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Sundaresan VM, Smani S, Rajwa P, Renzulli J, Sprenkle PC, Kim IY, Leapman MS. Prostate-specific antigen screening for prostate cancer: Diagnostic performance, clinical thresholds, and strategies for refinement. Urol Oncol 2024:S1078-1439(24)00505-2. [PMID: 39019723 DOI: 10.1016/j.urolonc.2024.06.003] [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: 11/12/2023] [Revised: 03/27/2024] [Accepted: 06/02/2024] [Indexed: 07/19/2024]
Abstract
Prostate specific antigen (PSA) has transformed the diagnosis and treatment of prostate cancer by enabling early detection at global scale. Due to expression in both benign and malignant cells, PSA-based prostate cancer screening using single cut-points yields imperfect diagnostic performance and has led to the detection and over-treatment of low-grade prostate cancer. Additional challenges in the interpretation of PSA include substantial inter and intrapersonal variation, differences with age and prostate volume, and selection of standardized PSA value cutoffs for clinical application. In response, refinements to PSA including risk and age-based thresholds, age and genetic adjustments, PSA density, percentage free PSA, and PSA velocity have been proposed and extensively studied. In this review, we focus on the clinical role of PSA as a screening biomarker with a particular emphasis on its test characteristics, clinically actionable thresholds, and strategies to refine its clinical interpretation.
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Affiliation(s)
| | - Shayan Smani
- Department of Urology, Yale School of Medicine, New Haven, CT
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Joseph Renzulli
- Department of Urology, Yale School of Medicine, New Haven, CT
| | | | - Isaac Y Kim
- Department of Urology, Yale School of Medicine, New Haven, CT
| | - Michael S Leapman
- Department of Urology, Yale School of Medicine, New Haven, CT; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT.
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Finati M, Davis M, Stephens A, Chiarelli G, Cirulli GO, Morrison C, Affas R, Sood A, Buffi N, Lughezzani G, Briganti A, Montorsi F, Carrieri G, Rogers C, Vickers AJ, Abdollah F. The Role of Baseline Prostate-specific Antigen Value Prior to Age 60 in Predicting Lethal Prostate Cancer: Analysis of a Contemporary North American Cohort. Eur Urol Oncol 2024:S2588-9311(24)00172-X. [PMID: 38991891 DOI: 10.1016/j.euo.2024.06.014] [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: 03/18/2024] [Revised: 06/12/2024] [Accepted: 06/25/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND AND OBJECTIVE Studies evaluating the role of baseline midlife prostate-specific antigen (PSA) as a predictor of development and progression of prostate cancer relied predominately on cohorts from the pre-PSA screening introduction era. The aim of our study was to examine the role of baseline PSA prior to the age of 60 yr as a predictor of developing lethal prostate cancer using a contemporary North American cohort. METHODS Our cohort included all men aged 40-59 yr who received their first PSA through our health system between the years 1995 and 2019. Patients were divided into four categories based on age: 40-44, 45-49, 50-54, and 55-59 yr. Baseline PSA was the predictor of interest. Lethal disease was defined as death from prostate cancer or development of metastatic disease either at diagnosis or during follow-up. Cancer-specific mortality and overall mortality were obtained by linking our database to the Michigan Vital Records registry. Competing-risk regression was used to evaluate the association between PSA and lethal prostate cancer. KEY FINDINGS AND LIMITATIONS A total of 129067 men met the inclusion criteria during the study period. The median follow-up for patients free from cancer was 7.4 yr. For men aged 40-44, 45-49, 50-54, and 55-59 yr, the estimated rates of lethal prostate cancer at 20 yr were 0.02%, 0.14%, 0.33%, and 0.51% in men with PSA CONCLUSIONS AND CLINICAL IMPLICATIONS Baseline PSA is a very strong predictor of the subsequent risk of developing lethal prostate cancer in a large contemporary diverse North American cohort, which was exposed to opportunistic PSA screening. The association was far larger than that found for polygenic risk scores, confirming that baseline PSA prior to the age of 60 yr is the most effective tool for adjusting subsequent screening. Compared with studies of unscreened cohorts, there was a smaller difference in discrimination between incident and lethal disease, reflecting the influence of screening. PATIENT SUMMARY In this study, we found that a single baseline prostate-specific antigen (PSA) value is strongly predictive of the subsequent risk of developing metastatic prostate cancer, as well as the risk of dying from prostate cancer. The initial PSA level can therefore be used to adjust the frequency of subsequent PSA testing.
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Affiliation(s)
- Marco Finati
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health, Detroit, MI, USA; Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Matthew Davis
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health, Detroit, MI, USA
| | - Alex Stephens
- Public Health Sciences, Henry Ford Health, Detroit, MI, USA
| | - Giuseppe Chiarelli
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health, Detroit, MI, USA; Department of Urology, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Giuseppe Ottone Cirulli
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health, Detroit, MI, USA; Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Chase Morrison
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health, Detroit, MI, USA
| | - Rafe Affas
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health, Detroit, MI, USA
| | - Akshay Sood
- Department of Urology, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nicolò Buffi
- Department of Urology, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Giovanni Lughezzani
- Department of Urology, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Alberto Briganti
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Carrieri
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Craig Rogers
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health, Detroit, MI, USA; Henry Ford Health, Detroit, MI, USA
| | - Andrew Julian Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Firas Abdollah
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health, Detroit, MI, USA; Henry Ford Health, Detroit, MI, USA.
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3
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Bjerner J, Bratt O, Aas K, Albertsen PC, Fosså SD, Kvåle R, Lilja H, Müller C, Müller S, Stensvold A, Thomas O, Røe OD, Vickers A, Walz J, Carlsson SV, Oldenburg J. Baseline Serum Prostate-specific Antigen Value Predicts the Risk of Subsequent Prostate Cancer Death-Results from the Norwegian Prostate Cancer Consortium. Eur Urol 2024; 86:20-26. [PMID: 37169639 PMCID: PMC10840440 DOI: 10.1016/j.eururo.2023.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/27/2023] [Accepted: 04/25/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Prostate-specific antigen (PSA) levels in midlife are strongly associated with the long-term risk of lethal prostate cancer in cohorts not subject to screening. This is the first study evaluating the association between PSA levels drawn as part of routine medical care in the Norwegian population and prostate cancer incidence and mortality. The objective of the study was to determine the association between midlife PSA levels <4.0 ng/ml, drawn aspart of routine medical care, and long-term risk of prostate cancer death. METHODS The Norwegian Prostate Cancer Consortium collected >8 million PSA results from >1 million Norwegian males (more than or equal to) 40 yr of age. We studied 176 099 men (predefined age strata: 40-54 and 55-69 yr) without a prior prostate cancer diagnosis who had a nonelevated baseline PSA level (<4.0 ng/ml) between January 1,1995 and December 31, 2005. We assessed the 16-yr risk of prostate cancer mortality. We calculated the discrimination (C-index) between predefined PSA strata (<0.5, 0.5-0.9, 1.0-1.9, 2.0-2.9, and 3.0-3.9 ng/ml) and subsequent prostate cancer death. Survival curves were plotted using the Kaplan-Meier method. KEY FINDINGS AND LIMITATIONS The median follow-up time of men who did not get prostate cancer was 17.9 yr. Overall, 84% of men had a baseline PSA level of <2.0 ng/ml and 1346 men died from prostate cancer, with 712 deaths (53%) occurring in the 16% of men with the highest baseline PSA of 2.0-3.9 ng/ml. Baseline PSA levels were associated with prostate cancer mortality (C-index 0.72 for both age groups, 40-54 and 55-69 yr). The fact that the reason for any given PSA measurement remains unknown represents a limitation. CONCLUSIONS AND CLINICAL IMPLICATIONS We replicated prior studies that baseline PSA at age 40-69 yr can be used to stratify a man's risk of dying from prostate cancer within the next 15-20 yr. PATIENT SUMMARY A prostate-specific antigen level obtained as part of routine medical care is strongly associated with a man's risk of dying from prostate cancer in the next two decades.
