Development of a highly sensitive immunochemiluminometric assay for prostate-specific antigen

Prostate-Specific Antigen as an Ultrasensitive Biomarker for Patients with Early Recurrent Prostate Cancer: How Low Shall We Go? A Systematic Review

Serum prostate-specific antigen (PSA) needs to be monitored with ultrasensitive PSA assays (uPSAs) for oncologists to be able to start salvage radiotherapy (SRT) while PSA is <0.5 µg/L for patients with prostate cancer (PCa) relapsing after a radical prostatectomy (RP). Our systematic review (SR) aimed to summarize uPSAs for patients with localized PCa. The SR was registered as InPLASY2023110084. We searched for studies on Google Scholar, PUBMED and reference lists of reviews and studies. We only included studies on uPSAs published in English and excluded studies of women, animals, sarcoidosis and reviews. Of the 115 included studies, 39 reported PSA assay methods and 76 reported clinical findings. Of 67,479 patients, 14,965 developed PSA recurrence (PSAR) and 2663 died. Extremely low PSA nadir and early developments of PSA separated PSAR-prone from non-PSAR-prone patients (cumulative p value 3.7 × 1012). RP patients with the lowest post-surgery PSA nadir and patients who had the lowest PSA at SRT had the fewest deaths. In conclusion, PSA for patients with localized PCa in the pre-PSAR phase of PCa is strongly associated with later PSAR and survival. A rising but still exceedingly low PSA at SRT predicts a good 5-year overall survival.

Third-Generation Psa: Ultrasensitive or Ultraprecise Assay?

The ultrasensitive PSA assay has been recently acknowledged as a useful tool for the monitoring of patients prostatectomized for prostatic cancer. We have evaluated a commercially available ultrasensitive PSA assay (Immulite Third Generation PSA - DPC - Los Angeles CA) in comparison with the routinely used PSA (Immulite PSA - DPC - Los Angeles CA). When evaluated with different approaches, the analytical sensitivity of ultrasensitive PSA ranged between 0.0029 and 0.0038 ng/ml. The biological detection limit was 0.0098 ng/ml. Dilution of samples with low PSA levels showed a good recovery (from 88 to 113%) up to 1:128 dilution factor (final PSA levels ranging from 0.004 to 0.016 ng/ml in different samples). The assay precision was excellent in the low dose range, the highest interassay interadjustment CV among replicates being 5.84% when assaying serum samples with PSA lower than 1.0 ng/ml.

Besides its role in the follow-up of prostatectomized patients, the evaluated ultrasensitive PSA could be reliably used for the detection of clinically meaningful PSA variations in the low dose range, and it could therefore be a candidate for the assessment of PSA velocity.

The significance of reporting to the thousandths place: Figuring out the laboratory limitations

OBJECTIVES

A request to report laboratory values to a specific number of decimal places represents a delicate balance between clinical interpretation of a true analytical change versus laboratory understanding of analytical imprecision and significant figures. Prostate specific antigen (PSA) was used as an example to determine if an immunoassay routinely reported to the hundredths decimal place based on significant figure assessment in our laboratory was capable of providing analytically meaningful results when reported to the thousandths places when requested by clinicians.

DESIGN AND METHODS

Results of imprecision studies of a representative PSA assay (Roche MODULAR E170) employing two methods of statistical analysis are reported. Sample pools were generated with target values of 0.01 and 0.20 μg/L PSA as determined by the E170. Intra-assay imprecision studies were conducted and the resultant data were analyzed using two independent statistical methods to evaluate reporting limits.

RESULTS

These statistical methods indicated reporting results to the thousandths place at the two assessed concentrations was an appropriate reflection of the measurement imprecision for the representative assay. This approach used two independent statistical tests to determine the ability of an analytical system to support a desired reporting level. Importantly, data were generated during a routine intra-assay imprecision study, thus this approach does not require extra data collection by the laboratory.

CONCLUSIONS

Independent statistical analysis must be used to determine appropriate significant figure limitations for clinically relevant analytes. Establishing these limits is the responsibility of the laboratory and should be determined prior to providing clinical results.

