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Family history, obesity, urological factors and diabetic medications and their associations with risk of prostate cancer diagnosis in a large prospective study. Br J Cancer 2022; 127:735-746. [PMID: 35610365 PMCID: PMC9381576 DOI: 10.1038/s41416-022-01827-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/22/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Prostate cancer (PC) aetiology is unclear. PC risk was examined in relation to several factors in a large population-based prospective study. Methods Male participants were from Sax Institute’s 45 and Up Study (Australia) recruited between 2006 and 2009. Questionnaire and linked administrative health data from the Centre for Health Record Linkage and Services Australia were used to identify incident PC, healthcare utilisations, Prostate Specific Antigen (PSA) testing reimbursements and dispensing of metformin and benign prostatic hyperplasia (BPH) prescriptions. Multivariable Cox and Joint Cox regression analyses were used to examine associations by cancer spread, adjusting for various confounders. Results Of 107,706 eligible men, 4257 developed incident PC up to end 2013. Risk of PC diagnosis increased with: PC family history (versus no family history of cancer; HRadjusted = 1.36; 95% CI:1.21–1.52); father and brother(s) diagnosed with PC (versus cancer-free family history; HRadjusted = 2.20; 95% CI:1.61–2.99); severe lower-urinary-tract symptoms (versus mild; HRadjusted = 1.77; 95% CI:1.53–2.04) and vasectomy (versus none; HRadjusted = 1.08; 95% CI:1.00–1.16). PC risk decreased with dispensed prescriptions (versus none) for BPH (HRadjusted = 0.76; 95% CI:0.69–0.85) and metformin (HRadjusted = 0.57; 95% CI:0.48–0.68). Advanced PC risk increased with vasectomy (HRadjusted = 1.28; 95% CI:1.06–1.55) and being obese (versus normal weight; HRadjusted = 1.31; 95% CI:1.01–1.69). Conclusion Vasectomy and obesity are associated with an increased risk of advanced PC. The reduced risk of localised and advanced PC associated with BPH, and diabetes prescriptions warrants investigation.
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Inoue T, Yoshimura K, Terada N, Tsukino H, Murota T, Kinoshita H, Kamoto T, Ogawa O, Matsuda T. Prostate-specific antigen density during dutasteride treatment for 1 year predicts the presence of prostate cancer in benign prostatic hyperplasia after the first negative biopsy (PREDICT study). Int J Urol 2021; 28:849-854. [PMID: 34008275 DOI: 10.1111/iju.14590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 04/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To prospectively evaluate the detection rate of prostate cancer, and to identify the risk factors of prostate cancer detection after a 1-year administration of dutasteride and first negative prostate biopsy. METHODS Patients with benign prostatic hyperplasia who presented high prostate-specific antigen levels after the first negative prostate biopsy were administered 0.5 mg dutasteride daily for 1 year. They underwent a repeat prostate biopsy after 1 year. The primary end-point was the detection rate of prostate cancer. The secondary end-point was the ability of prostate-specific antigen kinetics to predict prostate cancer detection. Prostate-specific antigen was measured before the initial prostate biopsy and at 6, 9 and 12 months after starting dutasteride. Patients were classified into a prostate cancer and a non-prostate cancer group. RESULTS Prostate cancer was detected in 15 of 149 participants (10.1%). The total prostate-specific antigen change between the prostate cancer and non-prostate cancer group at 1 year was significantly different (P = 0.002). Although prostate-specific antigen levels at baseline did not significantly differ between study groups (P = 0.102), prostate-specific antigen levels at 6, 9 and 12 months were significantly different (P = 0.002, P = 0.001 and P < 0.001, respectively). The mean reduction rate of prostate-specific antigen density between the prostate cancer and non-prostate cancer group at 1 year was significantly different (-4.25 ± 76.5% vs -38.0 ± 28.7%, P = 0.001). Using a multivariate analysis, a >10% increase of prostate-specific antigen density at 1 year post-dutasteride treatment was the only predictive risk factor for prostate cancer after the first negative prostate biopsy (odds ratio 11.238, 95% confidence interval 3.112-40.577, P < 0.001). CONCLUSION In the present study cohort, >10% increase in prostate-specific antigen density represented the only significant predictive risk factor for prostate cancer diagnosis in patients with elevated prostate-specific antigen after the first negative prostate biopsy.
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Affiliation(s)
- Takaaki Inoue
- Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Hyogo, Japan.,Department of Urology and Stone Center, Hara Genitourinary Hospital, Hyogo, Japan
| | - Koji Yoshimura
- Department of Urology, Shizuoka General Hospital, Shizuoka, Japan
| | - Naoki Terada
- Department of Urology, Faculty of Medicine, Miyazaki University, Miyazaki, Japan
| | - Hiromasa Tsukino
- Department of Urology, Faculty of Medicine, Miyazaki University, Miyazaki, Japan
| | - Takashi Murota
- Department of Urology, General Medical Center, Kansai Medical University, Osaka, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Toshiyuki Kamoto
- Department of Urology, Faculty of Medicine, Miyazaki University, Miyazaki, Japan
| | - Osamu Ogawa
- Department of Urology, Kyoto University Hospital, Kyoto, Japan
| | - Tadashi Matsuda
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
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3
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Busato WFS. Use of 5α-reductase inhibitor and delay in prostate cancer diagnosis and treatment. Int Braz J Urol 2020; 46:456-458. [PMID: 32167713 PMCID: PMC7088470 DOI: 10.1590/s1677-5538.ibju.2020.03.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 02/24/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Wilson F S Busato
- Disciplina de Urologia, Universidade do Vale do Itajaí - Univali, Itajaí, SC, Brasil.,Departamento de Uro-Oncologia, Sociedade Brasileira de Urologia - SBU, Rio de Janeiro, RJ, Brasil
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4
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Walsh PC. Re: Association of Treatment with 5α-Reductase inhibitors with Time to Diagnosis and Mortality in Prostate Cancer. Eur Urol 2019; 76:704. [DOI: 10.1016/j.eururo.2019.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 07/10/2019] [Indexed: 11/29/2022]
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5
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Rossanese M, Crestani A, Inferrera A, Giannarini G, Bartoletti R, Tubaro A, Ficarra V. Medical treatment for benign prostatic hyperplasia: Where do we stand? Urologia 2019; 86:115-121. [DOI: 10.1177/0391560319859785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Male lower urinary tract symptoms are frequently due to benign prostatic enlargement. Medical therapy is strongly recommended in patients with moderate to severe symptoms. Lower urinary tract symptoms may require a different medical approach using drugs with different mechanisms of action. Alpha-1 blockers, muscarinic receptor antagonists and phosphodiesterase type 5 inhibitors are the most frequently used drugs. 5-Alpha reductase inhibitors are commonly prescribed to reduce prostate volume and to prevent benign prostatic hyperplasia progression. Currently, medical treatment of lower urinary tract symptoms suggestive of benign prostatic enlargement can be tailored according to different symptom characteristics and severity, and to different patient comorbidities and preferences. For this reason, the decision-making process should be based on an accurate patient counselling with detailed clarification of potential benefits and, above all, potential side effects of different drugs. This non-systematic review of the literature presents an update of the current options for medical treatment of lower urinary tract symptoms suggestive of benign prostatic enlargement, helping urologists in the decision-making and counselling process.