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Affiliation(s)
- Johan Bjerner
- Fürst Laboratories, Department of Clinical Chemistry, Oslo, Norway
| | - Ola Bratt
- Department of Urology, Institute of Clinical Sciences, Gothenburg University, Gothenburg, Sweden; Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kirsti Aas
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Peter C Albertsen
- Division of Urology, Department of Surgery, University of Connecticut Health Center, Farmington, CT, USA
| | - Sophie D Fosså
- National Advisory Unit for Late Effects After Cancer Treatment, Oslo University Hospital, Oslo, Norway; Medical Faculty of University of Oslo, Oslo, Norway
| | - Rune Kvåle
- Department of Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway; Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Hans Lilja
- Departments of Laboratory Medicine, Surgery and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Translational Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | | | - Stig Müller
- Department of Urology, Akershus University Hospital, Lørenskog, Norway
| | | | - Owen Thomas
- Department of Biostatistics, Akershus University Hospital, Lørenskog, Norway
| | - Oluf D Røe
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Cancer Clinic, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway
| | - Andrew Vickers
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jochen Walz
- Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - Sigrid V Carlsson
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jan Oldenburg
- Medical Faculty of University of Oslo, Oslo, Norway; Department of Oncology, Akershus University Hospital, Lørenskog, Norway.
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Iyer HS, Stone BV, Roscoe C, Hsieh MC, Stroup AM, Wiggins CL, Schumacher FR, Gomez SL, Rebbeck TR, Trinh QD. Access to Prostate-Specific Antigen Testing and Mortality Among Men With Prostate Cancer. JAMA Netw Open 2024; 7:e2414582. [PMID: 38833252 PMCID: PMC11151156 DOI: 10.1001/jamanetworkopen.2024.14582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/02/2024] [Indexed: 06/06/2024] Open
Abstract
Importance Prostate-specific antigen (PSA) screening for prostate cancer is controversial but may be associated with benefit for certain high-risk groups. Objectives To evaluate associations of county-level PSA screening prevalence with prostate cancer outcomes, as well as variation by sociodemographic and clinical factors. Design, Setting, and Participants This cohort study used data from cancer registries based in 8 US states on Hispanic, non-Hispanic Black, and non-Hispanic White men aged 40 to 99 years who received a diagnosis of prostate cancer between January 1, 2000, and December 31, 2015. Participants were followed up until death or censored after 10 years or December 31, 2018, whichever end point came first. Data were analyzed between September 2023 and January 2024. Exposure County-level PSA screening prevalence was estimated using the Behavior Risk Factor Surveillance System survey data from 2004, 2006, 2008, 2010, and 2012 and weighted by population characteristics. Main Outcomes and Measures Multivariable logistic, Cox proportional hazards regression, and competing risks models were fit to estimate adjusted odds ratios (AOR) and adjusted hazard ratios (AHR) for associations of county-level PSA screening prevalence at diagnosis with advanced stage (regional or distant), as well as all-cause and prostate cancer-specific survival. Results Of 814 987 men with prostate cancer, the mean (SD) age was 67.3 (9.8) years, 7.8% were Hispanic, 12.2% were non-Hispanic Black, and 80.0% were non-Hispanic White; 17.0% had advanced disease. There were 247 570 deaths over 5 716 703 person-years of follow-up. Men in the highest compared with lowest quintile of county-level PSA screening prevalence at diagnosis had lower odds of advanced vs localized stage (AOR, 0.86; 95% CI, 0.85-0.88), lower all-cause mortality (AHR, 0.86; 95% CI, 0.85-0.87), and lower prostate cancer-specific mortality (AHR, 0.83; 95% CI, 0.81-0.85). Inverse associations between PSA screening prevalence and advanced cancer were strongest among men of Hispanic ethnicity vs other ethnicities (AOR, 0.82; 95% CI, 0.78-0.87), older vs younger men (aged ≥70 years: AOR, 0.77; 95% CI, 0.75-0.79), and those in the Northeast vs other US Census regions (AOR, 0.81; 95% CI, 0.79-0.84). Inverse associations with all-cause mortality were strongest among men of Hispanic ethnicity vs other ethnicities (AHR, 0.82; 95% CI, 0.78-0.85), younger vs older men (AHR, 0.81; 95% CI, 0.77-0.85), those with advanced vs localized disease (AHR, 0.80; 95% CI, 0.78-0.82), and those in the West vs other US Census regions (AHR, 0.89; 95% CI, 0.87-0.90). Conclusions and Relevance This population-based cohort study of men with prostate cancer suggests that higher county-level prevalence of PSA screening was associated with lower odds of advanced disease, all-cause mortality, and prostate cancer-specific mortality. Associations varied by age, race and ethnicity, and US Census region.