Nucleic Acid Detection Immunoassay for Prostate-Specific Antigen Based on Immuno-PCR Methodology

BACKGROUND

Serum prostate-specific antigen (PSA) concentrations after radical prostatectomy typically become undetectable with the use of current immunometric assay methods. Despite modern surgical techniques, 15%–30% of prostate cancer patients undergoing radical prostatectomy develop a biochemical recurrence during follow-up. Unfortunately, poor analytical sensitivity of standard PSA assays delays biochemical recurrence detection, and because of day-to-day assay imprecision ultrasensitive PSA assays cannot assess PSA kinetics. We developed an immuno-PCR assay for total PSA that has a limit of quantification &gt;10 times lower than current ultrasensitive assays.

METHODS

The 2-site immunometric assay for total PSA employed 2 monoclonal antibodies, one conjugated to a double-stranded DNA label and the other bound to paramagnetic microparticles. After several washing steps, quantification cycles were determined and values were converted to PSA concentrations. We characterized analytical performance and compared accuracy with a commercially available total PSA assay.

RESULTS

The limit of quantification was 0.65 ng/L and the assay was linear in the range of 0.25–152.0 ng/L. Total imprecision estimates at PSA concentrations of 3.8, 24.1, and 69.1 ng/L were &lt;15.2%, &lt;9.4%, and &lt;10.6%, respectively. Recovery of supplemented PSA ranged from 87.5% to 119.2% (mean 100.3%). Dilution recovery ranged from 96.4% to 115.3% (mean 102.3%). There was no high-dose hook effect up to 50 000 ng/L of PSA. Comparison with the commercial PSA assay showed a regression slope of 1.06 and a correlation coefficient of 0.996.

CONCLUSIONS

The analytical characteristics of the assay support the use of this assay for the accurate and precise measurement of serum PSA, even at sub–nanogram-per-liter concentrations.

Comparative study of random and oriented antibody immobilization as measured by dual polarization interferometry and surface plasmon resonance spectroscopy

Dual polarization interferometry (DPI) is used for a detailed study of antibody immobilization with and without orientation control, using prostate specific antigen (PSA) and its antibody as model. Thiol modified DPI chips were activated by a heterobifunctional cross-linker (sulfo-GMBS). PSA antibody was either directly immobilized via covalent binding or coupled via the Fc-fragment to protein G covalently attached to the activated chip. The direct covalent binding leads to a random antibody orientation and the coupling through protein G leads to an end-on orientation. Ethanolamine (ETH) was used to block remaining active sites following the direct antibody immobilization and protein G immobilization. A homobifunctional cross-linker (BS3) was used to stabilize the antibody layer coupled on protein G. DPI provides a real-time measurement of the stepwise molecular binding processes and gives detailed geometrical and structural values of each layer, i.e., thickness, mass, and density. These values evidence the end-on orientation of closely packed antibody on protein G layer and reveal structural effects of ETH blocking/deactivation and BS3 stabilization. With the end-on immobilized antibody, PSA at 10 pg/mL can be detected by DPI through a sandwich complex that satisfies the clinical requirement (assuming <30 pg/mL as clinically safe). However, the randomly immobilized antibody failed to detect PSA at 1 ng/mL. In a parallel study using surface plasmon resonance (SPR) spectroscopy, random and end-on antibody immobilization on streptavidin-modified gold surface was evaluated to further validate the importance of antibody orientation control. With the closely packed antibody layer on protein G surface, SPR can also detect PSA at 10 pg/mL.

Bispecific Antibodies for Diagnostic Applications

Bispecific monoclonal antibodies (BsMAb) are unique engineered macromolecules that have two different pre-determined binding specificities. Their ability to simultaneously bind to a specific antigen and a given detection moiety enables them to function as excellent bifunctional immunoprobes in diagnostic assays. BsMAb are being exploited for the development of simple, rapid, and highly sensitive immunoassays for diagnosis of bacterial and viral infectious diseases. This chapter describes the use of BsMAb for the detection of Mycobacterium tuberculosis, Escherichia coli O157:H7, Bordetella pertussis, Severe Acute Respiratory Syndrome coronavirus, and Dengue virus. Further, BsMAb have been utilized for diagnosis of various types of cancers. The use of BsMAb in detection of prostate cancer and in cancer diagnostic imaging is also discussed.