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Affiliation(s)
- Marta Rossanese
- Urologic Section, Department of Human and Paediatric Pathology ‘Gaetano Barresi’, University of Messina, Messina, Italy
| | | | - Antonino Inferrera
- Urologic Section, Department of Human and Paediatric Pathology ‘Gaetano Barresi’, University of Messina, Messina, Italy
| | - Gianluca Giannarini
- Urology Unit, Academic Medical Centre Hospital ‘Santa Maria della Misericordia’, Udine, Italy
| | - Riccardo Bartoletti
- Urologic Section, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Andrea Tubaro
- Department of Urology, Sant’Andrea Hospital, ‘La Sapienza’ University of Rome, Rome, Italy
| | - Vincenzo Ficarra
- Urologic Section, Department of Human and Paediatric Pathology ‘Gaetano Barresi’, University of Messina, Messina, Italy
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6
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Rivero JR, Thompson IM, Liss MA, Kaushik D. Chemoprevention in Prostate Cancer: Current Perspective and Future Directions. Cold Spring Harb Perspect Med 2018; 8:cshperspect.a030494. [PMID: 29311128 DOI: 10.1101/cshperspect.a030494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Chemoprevention of prostate cancer aims to reduce the mortality as well as the public burden of overdetection, which increases anxiety, cost, and morbidity related to the disease. The role of 5-α-reductase inhibitors has been well investigated and shown to decrease the risk of prostate cancer. No current evidence exists to encourage the use of nutrients or vitamins as chemopreventive agents. The modulation of inflammation is one of the most promising targets for chemoprevention of prostate cancer.
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Affiliation(s)
- J Ricardo Rivero
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229
| | - Ian M Thompson
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229.,Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229
| | - Michael A Liss
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229.,Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229
| | - Dharam Kaushik
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229.,Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229
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Abstract
INTRODUCTION AKR1C3 is a drug target in hormonal and hormonal independent malignancies and acts as a major peripheral 17β-hydroxysteroid dehydrogenase to yield the potent androgens testosterone and dihydrotestosterone, and as a prostaglandin (PG) F synthase to produce proliferative ligands for the PG FP receptor. AKR1C3 inhibitors may have distinct advantages over existing therapeutics for the treatment of castration resistant prostate cancer, breast cancer and acute myeloid leukemia. Area covered: This article reviews the patent literature on AKR1C3 inhibitors using SciFinder which identified inhibitors in the following chemical classes: N-phenylsulfonyl-indoles, N-(benzimidazoylylcarbonyl)- N-(indoylylcarbonyl)- and N-(pyridinepyrrolyl)- piperidines, N-benzimidazoles and N-benzindoles, repurposed nonsteroidal antiinflammatory drugs (indole acetic acids, N-phenylanthranilates and aryl propionic acids), isoquinolines, and nitrogen and sulfur substituted estrenes. The article evaluates inhibitor AKR potency, specificity, efficacy in cell-based and xenograft models and clinical utility. The advantage of bifunctional compounds that either competitively inhibit AKR1C3 and block its androgen receptor (AR) coactivator function or act as AKR1C3 inhibitors and direct acting AR antagonists are discussed. Expert opinion: A large number of potent and selective inhibitors of AKR1C3 have been described however, preclinical optimization, is required before their benefit in human disease can be assessed.
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Affiliation(s)
- Trevor M Penning
- a Center of Excellence in Environmental Toxicology & Department of Systems Pharmacology & Translational Therapeutics, Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA
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8
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Pre-radiotherapy PSA progression is a negative prognostic factor in prostate cancer patients using 5‑alpha-reductase inhibitors. Strahlenther Onkol 2017; 194:17-22. [PMID: 28695317 DOI: 10.1007/s00066-017-1176-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 06/22/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate the impact of 5‑alpha-reductase inhibitor (5-ARI) use on radiotherapy outcomes for localized prostate cancer. PATIENTS AND METHODS We included 203 patients on a 5-ARI from our institutional database comprising over 2500 patients who had been treated with either external beam radiotherapy (EBRT) or brachytherapy for localized prostate cancer. Patients received a 5-ARI for urinary symptoms or active surveillance. Cancer progressions at the time of definitive treatment were analyzed according to the following criteria: (a) progression of Gleason score or increase in cancer volume on biopsy, (b) first biopsy positive for cancer after being treated for urinary symptoms with a 5-ARI, and (c) prostate-specific antigen (PSA) progression with or without a previous cancer diagnosis. Biochemical failure (BF) was defined by the Phoenix definition. Log-rank test was used for survival analysis. RESULTS At a median follow-up of 38.2 months (standard deviation 22.2 months), 10 (4.9%) patients experienced BF. Concerning prostate cancer progression criteria, 52% of men demonstrated none, 37% showed only one criterion, and 11% showed two. Using univariate analysis, PSA progression (p = 0.004) and appearance of a positive biopsy (p < 0.001) were significant predictive factors for BF, while Gleason progression (p = 0.3) was not. In multivariate analysis adjusted for cancer aggressiveness, rising PSA (hazard ratio, HR, 5.7; 95% confidence interval, CI, 1.1-28.8; p = 0.04) and the number of cancer progression factors (HR 2.9, 95% CI 1.2-7.0, p = 0.02) remained adverse risk factors. CONCLUSION PSA progression experienced during 5‑ARI treatment before radiotherapy is predictive of worse biochemical outcome. Such details should be considered when counseling men prior to radiation therapy.
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9
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Biomarkers for prostate cancer: present challenges and future opportunities. Future Sci OA 2015; 2:FSO72. [PMID: 28031932 PMCID: PMC5137959 DOI: 10.4155/fso.15.72] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/10/2015] [Indexed: 01/30/2023] Open
Abstract
Prostate cancer (PCa) has variable biological potential with multiple treatment options. A more personalized approach, therefore, is needed to better define men at higher risk of developing PCa, discriminate indolent from aggressive disease and improve risk stratification after treatment by predicting the likelihood of progression. This may improve clinical decision-making regarding management, improve selection for active surveillance protocols and minimize morbidity from treatment. Discovery of new biomarkers associated with prostate carcinogenesis present an opportunity to provide patients with novel genetic signatures to better understand their risk of developing PCa and help forecast their clinical course. In this review, we examine the current literature evaluating biomarkers in PCa. We also address current limitations and present several ideas for future studies.
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10
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Affiliation(s)
- Charles J Ryan
- University of California, San Francisco, San Francisco, CA
| | - June M Chan
- University of California, San Francisco, San Francisco, CA
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11
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PSA velocity: A systematic review of clinical applications. Urol Oncol 2014; 32:1116-25. [DOI: 10.1016/j.urolonc.2014.04.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/11/2014] [Accepted: 04/12/2014] [Indexed: 11/23/2022]
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12
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5ARI and PSA: open questions. Urologia 2014; 81:12-16. [DOI: 10.5301/uro.5000070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2014] [Indexed: 11/20/2022]
Abstract
No consensus has ever been reached on the predictive value of serum prostate specific antigen (PSA) for the diagnosis of prostate cancer. Limitations of PSA testing in clinical practice have been often discussed in the peer-reviewed literature following data derived from clinical trials such as the Prostate Cancer Prevention Trial (PCPT) and the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) study that showed a linear rise in the risk of prostate cancer with increasing PSA levels. Benign prostatic hyperplasia is a known confounding factor for the use of PSA as a marker of prostate cancer. Increased prostate volume observed with ageing, urinary retention, acute and chronic inflammatory conditions of the prostate, sexual activity and digital rectal examination may all cause an increase of PSA values. Both finasteride and dutasteride, 5-alpha reductase inhibitors (5ARI) used in the treatment of BPH, are known to induce a significant decrease of serum PSA levels close to 50%. The observed change in PSA values following 5ARI treatment has raised questions about the accuracy of PSA testing for the early diagnosis of prostate cancer in patients on finasteride/dutasteride treatment. Careful analysis of data from various clinical trials on pharmacological treatment of LUTS due to BPH suggested that the accuracy of PSA testing is not just maintained but rather increased following 5ARI use. Then, the question of PSA accuracy during 5ARI treatment can be considered closed.