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Affiliation(s)
- Hari S. Iyer
- Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Benjamin V. Stone
- Department of Urology and Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Urology, Massachusetts General Hospital, Boston
| | - Charlotte Roscoe
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mei-Chin Hsieh
- Louisiana Tumor Registry and Epidemiology Program, School of Public Health at Louisiana State University Health Sciences Center, New Orleans
| | - Antoinette M. Stroup
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
- New Jersey State Cancer Registry, Trenton
| | - Charles L. Wiggins
- New Mexico Tumor Registry, University of New Mexico Comprehensive Cancer Center, Albuquerque
| | - Fredrick R. Schumacher
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Population and Cancer Prevention Program, Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Scarlett L. Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Timothy R. Rebbeck
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Department of Urology and Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
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5
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Stone A, Goldberg H. Modifying and personalizing prostate cancer screening. Transl Androl Urol 2024; 13:899-901. [PMID: 38855594 PMCID: PMC11157386 DOI: 10.21037/tau-23-612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 03/08/2024] [Indexed: 06/11/2024] Open
Affiliation(s)
- Alexandra Stone
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Hanan Goldberg
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA
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Garraway IP, Carlsson SV, Nyame YA, Vassy JL, Chilov M, Fleming M, Frencher SK, George DJ, Kibel AS, King SA, Kittles R, Mahal BA, Pettaway CA, Rebbeck T, Rose B, Vince R, Winn RA, Yamoah K, Oh WK. Prostate Cancer Foundation Screening Guidelines for Black Men in the United States. NEJM EVIDENCE 2024; 3:EVIDoa2300289. [PMID: 38815168 DOI: 10.1056/evidoa2300289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
BACKGROUND In the United States, Black men are at highest risk for being diagnosed with and dying from prostate cancer. Given this disparity, we examined relevant data to establish clinical prostate-specific antigen (PSA) screening guidelines for Black men in the United States. METHODS A comprehensive literature search identified 1848 unique publications for screening. Of those screened, 287 studies were selected for full-text review, and 264 were considered relevant and form the basis for these guidelines. The numbers were reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS Three randomized controlled trials provided Level 1 evidence that regular PSA screening of men 50 to 74 years of age of average risk reduced metastasis and prostate cancer death at 16 to 22 years of follow-up. The best available evidence specifically for Black men comes from observational and modeling studies that consider age to obtain a baseline PSA, frequency of testing, and age when screening should end. Cohort studies suggest that discussions about baseline PSA testing between Black men and their clinicians should begin in the early 40s, and data from modeling studies indicate prostate cancer develops 3 to 9 years earlier in Black men compared with non-Black men. Lowering the age for baseline PSA testing to 40 to 45 years of age from 50 to 55 years of age, followed by regular screening until 70 years of age (informed by PSA values and health factors), could reduce prostate cancer mortality in Black men (approximately 30% relative risk reduction) without substantially increasing overdiagnosis. CONCLUSIONS These guidelines recommend that Black men should obtain information about PSA screening for prostate cancer. Among Black men who elect screening, baseline PSA testing should occur between ages 40 and 45. Depending on PSA value and health status, annual screening should be strongly considered. (Supported by the Prostate Cancer Foundation.).
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Affiliation(s)
- Isla P Garraway
- Department of Urology, David Geffen School of Medicine, University of California and Department of Surgical and Perioperative Care, VA Greater Los Angeles Healthcare System, Los Angeles
| | - Sigrid V Carlsson
- Departments of Surgery and Epidemiology and Biostatistics, Urology Service, Memorial Sloan Kettering Cancer Center, New York
- Department of Urology, Sahlgrenska Academy at Gothenburg University, Gothenburg, and Department of Translational Medicine, Division of Urological Cancers, Medical Faculty, Lund University, Lund, Sweden
| | - Yaw A Nyame
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle
- Department of Urology, University of Washington, Seattle
| | - Jason L Vassy
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Health Administration, Bedford and Boston
- Harvard Medical School and Brigham and Women's Hospital, Boston
| | - Marina Chilov
- Medical Library, Memorial Sloan Kettering Cancer Center, New York
| | - Mark Fleming
- Virginia Oncology Associates, US Oncology Network, Norfolk, VA
| | - Stanley K Frencher
- Martin Luther King Jr. Community Hospital and University of California, Los Angeles
| | - Daniel J George
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC
| | - Adam S Kibel
- Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Sherita A King
- Section of Urology, Medical College of Georgia at Augusta University and Charlie Norwood Veterans Affairs Medical Center, Augusta, GA
| | - Rick Kittles
- Morehouse School of Medicine, Community Health and Preventive Medicine, Atlanta
| | - Brandon A Mahal
- Sylvester Comprehensive Cancer Center, Miami
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami
| | - Curtis A Pettaway
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston
| | - Timothy Rebbeck
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
- Harvard T.H. Chan School of Public Health, Boston
| | - Brent Rose
- Department of Radiation Oncology, University of California, San Diego
- Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Randy Vince
- Department of Urology, University of Michigan, Ann Arbor
| | - Robert A Winn
- Massey Cancer Center, Virginia Commonwealth University, Richmond
- Department of Internal Medicine, Virginia Commonwealth University, Richmond
| | - Kosj Yamoah
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
- James A. Haley Veterans' Hospital, Tampa, FL
| | - William K Oh
- Prostate Cancer Foundation, Santa Monica, CA
- Division of Hematology and Medical Oncology, Tisch Cancer Institute at Mount Sinai, New York
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Tesfai A, Norori N, Harding TA, Wong YH, Hobbs MD. Variation in harms and benefits of prostate-specific antigen screening for prostate cancer by socio-clinical risk factors: A rapid review. BJUI COMPASS 2024; 5:417-432. [PMID: 38751945 PMCID: PMC11090766 DOI: 10.1002/bco2.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/25/2023] [Indexed: 05/18/2024] Open
Abstract
Objective To analyse the latest evidence on the relative harms and benefits of screening and diagnostic pathways with close examination of (i) men aged 50 years or older, (ii) men whose ethnicity places them at higher risk and (iii) men with a family history. Methods We conducted a literature search using PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) databases and other sources, from January 1990 to 25 January 2023. Two independent reviewers selected for randomised controlled trials (RCTs) and cohort studies which met our inclusion criteria. Results Twenty-eight articles were selected, from six trials, including the Göteborg trial-reported separately from European Randomised Study of Screening for Prostate Cancer (ERSPC). Prostate-specific antigen (PSA)-based screening led to the increased detection of low-grade cancer and reduction of advanced/metastatic disease but had contradictory effects on prostate cancer (PCa)-specific mortality (no difference or reduced), possibly due to issues of contamination or compliance. Screening men from a relatively young age (50-55) reduced risk of PCa-specific mortality in a subanalysis of an 18-year follow-up study and in a 17-year cohort study from the main Göteborg trial. Moreover, one Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial analysis reported a trend of reduced risk of PCa-specific mortality for men with a family history who were screened. [Correction added on 05 March 2024, after first online publication: "Cancer Screening Trial" has been added to the preceding sentence.] However, we did not find relevant studies for ethnicity. Conclusion Under current UK practice, the choice to conduct a PSA test relies on a shared decision-making approach guided by known risk factors. However, we found there was a lack of strong evidence on the harms and benefits of PSA screening by socio-clinical risk factors and suggest further research is required to understand the long-term impact of screening on high-risk populations in the current diagnostic setting.