Prostate-specific antigen immunosensing based on mixed self-assembled monolayers, camel antibodies and colloidal gold enhanced sandwich assays

Prostate-specific antigen (PSA) is a valuable biomarker for prostate cancer screening. We developed a PSA immunoassay on a commercially available surface plasmon resonance biosensor. Our PSA receptor molecule consists of a single domain antigen-binding fragment, cAbPSA-N7, derived from dromedary heavy-chain antibodies and identified after phage display. It binds PSA with a high k(on) value of 1.9x10(6) M-1 s-1, and was covalently immobilised on a gold substrate via a mixed self-assembled monolayer (SAM) of alkanethiols by using carbodiimide-coupling chemistry in 10mM acetate buffer pH 5.5 to obtain an optimal pre-concentration. The best performing and optimised mixed SAM consisted of (10%) 16-mercapto-1-hexadecanoic acid (16-MHA) for covalent cAbPSA-N7 immobilisation and (90%) 11-mercapto-1-undecanol (11-MUOH) to minimise non-specific adsorption of the analyte. In this way, two advantages are incorporated in a single coupling layer. Up to 28 fmol/mm2 of cAbPSA-N7 could be immobilised and 30% of its binding sites participate actively in PSA interaction. In addition, the optimised layer showed also optimal performance to assess physiological samples. Although PSA concentrations as low as 10 ng/ml could be detected directly, this detection limit could be enhanced to PSA levels in the sub ng/ml range by introducing a sandwich assay involving a biotinylated secondary antibody and streptavidin modified gold nanoparticles. This approach realizes the PSA detection at clinical relevant concentrations.

How sensitive is a prostate-specific antigen measurement? How sensitive does it need to be?

Assays are now available that can measure very low concentrations of prostate-specific antigen (PSA), but their analytic performance and clinical utility are not well defined. This brief article highlights some of the clinical issues related to the limited prognostic significance of small changes in PSA concentrations in men with prostate cancer who have been treated with prostate ablation therapy. College of American Pathologists proficiency survey data are presented, illustrating the performance of commercial PSA assays with low PSA concentration survey samples tested between 1998 and 2002. The performance of the assays appears to be improving, but many of the currently used assays have intralaboratory coefficients of variation greater than 20% for PSA concentrations less than 0.4 ng/mL. Also, there are major differences in the level of PSA reported by various assays in these low concentration samples. These level differences (if they are also seen in clinical samples) may cause clinical problems when fixed serum PSA thresholds (eg, 0.2 ng/mL) are used to make clinical decisions related to prostate tumor recurrence.

Amperometric biosensors for detection of the prostate cancer marker (PSA)

Prostate specific antigen (PSA) has been identified as the most reliable clinical tool for diagnosing and monitoring prostate cancer (CAP). Since, there is no curative therapy available for prostate cancer, detecting the disease at the early stage is the best hope of increasing mortality rate. There are some procedures available for the detection of prostate cancer e.g. Tandem-R PSA, Hybritech Inc. (USA), IMx-PSA Abbott Laboratories (USA). However, these are time consuming and costly. We have developed a very simple and cost effective technique for identification and monitoring of prostate cancer using amperometric immunosensor. PSA is a glycoprotein with 93% peptide and 7% sugar content and isoelectric pH of 6.9. It may exist in the human serum as free (f-PSA) and complex (PSA-ACT) forms. Normally if the total PSA (t-PSA) level is more than 10 ng/ml, CAP is suspected. This paper presents an amperometric detection procedure for t-PSA using three electrode system in which working electrode (WE) is made of hydroxyethyl cellulose (HEC) and rhodinised carbon. The method used is rapid, very easy to use and involves low cost compared with other procedures. The electrochemical response was directly observed due to enzymatic reaction via a sandwich immunoassay on the WE. Monoclonal capture antibody (Mab) to PSA was immobilised on the WE and the other Mab labelled by the enzyme marker, horseradish peroxidase (HRP), was used as a tracer antibody.

