Prostate-specific antigen-based screening for prostate cancer in the third millennium: useful or hype?

Predictive value of controlling nutritional status score for prostate cancer diagnosis

Objective

This study aims to explore the predictive value of the Controlling Nutritional Status (CONUT) score for prostate cancer (PCa) diagnosis.

Methods

The data of 114 patients who underwent prostate needle biopsies from June 2020 to December 2022 were retrospectively analyzed. The relationship between CONUT score and various clinical factors as well as PCa diagnosis was evaluated.

Results

The pathological results classified patients into the PCa (n = 38) and non-PCa (n = 76) groups. Compared with the non-PCa group, the PCa group exhibited statistically significant differences in age, prostate-specific antigen (PSA), PSA density (PSAD), the proportion of PI-RADS ≥ 3 in mpMRI, and the CONUT score, prostate volume, lymphocyte count, and total cholesterol concentration (p < 0.05). ROC curve analyses indicated the diagnostic accuracy as follows: age (AUC = 0.709), prostate volume (AUC = 0.652), PSA (AUC = 0.689), PSAD (AUC = 0.76), PI-RADS ≥ 3 in mpMRI (AUC = 0.846), and CONUT score (AUC = 0.687). When CONUT score was combined with PSA and PSAD, AUC increased to 0.784. The AUC of CONUT score combined with PSA, PSAD, and mpMRI was 0.881, indicates a higher diagnostic value. Based on the optimal cut-off value of CONUT score, compared with the low CONUT score group, the high CONUT score group has a higher positive rate of PCa diagnosis (p < 0.05).

Conclusion

CONUT score is an excellent auxiliary index for PCa diagnosis in addition to the commonly used PSA, PSAD, and mpMRI in clinical practice. Further prospective trials with a larger sample size are warranted to confirm the present study findings.

Cell-free DNA as a Promising Diagnostic Biomarker in Prostate Cancer: A Systematic Review and Meta-Analysis

Objective

The detection of cell-free DNA (cfDNA) as a part of “liquid biopsy” of prostate cancer (PCa) has been widely explored. However, its diagnostic value for PCa remains controversial. Based on the data from the latest literature published in the past decade, the present review was conducted to clarify the diagnostic value of cfDNA in PCa.

Methods

The related studies were systematically searched in the databases of PubMed, Embase, Web of Science, and Cochrane Library from January 1, 2010 to December 1, 2020. Sensitivity (SEN), specificity (SPE), and other relative parameters were pooled using a random model.

Results

14 eligible studies with 1049 PCa patients and 973 controls were selected based on the inclusion and exclusion criteria. Results demonstrated that cfDNA showed favorable SPE (0.89, 95% CI: 0.79, 0.94) but unsatisfied SEN (0.56, 95% CI: 0.43, 0.68) in the PCa diagnosis. The positive likelihood ratios (PLR), negative likelihood ratios (NLR), and diagnostic odds ratios (DOR) were 5.1 (95% CI: 3.1, 8.5), 0.49 (95% CI: 0.39, 0.63), and 10 (95% CI: 6, 17), respectively. The summary receiver operating characteristic graph (SROC) with an area under the curve (AUC) of 0.80 (95% CI: 0.76, 0.83) was constructed which indicated favorable diagnostic accuracy for PCa. Results of the subgroup analysis and metaregression analysis reminded “ethnicity” and “methylation” might be sources of heterogeneity. The potential publication bias was not found using Deek's funnel plot asymmetry test (p > 0.05).

Conclusions

Our meta-analysis illustrated that the cfDNA could undertake a promising role in the PCa diagnosis.