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Dalela D, Corsi NJ, Bronkema C, Sood A, Arora S, Majdalany SE, Butaney M, Jamil M, Li P, Palma-Zamora I, Rakic N, Kovacevic N, Jeong W, Menon M, Rogers CG, Schonberg MA, Abdollah F. Prostate Specific Antigen Screening on a Nationwide Level: Featuring the Contribution of Race and Life Expectancy in Decision Making. Clin Genitourin Cancer 2024; 22:269-280.e2. [PMID: 38233279 DOI: 10.1016/j.clgc.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Estimation of life expectancy (LE) is important for the relative benefit of prostate specific antigen (PSA) screening. Limited data exists regarding screening for Black men with extended LE. The aim of the current study was to assess temporal trends in screening in United States (US) Black men with limited vs. extended LE, using a nationally representative dataset. MATERIALS AND METHODS Using the National Health Institution Survey (NHIS) 2000 to 2018, men aged ≥40 without prior history of prostate cancer (PCa) who underwent PSA screening in the last 12 months were stratified into limited LE (ie, LE <15 years) and extended LE (ie, LE≥15 years) using the validated Schonberg index. LE-stratified temporal trends in PSA screening were analyzed for all men, and then in Black men. Weighted multivariable analyses and dominance analyses identified the predictors of PSA screening. RESULTS PSA screening declined over the study period both for all eligible men with limited and extended LE, particularly between NHIS 2008 and 2013 (27.9%-20.7% in the extended). Screening increased significantly in Black men with extended LE (17.6% in 2010-25.7% in 2018). However, LE was not an independent predictor of screening in the Black cohort. Prior recipient of colonoscopy (55%-57%) and visit to health care provider (24%-32%) were the most important determinants for screening. CONCLUSION For US men with extended LE, only 1 in 4 receive PSA screening, with a decline over the study-period. Screening rates increased for Black men. However, these changes were not driven by LE consideration itself, but participation in other screenings and access to a provider.
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Affiliation(s)
- Deepansh Dalela
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; University of Texas Southwestern Medical Center, Dallas, TX; Wayne State University School of Medicine, Detroit, MI
| | - Nicholas J Corsi
- Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; University of Texas Southwestern Medical Center, Dallas, TX; Wayne State University School of Medicine, Detroit, MI
| | - Chandler Bronkema
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Akshay Sood
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sohrab Arora
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | - Sami E Majdalany
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | - Mohit Butaney
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | - Marcus Jamil
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | - Pin Li
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Mi
| | - Isaac Palma-Zamora
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | - Nikola Rakic
- Department of Urology, Baylor College of Medicine, Houston, TX
| | - Natalija Kovacevic
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | - Wooju Jeong
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Mani Menon
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Craig G Rogers
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | - Mara A Schonberg
- Division of General Medicine, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
| | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI.
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9
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Scherer TP, Poyet C. Prognostic properties of the baseline prostate-specific antigen value-insights from the European randomized study of screening for prostate cancer. Transl Androl Urol 2024; 13:473-475. [PMID: 38590968 PMCID: PMC10999015 DOI: 10.21037/tau-23-606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/24/2024] [Indexed: 04/10/2024] Open
Affiliation(s)
- Thomas Paul Scherer
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Cédric Poyet
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
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10
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Amini AE, Hunter AE, Almashad A, Feng AJ, Patel ND, O'Dea MR, McCormick SR, Rodgers LH, Salari K. Magnetic Resonance Imaging-based Prostate Cancer Screening in Carriers of Pathogenic Germline Mutations: Interim Results from the Initial Screening Round of the Prostate Cancer Genetic Risk Evaluation and Screening Study. Eur Urol Oncol 2024:S2588-9311(24)00041-5. [PMID: 38453598 DOI: 10.1016/j.euo.2024.01.015] [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: 12/03/2023] [Revised: 01/08/2024] [Accepted: 01/25/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND The risk of early-onset and clinically aggressive prostate cancer is elevated in carriers of certain rare pathogenic germline mutations. The utility of augmenting traditional prostate-specific antigen (PSA)-based screening measures with multiparametric magnetic resonance imaging (MRI) in this population is not yet known. OBJECTIVE To evaluate MRI-based screening in comparison with traditional PSA-based screening among individuals at an elevated genetic risk for prostate cancer. DESIGN, SETTING, AND PARTICIPANTS Male germline carriers of pathogenic/likely pathogenic variants in any of 19 prostate cancer risk genes between the ages of 35 and 74 yr with no prior history of prostate cancer were recruited. Intervention Enrolled participants underwent screening with annual PSA, digital rectal examination (DRE), and triennial multiparametric MRI. Individuals with abnormal DRE, elevated age-adjusted PSA (>1.5 ng/ml for 35-49 yr, >2.0 ng/ml for 50-54 yr, and >3.0 ng/ml for 55-74 yr), or suspicious multiparametric MRI (Prostate Imaging Reporting and Data System [PI-RADS] ≥3 lesion) were offered prostate biopsy. Outcome measurements and statistical analysis Endpoints were diagnosis of any and clinically significant prostate cancer, and alternative screening strategies were compared by a decision curve analysis. RESULTS AND LIMITATIONS To date, 101 males have completed the first round of screening. The greatest proportion of participants are carriers of BRCA2 (n = 44), BRCA1 (n = 35), and ATM (n = 7) variants. Twenty-one have undergone biopsy, resulting in the detection of nine cases of cancer (seven clinically significant). For the detection of clinically significant prostate cancer, abnormal MRI (PI-RADS ≥3) demonstrated 100% sensitivity (7/7) with a negative predictive value (NPV) of 100%, whereas PSA-based screening alone had 57% (4/7) sensitivity with an NPV of 73%. Of six screening strategies evaluated in the decision curve analysis, MRI-based screening alone achieved superior net benefit at all threshold probabilities compared with PSA screening-detecting one additional cancer case per 7.5 patients, while avoiding more unnecessary biopsies at the same threshold probability. CONCLUSIONS Disease prevalence is high among carriers of prostate cancer-associated pathogenic germline mutations. Early results suggest that MRI-based screening enhances early detection of clinically significant disease beyond PSA screening alone. PATIENT SUMMARY In this study, we present the interim results from the PROGRESS prostate cancer screening trial. We found that in certain germline carriers of prostate cancer risk mutations, magnetic resonance imaging-based screening enhances detection of prostate cancer while reducing biopsies triggered, in comparison with traditional prostate-specific antigen screening strategies.
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Affiliation(s)
- Andrew E Amini
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexandra E Hunter
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aya Almashad
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aileen J Feng
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Neel D Patel
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Margaret R O'Dea
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shelley R McCormick
- Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Linda H Rodgers
- Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Keyan Salari
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA.
