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Simpkin AJ, Donovan JL, Tilling K, Athene Lane J, Martin RM, Albertsen PC, Bill-Axelson A, Ballentine Carter H, Bosch JLHR, Ferrucci L, Hamdy FC, Holmberg L, Jeffrey Metter E, Neal DE, Parker CC, Metcalfe C. Prostate-specific antigen patterns in US and European populations: comparison of six diverse cohorts. BJU Int 2016; 118:911-918. [PMID: 26799945 DOI: 10.1111/bju.13422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether there are differences in prostate-specific antigen (PSA) levels at diagnosis or changes in PSA levels between US and European populations of men with and without prostate cancer (PCa). SUBJECTS AND METHODS We analysed repeated measures of PSA from six clinically and geographically diverse cohorts of men: two cohorts with PSA-detected PCa, two cohorts with clinically detected PCa and two cohorts without PCa. Using multilevel models, average PSA at diagnosis and PSA change over time were compared among study populations. RESULTS The annual percentage PSA change of 4-5% was similar between men without cancer and men with PSA-detected cancer. PSA at diagnosis was 1.7 ng/mL lower in a US cohort of men with PSA-detected PCa (95% confidence interval 1.3-2.0 ng/mL), compared with a UK cohort of men with PSA-detected PCa, but there was no evidence of a different rate of PSA change between these populations. CONCLUSION We found that PSA changes over time are similar in UK and US men diagnosed through PSA testing and even in men without PCa. Further development of PSA models to monitor men on active surveillance should be undertaken in order to take advantage of these similarities. We found no evidence that guidelines for using PSA to monitor men cannot be passed between US and European studies.
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Affiliation(s)
- Andrew J Simpkin
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jenny L Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kate Tilling
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J Athene Lane
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Richard M Martin
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- NIHR Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK
| | - Peter C Albertsen
- Division of Urology, University of Connecticut Health Center, Farmington, CT, USA
| | - Anna Bill-Axelson
- Institution of Surgical Sciences, Department of Urology, Uppsala University, Uppsala, Sweden
| | | | - J L H Ruud Bosch
- Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health, Baltimore, MA, USA
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Lars Holmberg
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Regional Cancer Centre, Uppsala/Örebro Region, Uppsala, Sweden
| | - E Jeffrey Metter
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - David E Neal
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Christopher C Parker
- Academic Urology Unit, Royal Marsden Hospital, Institute of Cancer Research, London, UK
| | - Chris Metcalfe
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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2
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Renard-Penna R, Rouvière O, Puech P, Borgogno C, Abbas L, Roy C, Claudon M, Correas JM, Cormier L, Ploussard G, Mejean A, Tezenas-du-Montcel S, Rozet F. Current practice and access to prostate MR imaging in France. Diagn Interv Imaging 2016; 97:1125-1129. [PMID: 27451262 DOI: 10.1016/j.diii.2016.06.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 06/18/2016] [Accepted: 06/23/2016] [Indexed: 01/09/2023]
Abstract
PURPOSE To obtain an overview of the degree of discrepancy between current clinical practice of prostate magnetic resonance imaging (MRI) in France and recommendations. MATERIALS AND METHODS A brief survey was sent to 1229 members of the French society of urology in order to identify their indications of prostate MRI and its impact on patient management. The urologists were asked to answer several questions regarding age, practice modality, prostate MRI examinations (technique, indication before first biopsy, second biopsy, cancer staging, active surveillance, recurrence, focal therapy) and quality of reports. RESULTS A total of 445 responses were received (participation rate of 36%). The mean delay for obtaining an appointment for prostate MRI ranged between 15-30 days in 54%. Fifty-four percent of MRI reports contained a PIRADS score and 23% a Likert score. The indications of multiparametric-MRI were tumor detection/location prior to repeat biopsy (90%), cancer staging (85%), management of patients under active surveillance (85%), selection of candidates to focal therapy (63%), tumor detection/location in biopsy naïve patients (53%), detection of local recurrence after radical (51%). Only 119 urologists (28.6%) had access to image fusion (MRI and transrectal ultrasound) and 351 (85.4%) used cognitive fusion. Mostly, targeted biopsies are done by urologists alone (nearly 80%), a very few are done by radiologists (8%) or by the two of them in collaboration (12%). CONCLUSION The majority of urologists consider that prostate MRI is essential for the management of patients with prostate cancer. Practices are ahead of recommendations particularly before the first biopsy and in active surveillance.