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13
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Abstract
Prostate-specific antigen or PSA is a protein biomarker which is produced by the cells of prostate gland. The normal level of PSA in blood is often elevated in men with prostate cancer. In India, prostate cancer is one among the five, mostly cited cancer in men and it is getting increased by 1% every year. The screening test used for prostate cancer is the Prostate Specific Antigen test. The first PSA assay was determined in 1979. Most of the current techniques used for PSA detection are utilizing large analyzers, there by increased time and cost. Increased PSA levels can also because of prostatitis (inflammation of the prostate gland) or due to many other reasons. A proper technique to differential diagnose this disease is also an issue. The benchmark for the PSA level cannot be determined accurately. For this, various types of biosensors are used. This review journal is is trying to analyze variouus Nano-Biosensors used for early detection of PSA from blood in an early stage itself.
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14
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Koo KC, Lee DH, Lee SH, Chung BH. Peripheral zone prostate-specific antigen density: an effective parameter for prostate cancer prediction in men receiving 5α-reductase inhibitors. Prostate Int 2013; 1:102-8. [PMID: 24223410 PMCID: PMC3814120 DOI: 10.12954/pi.13022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 09/08/2013] [Indexed: 11/25/2022] Open
Abstract
Purpose: To evaluate the predictive performance of various parameters derived from volume-adjusted prostate-specific antigen (PSA) values in detecting prostate cancer (PCa) and high-grade (Gleason score≥7) PCa according to treatment with a 5α-reductase inhibitor (5ARI). Methods: The results of 3,520 prostate biopsies performed between May 2006 and January 2013 were retrospectively assessed. With adjustment for age, 291 patients who had received 5ARI treatment for more than 6 months were identified and matched 1:3 to patients naïve to 5ARIs, resulting in a total of 873 patients. Peripheral zone (PZ) and transition zone (TZ) volumes were determined by transrectal ultrasonography. Receiver-operating characteristic (ROC) curve analysis was used to compare predictive performances of PSA, PSA density (PSAD; PSA/prostate volume), PZPSAD (PSA/PZ volume), and TZPSAD (PSA/TZ volume) for detecting PCa and high-grade PCa for each group. Results: The area under the ROC curve (AUC) was higher for PSAD than for PSA in the 5ARI group (0.751 vs. 0.677) and in the 5ARI-naïve group (0.649 vs. 0.582), respectively (P<0.001). In the 5ARI group, the AUC for PZPSAD was even higher than that for PSAD (0.781 vs. 0.751, P=0.038); in the 5ARI-naïve group, however, PZPSAD failed to achieve significant superiority (0.652 vs. 0.649, P=0.321). All volume-adjusted PSA indexes showed higher predictive accuracies for detecting PCa than did PSA in both groups. For detecting high-grade cancer, PZPSAD also revealed the highest predictive value in the 5ARI group, whereas PSA revealed the highest predictive value in the 5ARI-naïve group. Conclusions: The diagnostic performance of PSAD in the detection of PCa is superior to that of PSA. For patients receiving 5ARI for more than 6 months, PZPSAD confers additional benefits for detecting both PCa and high-grade PCa.
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Affiliation(s)
- Kyo Chul Koo
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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15
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Ankerst DP, Till C, Boeck A, Goodman PJ, Tangen CM, Thompson IM. Predicting risk of prostate cancer in men receiving finasteride: effect of prostate volume, number of biopsy cores, and American Urological Association symptom score. Urology 2013; 82:1076-81. [PMID: 24055241 DOI: 10.1016/j.urology.2013.07.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 06/27/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine the effect of prostate volume, number of biopsy cores, and American Urological Association symptom score (AUASS) for prostate cancer risk assessment among men receiving finasteride in the Prostate Cancer Prevention Trial. METHODS Data from 4509 men on the finasteride arm of the Prostate Cancer Prevention Trial who were on treatment at the time of their AUASS and prostate-specific antigen (PSA) measurement before biopsy were included in multivariable logistic regression analyses. RESULTS Six hundred eighty-two (15.1%) participants had prostate cancer; 257 (37.7%) of these had high-grade disease. For prostate cancer risk, the model included PSA (odds ratio corresponding to a 2-fold increase in PSA: 2.70; P <.0001), digital rectal examination (2.53; P <.0001), age (1.03; P = .001), and prostate volume (odds ratio 0.54 for a 2-fold increase in volume; P <.0001). For high-grade disease, PSA (3.39; P <.0001), digital rectal examination (2.75; P <.0001), age (1.05; P = .001), and volume (0.55; P <.0001) were statistically significant. AUASS was not statistically significant in any of the models that included prostate volume, but was in models in which volume was not included. The number of biopsy cores did not significantly improve risk assessment in any of the models considered. CONCLUSION Although in the general population, obtaining a cancer diagnosis is improved by assessing prostate volume and increasing the number of biopsy cores, neither steps are required in men receiving finasteride. Obtaining fewer biopsy cores in men receiving finasteride preserves biopsy sensitivity and will likely reduce cost and morbidity.
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Affiliation(s)
- Donna P Ankerst
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX; Departments of Mathematics, Technical University Munich, Garching, Germany; Department of Life Sciences, Technical University Munich, Garching, Germany.
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Taioli E, Sears V, Watson A, Flores-Obando RE, Jackson MD, Ukoli FA, de Syllos Cólus IM, Fernandez P, McFarlane-Anderson N, Ostrander EA, Rodrigues IS, Stanford JL, Taylor JA, Tulloch-Reid M, Ragin CCR. Polymorphisms in CYP17 and CYP3A4 and prostate cancer in men of African descent. Prostate 2013; 73:668-76. [PMID: 23129512 PMCID: PMC3881417 DOI: 10.1002/pros.22612] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 10/01/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND A meta and pooled analysis of published and unpublished case-control studies was performed to evaluate the association of CYP17 (rs743572) and CYP3A4 (rs2740574) polymorphisms and prostate cancer (PCa) in men from the USA, Caribbean, and Africa. METHODS Eight publications (seven studies) and two unpublished studies for CYP17 included 1,580 subjects (559 cases and 1,021 controls) and eleven publications and three unpublished studies for CYP3A4 included 3,400 subjects (1,429 cases and 1,971 controls). RESULTS Overall, the CYP17 heterozygous and homozygous variants were not associated with PCa, but they confer a 60% increased risk of PCa in a sub-group analysis restricted to African-American men (T/C + C/C, OR: 1.6, 95% CI: 1.1-2.4). No associations were observed for CYP3A4, overall and in stratified analyses for African-Americans and Africans. The pooled analysis suggests that after adjusting for study, age, PSA, and family history of PCa, CYP17 was associated with PCa for men of African ancestry (Adjusted OR: 3.5, 95% CI: 1.2-10.0). CONCLUSIONS Our findings suggest that genetic factors involved in the androgen pathway play a role in PCa risk among men of African ancestry.
