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Augmented mast cell infiltration and microvessel density in prostate cancer. Contemp Oncol (Pozn) 2013; 17:378-82. [PMID: 24592126 PMCID: PMC3934053 DOI: 10.5114/wo.2013.37220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 11/25/2012] [Accepted: 11/27/2012] [Indexed: 11/25/2022] Open
Abstract
Aim of the study Recent investigations have taken into account the role of mast cells in prostate cancer formation, analyzing their dual functions (as tumour growth promoters and tumour growth inhibitors). The aim of our study was to compare mast cell infiltration and microvessel density in prostate cancer and in benign prostate hyperplasia. We also attempted to find possible relationships among mast cell infiltration and microvessel density, Gleason score, as well as serum levels of prostate-specific antigen (PSA). Material and methods The investigation was confined to evaluations of material from prostate needle biopsies, carried out in 26 patients with prostate cancer, and of 14 specimens diagnosed as benign hyperplasia. The numbers of tryptase positive mast cells and CD34 positive vessels were determined using a computer image analysis system. In the patients with prostate cancer, both mast cell infiltrates and microvessel density were significantly increased, as compared to the control patients. Results Significant positive correlations were identified between the mean numbers of mast cells and microvessel densities, both in the prostate cancer group and in the control group. Moreover, significant positive correlations were observed between Gleason score on one hand and the number of mast cells and microvessel density on the other. The correlations between PSA serum levels and both mast cell infiltration and microvessel density were positive, but not in a statistically significant way. Conclusions The reported investigations may support the assumption of mast cell promoter function in prostate cancer development, whereas no evidence was found for their opposite
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Abstract
Cancer screening is one of the most common requests directed to primary care physicians in the office setting. In this article, we look at current recommendations, evidence for, and controversy surrounding screening for cancers of the lung, colon, and prostate, which together account for 51% of cancer deaths in men. We also look at screening for testicular cancer, which, although a relatively minor contributor to cancer mortality, is a prototypically male cancer with a proposed screening test.
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Bryant RJ, Hamdy FC. Screening for prostate cancer: an update. Eur Urol 2007; 53:37-44. [PMID: 17826892 DOI: 10.1016/j.eururo.2007.08.034] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Accepted: 08/17/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To review evidence regarding the potential introduction of prostate cancer screening programmes and highlight issues pertinent to the management of screen-detected prostate cancer. METHODS Screening for prostate cancer is a controversial health care issue in general and urological practice. A PubMed database search was performed, followed by a systematic review of the literature, to examine the evidence base underlying prostate cancer screening. RESULTS A prostate cancer screening programme should satisfy several key postulates prior to its introduction. To date, several of these postulates have not been satisfied, and the evidence available for prostate cancer screening is currently insufficient to warrant its introduction as a public health policy. The natural history of screen-detected prostate cancer remains poorly understood, and recent evidence suggests that a screening programme may detect a large number of men with indolent disease who may be subsequently overtreated. Several randomised clinical trials are currently in progress and it is hoped that they will provide robust evidence to inform future practice. CONCLUSIONS National systematic prostate cancer screening programmes outside randomised clinical trial settings have not been implemented to date owing to lack of robust evidence that such programmes would improve survival and/or quality of life in men with screen-detected disease. Forthcoming results of clinical trials and the application of appropriate risk stratification to prevent overtreatment of indolent prostate cancer are likely to change practice in coming years.
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Affiliation(s)
- Richard J Bryant
- Academic Urology Unit, Section of Oncology, School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield, United Kingdom
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Rao DS, Gui D, Koski ME, Popoviciu LM, Wang H, Reiter RE, Said JW. An inverse relation between COX-2 and E-cadherin expression correlates with aggressive histologic features in prostate cancer. Appl Immunohistochem Mol Morphol 2007; 14:375-83. [PMID: 17122632 DOI: 10.1097/01.pai.0000210417.61117.6c] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The identification of biomarkers in prostatic carcinoma has yielded important data regarding prognosis and has aided in increasing diagnostic accuracy. Additionally, this approach has yielded important insights into the biology of prostatic carcinoma. In this study, we report that the expression of the cyclooxygenase isoenzyme, COX-2, is significantly increased in prostatic carcinoma, whereas that of the cell adhesion molecule, E-cadherin, is decreased. The expression of COX-2 was positively correlated with higher tumor stage, and the presence of carcinoma in surgical margins at prostatectomy. Conversely, the expression of E-cadherin was inversely related to these prognostic indicators. Lastly, the expressions of COX-2 and E-cadherin were very strongly and inversely correlated. These results provide important insights into the biologic underpinnings of prostate carcinoma; and further studies into COX-2 expression in prostate core biopsies may show utility in preprostatectomy prognostication. Furthermore, these results may provide a rational basis for therapeutic intervention and chemoprevention with COX-2 inhibitor therapy in prostate carcinoma.