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11
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Kensler KH, Johnson R, Morley F, Albrair M, Dickerman BA, Gulati R, Holt SK, Iyer HS, Kibel AS, Lee JR, Preston MA, Vassy JL, Wolff EM, Nyame YA, Etzioni R, Rebbeck TR. Prostate cancer screening in African American men: a review of the evidence. J Natl Cancer Inst 2024; 116:34-52. [PMID: 37713266 PMCID: PMC10777677 DOI: 10.1093/jnci/djad193] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Prostate cancer is the most diagnosed cancer in African American men, yet prostate cancer screening regimens in this group are poorly guided by existing evidence, given underrepresentation of African American men in prostate cancer screening trials. It is critical to optimize prostate cancer screening and early detection in this high-risk group because underdiagnosis may lead to later-stage cancers at diagnosis and higher mortality while overdiagnosis may lead to unnecessary treatment. METHODS We performed a review of the literature related to prostate cancer screening and early detection specific to African American men to summarize the existing evidence available to guide health-care practice. RESULTS Limited evidence from observational and modeling studies suggests that African American men should be screened for prostate cancer. Consideration should be given to initiating screening of African American men at younger ages (eg, 45-50 years) and at more frequent intervals relative to other racial groups in the United States. Screening intervals can be optimized by using a baseline prostate-specific antigen measurement in midlife. Finally, no evidence has indicated that African American men would benefit from screening beyond 75 years of age; in fact, this group may experience higher rates of overdiagnosis at older ages. CONCLUSIONS The evidence base for prostate cancer screening in African American men is limited by the lack of large, randomized studies. Our literature search supported the need for African American men to be screened for prostate cancer, for initiating screening at younger ages (45-50 years), and perhaps screening at more frequent intervals relative to men of other racial groups in the United States.
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Affiliation(s)
- Kevin H Kensler
- Department of Population Health Sciences, Weill Cornell Medical Center, New York, NY, USA
| | - Roman Johnson
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Faith Morley
- Department of Population Health Sciences, Weill Cornell Medical Center, New York, NY, USA
| | - Mohamed Albrair
- Department of Global Health, University of Washington, Seattle, WA, USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Barbra A Dickerman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Roman Gulati
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Sarah K Holt
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Hari S Iyer
- Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Adam S Kibel
- Department of Urology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jenney R Lee
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Mark A Preston
- Department of Urology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jason L Vassy
- VA Boston Healthcare System, Boston, MA, USA
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Erika M Wolff
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Yaw A Nyame
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Timothy R Rebbeck
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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12
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Remmers S, Bangma CH, Godtman RA, Carlsson SV, Auvinen A, Tammela TLJ, Denis LJ, Nelen V, Villers A, Rebillard X, Kwiatkowski M, Recker F, Wyler S, Zappa M, Puliti D, Gorini G, Paez A, Lujan M, Nieboer D, Schröder FH, Roobol MJ. Relationship Between Baseline Prostate-specific Antigen on Cancer Detection and Prostate Cancer Death: Long-term Follow-up from the European Randomized Study of Screening for Prostate Cancer. Eur Urol 2023; 84:503-509. [PMID: 37088597 PMCID: PMC10759255 DOI: 10.1016/j.eururo.2023.03.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/01/2023] [Accepted: 03/28/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND The European Association of Urology guidelines recommend a risk-based strategy for prostate cancer screening based on the first prostate-specific antigen (PSA) level and age. OBJECTIVE To analyze the impact of the first PSA level on prostate cancer (PCa) detection and PCa-specific mortality (PCSM) in a population-based screening trial (repeat screening every 2-4 yr). DESIGN, SETTING, AND PARTICIPANTS We evaluated 25589 men aged 55-59 yr, 16898 men aged 60-64 yr, and 12936 men aged 65-69 yr who attended at least one screening visit in the European Randomized Study of Screening for Prostate Cancer (ERSPC) trial (screening arm: repeat PSA testing every 2-4 yr and biopsy in cases with elevated PSA; control arm: no active screening offered) during 16-yr follow-up (FU). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We assessed the actuarial probability for any PCa and for clinically significant (cs)PCa (Gleason ≥7). Cox proportional-hazards regression was performed to assess whether the association between baseline PSA and PCSM was comparable for all age groups. A Lorenz curve was computed to assess the association between baseline PSA and PCSM for men aged 60-61 yr. RESULTS AND LIMITATIONS The overall actuarial probability at 16 yr ranged from 12% to 16% for any PCa and from 3.7% to 5.7% for csPCa across the age groups. The actuarial probability of csPCa at 16 yr ranged from 1.2-1.5% for men with PSA <1.0 ng/ml to 13.3-13.8% for men with PSA ≥3.0 ng/ml. The association between baseline PSA and PCSM differed marginally among the three age groups. A Lorenz curve for men aged 60-61 yr showed that 92% of lethal PCa cases occurred among those with PSA above the median (1.21 ng/ml). In addition, for men initially screened at age 60-61 yr with baseline PSA <2 ng/ml, further continuation of screening is unlikely to be beneficial after the age of 68-70 yr if PSA is still <2 ng/ml. No case of PCSM emerged in the subsequent 8 yr (up to age 76-78 yr). A limitation is that these results may not be generalizable to an opportunistic screening setting or to contemporary clinical practice. CONCLUSIONS In all age groups, baseline PSA can guide decisions on the repeat screening interval. Baseline PSA of <1.0 ng/ml for men aged 55-69 yr is a strong indicator to delay or stop further screening. PATIENT SUMMARY In prostate cancer screening, the patient's baseline PSA (prostate-specific antigen) level can be used to guide decisions on when to repeat screening. The PSA test when used according to current knowledge is valuable in helping to reduce the burden of prostate cancer.
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Affiliation(s)
- Sebastiaan Remmers
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands.
| | - Chris H Bangma
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands
| | - Rebecka A Godtman
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at Goteborg University, Goteborg, Sweden
| | - Sigrid V Carlsson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at Goteborg University, Goteborg, Sweden; Departments of Surgery (Urology Service) and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anssi Auvinen
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Teuvo L J Tammela
- Department of Urology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Louis J Denis
- Department of Urology, Meeting Centre Antwerp, Antwerp, Belgium
| | - Vera Nelen
- Provincial Institute for Hygiene, Antwerp, Belgium
| | - Arnauld Villers
- Department of Urology, Université Lille Nord de France, Lille, France
| | - Xavier Rebillard
- Department of Urology, Clinique Beau Soleil, Montpellier, France
| | - Maciej Kwiatkowski
- Department of Urology, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty, University of Basel, Basel, Switzerland; Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | | | - Stephen Wyler
- Department of Urology, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty, University of Basel, Basel, Switzerland
| | - Marco Zappa
- Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Donella Puliti
- Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Giuseppe Gorini
- Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Alvaro Paez
- Department of Urology, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Marcos Lujan
- Department of Urology, Hospital Infanta Cristina, Madrid, Spain
| | - Daan Nieboer
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Fritz H Schröder
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands
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13
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Yim K, Ma C, Carlsson S, Lilja H, Mucci L, Penney K, Kibel AS, Eggener S, Preston MA. Free PSA and Clinically Significant and Fatal Prostate Cancer in the PLCO Screening Trial. J Urol 2023; 210:630-638. [PMID: 37384841 PMCID: PMC10894656 DOI: 10.1097/ju.0000000000003603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/14/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE We studied whether adding percent free PSA to total PSA improves prediction of clinically significant prostate cancer and fatal prostate cancer. MATERIALS AND METHODS A total of 6,727 men within the intervention arm of PLCO (Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial) had baseline percent free PSA. Of this cohort, 475 had clinically significant prostate cancer and 98 had fatal prostate cancer. Cumulative incidence and Cox analyses were conducted to evaluate the association between percent free PSA/PSA and clinically significant prostate cancer/fatal prostate cancer. Harrell's C index evaluated predictive ability. Kaplan-Meier analysis assessed survival. RESULTS Median follow-up was 19.7 years, median baseline PSA was 1.19 ng/mL, median percent free PSA was 18%. Cumulative incidence of fatal prostate cancer for men with baseline PSA ≥2 ng/mL and percent free PSA ≤10 was 3.2% and 6.1% at 15 and 25 years, respectively, compared to 0.03% and 1.1% for men with percent free PSA >25%. In younger men (55-64 years) with baseline PSA 2-10 ng/mL, C index improved from 0.56 to 0.60 for clinically significant prostate cancer and from 0.53 to 0.64 for fatal prostate cancer with addition of percent free PSA. In older men (65-74 years), C index improved for clinically significant prostate cancer from 0.60 to 0.66, with no improvement in fatal prostate cancer. Adjusting for age, digital rectal exam, family history of prostate cancer, and total PSA, percent free PSA was associated with clinically significant prostate cancer (HR 1.05, P < .001) per 1% decrease. Percent free PSA improved prediction of clinically significant prostate cancer and fatal prostate cancer for all race groups. CONCLUSIONS In a large U.S. screening trial, the addition of percent free PSA to total PSA in men with baseline PSA ≥2 ng/mL improved prediction of clinically significant prostate cancer and fatal prostate cancer. Free PSA should be used to risk-stratify screening and decrease unnecessary prostate biopsies.