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Affiliation(s)
- Emanuela Taioli
- North Shore Long Island Jewish Health System, The Feinstein Institute for Medical Research, Manhasset, New York 11030, USA.
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Shelton PQ, Ivanowicz AN, Wakeman CM, Rydberg MG, Norton J, Riggs SB, Teigland CM. Active Surveillance of Very-low-risk Prostate Cancer in the Setting of Active Treatment of Benign Prostatic Hyperplasia With 5α-reductase Inhibitors. Urology 2013; 81:979-84. [DOI: 10.1016/j.urology.2012.10.089] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 10/24/2012] [Accepted: 10/26/2012] [Indexed: 11/17/2022]
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Editorial Comment. Urology 2013; 81:984; discussion 984-5. [DOI: 10.1016/j.urology.2012.10.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Newcombe PJ, Reck BH, Sun J, Platek GT, Verzilli C, Kader AK, Kim ST, Hsu FC, Zhang Z, Zheng SL, Mooser VE, Condreay LD, Spraggs CF, Whittaker JC, Rittmaster RS, Xu J. A comparison of Bayesian and frequentist approaches to incorporating external information for the prediction of prostate cancer risk. Genet Epidemiol 2013; 36:71-83. [PMID: 22890972 DOI: 10.1002/gepi.21600] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We present the most comprehensive comparison to date of the predictive benefit of genetics in addition to currently used clinical variables, using genotype data for 33 single-nucleotide polymorphisms (SNPs) in 1,547 Caucasian men from the placebo arm of the REduction by DUtasteride of prostate Cancer Events (REDUCE®) trial. Moreover, we conducted a detailed comparison of three techniques for incorporating genetics into clinical risk prediction. The first method was a standard logistic regression model, which included separate terms for the clinical covariates and for each of the genetic markers. This approach ignores a substantial amount of external information concerning effect sizes for these Genome Wide Association Study (GWAS)-replicated SNPs. The second and third methods investigated two possible approaches to incorporating meta-analysed external SNP effect estimates - one via a weighted PCa 'risk' score based solely on the meta analysis estimates, and the other incorporating both the current and prior data via informative priors in a Bayesian logistic regression model. All methods demonstrated a slight improvement in predictive performance upon incorporation of genetics. The two methods that incorporated external information showed the greatest receiver-operating-characteristic AUCs increase from 0.61 to 0.64. The value of our methods comparison is likely to lie in observations of performance similarities, rather than difference, between three approaches of very different resource requirements. The two methods that included external information performed best, but only marginally despite substantial differences in complexity.
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Affiliation(s)
- Paul J Newcombe
- Genetics Division, GlaxoSmithKline, Stevenage, United Kingdom.
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Ferreira JG, Diniz PMM, Andrade de Paula CA, Lobo YA, Paredes-Gamero EJ, Paschoalin T, Nogueira-Pedro A, Maza PK, Toledo MS, Suzuki E, Oliva MLV. The impaired viability of prostate cancer cell lines by the recombinant plant kallikrein inhibitor. J Biol Chem 2013; 288:13641-54. [PMID: 23511635 DOI: 10.1074/jbc.m112.404053] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Kallikreins play a pivotal role in establishing prostate cancer. RESULTS In contrast to the classical Kunitz plant inhibitor SbTI, the recombinant kallikrein inhibitor (rBbKIm) led to prostate cancer cell death, whereas fibroblast viability was not affected. CONCLUSION rBbKIm shows selective cytotoxic effect and angiogenesis inhibition against prostate cancer cells. SIGNIFICANCE New actions of rBbKIm may contribute to understanding the mechanisms of prostate cancer. Prostate cancer is the most common type of cancer, and kallikreins play an important role in the establishment of this disease. rBbKIm is the recombinant Bauhinia bauhinioides kallikreins inhibitor that was modified to include the RGD/RGE motifs of the inhibitor BrTI from Bauhinia rufa. This work reports the effects of rBbKIm on DU145 and PC3 prostate cancer cell lines. rBbKIm inhibited the cell viability of DU145 and PC3 cells but did not affect the viability of fibroblasts. rBbKIm caused an arrest of the PC3 cell cycle at the G0/G1 and G2/M phases but did not affect the DU145 cell cycle, although rBbKIm triggers apoptosis and cytochrome c release into the cytosol of both cell types. The differences in caspase activation were observed because rBbKIm treatment promoted activation of caspase-3 in DU145 cells, whereas caspase-9 but not caspase-3 was activated in PC3 cells. Because angiogenesis is important to the development of a tumor, the effect of rBbKIm in this process was also analyzed, and an inhibition of 49% was observed in in vitro endothelial cell capillary-like tube network formation. In summary, we demonstrated that different properties of the protease inhibitor rBbKIm may be explored for investigating the androgen-independent prostate cancer cell lines PC3 and DU145.
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Affiliation(s)
- Joana Gasperazzo Ferreira
- Departments of Biochemistry, Universidade Federal de São Paulo-Escola Paulista de Medicina, 04044-020, São Paulo, Brazil
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Mayhoub AS, Marler L, Kondratyuk TP, Park EJ, Pezzuto JM, Cushman M. Optimization of thiazole analogues of resveratrol for induction of NAD(P)H:quinone reductase 1 (QR1). Bioorg Med Chem 2012; 20:7030-9. [PMID: 23142320 DOI: 10.1016/j.bmc.2012.10.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 10/03/2012] [Accepted: 10/09/2012] [Indexed: 11/25/2022]
Abstract
NAD(P)H:quinone reductase 1 (QR1) belongs to a class of enzymes called cytoprotective enzymes. It exhibits its cancer protective activity mainly by inhibiting the formation of intracellular semiquinone radicals, and by generating α-tocopherolhydroquinone, which acts as a free radical scavenger. It is therefore believed that QR1 inducers can act as cancer chemopreventive agents. Resveratrol (1) is a naturally occurring stilbene derivative that requires a concentration of 21 μM to double QR1 activity (CD = 21 μM). The stilbene double bond of resveratrol was replaced with a thiadiazole ring and the phenols were eliminated to provide a more potent and selective derivative 2 (CD = 2.1 μM). Optimizing the substitution pattern of the two phenyl rings and the central heterocyclic linker led to a highly potent and selective QR1 inducer 9o with a CD value of 0.087 μM.
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Affiliation(s)
- Abdelrahman S Mayhoub
- Department of Medicinal Chemistry and Molecular Pharmacology, College of Pharmacy, and the Purdue Center for Cancer Research, Purdue University, West Lafayette, IN 47907, USA
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Ligand-independent activation of EphA2 by arachidonic acid induces metastasis-like behaviour in prostate cancer cells. Br J Cancer 2012; 107:1737-44. [PMID: 23037715 PMCID: PMC3493871 DOI: 10.1038/bjc.2012.457] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: High intake of omega-6 polyunsaturated fatty acids (PUFA) has been associated with clinical progression in prostate cancer (CaP). This study investigates the signalling mechanism by which the omega-6 PUFA arachidonic acid (AA) induces prostatic cellular migration to bone marrow stroma. Methods: Western blot analysis of the PC-3, PC3-GFP, DU 145 and LNCaP cells or their lipid raft (LR) components post AA stimulation was conducted in association with assays for adhesion and invasion through the bone marrow endothelial monolayers. Results: Arachidonic acid increased transendothelial migration of PC3-GFP cells (adhesion 37%±0.08, P=0.0124; transmigration 270%±0.145, P=0.0008). Akt, Src and focal adhesion kinase (FAK) pathways were induced by AA and integrally involved in transendothelial migration. LR were critical in AA uptake and induced Akt activity. Ephrin receptor A2 (EphA2), localised in LR, is expressed in DU 145 and PC-3 cells. Arachidonic acid induced a rapid increase of EphA2 Akt-dependent/ligand-independent activation, while knockdown of the EphrinA1 ligand decreased AA induced transendothelial migration, with an associated decrease in Src and FAK activity. Arachidonic acid activated Akt in EphA2− LNCaP cells but failed to induce BMEC transendothelial invasion. Conclusion: Arachidonic acid induced stimulation of EphA2 in vitro is associated fundamentally with CaP epithelial migration across the endothelial barrier.