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Affiliation(s)
- Dinesh S Rao
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, UCLA, Los Angeles, CA 90095,
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Prostate Cancer. Integr Med (Encinitas) 2007. [DOI: 10.1016/b978-1-4160-2954-0.50082-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Gennari R, Veronesi U, Andreoli C, Betka J, Castelli A, Gatti G, Hugosson J, Llovet JM, Melia J, Nakhosteen JA, Pastorino U, Sideri M, Stephan C, Veronesi P, Zurrida S. Early detection of cancer: ideas for a debate. Crit Rev Oncol Hematol 2006; 61:97-103. [PMID: 17113782 DOI: 10.1016/j.critrevonc.2006.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Revised: 07/30/2006] [Accepted: 08/18/2006] [Indexed: 10/23/2022] Open
Abstract
Even if the overall number of cancer is increasing, the mortality has started to decrease in the Western World. The role of early detection in this decrease is a matter of debate. To assess its impact on mortality it is important to distinguish between diagnosis of cancer in symptomatic patients, and early detection in asymptomatic individuals who may self-refer or who may be offered ad hoc or systematic screening. The policies for early detection and screening vary greatly between European countries, despite many similarities in their cancer burden, and this partly reflects the uncertainties surrounding asymptomatic testing for cancer. A Task Force of European expert, held in Azzate (VA), Italy, established to address these issues, acknowledged the need for more research in the field of individual risk assessment since general statistics are more and more perceived as inadequate to design personal early detection plans. The group also recognised that combinations of early detection and screening will enforce the effectiveness of new treatments in curbing mortality curves, although policies will vary with different cancers.
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Affiliation(s)
- R Gennari
- European School of Oncology, Cordinator Task Force on Early Detection of Cancer, Via del Bollo, 4, 20123 Milan, Italy.
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Paiss T, Herkommer K, Kahn D, Gschwend JE, Küfer R, Maier C, Vogel W, Högel J, Hautmann RE. [Prospective evaluation of prostate cancer screening in men with a family history of the disease]. Urologe A 2006; 45:1002-5. [PMID: 16830128 DOI: 10.1007/s00120-006-1056-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Family history is one of the strongest risk factors for prostate cancer. In this prospective study we evaluated the results of prostate cancer screening performed in healthy brothers of prostate cancer patients. The detection rate of prostate cancer and the positive predictive value of the examinations were determined. MATERIAL AND METHODS The study population comprised 513 healthy men who were 38-75 years of age (median 62.0 years). Of these men, 268 having only one affected brother with prostate cancer were assigned to the sporadic group, and 245 probands having 2-10 affected relatives were assigned to the familial group. An abnormal PSA and/or a pathological digital rectal examination (DRE) was noted in 17.5% of familial (43/245) and 15.8% of sporadic probands (35/268). A biopsy of the prostate was performed in 60.5% of familial (26/43) and 71.4% of sporadic (25/35) men with pathological findings. RESULTS Prostate cancer was found in 15 of 26 familial (57.7%) and 16 of 25 sporadic (64.0%) probands by prostate biopsy. The overall detection rate was 6.0% (31/513). CONCLUSION Due to an increased prevalence the detection rate of prostate cancer and the positive predictive value of PSA and/or DRE are higher in men with a family history as expected in an unselected population. Our data suggest that in predisposed men prostate cancer screening should be recommended early. Furthermore an early indication for prostate biopsy is necessary. This recommendation should also be applied if only one first-degree relative has prostate cancer.