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Affiliation(s)
- R Renard-Penna
- Department of radiology, hôpital Tenon, Pitié-Salpétrière hospital, AP-HP, GRC n(o) 5, ONCOTYPE-URO, institut universitaire de cancérologie, UPMC université Paris 06, 83, boulevard de l'Hôpital, 75013 Paris, France.
| | - O Rouvière
- Hospices civils de Lyon, department of urinary and vascular radiology, hôpital Édouard-Herriot, 69437 Lyon, France; Faculté de médecine Lyon Est, université de Lyon, université Lyon 1, 69003 Lyon, France
| | - P Puech
- Department of radiology, Inserm, university de Lille, U1189 - ONCO-THAI - Image assisted laser therapy for oncology, CHU de Lille, 59000 Lille, France
| | - C Borgogno
- Department of urology, René-Dubos hospital, 95300 Pontoise, France
| | - L Abbas
- AP-HP, Pitié-Salpétrière hospital, department of biostatistics, public health and medical information, 75013 Paris, France; Sorbonne université, UPMC université-Paris 06 UMR_S1136, Inserm UMR_S 1136, institut Pierre-Louis d'épidémiologie et de Santé publique, 75013 Paris, France
| | - C Roy
- Department of radiology B, universitary hospital of Strasbourg, Civil hospital, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - M Claudon
- Department of radiology adults, Brabois hospital, university of Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - J-M Correas
- Department of radiology, hospital Necker, 75015 Paris, France
| | - L Cormier
- Bourgogne university, academic department of urology, 21000 Dijon, France
| | - G Ploussard
- Department of urology, Saint-Louis hospital, Assistance publique-Hôpitaux de Paris, université Paris Diderot, Paris 7, Sorbonne Paris Cité, Paris, France
| | - A Mejean
- AP-HP, HEGP academic department of urology, 75007 Paris, France
| | - S Tezenas-du-Montcel
- AP-HP, Pitié-Salpétrière hospital, department of biostatistics, public health and medical information, 75013 Paris, France; Sorbonne université, UPMC université-Paris 06 UMR_S1136, Inserm UMR_S 1136, institut Pierre-Louis d'épidémiologie et de Santé publique, 75013 Paris, France
| | - F Rozet
- Montsouris institute, urology department, 75014 Paris, France
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3
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Simpkin AJ, Rooshenas L, Wade J, Donovan JL, Lane JA, Martin RM, Metcalfe C, Albertsen PC, Hamdy FC, Holmberg L, Neal DE, Tilling K. Development, validation and evaluation of an instrument for active monitoring of men with clinically localised prostate cancer: systematic review, cohort studies and qualitative study. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundActive surveillance [(AS), sometimes called active monitoring (AM)],is a National Institute for Health and Care Excellence-recommended management option for men with clinically localised prostate cancer (PCa). It aims to target radical treatment only to those who would benefit most. Little consensus exists nationally or internationally about safe and effective protocols for AM/AS or triggers that indicate if or when men should move to radical treatment.ObjectiveThe aims of this project were to review how prostate-specific antigen (PSA) has been used in AM/AS programmes; to develop and test the validity of a new model for predicting future PSA levels; to develop an instrument, based on PSA, that would be acceptable and effective for men and clinicians to use in clinical practice; and to design a robust study to evaluate the cost-effectiveness of the instrument.MethodsA systematic review was conducted to investigate how PSA is currently used to monitor men in worldwide AM/AS studies. A model for PSA change with age was developed using Prostate testing for cancer and Treatment (ProtecT) data and validated using data from two PSA-era cohorts and two pre-PSA-era cohorts. The model was used to derive 95% PSA reference ranges (PSARRs) across ages. These reference ranges were used to predict the onset of metastases or death from PCa in one of the pre-PSA-era cohorts. PSARRs were incorporated into an active monitoring system (AMS) and demonstrated to 18 clinicians and 20 men with PCa from four NHS trusts. Qualitative interviews investigated patients’ and clinicians’ views about current AM/AS protocols and the acceptability of the AMS within current practice.ResultsThe systematic review found that the most commonly used triggers for clinical review of PCa were PSA doubling time (PSADT) < 3 years or PSA velocity (PSAv) > 1 ng/ml/year. The model for PSA change (developed using ProtecT study data) predicted PSA values in AM/AS cohorts within 2 ng/ml of observed PSA in up to 79% of men. Comparing the three PSA markers, there was no clear optimal approach to alerting men to worsening cancer. The PSARR and PSADT markers improved the modelc-statistic for predicting death from PCa by 0.11 (21%) and 0.13 (25%), respectively, compared