Predictive value of the monocyte-to-lymphocyte ratio in the diagnosis of prostate cancer

It has been reported that inflammation and immune system are related to prostate cancer. The neutrophil-to-lymphocyte ratio (NLR), as well as the platelet-to-lymphocyte ratio (PLR), have already been proposed as new indices to help diagnose prostate cancer (PCa). However, the monocyte-to-lymphocyte ratio (MLR) with regard to PCa has rarely been mentioned.To investigate the capability of the MLR to predict PCa.Patients who were pathologically diagnosed with PCa in our hospital and healthy control subjects who conformed to the inclusion criteria were enrolled. Patient data were recorded, including age, complete blood counts, blood biochemistry, and serum prostate-specific antigen (PSA) levels. The differences in these data between the groups were analyzed and the diagnostic value of the MLR was compared with PSA.Our study included a total of 100 patients with PCa and 103 healthy control subjects. Patients with PCa presented with a significantly higher NLR, MLR, and PLR compared to control subjects. However, the hemoglobin and lymphocyte levels were lower (P < .05) in PCa patients. The area under the curve (AUC) of PSA and ratio of free/total serum prostate-specific antigen were 0.899 (95% confidence interval [CI]: 0.857-0.942) and 0.872 (95% CI: 0.818-0.926), respectively, while the AUC of the MLR was 0.852 (95% CI: 0.798-0.906), which was higher than that of the NLR, PLR, and any other blood parameters. Additionally, the optimal cut-off value of the MLR for PCa was 0.264, with a specificity of 87.4% and a sensitivity of 72.0%. An evaluation of the diagnostic value of MLR + PSA gave an AUC of 0.936 (95% CI: 0.902-0.970). However, the AUC of MLR + PSA + f/tPSA was 0.996 (95% CI: 0.991-1.000). The diagnostic value of MLR + NLR + PSA gave an AUC of 0.945 (95% CI: 0.913-0.977), and the specificity is 0.971.PSA remains the most important diagnostic indicator. MLR combined with PSA and f/tPSA has the higher predictive value than PSA. It suggests that MLR may be another good predictive indicator of PCa. It can help reduce the clinical false positive rate.

Diagnostic accuracy of high b-value diffusion weighted imaging for patients with prostate cancer: a diagnostic comprehensive analysis

We performed a meta-analysis to assess the diagnostic accuracy of high b-value diffusion-weighted imaging for patients with prostate cancer. A comprehensive literature search of the PubMed, Excerpta Medica Database, Cochrane Library, China National Knowledge Infrastructure, China Biology Medicine disc, and Wanfang databases from January 1, 1995, to April 30, 2021, was conducted. The quality of the retrieved papers was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and their 95% confidence intervals (CIs) were evaluated using bivariate mixed effects models. A total of twenty-four articles matched the selection criteria and were finally included after screening the titles, abstracts, and full texts of 641 initial articles. The pooled sensitivity and specificity (95% CI) were 0.84 (0.80-0.87) and 0.87 (0.81-0.91), respectively. The pooled positive and negative likelihood ratios (95% CI) were 6.4 (4.4-9.3) and 0.19 (0.16-0.23), respectively. The diagnostic odds ratio was 34 (95% CI: 22-51). The area under the summary receiver operator characteristic curve was 0.91 (95% CI: 0.88-0.93). Subgroup analysis presents similar results. The diagnostic accuracy of high b-value diffusion-weighted imaging was similarly high in the qualitative and quantitative evaluation of prostate cancer.

lncRNA Erbb4-IR is downregulated in prostate carcinoma and predicts prognosis

Long non-coding (lnc) RNA Erbb4-IR has been associated with diabetic renal injury; however, its roles in other diseases remain unknown. Therefore, the present study investigated the involvement of Erbb4-IR in prostate carcinoma. Reverse transcription-quantitative PCR was used to analyze gene expression in tissue samples collected from patients with prostate carcinoma. Overexpression experiments via cell transfection were performed to determine the association between Erbb4-IR and microRNA (miR)-21. Furthermore, Cell Counting Kit-8 and cell apoptosis assays were performed to assess cell proliferation and apoptotic rate, respectively. The results revealed that Erbb4-IR was downregulated in prostate carcinoma tissues compared with adjacent non-cancerous tissues, and that low expression of Erbb4-IR in tumor tissues was closely associated with poor survival. Furthermore, miR-21 was upregulated in prostate carcinoma tissues compared with adjacent non-cancerous tissues and was inversely associated with Erbb4-IR expression in tumor tissues. In vitro cell experiments revealed that Erbb4-IR overexpression resulted in the downregulation of miR-21, while miR-21 overexpression did not significantly affect the expression of Erbb4-IR. Moreover, Erbb4-IR overexpression increased apoptosis and inhibited the proliferation of prostate carcinoma cells. miR-21 overexpression resulted in the opposite effect and attenuated the effects of Erbb4-IR overexpression. Therefore, the results of the present study suggested that lncRNA Erbb4-IR is downregulated in prostate carcinoma and may inhibit cancer development by downregulating miR-21.

