starting with the past and current status of PSA, summarizing published data on the evaluations of various KLKs as biomarkers in the diagnosis, prognostication, and monitoring of prostate cancer.
Collapse
|
44
|
Garrido-Medina R, Farina-Gomez N, Diez-Masa JC, de Frutos M. Immunoaffinity chromatographic isolation of prostate-specific antigen from seminal plasma for capillary electrophoresis analysis of its isoforms. Anal Chim Acta 2014; 820:47-55. [DOI: 10.1016/j.aca.2014.02.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 02/21/2014] [Accepted: 02/22/2014] [Indexed: 01/07/2023]
|
45
|
Hoeh MP, Deane LA. PSA Screening: A Discussion Based on the USPSTF Recommendations and the AUA and EAU Guidelines. JOURNAL OF MEN'S HEALTH 2014. [DOI: 10.1089/jomh.2014.3502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
46
|
Abstract
This article updates advances in prostate cancer screening based on prostate-specific antigen, its derivatives, and human kallikrein markers. Many men are diagnosed with indolent disease not requiring treatment. Although there is evidence of a survival benefit from screening, the numbers needed to screen and treat remain high. There is risk of exposing men to the side effects of treatment for nonthreatening disease. A screening test is needed with sufficiently good performance characteristics to detect disease at an early stage so treatment may be offered with curative intent, while reducing the number of negative or unnecessary biopsies.
Collapse
Affiliation(s)
- Richard J Bryant
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Hans Lilja
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Headley Way, Headington, Oxford OX3 9DU, UK; Department of Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue (Mailbox 213), New York, NY 10065, USA; Department of Surgery (Urology), Memorial Sloan-Kettering Cancer Center, 1275 York Avenue (Mailbox 213), New York, NY 10065, USA; Department of Medicine (GU-Oncology), Memorial Sloan-Kettering Cancer Center, 1275 York Avenue (Mailbox 213), New York, NY 10065, USA.
| |
Collapse
|
47
|
Romero Otero J, Garcia Gomez B, Campos Juanatey F, Touijer KA. Prostate cancer biomarkers: an update. Urol Oncol 2014; 32:252-60. [PMID: 24495450 DOI: 10.1016/j.urolonc.2013.09.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 09/13/2013] [Accepted: 09/17/2013] [Indexed: 01/07/2023]
Abstract
Many aspects of prostate cancer diagnosis and treatment could be greatly advanced with new, effective biomarkers. Prostate-specific antigen (PSA) has multiple weaknesses as a biomarker, such as not distinguishing well between cancer and benign prostatic hyperplasia or between indolent and aggressive cancers, thus leading to overtreatment, especially unnecessary biopsies. PSA also often fails to indicate accurately which patients are responding to a given treatment. Yet PSA is the only prostate cancer biomarker routinely used by urologists. Here, we provide updated information on the most relevant of the other biomarkers currently in use or in development for prostate cancer. Recent research shows improvement over using PSA alone by comparing total PSA (tPSA) or free PSA (fPSA) with new, related markers, such as prostate cancer antigen (PCA) 3, the individual molecular forms of PSA (proPSA, benign PSA, and intact PSA), and kallikreins other than PSA. Promising results have also been seen with the use of the fusion gene TMPRSS2:ERG and with various forms of the urokinase plasminogen activation receptor. Initially, there were high hopes for early PCA, but those data were not reproducible and thus research on early PCA has been abandoned. Much work remains to be done before any of these biomarkers are fully validated and accepted. Currently, the only markers discussed in this paper with Food and Drug Administration-approved tests are PCA 3 and an isoform of proPSA, [-2]proPSA. Assays are in development for most of the other biomarkers described in this paper. While the biomarker validation process can be long and filled with obstacles, the rewards will be great-in terms of both patient care and costs to the health care system.
Collapse
Affiliation(s)
| | | | - Felix Campos Juanatey
- Hospital Universitario 12 Octubre, Madrid, Spain; Hospital Universitario Marques De Valdecilla, Santander, Spain
| | - Karim A Touijer
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Urology, Weill Medical College of Cornell University, New York, NY.