with using diagnostic information alone [PSA, age, tumour stage (T-stage)]. Interviews revealed variation in clinical practice regarding eligibility and follow-up protocols. Patients and clinicians perceive current AM/AS practice to be framed by uncertainty, ranging from uncertainty about selection of eligible AM/AS candidates to uncertainty about optimum follow-up protocols and thresholds for clinical review/radical treatment. Patients and clinicians generally responded positively to the AMS. The impact of the AMS on clinicians’ decision-making was limited by a lack of data linking AMS values to long-term outcomes and by current clinical practice, which viewed PSA measures as one of several tools guiding clinical decisions in AM/AS. Patients reported that they would look to clinicians, rather than to a tool, to direct decision-making.LimitationsThe quantitative findings were severely hampered by a lack of clinical outcomes or events (such as metastases). The qualitative findings were limited through reliance on participants’ reports of practices and recollections of events rather than observations of actual interactions.ConclusionsPatients and clinicians found that the instrument provided additional, potentially helpful, information but were uncertain about the current usefulness of the risk model we developed for routine management. Comparison of the model with other monitoring strategies will require clinical outcomes from ongoing AM/AS studies.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Andrew J Simpkin
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Leila Rooshenas
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Julia Wade
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jenny L Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J Athene Lane
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Richard M Martin
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Chris Metcalfe
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Peter C Albertsen
- Division of Urology, University of Connecticut Health Center, Farmington, CT, USA
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Lars Holmberg
- Faculty of Life Sciences & Medicine, King’s College London, London, UK
- Regional Cancer Centre, Uppsala/Örebro Region, Uppsala, Sweden
| | - David E Neal
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Kate Tilling
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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4
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Simpkin AJ, Tilling K, Martin RM, Lane JA, Hamdy FC, Holmberg L, Neal DE, Metcalfe C, Donovan JL. Systematic Review and Meta-analysis of Factors Determining Change to Radical Treatment in Active Surveillance for Localized Prostate Cancer. Eur Urol 2015; 67:993-1005. [PMID: 25616709 DOI: 10.1016/j.eururo.2015.01.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 01/02/2015] [Indexed: 10/24/2022]
Abstract
CONTEXT Many men with clinically localized prostate cancer are being monitored as part of active surveillance (AS) programs, but little is known about reasons for receiving radical treatment. OBJECTIVES A systematic review of the evidence about AS was undertaken, with a meta-analysis to identify predictors of radical treatment. EVIDENCE ACQUISITION A comprehensive search of the Embase, MEDLINE and Web of Knowledge databases to March 2014 was performed. Studies reporting on men with localized prostate cancer followed by AS or monitoring were included. AS was defined where objective eligibility criteria, management strategies, and triggers for clinical review or radical treatment were reported. EVIDENCE SYNTHESIS The 26 AS cohorts included 7627 men, with a median follow-up of 3.5 yr (range of medians 1.5-7.5 yr). The cohorts had a wide range of inclusion criteria, monitoring protocols, and triggers for radical treatment. There were eight prostate cancer deaths and five cases of metastases in 24,981 person-years of follow-up. Each year, 8.8% of men (95% confidence interval 6.7-11.0%) received radical treatment, most commonly because of biopsy findings, prostate-specific antigen triggers, or patient choice driven by anxiety. Studies in which most men changed treatment were those including only low-risk Gleason score 6 disease and scheduled rebiopsies. CONCLUSIONS The wide variety of AS protocols and lack of robust evidence make firm conclusions difficult. Currently, patients and clinicians have to make judgments about the balance of risks and benefits in AS protocols. The publication of robust evidence from randomized trials and longer-term follow-up of cohorts is urgently required. PATIENT SUMMARY We reviewed 26 studies of men on active surveillance for prostate cancer. There was evidence that studies including men with the lowest risk disease and scheduled rebiopsy had higher rates of radical treatment.