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Affiliation(s)
- Kendrick Yim
- Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Chaoran Ma
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sigrid Carlsson
- Departments of Surgery (Urology Service) and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Hans Lilja
- Department of Pathology and Laboratory Medicine, Surgery, and Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Lorelei Mucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kathryn Penney
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Adam S Kibel
- Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Scott Eggener
- Department of Urology, University of Chicago, Chicago, Illinois
| | - Mark A Preston
- Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts
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14
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Pathak S, Zajac KK, Annaji M, Govindarajulu M, Nadar RM, Bowen D, Babu RJ, Dhanasekaran M. Clinical outcomes of chemotherapy in cancer patients with different ethnicities. Cancer Rep (Hoboken) 2023; 6 Suppl 1:e1830. [PMID: 37150853 PMCID: PMC10440845 DOI: 10.1002/cnr2.1830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Choosing the most effective chemotherapeutic agent with safest side effect profile is a common challenge in cancer treatment. Although there are standardized chemotherapy protocols in place, protocol changes made after extensive clinical trials demonstrate significant improvement in the efficacy and tolerability of certain drugs. The pharmacokinetics, pharmacodynamics, and tolerance of anti-cancer medications are all highly individualized. A driving force behind these differences lies within a person's genetic makeup. RECENT FINDINGS Pharmacogenomics, the study of how an individual's genes impact the processing and action of a drug, can optimize drug responsiveness and reduce toxicities by creating a customized medication regimen. However, these differences are rarely considered in the initial determination of standardized chemotherapeutic protocols and treatment algorithms. Because pharmacoethnicity is influenced by both genetic and nongenetic variables, clinical data highlighting disparities in the frequency of polymorphisms between different ethnicities is steadily growing. Recent data suggests that ethnic variations in the expression of allelic variants may result in different pharmacokinetic properties of the anti-cancer medication. In this article, the clinical outcomes of various chemotherapy classes in patients of different ethnicities were reviewed. CONCLUSION Genetic and nongenetic variables contribute to the interindividual variability in response to chemotherapeutic drugs. Considering pharmacoethnicity in the initial determination of standard chemotherapeutic protocols and treatment algorithms can lead to better clinical outcomes of patients of different ethnicities.
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Affiliation(s)
- Suhrud Pathak
- Department of Drug Discovery and Development, Harrison College of PharmacyAuburn UniversityAuburnAlabamaUSA
| | - Kelsee K. Zajac
- Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical SciencesUniversity of ToledoToledoOhioUSA
| | - Manjusha Annaji
- Department of Drug Discovery and Development, Harrison College of PharmacyAuburn UniversityAuburnAlabamaUSA
| | - Manoj Govindarajulu
- Department of Drug Discovery and Development, Harrison College of PharmacyAuburn UniversityAuburnAlabamaUSA
| | - Rishi M. Nadar
- Department of Drug Discovery and Development, Harrison College of PharmacyAuburn UniversityAuburnAlabamaUSA
| | - Dylan Bowen
- Department of Drug Discovery and Development, Harrison College of PharmacyAuburn UniversityAuburnAlabamaUSA
| | - R. Jayachandra Babu
- Department of Drug Discovery and Development, Harrison College of PharmacyAuburn UniversityAuburnAlabamaUSA
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15
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Wei JT, Barocas D, Carlsson S, Coakley F, Eggener S, Etzioni R, Fine SW, Han M, Kim SK, Kirkby E, Konety BR, Miner M, Moses K, Nissenberg MG, Pinto PA, Salami SS, Souter L, Thompson IM, Lin DW. Early Detection of Prostate Cancer: AUA/SUO Guideline Part I: Prostate Cancer Screening. J Urol 2023; 210:46-53. [PMID: 37096582 PMCID: PMC11060750 DOI: 10.1097/ju.0000000000003491] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE The summary presented herein covers recommendations on the early detection of prostate cancer and provides a framework to facilitate clinical decision-making in the implementation of prostate cancer screening, biopsy, and follow-up. This is Part I of a two-part series that focuses on prostate cancer screening. Please refer to Part II for discussion of initial and repeat biopsies as well as biopsy technique. MATERIALS AND METHODS The systematic review utilized to inform this guideline was conducted by an independent methodological consultant. The systematic review was based on searches in Ovid MEDLINE and Embase and Cochrane Database of Systematic Reviews (January 1, 2000-November 21, 2022). Searches were supplemented by reviewing reference lists of relevant articles. RESULTS The Early Detection of Prostate Cancer Panel developed evidence- and consensus-based guideline statements to provide guidance in prostate cancer screening, initial and repeat biopsy, and biopsy technique. CONCLUSIONS Prostate-specific antigen (PSA)-based prostate cancer screening in combination with shared decision-making (SDM) is recommended. Current data regarding risk from population-based cohorts provide a basis for longer screening intervals and tailored screening, and the use of available online risk calculators is encouraged.