Voltammetric Application of Polypyrrole-Modified Microelectrode Array for the Characterization of DNA Methylation in Glutathione S-Transferase Pi 1

Direct and efficient label-free voltammetric detection of Glutathione S-Transferase Pi 1 (GSTP1) hypermethylation is reported using a custom developed 16-channel Microelectrode Array chip. The microelectrode array chip is used in a dipstick configuration allowing detection of DNA hybridization in a solution volume of only 0.35 mL. Platinum microelectrode disks (n = 16) 30 µm in diameter have been modified with a polypyrrole bilayer before any contact with the oligonucleotides. The attachment of the 15-mer Probe DNA to the bilayer is random but controlled by the presence of aliphatic tether groups allowing it to form a bidentate complex with the probe DNA. The voltammetric detection procedure of methylated GSTP1-specific target DNA is combined with bisulfite treatment of target DNA. Changes at the interface of the modified microelectrodes in an array configuration are used to record simultaneously cyclic voltammetry on all of the devices. The detection of the hybridization is evaluated statistically for a yes or no event by comparing the changes in recorded cyclic voltammograms before and after exposure to the Target DNA. All cyclic voltammograms of the methylated target show a greater percentage change than those with the non-methylated target exposure and show a greater change in cyclic voltammogram area after methylated target exposure. We observe an average percentage difference of 25.6% ± 4.9 with a variation of 19.1%. These results demonstrate that the fast sensing strategy possesses sensitivity and good specificity. Furthermore, this technology can potentially support rapid, accurate diagnosis and risk assessment of patients with prostate cancer.

Diagnostic Performance of Biparametric MRI for Detection of Prostate Cancer: A Systematic Review and Meta-Analysis

OBJECTIVE

The purpose of this study was to perform a systematic review and meta-analysis to estimate the diagnostic performance of biparametric MRI (bpMRI) for detection of prostate cancer (PCa).

MATERIALS AND METHODS

Two independent reviewers performed a systematic review of the literature published from January 2000 to July 2017 by using predefined search terms. The standard of pathologic reference was established at prostatectomy or prostate biopsy. The numbers of true- and false-positive and true- and false-negative results were extracted. The Quality Assessment of Diagnostic Accuracy Studies tool was used to assess the quality of the selected studies. Statistical analysis included pooling of diagnostic accuracy, meta-regression, subgroup analysis, head-to-head comparison, and identification of publication bias.

RESULTS

Thirty-three studies were used for general data pooling. The overall sensitivity was 0.81 (95% CI, 0.76-0.85), and overall specificity was 0.77 (95% CI, 0.69-0.84). As for clinically relevant PCa, bpMRI maintained high diagnostic value (AUC, 0.85; 95% CI, 0.82-0.88). There was no evidence of publication bias (p = 0.67). From head-to-head comparison for detection of PCa, multiparametric MRI (mpMRI) had significantly higher pooled sensitivity (0.85; 95% CI, 0.78-0.93) than did bpMRI (0.80; 95% CI, 0.71-0.90) (p = 0.01). However, the pooled specificity values were not significantly different (mpMRI, 0.77 [95% CI, 0.58-0.95]; bpMRI, 0.80 [95% CI, 0.64-0.96]; p = 0.82).