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Systematic, evidence-based discovery of biomarkers at the NCI. Clin Exp Metastasis 2012; 29:645-52. [PMID: 22868876 DOI: 10.1007/s10585-012-9507-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 06/13/2012] [Indexed: 10/28/2022]
Abstract
In the past decade, biomarker discovery has become ubiquitous in cancer research. However, despite this interest in biomarker research, few newly-characterized biomarkers have emerged as clinically-used entities. Here, we review the current state of biomarker research in cancer and identify challenges that stall many biomarker discovery efforts. We outline a model for systematic biomarker discovery, exemplified by recent efforts in prostate cancer, in which bioinformatics plays a central role in identifying promising new candidate biomarkers. Finally, we review the role of the National Cancer Institute's Early Detection Research Network (EDRN) in biomarker studies and the importance of EDRN-led efforts to establish a research standard for more effective biomarker discovery efforts.
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Liang Y, Ketchum NS, Louden C, Jimenez-Rios MA, Thompson IM, Camarena-Reynoso HR. The use of the finasteride-adjusted Prostate Cancer Prevention Trial Prostate Cancer Risk Calculator in a Mexican referral population: a validation study. Urol Int 2012; 89:9-16. [PMID: 22626812 DOI: 10.1159/000338270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 03/19/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To perform the first validation study of the finasteride-adjusted Prostate Cancer Prevention Trial Prostate Cancer Risk Calculator (finPCPTRC) in a contemporary referral population in Mexico. METHODS 837 patients referred to the Instituto Nacional de Cancerología, Mexico City, Mexico, between 2005 and 2009 were used to validate the finPCPTRC by examining various measures of discrimination and calibration. Net benefit curve analysis was used to gain insight into the use of the finPCPTRC for clinical decisions. RESULTS Prostate cancer (PCa) incidence (72.8%) was high in this Mexican referral cohort and 45.7% of men who were diagnosed with PCa had high-grade lesions (HGPCa, Gleason score >6). 1.3% of the patients were taking finasteride. The finPCPTRC was a superior diagnostic tool compared to prostate-specific antigen alone when discriminating patients with PCa from those without PCa (AUC = 0.784 vs. AUC = 0.687, p < 0.001) and when discriminating patients with HGPCa from those without HGPCa (AUC = 0.768 vs. AUC = 0.739, p < 0.001). The finPCPTRC underestimated the risk of PCa but overestimated the risk of HGPCa (both p < 0.001). Compared with other strategies to opt for biopsy, the net benefit would be larger with utilization of the finPCPTRC for patients accepting higher risks of HGPCa. CONCLUSIONS Rates of biopsy-detectable PCa and HGPCa were high and 1.3% of this referral cohort in Mexico was taking finasteride. The risks of PCa or HGPCa calculated by the finPCPTRC were not well calibrated for this referral Mexican population and new clinical diagnostic tools are needed.
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Affiliation(s)
- Yuanyuan Liang
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA. liangy @ uthscsa.edu
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Liang Y, Messer JC, Louden C, Jimenez-Rios MA, Thompson IM, Camarena-Reynoso HR. Prostate cancer risk prediction in a urology clinic in Mexico. Urol Oncol 2012; 31:1085-92. [PMID: 22306115 DOI: 10.1016/j.urolonc.2011.12.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Revised: 12/28/2011] [Accepted: 12/28/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To evaluate factors affecting the risk of prostate cancer (CaP) and high-grade disease (HGCaP, Gleason score ≥ 7) in a Mexican referral population, with comparison to the Prostate Cancer Prevention Trial Prostate Cancer Risk Calculator (PCPTRC). METHODS AND MATERIALS From a retrospective study of 826 patients who underwent prostate biopsy between January 2005 and December 2009 at the Instituto Nacional de Cancerología, Mexico, logistic regression was used to assess the effects of age, prostate-specific antigen (PSA), digital rectal exam (DRE), first-degree family history of CaP, and history of a prior prostate biopsy on CaP and HGCaP, separately. Internal discrimination, goodness-of-fit, and clinical utility of the resulting models were assessed with comparison to the PCPTRC. RESULTS Rates of both CaP (73.2%) and HGCaP (33.3%) were high among referral patients in this Mexican urology clinic. The PCPTRC generally underestimated the risk of CaP but overestimated the risk of HGCaP. Four factors influencing CaP on biopsy were logPSA, DRE, family history and a prior biopsy history (all P < 0.001). The internal AUC of the logistic model was 0.823 compared with 0.785 of the PCPTRC for CaP (P < 0.001). The same 4 factors were significantly associated with HGCaP as well and the AUC was 0.779 compared with 0.766 of the PCPTRC for HGCaP (P = 0.13). CONCLUSIONS Lack of screening programs or regular urologic checkups in Mexico imply that men typically first reach specialized clinics with a high cancer risk. This renders diagnostic tools developed on comparatively healthy populations, such as the PCPTRC, of lesser utility. Continued efforts are needed to develop and externally validate new clinical diagnostic tools specific to high-risk referral populations incorporating new biomarkers and more clinical characteristics.
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Affiliation(s)
- Yuanyuan Liang
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX 78229, USA; Department of Urology, UTHSCSA, San Antonio, TX 78229, USA; School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA; Cancer Therapy and Research Center, UTHSCSA, San Antonio, TX 78229, USA.
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Niu Y, Ge R, Hu L, Diaz C, Wang Z, Wu CL, Olumi AF. Reduced levels of 5-α reductase 2 in adult prostate tissue and implications for BPH therapy. Prostate 2011; 71:1317-24. [PMID: 21308715 DOI: 10.1002/pros.21348] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Accepted: 01/04/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND 5-α reductase 2 (5-AR 2) is a key enzyme that is responsible of proper development of prostate tissue. Inhibition of 5-AR 2 has proven to be efficacious for management of urinary symptoms secondary benign prostatic hyperplasia (BPH). However, some patients are resistant to the therapeutic effects of 5-AR 2 inhibitor. We wished to determine why some benign non-cancerous adult human prostates do not express 5-AR 2, and hypothesized that methylation of 5-AR 2 promoter region correlated with low expression of 5-AR 2 protein. METHODS The transition zone of 42 human prostate tissues after radical prostatectomy was used for evaluation. Initially, 21 paraffin embedded samples were used to assess immunoreactivity to 5-AR 2 antibody in non-cancerous BPH samples. In the next 21 samples, fresh frozen prostate transition zone samples without cancer were assessed for immunoreactivity and methylation of the 5-AR 2 promoter using methyl-specific PCR. RESULTS We show that 6/21 (29%) of benign human prostate samples did not express the 5-AR 2 protein. Moreover, the promoter region of 5-AR 2 contains a CpG island that is methylated in benign prostate epithelial cells in culture and also in 39% (7/18) human prostate tissues. We show a strong correlation between methylation of the 5-AR 2 promoter region and absence of 5-AR 2 protein expression (P = 0.0025, Fisher's exact test). CONCLUSIONS Methylation of 5-AR 2 promoter may account for low or absent expression of 5-AR 2 in some human adult prostate tissues.