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Affiliation(s)
- John T Wei
- University of Michigan, Ann Arbor, Michigan
| | | | | | | | | | - Ruth Etzioni
- Fred Hutchinson Cancer Center, Seattle, Washington
| | - Samson W Fine
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Misop Han
- Johns Hopkins University, Baltimore, Maryland
| | - Sennett K Kim
- American Urological Association, Linthicum, Maryland
| | - Erin Kirkby
- American Urological Association, Linthicum, Maryland
| | | | | | | | - Merel G Nissenberg
- National Alliance of State Prostate Cancer Coalitions, Los Angeles, California
| | | | | | - Lesley Souter
- Nomadic EBM Methodology, Smithville, Ontario, Canada
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16
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Affiliation(s)
- Paul F Pinsky
- From the Early Detection Branch (P.F.P.) and the Prostate and Urologic Cancer Branch (H.P.), Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Howard Parnes
- From the Early Detection Branch (P.F.P.) and the Prostate and Urologic Cancer Branch (H.P.), Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD
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17
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Tribukait B, Lundgren PO, Kjellman A, Norming U, Nyman CR, Jagarlmundi K, Gustafsson O. Prediction of Overall Survival by Thymidine Kinase 1 Combined with Prostate-Specific Antigen in Men with Prostate Cancer. Int J Mol Sci 2023; 24:ijms24065160. [PMID: 36982234 PMCID: PMC10049218 DOI: 10.3390/ijms24065160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/21/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
Thymidine kinase 1 (TK1) is an intracellular enzyme involved in DNA-precursor synthesis. Increased serum TK1 levels are used as a biomarker in various malignancies. We combined serum TK1 with PSA and evaluated its capacity to predict overall survival (OS) in 175 men with prostate cancer (PCa), detected by screening in 1988-1989 (n = 52) and during follow-up (median 22.6 years) (n = 123). TK1 was measured in frozen serum, age was stratified into four groups, and dates of PCa diagnosis and dates of death were obtained from Swedish population-based registries. The median concentration of TK1 and PSA was 0.25 and 3.8 ng/ml. TK1 was an independent variable of OS. In the multivariate analysis, PSA was not statistically significant in combination with age whereas the significance remained for TK1 + PSA. Measured once, TK1 + PSA predicted a difference of up to 10 years (depending on patient subgroup) in OS at a median of 9 years before PCa diagnosis. The TK1 concentration in 193 controls without malignancies did not differ from that of the PCa patients, hence TK1 was likely not released from incidental PCa. Thus, TK1 in the blood circulation may indicate the release of TK1 from sources other than cancers, nonetheless associated with OS.
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Affiliation(s)
- Bernhard Tribukait
- Department of Oncology-Pathology, Karolinska Institute and University Hospital Solna, 141 86 Stockholm, Sweden
- Cancer Centrum Karolinska, CCK, Plan 00, Visionsgatan 56, Karolinska Universitetssjukhuset, Solna, 171 64 Stockholm, Sweden
| | - Per-Olof Lundgren
- Department of Clinical Science, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Anders Kjellman
- Department of Clinical Science, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Ulf Norming
- Department of Clinical Science and Education, Södersjukhuset, 118 83 Stockholm, Sweden
| | - Claes R Nyman
- Department of Clinical Science and Education, Södersjukhuset, 118 83 Stockholm, Sweden
| | - Kiran Jagarlmundi
- Research and Development Division, AroCell AB, 111 52 Stockholm, Sweden
| | - Ove Gustafsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, 141 86 Stockholm, Sweden
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18
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Qian Z, Al Khatib K, Chen X, Belani S, Labban M, Lipsitz S, Cole AP, Iyer HS, Trinh QD. Investigating the racial gap in prostate cancer screening with prostate-specific antigen among younger men from 2012 to 2020. JNCI Cancer Spectr 2023; 7:7008336. [PMID: 36708009 PMCID: PMC9991604 DOI: 10.1093/jncics/pkad003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/10/2023] [Accepted: 01/18/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The United States Preventive Services Task Force recommended against prostate-specific antigen (PSA) screening in 2012, which was modified in 2018 into shared decision making for men aged 55-70 years with a life expectancy over 10 years. We studied the trends in PSA screening in younger Black and White men with the implementation of the 2012 and 2018 guidelines. METHODS Younger Black and White men (aged 40-54 years) were identified using the Behavioral Risk Factor Surveillance System database biennially from 2012 to 2020. Our primary outcome was PSA screening within 2 years of the survey. An adjusted logistic regression model with 2-way interaction assessment between race and survey year was used to investigate the temporal trend of PSA screening in younger Black and White men. RESULTS A total of 142 892 men were included. We saw steadily decreasing odds of PSA screening among both younger Black and White men in 2014, 2016, 2018, and 2020 compared with 2012 (for younger Black men: odds ratio [OR]2014 = 0.77, 95% confidence interval [CI] = 0.62 to 0.96, OR2016 = 0.51, 95% CI = 0.41 to 0.63, OR2018 = 0.33, 95%CI = 0.27 to 0.42, OR2020 = 0.25, 95% CI = 0.18 to 0.32; and for younger White men: OR2014 = 0.81, 95% CI = 0.76 to 0.87, OR2016 = 0.66, 95% CI = 0.61 to 0.71, OR2018 = 0.41, 95%CI = 0.37 to 0.44, OR2020 = 0.36, 95% CI = 0.33 to 0.39). Younger Black men showed a brisker decrease in PSA screening in 2016, 2018, and 2020 compared with younger White men (all P < .05). CONCLUSIONS PSA screening among younger men steadily decreased over the past decade since the 2012 United States Preventive Services Task Force guidelines, demonstrating a narrowing racial gap. How such an observed trend translates to long-term clinical outcomes for younger Black men remains to be seen.
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Affiliation(s)
- Zhiyu Qian
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Khalid Al Khatib
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Xi Chen
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sanvi Belani
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Muhieddine Labban
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stuart Lipsitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander P Cole
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hari S Iyer
- Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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19
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Ma C, Ericsson C, Carlsson SV, Lilja H, Kibel A, Graff RE, Plym A, Giovannucci E, Mucci LA, Preston MA, Penney KL. Addition of a Genetic Risk Score for Identification of Men with a Low Prostate-specific Antigen Level in Midlife at Risk of Developing Lethal Prostate Cancer. EUR UROL SUPPL 2023; 50:27-30. [PMID: 36861107 PMCID: PMC9969275 DOI: 10.1016/j.euros.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 02/22/2023] Open
Abstract
Men with a low prostate-specific antigen (PSA) level (<1 ng/ml) in midlife may extend the rescreening interval (if aged 40-59 yr) or forgo future PSA screening (if aged >60 yr) owing to their low risk of aggressive prostate cancer (PCa). However, there is a subset of men who develop lethal PCa despite low baseline PSA. We investigated how a PCa polygenic risk score (PRS) in addition to baseline PSA impacts the prediction of lethal PCa among 483 men aged 40-70 yr from the Physicians' Health Study followed over a median of 33 yr. We examined the association of the PRS with the risk of lethal PCa (lethal cases vs controls) using logistic regression adjusted for baseline PSA. The PCa PRS was associated with risk of lethal PCa (odds ratio per 1 standard deviation in PRS [OR] 1.79, 95% confidence interval [CI] 1.28-2.49). The association between the PRS and lethal PCa was stronger for those with PSA <1 ng/ml (OR 2.23, 95% CI 1.19-4.21) than for men with PSA ≥1 ng/ml (OR 1.61, 95% CI 1.07-2.42). Our PCa PRS improved the identification of men with PSA <1 ng/ml at greater risk of future lethal PCa who should consider ongoing PSA testing. Patient summary A subset of men develop fatal prostate cancer despite having low prostate-specific antigen (PSA) levels in middle age. A risk score based on multiple genes can help in predicting men who may be at risk of developing lethal prostate cancer and who should be advised to have regular PSA measurements.