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Affiliation(s)
- Andrew J Simpkin
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
| | - Kate Tilling
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Richard M Martin
- School of Social and Community Medicine, University of Bristol, Bristol, UK; NIHR Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK
| | - J Athene Lane
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - David E Neal
- Cancer Research UK, Cambridge Research Institute, Cambridge, UK
| | - Chris Metcalfe
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jenny L Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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5
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Mozer P, Rouprêt M, Le Cossec C, Granger B, Comperat E, de Gorski A, Cussenot O, Renard-Penna R. First round of targeted biopsies using magnetic resonance imaging/ultrasonography fusion compared with conventional transrectal ultrasonography-guided biopsies for the diagnosis of localised prostate cancer. BJU Int 2014; 115:50-7. [PMID: 24552477 DOI: 10.1111/bju.12690] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To assess the accuracy of magnetic resonance imaging (MRI)/transrectal ultrasonography (TRUS) fusion to guide first-round biopsies in the diagnosis of localised prostate cancer (PCa) in men with a prostate-specific antigen (PSA) ≤10 ng/mL. PATIENTS AND METHODS A prospective study was conducted on men who met the following criteria: first-round biopsy, multiparametric MRI (mpMRI) showing a lesion with a Likert score ≥2 and a PSA <10 ng/mL. All men underwent a extended 12-core protocol plus a protocol of two or three targeted cores on the mpMRI index lesion. The UroStation (Koelis, Grenoble, France) and a V10 ultrasound system with an end-fire three-dimensional TRUS transducer were used for the fusion imaging procedure. Significant PCa was defined as: at least one core with a Gleason score of 3 + 4 or 6 with a maximum cancer core length ≥4 mm. RESULTS A total of 152 men, whose median PSA level was 6 ng/mL, were included in the study. The proportion of positive cores was significantly higher with the targeted-core protocol than with the extended 12-core protocol (P < 0.001). The proportion of men with clinically significant PCa was higher with the targeted-core protocol than with the extended 12-core protocol (P = 0.03). The proportion of patients having at least one positive biopsy (targeted-core protocol) was significantly different among the Likert score categories (P < 0.001). CONCLUSIONS For the first round of biopsies, MRI/TRUS-fusion targeted biopsies detected more men with clinically significant PCa than did standard extended 12-core biopsy alone.