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Affiliation(s)
- T Paiss
- Abteilung für Urologie und Kinderurologie, Urologische Universitätsklinik und Poliklinik, Prittwitzstrasse 43, 89075, Ulm,
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Froehner M, Koch R, Litz RJ, Haase M, Klenk U, Oehlschlaeger S, Baretton GB, Wirth MP. Comparison of tumor- and comorbidity-related predictors of mortality after radical prostatectomy. ACTA ACUST UNITED AC 2006; 39:449-54. [PMID: 16303719 DOI: 10.1080/00365590510031174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To identify and compare tumor- and non-tumor-related predictors of survival after radical prostatectomy and to incorporate the latter into the tumor node metastasis classification of prostate cancer. MATERIAL AND METHODS A total of 402 patients who underwent radical prostatectomy (mean follow-up period 6.9 years) were stratified according to postoperative tumor stage, Gleason score, prostate-specific antigen level, age and five comorbidity classifications. Cox proportional hazard models were used to identify independent prognostic factors predicting overall survival. RESULTS Comorbidity (American Society of Anesthesiologists Physical Status classification), Gleason score and age, but not tumor stage, were independent predictors of overall survival. Based on tumor stage and the identified independent prognostic factors, an easily applicable prognostic score was developed to predict overall mortality. CONCLUSION A prognostic classification of radical prostatectomy patients based on Gleason score, comorbidity and age and supplementary to a coarsened variant of the tumor node metastasis classification may be of clinical value.
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Affiliation(s)
- Michael Froehner
- Department of Urology, University Hospital "Carl Gustav Carus", Technical University of Dresden, Dresden, Germany.
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Gates TJ, Beelen MJ, Hershey CL. Cancer Screening in Men. Prim Care 2006; 33:115-38, ix. [PMID: 16516683 DOI: 10.1016/j.pop.2005.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Thomas J Gates
- Department of Family and Community Medicine, Lancaster General Hospital, 555 North Duke Street, Lancaster, PA 17604, USA.
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Aus G, Damber JE, Khatami A, Lilja H, Stranne J, Hugosson J. Individualized screening interval for prostate cancer based on prostate-specific antigen level: results of a prospective, randomized, population-based study. ACTA ACUST UNITED AC 2005; 165:1857-61. [PMID: 16157829 PMCID: PMC1950470 DOI: 10.1001/archinte.165.16.1857] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate the future cumulative risk of prostate cancer in relation to levels of prostate-specific antigen (PSA) in blood and to determine whether this information could be used to individualize the PSA testing interval. METHODS The study included 5855 of 9972 men (aged 50-66 years) who accepted an invitation to participate in a prospective, randomized study of early detection for prostate cancer. We used a protocol based on biennial PSA measurements starting from 1995 and 1996. Men with serum PSA levels of 3.0 ng/mL or more were offered prostate biopsies. RESULTS Among the 5855 men, 539 cases of prostate cancer (9.2%) were detected after a median follow-up of 7.6 years (up to July 1, 2003). Cancer detection rates during the follow-up period in relation to PSA levels were as follows: 0 to 0.49 ng/mL, 0% (0/958); 0.50 to 0.99 ng/mL, 0.9% (17/1992); 1.00 to 1.49 ng/mL, 4.7% (54/1138); 1.50 to 1.99 ng/mL, 12.3% (70/571); 2.00 to 2.49 ng/mL, 21.4% (67/313); 2.50 to 2.99 ng/mL, 25.2% (56/222); 3.00 to 3.99 ng/mL, 33.3% (89/267); 4.00 to 6.99 ng/mL, 38.9% (103/265); 7.00 to 9.99 ng/mL, 50.0% (30/60); and for men with an initial PSA of 10.00 ng/mL or higher, 76.8% (53/69). Not a single case of prostate cancer was detected within 3 years in 2950 men (50.4% of the screened population) with an initial PSA level less than 1 ng/mL. CONCLUSIONS Retesting intervals should be individualized on the basis of the PSA level, and the large group of men with PSA levels of less than 1 ng/mL can safely be scheduled for a 3-year testing interval.
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Affiliation(s)
- Gunnar Aus
- Department of Urology, Sahlgrens University Hospital, Göteborg, Sweden.