CONCLUSION

The results of this meta-analysis suggest that bpMRI has high diagnostic accuracy in the detection of PCa and maintains a high detection rate for clinically relevant PCa. However, owing to high heterogeneity among the included studies, caution is needed in applying the results of the meta-analysis.

Serum monocyte fraction of white blood cells is increased in patients with high Gleason score prostate cancer

Systemic inflammation and immune responses are reported to be associated with progressive prostate cancer. In this study, we explored which among the fractions of white blood cell (WBC) and C-reactive protein (CRP) level were associated with high Gleason score prostate cancer. Prostate needle biopsy was performed in 966 men with suspicion of prostate cancer. We assessed age, serum prostate-specific antigen (PSA), prostate volume, WBC count, fractions of WBCs (neutrophils, lymphocytes, monocytes, basophils, and eosinophils), and CRP level before biopsy for associations with biopsy findings. Among all men, 553 (57.2%) were positive for prostate cancer including 421 with high Gleason score cancer (Gleason score ≥7). Age, PSA, PSA density (PSAD), serum monocyte fraction of WBC, monocyte-to-lymphocyte ratio (MLR), and CRP were significantly associated with high Gleason score cancer (p<0.01). Multivariate analysis showed that age, PSA, PSAD, and serum monocyte fraction were significantly associated with high Gleason score prostate cancer (p <0.01). In 571 patients with PSA of <10 ng/ml, age, PSA, PSAD, serum WBC count, neutrophil fraction, monocyte fraction, and MLR were significantly associated with high Gleason score prostate cancer (p<0.05). Multivariate analysis showed that age, PSAD, and serum monocyte fraction were significantly associated with high Gleason score prostate cancer (p<0.01). The monocyte fraction of WBCs was increased in patients with high Gleason score prostate cancer, suggesting an interaction of monocytes with the progression of prostate cancer.

Optimized b-value selection for the discrimination of prostate cancer grades, including the cribriform pattern, using diffusion weighted imaging

Multiparametric magnetic resonance imaging (MP-MRI), including diffusion-weighted imaging, is commonly used to diagnose prostate cancer. This radiology–pathology study correlates prostate cancer grade and morphology with common b-value combinations for calculating apparent diffusion coefficient (ADC). Thirty-nine patients undergoing radical prostatectomy were recruited for MP-MRI prior to surgery. Diffusion imaging was collected with seven b-values, and ADC was calculated. Excised prostates were sliced in the same orientation as the MRI using 3-D printed slicing jigs. Whole-mount slides were digitized and annotated by a pathologist. Annotated samples were aligned to the MRI, and ADC values were extracted from annotated peripheral zone (PZ) regions. A receiver operating characteristic (ROC) analysis was performed to determine accuracy of tissue type discrimination and optimal ADC b-value combination. ADC significantly discriminates Gleason (G) G4-5 cancer from G3 and other prostate tissue types. The optimal b-values for discriminating high from low-grade and noncancerous tissue in the PZ are 50 and 2000, followed closely by 100 to 2000 and 0 to 2000. Optimal ADC cut-offs are presented for dichotomized discrimination of tissue types according to each b-value combination. Selection of b-values affects the sensitivity and specificity of ADC for discrimination of prostate cancer.

Emerging biomarkers in the detection and prognosis of prostate cancer

The prostate-specific antigen (PSA) is currently the most used tumor marker in the early detection of the prostate cancer (PCa), despite its low specificity and low negative predictive value. New biomarkers, including urine prostate cancer gene 3 (PCA3) score, Prostate Health Index (PHI), and the four-kallikrein panel, have been investigated during recent years especially with the aim of detecting aggressive PCa. Results suggest the ability of these biomarkers to improve the specificity of PSA in the detection of PCa, although there are not enough results directly comparing these biomarkers to know their complementarity. The relationship with PCa aggressiveness seems to be confirmed for PHI and for the four-kallikrein panel, but not for PCA3 score. However, available results suggest that emerging biomarkers may be useful as part of a multivariable approach for the screening and prognosis of PCa. Nevertheless, larger prospective studies comparing these biomarkers are necessary to evaluate definitely their value in the management of early PCa.