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Affiliation(s)
- Pierre Mozer
- Academic Department of Urology, AP-HP, Hopital Pitié-Salpétrière, Paris, France; UPMC University of Paris 06, Institut des Systèmes Intelligents et de Robotique
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6
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Simpkin AJ, Metcalfe C, Martin RM, Lane JA, Donovan JL, Hamdy FC, Neal DE, Tilling K. Longitudinal prostate-specific antigen reference ranges: Choosing the underlying model of age-related changes. Stat Methods Med Res 2013; 25:1875-1891. [PMID: 24108270 DOI: 10.1177/0962280213503928] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Serial measurements of prostate-specific antigen (PSA) are used as a biomarker for men diagnosed with prostate cancer following an active monitoring programme. Distinguishing pathological changes from natural age-related changes is not straightforward. Here, we compare four approaches to modelling age-related change in PSA with the aim of developing reference ranges for repeated measures of PSA. A suitable model for PSA reference ranges must satisfy two criteria. First, it must offer an accurate description of the trend of PSA on average and in individuals. Second, it must be able to make accurate predictions about new PSA observations for an individual and about the entire PSA trajectory for a new individual.
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Affiliation(s)
- Andrew J Simpkin
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Chris Metcalfe
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Richard M Martin
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J Athene Lane
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jenny L Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - David E Neal
- Cambridge Research Institute Cancer Research, Cambridge, UK
| | - Kate Tilling
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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7
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Abstract
Mechanisms postulated to link folate and B12 metabolism with cancer, including genome-wide hypomethylation, gene-specific promoter hypermethylation, and DNA uracil misincorporation, have been observed in prostate tumor cells. However, epidemiological studies of prostate cancer risk, based on dietary intakes and blood levels of folate and vitamin B12 and on folate-pathway gene variants, have generated contradictory findings. In a meta-analysis, circulating concentrations of B12 (seven studies, OR = 1.10; 95% CI 1.01, 1.19; P = 0.002) and (in cohort studies) folate (five studies, OR = 1.18; 95% CI 1.00, 1.40; P = 0.02) were positively associated with an increased risk of prostate cancer. Homocysteine was not associated with risk of prostate cancer (four studies, OR = 0.91; 95% CI 0.69, 1.19; P = 0.5). In a meta-analysis of folate-pathway polymorphisms, MTR 2756A > G (eight studies, OR = 1.06; 95% CI 1.00, 1.12; P = 0.06) and SHMT1 1420C > T (two studies, OR = 1.11; 95% CI 1.00, 1.22; P = 0.05) were positively associated with prostate cancer risk. There were no effects due to any other polymorphisms, including MTHFR 677C > T (12 studies, OR = 1.04; 95% CI 0.97, 1.12; P = 0.3). The positive association of circulating B12 with an increased risk of prostate cancer could be explained by reverse causality. However, given current controversies over mandatory B12 fortification, further research to eliminate a causal role of B12 in prostate cancer initiation and/or progression is required. Meta-analysis does not entirely rule out a positive association of circulating folate with increased prostate cancer risk. As with B12, even a weak positive association would be a significant public health issue, given the high prevalence of prostate cancer and concerns about the potential harms versus benefits of mandatory folic acid fortification.
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Drouin SJ, Comperat E, Cussenot O, Bitker MO, Haertig A, Rouprêt M. Clinical characteristics and pathologic findings in patients eligible for active surveillance who underwent radical prostatectomy. Urol Oncol 2012; 30:402-7. [DOI: 10.1016/j.urolonc.2010.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 04/09/2010] [Accepted: 04/12/2010] [Indexed: 10/19/2022]
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9