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Rodríguez Alonso A, González Blanco A, Pita Fernandez S, Suárez Pascual G, Bonelli Martín C, Lorenzo Franco J, Alvarez Fernández JC, Cuerpo Pérez MA. Diagnóstico del cáncer de próstata mediante biopsia ampliada de 24 cilindros. Actas Urol Esp 2005; 29:934-42. [PMID: 16447590 DOI: 10.1016/s0210-4806(05)73373-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine the diagnostic performance of extended prostatic biopsy (PB) in prostate cancer (PC) and variables affecting positivity. MATERIALS AND METHODS Patients (n = 147) underwent 24 cylinder PB at the Arquitecto Marcide Hospital, Ferrol, La Coruña, between December 2002-September 2004. Inclusion criteria were the following: patients aged < or = 70 with one or more negative PB or aged < or = 75 with two or more negative PB. An univariate analysis was carried out using the chi-squared test for the qualitative variables and the t-Student and U Mann-Whitney tests in the case of the quantitative variables, plus a logistical regression analysis in order to identify those variables related to the extended PB positivity. RESULTS 60 patients (40.82%) were identified as having PC. Significant differences were observed in prostatic volume, free/total PSA ratio in the initial PB, free/total PSA ratio in the extended PB, PSA-density in the extended PB as well as the existence of chronic prostatitis in previous PB. During the multivariate analysis it was found that the PSA-density and the presence of chronic prostatitis in previous PB independently predicted the positivity of the extended PB. CONCLUSIONS Extended PB allows for the detection of PC in 40.82% of patients with previous negative PB. The increase in PSA density is associated with a greater probability of PC, whilst the existence of chronic prostatitis in prior PB significantly reduces the probability of PC in the extended PB.
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Abstract
The discovery and the use of serum prostate specific antigen (PSA) has considerably improved the diagnosis of prostate cancer during the past 20 years. Before PSA era, early diagnosis was only based on the digital rectal examination (DRE) of which the Limitations have been evidenced; over half of the tumours diagnosed by such means had already spread out of the prostate and were incurable. Assessment of serum PSA has allowed the diagnosis to be made at an earlier stage of the disease, curable by current treatments. Whichever the diagnostic tools, transrectal ultrasound (TRUS) prostatic biopsies remain necessary for diagnosis ascertainment, taking into account the low specificity of PSA assessment. The feasibility of a diagnosis at an early and curable stage of the disease has logically resulted in screening procedures aimed at reducing the high mortality related to prostate cancer. The numerous publications on prostate cancer screening provide precise information on the accuracy of available diagnostic means (PSA, DRE, TRUS, combined PSA and DRE), on the characteristics of screened tumours (stage and differentiation), and also on the population of men likely to benefit from the screening (age at beginning and end of the screening, frequency of PSA testing, identification of the men with ethnic and/or genetic predisposition). In those early diagnosed prostate cancers, the assessment of loco-regional cancer extension (extracapsular and/or, microscopic nodal involvement), remains unsatisfactory because no imaging technique (ultrasonography, CT scan, MRI,...) allows visualising the tumour itself or microscopic metastases. Nevertheless, the combination of multiple parameters such as DRE data, PSA level, biopsy data and tumour differentiation helps approaching with an increasing precision (nomograms) the true pathologic stage of the disease. Such advances allow distinguishing, among the very heterogeneous group of prostate cancers, tumours that differ from one to another in terms of disease stage, progression and prognosis, which is helpful for the determination of an adapted therapeutic strategy.
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Affiliation(s)
- G Fournier
- Service d'urologie, Centre hospitalier universitaire de Brest, hôpital de la Cavale Blanche, boulevard Tanguy-Prigent, 29609 Brest, France.
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Abstract
Benign prostatic hyperplasia (BPH) is a common condition, which increases with increasing age. Although not a life-threatening condition, BPH can significantly affect quality of life. BPH manifests clinically with lower urinary tract symptoms (LUTS) and may be associated with sexual dysfunction. As many as 60% of men aged 60 years have some degree of clinical BPH. With the projected increases in the distribution of people over the age of 60, BPH isset to become an even greater problem in men's health.