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Affiliation(s)
- Yinong Niu
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Marberger M, Freedland SJ, Andriole GL, Emberton M, Pettaway C, Montorsi F, Teloken C, Rittmaster RS, Somerville MC, Castro R. Usefulness of prostate-specific antigen (PSA) rise as a marker of prostate cancer in men treated with dutasteride: lessons from the REDUCE study. BJU Int 2011; 109:1162-9. [PMID: 21699645 DOI: 10.1111/j.1464-410x.2011.10373.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine if dutasteride-treated men can be monitored safely and adequately for prostate cancer based on data from the Reduction by Dutasteride in Prostate Cancer Events (REDUCE) study. To analyse whether the use of treatment-specific criteria for repeat biopsy maintains the usefulness of prostate-specific antigen (PSA) level for detecting high grade cancers. PATIENTS AND METHODS The REDUCE study was a randomized, double-blind, placebo-controlled investigation of whether dutasteride (0.5 mg/day) reduced the risk of biopsy-detectable prostate cancer in men with a previous negative biopsy. The usefulness of PSA was evaluated using biopsy thresholds defined by National Comprehensive Cancer Network guidelines in the placebo group and any rise in PSA from nadir (the lowest PSA level achieved while in the study) in the dutasteride group. The number of cancers detected on biopsy in the absence of increased/suspicious PSA level as well as sensitivity, specificity, positive predictive value and negative predictive value for high grade prostate cancer detection were analysed by treatment group. Prostate cancer pathological characteristics were compared between men who did and did not meet biopsy thresholds. RESULTS Of 8231 men randomized, 3305 (dutasteride) and 3424 (placebo) underwent at least one prostate biopsy during the study and were included in the analysis. If only men meeting biopsy thresholds underwent biopsy, 25% (47/191) of Gleason 7 and 24% (7/29) of Gleason 8-10 cancers would have been missed in the dutasteride group, and 37% (78/209) of Gleason 7 and 22% (4/18) Gleason 8-10 cancers would have been missed in the placebo group. In both groups, the incidence of Gleason 7 and Gleason 8-10 cancers generally increased with greater rises in PSA. Sensitivity of PSA kinetics was higher and specificity was lower for the detection of Gleason 7-10 cancers in men treated with dutasteride vs placebo. Men with Gleason 7 and Gleason 8-10 cancer meeting biopsy thresholds had greater numbers of positive cores, percent core involvement, and biopsy cancer volume vs men not meeting thresholds. CONCLUSION Using treatment-specific biopsy thresholds, the present study shows that the ability of PSA kinetics to detect high grade prostate cancer is maintained with dutasteride compared with placebo in men with a previous negative biopsy. The sensitivity of PSA kinetics with dutasteride was similar to (Gleason 8-10) or higher than (Gleason 7-10) the placebo group; however, biopsy decisions based on a single increased PSA measurement from nadir in the dutasteride group resulted in a lower specificity compared with using a comparable biopsy threshold in the placebo group, indicating the importance of confirmation of PSA measurements.
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Bratt O, Schumacher MC. Natural history of prostate cancer, chemoprevention and active surveillance. Acta Oncol 2011; 50 Suppl 1:116-9. [PMID: 21604951 DOI: 10.3109/0284186x.2010.527369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Shariat SF, Semjonow A, Lilja H, Savage C, Vickers AJ, Bjartell A. Tumor markers in prostate cancer I: blood-based markers. Acta Oncol 2011; 50 Suppl 1:61-75. [PMID: 21604943 PMCID: PMC3571678 DOI: 10.3109/0284186x.2010.542174] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
UNLABELLED The introduction of total prostate specific antigen (total PSA) testing in blood has revolutionized the detection and management of men with prostate cancer (PCa). The objective of this review was to discuss the challenges of PCa biomarker research, definition of the type of PCa biomarkers, the statistical considerations for biomarker discovery and validation, and to review the literature regarding total PSA velocity and novel blood-based biomarkers. METHODS An English-language literature review of the Medline database (1990 to August 2010) of published data on blood-based biomarkers and PCa was undertaken. RESULTS The inherent biological variability of total PSA levels affects the interpretation of any single result. Men who will eventually develop PCa have increased total PSA levels years or decades before the cancer is diagnosed. Total PSA velocity improves predictiveness of total PSA only marginally, limiting its value for PCa screening and prognostication. The combination of PSA molecular forms and other biomarkers improve PCa detection substantially. Several novel blood-based biomarkers such as human glandular kallikrein 2 (hK2), urokinase plasminogen activator (uPA) and its receptor (uPAR), transforming growth factor-beta 1 (TGF-β1); interleukin-6 (IL-6) and its receptor (IL-6R) may help PCa diagnosis, staging, prognostication, and monitoring. Panels of biomarkers that capture the biologic potential of PCa are in the process of being validated for PCa prognostication. CONCLUSIONS PSA is a strong prognostic marker for long-term risk of clinically relevant cancer. However, there is a need for novel biomarkers that aid clinical decision making about biopsy and initial treatment. There is no doubt that progress will continue based on the integrated collaboration of researchers, clinicians and biomedical firms.
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Affiliation(s)
- Shahrokh F. Shariat
- Department of Urology and Medical Oncology, Weill Cornell Medical Center, New York, NY, USA
| | - Axel Semjonow
- Department of Urology, Prostate Center, University Hospital Muenster, Muenster, Germany
| | - Hans Lilja
- Department of Surgery (Urology Service), Clinical Laboratories, and Medicine (Genito-Urinary Oncology Service), Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Caroline Savage
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andrew J. Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anders Bjartell
- Department of Urology Malmö-Lund, Skåne University Hospital, Lund University, Sweden
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Abstract
Over the past two decades, many more men are diagnosed with prostate cancer then die of the disease. This increase in diagnosis has led to aggressive treatment of indolent disease in many individuals and has been the impetus for finding a means of reducing the risk of prostate cancer. In the past decade, there have been eight large trials of prostate cancer risk reduction using dietary supplements, 5α-reductase inhibitors, or anti-estrogens. The only two trials which have demonstrated efficacy are those involving 5α-reductase inhibitors: the PCPT (finasteride) and REDUCE (dutasteride). This review examines prostate cancer risk reduction, with emphasis on conclusions that can be drawn from these two landmark studies.
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Affiliation(s)
- Roger S Rittmaster
- Oncology Clinical Development, GlaxoSmithKline Inc., 5 Moore Drive, Research Triangle Park, NC 27709, USA.