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Rowlands MA, Holly JMP, Hamdy F, Phillips J, Goodwin L, Marsden G, Gunnell D, Donovan J, Neal DE, Martin RM. Serum insulin-like growth factors and mortality in localised and advanced clinically detected prostate cancer. Cancer Causes Control 2011; 23:347-54. [PMID: 22183619 DOI: 10.1007/s10552-011-9883-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 12/05/2011] [Indexed: 12/14/2022]
Abstract
CONTEXT Many studies have reported associations of insulin-like growth factors (IGFs) and IGF-binding proteins (IGFBPs) with prostate cancer development, but none have investigated their association with fatal progression of prostate cancer. OBJECTIVE We investigated associations of circulating IGF-I, IGF-II, IGFBP-2 and IGFBP-3 with all-cause and prostate cancer mortality in men with clinically identified prostate cancer, stratified by whether localised (stage T1 or T2) or advanced (T3, T4, N1 or M1) at diagnosis. DESIGN, SETTING AND PARTICIPANTS UK hospital-based cohort study of 396 men with prostate cancer, diagnosed between 1990 and 2008, with mean follow-up of 3.7 years. MAIN OUTCOME MEASURES All-cause and prostate cancer-specific mortality. RESULTS In men with advanced cancer, there was some evidence that IGF-I was positively associated (HR 1.20; 95% CI: 0.96, 1.49; p = 0.11) and IGFBP-3 was inversely associated (HR 0.84; 95% CI: 0.70, 1.01; p = 0.07) with all-cause mortality after controlling for age, treatment status, smoking, prostate-specific antigen and Gleason grade at diagnosis. There was some evidence that IGF-I was positively associated with prostate cancer mortality in advanced cases (HR 1.23; 95% CI: 0.94, 1.62; p = 0.13). In advanced cancers, associations of IGF-I with all-cause (HR 1.68; 95% CI: 1.28, 2.23; p < 0.001) and prostate cancer-specific (HR 1.59; 95% CI: 1.11, 2.28; p = 0.01) mortality strengthened (and were conventionally statistically significant) after further controlling for IGFBP-3. CONCLUSIONS Measures of IGF-I and IGFBP-3 may have potential as prognostic markers in predicting risk of death in men with advanced prostate cancer. Large, prospective studies with repeat IGFs and IGFBPs are now required.
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Affiliation(s)
- Mari-Anne Rowlands
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
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10
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Prisman EZ, Gafni A, Finelli A. A stochastic approach to risk management for prostate cancer patients on active surveillance. J Theor Biol 2011; 284:61-70. [DOI: 10.1016/j.jtbi.2011.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 05/31/2011] [Accepted: 06/14/2011] [Indexed: 01/29/2023]
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11
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Prisman EZ, Gafni A, Finelli A. Testing the evolution process of prostate-specific antigen in early stage prostate cancer: what is the proper underlying model? Stat Med 2011; 30:3038-49. [PMID: 21826698 DOI: 10.1002/sim.4329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 06/02/2011] [Indexed: 11/09/2022]
Abstract
This paper empirically tests a model of stochastic evolutions of prostate-specific antigen (PSA), a trigger for intervention in an early stage prostate cancer surveillance program. It conducts hypothesis testing of the Geometric Browning Motion model based on its attributes of independent increments and linearity of the variance in the increment length versus a wide range of stochastic and deterministic alternatives. These alternatives include the currently accepted deterministic growth model. The paper reports strong empirical evidence in favour of the Geometric Browning Motion model. A model that best describes PSA evolution is a prerequisite to the establishment of decision-making criteria for abandoning active surveillance (i.e. a strategy that involves close monitoring) in early stage prostate cancer. Thus, establishing empirically the type of PSA process is a first step toward the identification of more accurate triggers for abandoning active surveillance and starting treatment while the chances of curing the disease are still high.
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Affiliation(s)
- Eliezer Z Prisman
- Schulich School of Business, York University, Toronto, Ontario, Canada.