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Affiliation(s)
- Majid Shabbir
- Department of Surgery, Royal Free and University College Medical School, Royal Free Campus, London NW3 2QG, England
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Luboldt HJ, Fornara P, Weissbach L, Wirth M, Lorenz W, Rübben H. Systematic Development of a Guideline for Early Detection of Prostate Cancer: The German Way in the Evidence Gap. Eur Urol 2004; 46:725-30. [PMID: 15548439 DOI: 10.1016/j.eururo.2004.07.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2004] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop an evidence-based guideline, helping physcians make prudent decisions about diagnostic care for men wishing to undergo examination for early detection of prostate cancer. METHODS A guideline development group, comprised of twenty healthcare professionals, including urologists, clinical chemists, pathologists, geriatricians, epidemiologists, technicians and a member of a patient self-help group, systematically gathered, evaluated, and discussed the most recent research available on early detection of prostate cancer. Nominal group technique (NGT) was employed to facilitate the decision-making process. RESULTS The NGT was sufficient to find a consensus among different medical disciplines in a timely fashion. A standardized guideline, containing a short version for physicians and a standardized patient information booklet, for nation-wide use was developed. CONCLUSIONS Population-based screening is not favoured, instead information should be given to men in their 50-70s, to enable shared decision-making between physician and patient for or against PSA-based early detection of prostate cancer.
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Affiliation(s)
- H-J Luboldt
- Department of Urology, University of Duisburg-Essen, Hufelandstr. 55, Essen, Germany.
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Secin FP, Carver B, Kattan MW, Eastham JA. Current Recommendations for Delaying Renal Transplantation after Localized Prostate Cancer Treatment: Are They Still Appropriate? Transplantation 2004; 78:710-2. [PMID: 15371673 DOI: 10.1097/01.tp.0000130176.82960.fd] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Since the advent of prostate-specific antigen (PSA) testing, most men diagnosed with prostate cancer (PC) have localized disease, which is curable with surgery or radiation therapy. Current policy for patients with end-stage renal disease (ESRD) and PC recommends waiting 5 years after primary therapy before enrollment on the transplant waiting list. The risk of dying during 5 years of dialysis is approximately 59%, whereas the risk of PC recurrence after surgery is generally much lower. Prognostic tools called nomograms can accurately assess a patient's probability of PC recurrence. This prompted the authors to reexamine current transplantation policy for patients with PC. METHODS The authors reviewed the Sloan-Kettering PC database to identify patients on dialysis undergoing radical prostatectomy. Clinical and pathologic features were analyzed to determine the likelihood of disease recurrence. RESULTS The authors identified two patients with ESRD in their PC database. Both men had elevated serum PSA detected during routine pretransplantation evaluation, and biopsy confirmed the PC. Both opted for surgery, with pathologic analysis revealing organ-confined disease and negative surgical margins. The postoperative nomogram predicted 7-year progression-free probabilities of 95% and 98%. Given the high likelihood of cure of their PC, immediate consideration for renal transplantation seemed appropriate for both patients. CONCLUSIONS PSA-based screening of the dialysis population has ensured earlier detection of PC. Given that nomograms will accurately predict the risk of PC recurrence, the time a patient must wait for a transplant should be based on this individualized risk assessment rather than on a general rule.
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Affiliation(s)
- Fernando P Secin
- Department of Urology, Memorial Sloan Kettering Cancer Center, 353 East 68th Street, New York, NY 10021, USA
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Roobol MJ, Schröder FH. European Randomized Study of Screening for Prostate Cancer: achievements and presentation. BJU Int 2004; 92 Suppl 2:117-22. [PMID: 14983969 DOI: 10.1111/j.1464-410x.2003.4698x.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Schmid HP, Riesen W, Prikler L. Update on screening for prostate cancer with prostate-specific antigen. Crit Rev Oncol Hematol 2004; 50:71-8. [PMID: 15094160 DOI: 10.1016/j.critrevonc.2003.11.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2003] [Indexed: 11/16/2022] Open
Abstract
Serum prostate-specific antigen (PSA) determination in conjunction with digital rectal examination (DRE) is recommended by the majority of clinical guidelines for early detection(opportunistic screening) of prostate cancer provided the patient is well informed and has a life-expectancy of at least 10 years. The major disadvantage of PSA is its lack of specificity. Various static and dynamic concepts have been developed to improve the diagnostic performance of PSA of which free/total PSA ratio and PSA doubling time seem to be the most promising. Apart from early detection, population screening(mass screening) is a distinct topic. The effect of the latter one with regard to reduction of prostate cancer specific mortality and quality of life issues is not yet clear. Several national and international prospective trials are currently being conducted to answer these important questions but results will only be available in a few years.
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Affiliation(s)
- Hans-Peter Schmid
- Department of Urology, Kantonsspital, CH-9007 St. Gallen, Switzerland.
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