| |
Collapse
|
48
|
Filella X, Giménez N. Evaluation of [-2] proPSA and Prostate Health Index (phi) for the detection of prostate cancer: a systematic review and meta-analysis. Clin Chem Lab Med 2013; 51:729-39. [PMID: 23154423 DOI: 10.1515/cclm-2012-0410] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 10/12/2012] [Indexed: 11/15/2022]
Abstract
The usefulness of %[-2] proPSA and Prostate Health Index (phi) in the detection of prostate cancer are currently unknown. It has been suggested that these tests can distinguish prostate cancer from benign prostatic diseases better than PSA or %fPSA. We performed a systematic review and meta-analysis of the available scientific evidence to evaluate the clinical usefulness of %[-2] proPSA and phi. Relevant published papers were identified by searching computerized bibliographic systems. Data on sensitivity and specificity were extracted from 12 studies: 10 studies about %[-2] proPSA (3928 patients in total, including 1762 with confirmed prostate cancer) and eight studies about phi (2919 patients in total, including 1515 with confirmed prostate cancer). The sensitivity for the detection of prostate cancer was 90% for %[-2] proPSA and phi, while the pooled specificity was 32.5% (95% CI 30.6-34.5) and 31.6% (95% CI 29.2-34.0) for %[-2] proPSA and phi, respectively. The measurement of %[-2] proPSA improves the accuracy of prostate cancer detection in comparison with PSA or %fPSA, particularly in the group of patients with PSA between 2 μg/L and 10 μg/L. Similar results were obtained measuring phi. Using these tests, it is possible to reduce the number of unnecessary biopsies, maintaining a high cancer detection rate. Published results also showed that %[-2] proPSA and phi are related to the aggressiveness of the tumor.
Collapse
Affiliation(s)
- Xavier Filella
- Department of Biochemistry and Molecular Genetics, Hospital Clinic, and Research Unit, Research Foundation Mutua Terrassa, University of Barcelona, Villarroel 170, 08036 Barcelona, Catalonia, Spain.
| | | |
Collapse
|
49
|
Thorek DLJ, Evans MJ, Carlsson SV, Ulmert D, Lilja H. Prostate-specific kallikrein-related peptidases and their relation to prostate cancer biology and detection. Established relevance and emerging roles. Thromb Haemost 2013; 110:484-92. [PMID: 23903407 PMCID: PMC4029064 DOI: 10.1160/th13-04-0275] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 07/17/2013] [Indexed: 01/05/2023]
Abstract
Kallikreins are a family of serine proteases with a range of tissue-specific and essential proteolytic functions. Among the best studied are the prostate tissue-specific KLK2 and KLK3 genes and their secreted protease products, human kallikrein 2, hk2, and prostate-specific antigen (PSA). Members of the so-called classic kallikreins, these highly active trypsin-like serine proteases play established roles in human reproduction. Both hK2 and PSA expression is regulated by the androgen receptor which has a fundamental role in prostate tissue development and progression of disease. This feature, combined with the ability to sensitively detect different forms of these proteins in blood and biopsies, result in a crucially important biomarker for the presence and recurrence of cancer. Emerging evidence has begun to suggest a role for these kallikreins in critical vascular events. This review discusses the established and developing biological roles of hK2 and PSA, as well as the historical and advanced use of their detection to accurately and non-invasively detect and guide treatment of prostatic disease.
Collapse
Affiliation(s)
- Daniel L J Thorek
- Hans Lilja, MD, PhD, Memorial Sloan-Kettering Cancer Center, 1275 York Ave Box 213, New York, NY 10065, USA, Tel.: +1 212 639 6982, Fax: +1 646 422 2379, E-mail:
| | | | | | | | | |
Collapse
|
50
|
Hansen J, Rink M, Graefen M, Shariat S, Chun FKH. Assays for prostate cancer : changing the screening paradigm? Mol Diagn Ther 2013; 17:1-8. [PMID: 23355098 DOI: 10.1007/s40291-013-0014-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Prostate cancer (PCa) screening and detection have changed dramatically since the introduction of serum prostate-specific antigen (PSA) testing. Despite the resulting improvement in early PCa detection and stage migration, in clinical practice the use of PSA testing may cause overdetection and ultimately overtreatment. As a consequence, novel biomarkers are needed to increase the specificity of PCa detection. The aim of this article is to present an overview of novel blood- and urine-based biomarkers that may optimize PCa detection, with improved identification of patients with significant PCa and avoidance of unnecessary prostate biopsies. A systematic and comprehensive PubMed search was performed using the MeSH search terms 'prostate cancer', 'biomarker', 'marker', and 'detection'. Results were restricted to the English language. Several blood- and urine-based biomarkers have the potential to improve prediction of the presence and/or significance of PCa. Ideally, biomarkers should be used in combination within multivariate models, leading to superior accuracy for prediction of any PCa or clinically significant PCa, compared with the use of a single marker.
Collapse
Affiliation(s)
- Jens Hansen
- Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | | | | | | | | |
Collapse
|