T2* relaxation time in the detection and assessment of aggressiveness of peripheral zone cancer in comparison with diffusion-weighted imaging

AIM

To investigate the feasibility of T2* relaxation time for distinguishing benign from malignant regions, as well as tumour aggressiveness, within the peripheral zone (PZ) of the prostate in comparison with diffusion-weighted imaging (DWI).

MATERIALS AND METHODS

Fifty-eight patients with prostate cancer underwent 3 T magnetic resonance imaging using multi-echo T2* and DWI (maximum b-value, 2000 s/mm(2)). Parametric maps were obtained for apparent diffusion coefficient (ADC) and T2* values. Two radiologists reviewed these maps and measured ADC and T2* values in sextants positive for cancer at biopsy. Data were analysed using mixed-model analysis of variance and receiver operating characteristic curves.

RESULTS

Ninety-three sextants exhibited a Gleason score of 6; 59 exhibited a Gleason score of 7 or 8. The T2* value was significantly lower in cancerous sextants than in the benign PZ (48.69+0.60 versus 74.14+0.56, p<0.001), as well as in cancerous sextants with higher rather than lower Gleason scores (43.18+0.89 versus 52.18+0.55, p<0.001). The T2* value showed significantly greater specificity for differentiating cancerous sextants from benign PZ than ADC (93.1% versus 89.7%, p<0.001), with equal sensitivity (82.8% versus 81%, p>0.05). The T2* value exhibited significantly greater sensitivity and specificity for differentiating sextants with low- and high-grade cancer than ADC (79.6% versus 64.5% and 81.4% versus 72.9%, respectively; p<0.05). The T2* value had a significantly greater area under the receiver operating characteristic curve for differentiating sextants with low- and high-grade cancer than ADC (0.77 versus 0.71, p<0.01).

CONCLUSION

Preliminary findings suggest that the T2* relaxation time has increased diagnostic value compared with DWI in prostate PZ cancer assessment.

Circulating irisin detection: Does it really work?

The recent discovery of irisin has generated considerable interest in the scientific community. However, many studies on the biochemistry and biology of this intriguing hormone yielded controversial results in humans, which were mostly attributable to a number of drawbacks in the methods used for its detection and measurement.

Exosomal lncRNA-p21 levels may help to distinguish prostate cancer from benign disease

Exosomes are membranous vesicles containing various biomolecules including lncRNAs which are involved in cellular communication and are secreted from many cells including cancer cells. In our study, investigated the exosomal GAS5 and lincRNA-p21 lncRNA levels in urine samples from 30 patients with prostate cancer (PCa) and 49 patients with benign prostatic hyperplasia. Quantification of lncRNA molecules was performed by real-time PCR. We observed a significant difference in the exosomal lincRNA-p21 levels between PCa and BPH patients whereas the GAS5 levels did not reveal a difference. Our data suggest that the discriminative potential of exosomal lincRNA-p21 levels may help to improve the diagnostic prediction of the malignant state for patients with PCa.

On-chip screening for prostate cancer: an EIS microfluidic platform for contemporary detection of free and total PSA

Prostate cancer affects a large part of the western male population. The need for an early and accurate detection is thus a great challenge in common clinical practice, but the lack of specificity of the serum marker PSA (Prostate Specific Antigen) is a serious problem since its increased concentration can be related to several abnormalities. PSA, however, is found in serum in both a free and a complexed form with other proteins and the percentage amount of unbound PSA (the free-to-total PSA ratio) can be employed to distinguish prostate cancer from benign prostatic conditions, and also to predict the future risk of prostate cancer. To improve the operating characteristics of current PSA tests and to provide a clinical tool able to run label-free and sensitive analysis, we thus developed a biosensing platform based on Electrochemical Impedance Spectroscopy (EIS), which allows the contemporary detection of free and total PSA on a single biochip, enabling a quick screening for the risk of prostate cancer thanks to the presence of two different immobilized antibodies specific for the different antigens researched.