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Andriole GL, Bostwick D, Brawley OW, Gomella L, Marberger M, Montorsi F, Pettaway C, Tammela TL, Teloken C, Tindall D, Freedland SJ, Somerville MC, Wilson TH, Fowler I, Castro R, Rittmaster RS. The Effect of Dutasteride on the Usefulness of Prostate Specific Antigen for the Diagnosis of High Grade and Clinically Relevant Prostate Cancer in Men With a Previous Negative Biopsy: Results From the REDUCE Study. J Urol 2011; 185:126-31. [DOI: 10.1016/j.juro.2010.09.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Gerald L. Andriole
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | | | - Otis W. Brawley
- American Cancer Society and Emory University, Atlanta, Georgia
| | - Leonard Gomella
- Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | | | - Curtis Pettaway
- The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | | - Claudio Teloken
- UFCSPA - Federal University of Health Sciences and Santa Casa Hospital, Porto Alegre, Brazil
| | | | | | | | | | - Ivy Fowler
- GlaxoSmithKline, Research Triangle Park, North Carolina
| | - Ramiro Castro
- GlaxoSmithKline, Research Triangle Park, North Carolina
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Umar A, Della'Zanna G, Lubet R. Further thoughts on preclinical animal models for cancer prevention: when is it best to start treatment? What are potential histopathologic endpoints? Semin Oncol 2010; 37:339-44. [PMID: 20816504 DOI: 10.1053/j.seminoncol.2010.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
One of the major questions in preclinical testing of potential cancer preventive agents is how to most closely approximate the testing protocol to be employed in phase III prevention trials. The nature of tumors arising in situ in animals allows one to initiate agent exposure from the time of tumor initiation until the time that preinvasive lesions already exist. The large phase III prevention trials have routinely followed participants for 3 to 7 years until a cancer endpoint, which generally implies that the timing of the intervention occurs further along during tumor progression. The objective of preclinical testing is to identify agents for large-scale phase III trials. Accordingly, initiating the tested intervention in preclinical studies later in the tumor progression process is more appropriate for any agent being proposed for phase III clinical trials. Furthermore, cancer, rather than advanced dysplastic lesions or other molecular markers (gene or protein expression), is the preferred primary endpoint. However, simultaneous examination of earlier designated "intermediate" endpoints (hyperplasias, dysplasias, or molecular markers) to determine whether their modulation correlates with that of the primary tumor endpoint would be useful, since these latter endpoints may be employed in phase II prevention trials.
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Affiliation(s)
- Asad Umar
- Division of Cancer Prevention, Gastrointestinal and Other Cancers Research Group, National Cancer Institute, Bethesda, MD, USA
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Helfand BT, Blackwell RH, McVary KT. Consequences of Switching 5α-Reductase Inhibitors on Prostate Specific Antigen Velocity. J Urol 2010; 184:218-23. [DOI: 10.1016/j.juro.2010.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Brian T. Helfand
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert H. Blackwell
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kevin T. McVary
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Medications and Surgical Interventions for Benign Prostatic Hyperplasia Are Potential Confounders of Prostate-Specific Antigen. Curr Urol Rep 2010; 11:224-7. [DOI: 10.1007/s11934-010-0113-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Predicting prostate biopsy outcome: artificial neural networks and polychotomous regression are equivalent models. Int Urol Nephrol 2010; 43:23-30. [PMID: 20464485 DOI: 10.1007/s11255-010-9750-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 04/20/2010] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Complex statistical models utilizing multiple inputs to derive a risk assessment may benefit prostate cancer (PC) detection where focus has been on prostate-specific antigen (PSA). This study develops a polychotomous logistic regression (PR) model and an artificial neural network (ANN) for predicting biopsy results, particularly for clinically significant PC. METHODS There were 3,025 men undergoing TRUS-guided biopsy (BX) with PSA <10 ng/ml selected. BX outcome classified as benign, atypical small acinar proliferation or high-grade prostatic intraepithelial neoplasia (ASAP/PIN), non-significant (NSPC) or clinically significant PC (CSPC). PR and ANN models were developed to distinguish between BX categories. Predictors were age, PSA, abnormal digital rectal examination (DRE), positive transrectal ultrasound (TRUS) and prostate volume. RESULTS Among the BXs, 44% were benign, 14% ASAP/PIN, 16% NSPC and 25% CSPC. Median age, PSA and volume were 64 years, 5.7 ng/ml and 50 cc. TRUS lesion was present in 47%, and DRE was abnormal in 39%. PR and ANN models did not differ on percentage BX outcomes correctly predicted (55, 57%, respectively) and were equally poor for both ASAP/PIN (0%) and NSPC (2%). For PR and ANN, 74-78% ASAP/PIN predicted benign, 2% NSPC and 20-24% CSPC. For NSPC, 69-71% predicted benign, 27-29% CSPC. Benign outcomes were well identified (86-88%), although 12-13% classified CSPC. CSPC was correctly identified in 65-66% with misclassifications largely benign (33% for PR and ANN). CONCLUSIONS Neither PR nor ANN was able to distinguish between the four biopsy outcomes: ASAP/PIN and NSPC were not distinguished from benign or CSPC. ANN did not perform better than PR. Inclusion of additional predictors may increase the performance of statistical models in predicting BX outcome.
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Ramírez-Backhaus M, Bahilo P, Arlandis S, Santamaría Navarro C, Pontones Moreno J, Jiménez-Cruz F. Prospective validation of a nomogram predictive of a positive initial prostate biopsy. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s2173-5786(10)70008-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ramírez-Backhaus M, Bahilo P, Arlandis S, Santamaría Navarro C, Pontones Moreno J, Jiménez-Cruz F. Validación prospectiva de un nomograma predictivo de la presencia de cáncer de próstata en pacientes que se someten a biopsia transrectal ecodirigida de 10 cilindros. Actas Urol Esp 2010. [DOI: 10.1016/s0210-4806(10)70008-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Eyre SJ, Ankerst DP, Wei JT, Nair PV, Regan MM, Bueti G, Tang J, Rubin MA, Kearney M, Thompson IM, Sanda MG. Validation in a multiple urology practice cohort of the Prostate Cancer Prevention Trial calculator for predicting prostate cancer detection. J Urol 2009; 182:2653-8. [PMID: 19836788 DOI: 10.1016/j.juro.2009.08.056] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Indexed: 11/26/2022]
Abstract
PURPOSE The Prostate Cancer Prevention Trial prostate cancer risk calculator was developed in a clinical trial cohort that does not represent men routinely referred for prostate biopsy. We assessed the generalizability of the Prostate Cancer Prevention Trial calculator in a cohort more representative of patients referred for consideration of prostate biopsy in American urology practice. MATERIALS AND METHODS Patients undergoing prostate biopsy by 12 urologists at 5 sites were enrolled in an Early Detection Research Network cohort. The Prostate Cancer Prevention Trial risk calculator was validated by examining area underneath the receiver operating characteristic curve, sensitivity, specificity and calibration comparing observed vs predicted risk of prostate cancer detection. RESULTS Cancer incidence was greater (43% vs 22%, p = 0.001) in the Early Detection Research Network validation cohort (645) compared to the Prostate Cancer Prevention Trial group (5,519). Early Detection Research Network participants were younger and more racially diverse, and had more abnormal digital rectal examinations and higher prostate specific antigen than Prostate Cancer Prevention Trial participants (all p <0.001). Cancer severity was worse in the Early Detection Research Network cohort than in the Prostate Cancer Prevention Trial (Gleason 7 or higher 60% vs 21%, p <0.001). Nevertheless, the Prostate Cancer Prevention Trial risk calculator was superior to prostate specific antigen alone for predicting cancer in the Early Detection Research Network (AUC 0.691 vs 0.655, p = 0.009) and calibration confirmed that the Prostate Cancer Prevention Trial risk score accurately predicted individual risks in the Early Detection Research Network cohort. CONCLUSIONS Differences between the Early Detection Research Network validation cohort and the Prostate Cancer Prevention Trial cohort underscore the importance of validating calculator performance in the multicenter urology practice setting. Our findings extend the applicability of the Prostate Cancer Prevention Trial calculator for measuring the risk of prostate cancer detection on biopsy to the routine American urology practice setting.