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12
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Lane JA, Hamdy FC, Martin RM, Turner EL, Neal DE, Donovan JL. Latest results from the UK trials evaluating prostate cancer screening and treatment: the CAP and ProtecT studies. Eur J Cancer 2011; 46:3095-101. [PMID: 21047592 DOI: 10.1016/j.ejca.2010.09.016] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 08/11/2010] [Accepted: 09/07/2010] [Indexed: 11/19/2022]
Abstract
The European Randomised Study of Screening for Prostate Cancer (ERSPC) demonstrated a significant reduction in prostate cancer-specific mortality. The ongoing Comparison Arm for ProtecT (CAP) cluster randomised controlled trial (RCT) evaluates prostate cancer screening effectiveness by comparing primary care centres allocated to a round of prostate specific antigen (PSA) testing (intervention) or standard clinical care. Over 550 centres (around 450,000 men) were randomised in eight United Kingdom areas (2002-2008). Intervention group participants were also eligible for the ProtecT (Prostate testing for cancer and Treatment) RCT evaluating active monitoring, radiotherapy and radical prostatectomy treatments for localised prostate cancer. In ProtecT, over 1500 of around 3000 men with prostate cancer were randomised from over 10,000 with an elevated PSA in around 111,000 attendees at clinics. Investigation of the psychological impact of screening in a sub-sample showed that 10% of men still experienced high distress up to 3 months following prostate biopsies (22/227), although most were relatively unaffected. The risk of prostate cancer with a raised PSA was lower if urinary symptoms were present (frequent nocturia odds ratio (OR) 0.44, 95% confidence interval (CI) 0.22-0.83) or if a repeat PSA decreased by > or = 20% prior to biopsy (OR 0.43, 95% CI 0.35-0.52). Men aged 45-49 years attended PSA clinics less frequently (442/1299, 34%) in a nested cohort with a cancer detection rate of 2.3% (10/442). The CAP and ProtecT trials (ISRCTN92187251 and ISRCTN20141217) will help resolve the prostate cancer screening debate, define the optimum treatment for localised disease and generate evidence to improve men's health.
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Affiliation(s)
- J A Lane
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
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13
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Pashayan N, Pharoah P, Neal DE, Hamdy F, Donovan J, Martin RM, Greenberg D, Duffy SW. PSA-detected prostate cancer and the potential for dedifferentiation--estimating the proportion capable of progression. Int J Cancer 2011; 128:1462-70. [PMID: 20499312 DOI: 10.1002/ijc.25471] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The aims were to determine whether prostate-specific antigen (PSA)-detected prostate cancers progress to higher Gleason score during the preclinical screen-detectable phase, and, if so, to estimate the proportion of tumours with progressive potential. We developed two multi-state Markov chain models to represent the natural history of two tumour populations, one with (Model I) and the other without (Model II) the potential for progression. For each, we derived the transition rates between the states and used these estimates to calculate the expected prevalence of preclinical low and intermediate-to-high Gleason score prostate cancers, using data from the Prostate Testing for Cancer and Treatment (ProtecT) study on 2,310 prostate cancers detected by PSA testing in 71,511 men 50-69 years. We compared the expected prevalence for each tumour population to that of the observed based on ProtecT and the European Randomised Study on Screening for Prostate Cancer (ERSPC)-Rotterdam Centre's first round screening data, the latter allowing independent assessment of the two models. The overall expected proportion of low Gleason score tumours was 0.56 under Model I and 0.81 under Model II, whereas the observed proportion based on either ProtecT or ERSPC-Rotterdam was 0.69. Using the observed prevalence from ERSPC-Rotterdam, we estimated that 22, 33 and 66% of the tumours in men aged 55-59, 60-64 and 65-69 years, respectively, had the potential for progression in the preclinical phase. PSA-detected prostate cancers are a mixture of progressive and non-progressive tumours with respect to Gleason score. The former may potentially benefit from screening. Identifying cancers with the potential for progression is important to target screening.
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Affiliation(s)
- Nora Pashayan
- Department of Public Health and Primary Care, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge, United Kingdom.
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14
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Associations of Folate, Vitamin B12, Homocysteine, and Folate-Pathway Polymorphisms with Prostate-Specific Antigen Velocity in Men with Localized Prostate Cancer. Cancer Epidemiol Biomarkers Prev 2010; 19:2833-8. [DOI: 10.1158/1055-9965.epi-10-0582] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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15
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Regional trends in prostate cancer incidence, treatment with curative intent and mortality in Norway 1980–2007. Cancer Epidemiol 2010; 34:359-67. [DOI: 10.1016/j.canep.2010.04.017] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 04/26/2010] [Accepted: 04/28/2010] [Indexed: 11/18/2022]
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