The new era of automated immunoassay

Use of immunoassays and other ligand-binding assays in clinical diagnosis has increased dramatically during the last several years. Despite impressive technical advances, "mass production" of these assays in a routine laboratory still presents many difficulties. This review of ligand-binding assay technology highlights some recent developments, emphasizing challenges and possible solutions for cost-effective patient care.

Relapse and cure rates of prostate cancer patients after radical prostatectomy and 5 years of follow-up

OBJECTIVES

We have compared the ability of an ultrasensitive prostate specific antigen assay and a regular PSA assay to identify relapse and cure rates of prostate cancer patients after radical prostatectomy, during a 5-year follow-up period.

DESIGN AND METHODS

We measured PSA by an ultrasensitive assay (detection limit 0.001 ng/mL) and a conventional PSA assay (detection limit 0.1 ng/mL) in serial serum samples obtained from 197 patients who have undergone radical prostatectomy.

RESULTS

Based on ultrasensitive PSA analysis, we have identified three groups of patients: 62% of patients did not show any significant changes in serum PSA; 15% of patients demonstrated slow PSA increases over time but none of the measurements exceeded 0.1 ng/mL within 4 years; and 23% of the patients had relatively significant increases of serum PSA and were classified as having 'fast relapse'. The vast majority of these patients were subsequently identified to have relapse by the regular PSA assay. The ultrasensitive PSA assay detected relapse by an average of eighteen months earlier than the conventional PSA method. Fast relapsing patients were associated with other prognostic indicators of the disease including pre-operative PSA, tumor volume, Gleason score, clinical stage, surgical margin positivity, periprostatic tissue involvement, capsular invasion and seminal vesicle invasion. The group with slowly rising PSA had prognosis which was between the patients in remission and fast relapsing patients.

CONCLUSIONS

The use of ultrasensitive PSA analysis for monitoring patients after radical prostatectomy provides earlier detection of relapse (by 18 months) and identifies three distinct groups of patients. Fast relapsing patients should be good candidates for early therapeutic interventions.

Novel bispecific immunoprobe for rapid and sensitive detection of prostate-specific antigen

Prostate-specific antigen (PSA) is one of the most useful tumor markers for the screening and follow-up of prostate cancer. Bispecific monoclonal antibodies (bsMAbs) are unique immunoprobes that incorporate two different binding sites in the same antibody molecule. This antibody designing can bring important advantages in the development of new immunoassays. We have developed a new hybrid hybridoma that secretes bsMAb anti-PSA × anti-horseradish peroxidase. This bsMAb has shown rapid kinetics and an excellent detection limit in a sandwich single-step assay with a total incubation time of 15 min and a 5-min substrate development. This assay in a manual format has a detection limit of 0.028 μg/L. Comparison with the Hybritech Tandem-E® PSA assay yielded a regression equation with slope = 0.433 [95% confidence interval (CI) = 0.415–0.451], intercept = 0.88 (CI = 0.45–1.31), and Sy|x = 1.83 μg/L (r = 0.98). This new immunoprobe can be used to develop a new generation of assays for clinical laboratories and can be adapted to screening devices for physicians’ offices and even home diagnostics.

Detection of nonprostatic PSA in serum and nonserum samples from women

Prostate-specific antigen (PSA) has been characterized as a specific prostate marker, although recent studies have suggested the existence of PSA of nonprostatic sources. We have assessed the presence of PSA by an ultrasensitive assay in 276 serum and nonserum samples from women. Our data show the presence of PSA in 90% of nonserum samples, including milk secretions, breast cysts, amniotic fluids and broncho-alveolar washings. We have also detected its presence in 58% of the sera tested, although it only exceeded 0.1 microg/l in 6 of the cases. We conclude that PSA can no longer be considered a specific prostate tissue marker; since the concentrations detected in women's serum are ultralow, this finding appears to interfere minimally with its value as a tumoral marker.