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Affiliation(s)
- Stephen J Eyre
- Division of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 20015, USA
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Abstract
Approximately one in six men in the United States will develop prostate cancer during their lifetime. Genetic and environmental variables play a role in determining prostate cancer risk. This article highlights the latest evidence regarding the risk factors for prostate cancer. The current screening strategies using prostate-specific antigen and digital rectal examination are also discussed, as well as the limitations of these protocols and potential methods for improving early detection.
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Affiliation(s)
- Stacy Loeb
- Brady Urological Institute, Johns Hopkins Medical Institutions, 600 N Wolfe Street, Marburg 1, Baltimore, MD 21287, USA.
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Berges R, Dreikorn K, Höfner K, Madersbacher S, Michel M, Muschter R, Oelke M, Reich O, Rulf W, Tschuschke C, Tunn U. Therapie des benignen Prostatasyndroms (BPS). Urologe A 2009; 48:1503-16. [DOI: 10.1007/s00120-009-2067-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kaplan DJ, Boorjian SA, Ruth K, Egleston BL, Chen DYT, Viterbo R, Uzzo RG, Buyyounouski MK, Raysor S, Giri VN. Evaluation of the Prostate Cancer Prevention Trial Risk calculator in a high-risk screening population. BJU Int 2009; 105:334-7. [PMID: 19709072 DOI: 10.1111/j.1464-410x.2009.08793.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
STUDY TYPE Diagnostic (exploratory cohort). LEVEL OF EVIDENCE 2b. OBJECTIVE To evaluate the Prostate Cancer Prevention Trial (PCPT) risk calculator in a screening cohort of young, racially diverse, high-risk men with a low baseline prostate-specific antigen (PSA) level and enrolled in the Prostate Cancer Risk Assessment Program (PRAP). The PCPT calculator provides an assessment of prostate cancer risk based on age, PSA level, race, previous biopsy, and family history. PATIENTS AND METHODS Eligibility for PRAP includes men aged 35-69 years who are African-American, have a family history of prostate cancer, or have a known BRCA1/2 mutation. PCPT risk scores were determined for PRAP participants, and were compared to observed prostate cancer rates. RESULTS In all, 624 participants were evaluated, including 382 (61.2%) African-American men and 242 (38.7%) men with a family history of prostate cancer; the median (range) age was 49.0 (34.0-69.0) years and the median PSA level 0.9 (0.1-27.2) ng/mL. The PCPT risk score correlated with prostate cancer diagnosis, as the median baseline risk score in patients diagnosed with prostate cancer was 31.3%, vs 14.2% in patients not diagnosed with prostate cancer (P < 0.001). The PCPT calculator similarly stratified the risk of diagnosis of Gleason score > or =7 disease, as the median risk score was 36.2% in patients diagnosed with Gleason > or =7 prostate cancer vs 15.2% in all other participants (P < 0.001). CONCLUSION The PCPT risk calculator score was found to stratify prostate cancer risk in a cohort of young, primarily African-American men with a low baseline PSA level. These results support further evaluation of this predictive tool for assessing the risk of prostate cancer in high-risk men.
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Affiliation(s)
- David J Kaplan
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, USA
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Walsh PC. Three Considerations Before Advising 5-α-Reductase Inhibitors for Chemoprevention. J Clin Oncol 2009; 27:e22; author reply e23. [DOI: 10.1200/jco.2009.22.9070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Patrick C. Walsh
- The James Buchanan Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD
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Locke JA, Nelson CC, Adomat HH, Hendy SC, Gleave ME, Guns EST. Steroidogenesis inhibitors alter but do not eliminate androgen synthesis mechanisms during progression to castration-resistance in LNCaP prostate xenografts. J Steroid Biochem Mol Biol 2009; 115:126-36. [PMID: 19442514 DOI: 10.1016/j.jsbmb.2009.03.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 03/24/2009] [Accepted: 03/26/2009] [Indexed: 11/16/2022]
Abstract
In castration-resistant prostate cancer (CRPC) many androgen-regulated genes become re-expressed and tissue androgen levels increase despite low serum levels. We and others have recently reported that CRPC tumor cells can de novo synthesize androgens from adrenal steroid precursors or cholesterol and that high levels of progesterone exist in LNCaP tumors after castration serving perhaps as an intermediate in androgen synthesis. Herein, we compare androgen synthesis from [(3)H-progesterone] in the presence of specific steroidogenesis inhibitors and anti-androgens in steroid starved LNCaP cells and CRPC tumors. Similarly, we compare steroid profiles in LNCaP tumors at different stages of CRPC progression. Steroidogenesis inhibitors targeting CYP17A1 and SRD5A2 significantly altered but did not eliminate androgen synthesis from progesterone in steroid starved LNCaP cells and CRPC tumors. Upon exposure to inhibitors of steroidogenesis prostate cancer cells adapt gradually during CRPC progression to synthesize DHT in a compensatory manner through alternative feed-forward mechanisms. Furthermore, tumors obtained immediately after castration are significantly less efficient at metabolizing progesterone ( approximately 36%) and produce a different steroid profile to CRPC tumors. Optimal targeting of the androgen axis may be most effective when tumors are least efficient at synthesizing androgens. Confirmatory studies in humans are required to validate these findings.
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Affiliation(s)
- Jennifer A Locke
- The Prostate Centre at Vancouver General Hospital and Department of Urologic Sciences, University of British Columbia, British Columbia, Canada
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Helfand BT, Anderson CB, Fought A, Kim DY, Vyas A, McVary KT. Postoperative PSA and PSA velocity identify presence of prostate cancer after various surgical interventions for benign prostatic hyperplasia. Urology 2009; 74:177-83. [PMID: 19428074 DOI: 10.1016/j.urology.2008.10.062] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Revised: 10/16/2008] [Accepted: 10/17/2008] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To determine whether prostate-specific antigen (PSA) values can distinguish those with prostate cancer (CaP) from those with histologic benign prostatic hyperplasia (BPH) only after surgical intervention. Prostatic adenoma inevitably remains after BPH surgery; therefore, patients remain at risk of developing CaP. Although the PSA level can be used for CaP screening in this population, it might be influenced by the efficacies of different BPH procedures. METHODS We performed a review of patients who had undergone transurethral resection of the prostate (TURP; n = 343), holmium laser resection of the prostate (HoLRP; n = 54), or open prostatectomy (OP; n = 68). The PSA and PSA velocity values were collected at regular intervals both pre- and postoperatively for all patients. Only patients with histologic BPH and those with incidental CaP who underwent a watchful waiting strategy were included. RESULTS The average preoperative PSA values were significantly different between the TURP, HoLRP, and OP groups. Only 1 patient had incidental CaP in the HoLRP group. No differences were present between the preoperative PSA values for patients with histologic BPH and those with incidental CaP undergoing a watchful waiting strategy (P > .05). However, the postoperative PSA values were increased in the patients with CaP (watchful waiting compared with the patient with BPH only (2.4 vs 1.7 ng/mL TURP and 4.1 vs 1.1 ng/mL OP). Similarly, patients with incidental CaP had a significantly elevated postoperative mean PSA velocity compared with patients without CaP (0.38 vs 0.06 ng/mL/y TURP and 0.47 vs -0.13 ng/mL/y OP; P < .05). CONCLUSIONS Postoperative PSA and PSA velocity measurements can be used to distinguish patients with CaP from those with histologic BPH only.
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Affiliation(s)
- Brian T Helfand
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinios 60611, USA
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