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Affiliation(s)
- Chaoran Ma
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Caroline Ericsson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sigrid V. Carlsson
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Hans Lilja
- Department of Pathology and Laboratory Medicine and Medicine, GU-Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Adam Kibel
- Division of Urology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Rebecca E. Graff
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, USA
| | - Anna Plym
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Division of Urology, Brigham and Women’s Hospital, Boston, MA, USA,Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Edward Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lorelei A. Mucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mark A. Preston
- Division of Urology, Brigham and Women’s Hospital, Boston, MA, USA,Corresponding authors. Division of Urology, Brigham and Women’s Hospital, 45 Francis Street, Boston, MA 02115, USA. Tel. +1 617 5258274. E-mail address: (M.A. Preston). Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115, USA. Tel. +1 617 5250860. E-mail address: (K.L. Penney).
| | - Kathryn L. Penney
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Corresponding authors. Division of Urology, Brigham and Women’s Hospital, 45 Francis Street, Boston, MA 02115, USA. Tel. +1 617 5258274. E-mail address: (M.A. Preston). Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115, USA. Tel. +1 617 5250860. E-mail address: (K.L. Penney).
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20
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Marima R, Mbeje M, Hull R, Demetriou D, Mtshali N, Dlamini Z. Prostate Cancer Disparities and Management in Southern Africa: Insights into Practices, Norms and Values. Cancer Manag Res 2022; 14:3567-3579. [PMID: 36597514 PMCID: PMC9805733 DOI: 10.2147/cmar.s382903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/01/2022] [Indexed: 12/29/2022] Open
Abstract
Prostate cancer (PCa) is a leading cause of mortality in men of African origin. While men of African descent in high-income countries (HICs) demonstrate poor prognosis compared to their European counterparts, African men on the African continent, particularly Southern Africa have shown even higher PCa mortality rates. Extrinsic factors such as the socioeconomic status, education level, income level, geographic location and race contribute to PCa patient outcome. These are further deepened by the African norms which are highly esteemed and may have detrimental effects on PCa patients' health. Insights into African cultures and social constructs have been identified as key elements towards improving men's health care seeking behaviour which will in turn improve PCa patients' outcome. Compared to Southern Africa, the Eastern, Western and Central African regions have lower PCa incidence rates but higher mortality rates. The availability of cancer medical equipment has also been reported to be disproportionate in Africa, with most cancer resources in Northern and Southern Africa. Even within Southern Africa, cancer management resources are unevenly available where one country must access PCa specialised care in the neighbouring countries. While PCa seems to be better managed in HICs, steps towards effective PCa management are urgently needed in Africa, as this continent represents a significant portion of low-middle-income countries (LMICs). Replacing African men in Africa with African American men may not optimally resolve PCa challenges in Africa. Adopting western PCa management practices can be optimised by integrating improved core-African norms. The aim of this review is to discuss PCa disparities in Africa, deliberate on the significance of integrating African norms around masculinity and discuss challenges and opportunities towards effective PCa care in Africa, particularly in Southern Africa.
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Affiliation(s)
- Rahaba Marima
- SAMRC Precision Oncology Research Unit (PORU), DSI/NRF SARChI Chair in Precision Oncology and Cancer Prevention (POCP), Pan African Cancer Research Institute (PACRI), University of Pretoria, Pretoria, South Africa
| | - Mandisa Mbeje
- SAMRC Precision Oncology Research Unit (PORU), DSI/NRF SARChI Chair in Precision Oncology and Cancer Prevention (POCP), Pan African Cancer Research Institute (PACRI), University of Pretoria, Pretoria, South Africa,Department of Medical Oncology, Faculty of Health Sciences, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Rodney Hull
- SAMRC Precision Oncology Research Unit (PORU), DSI/NRF SARChI Chair in Precision Oncology and Cancer Prevention (POCP), Pan African Cancer Research Institute (PACRI), University of Pretoria, Pretoria, South Africa
| | - Demetra Demetriou
- SAMRC Precision Oncology Research Unit (PORU), DSI/NRF SARChI Chair in Precision Oncology and Cancer Prevention (POCP), Pan African Cancer Research Institute (PACRI), University of Pretoria, Pretoria, South Africa
| | - Nompumelelo Mtshali
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Zodwa Dlamini
- SAMRC Precision Oncology Research Unit (PORU), DSI/NRF SARChI Chair in Precision Oncology and Cancer Prevention (POCP), Pan African Cancer Research Institute (PACRI), University of Pretoria, Pretoria, South Africa,Correspondence: Zodwa Dlamini, Tel +27 12 319 2614, Email
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21
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Chou A, Darst BF, Wilkens LR, Le Marchand L, Lilja H, Conti DV, Haiman CA. Association of Prostate-Specific Antigen Levels with Prostate Cancer Risk in a Multiethnic Population: Stability Over Time and Comparison with Polygenic Risk Score. Cancer Epidemiol Biomarkers Prev 2022; 31:2199-2207. [PMID: 36126957 PMCID: PMC9729398 DOI: 10.1158/1055-9965.epi-22-0443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/01/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Studies in men of European ancestry suggest prostate-specific antigen (PSA) as a marker of early prostate cancer development that may help to risk-stratify men earlier in life. METHODS We examined PSA levels in men measured up to 10+ years before a prostate cancer diagnosis in association with prostate cancer risk in 2,245 cases and 2,203 controls of African American, Latino, Japanese, Native Hawaiian, and White men in the Multiethnic Cohort. We also compared the discriminative ability of PSA to polygenic risk score (PRS) for prostate cancer. RESULTS Excluding cases diagnosed within 2 and 10 years of blood draw, men with PSA above the median had a prostate cancer OR (95% CIs) of 9.12 (7.66-10.92) and 3.52 (2.50-5.03), respectively, compared with men with PSA below the median. A PSA level above the median identified 90% and 75% of cases diagnosed more than 2 and 10 years after blood draw, respectively. The associations were significantly greater for Gleason ≤7 versus 8+ disease. At 10+ years, the association of prostate cancer with PSA was comparable with that with the PRS [OR per SD increase: 1.88 (1.45-2.46) and 2.12 (1.55-2.93), respectively]. CONCLUSIONS We found PSA to be an informative marker of prostate cancer risk at least a decade before diagnosis across multiethnic populations. This association was diminished with increasing time, greater for low grade tumors, and comparable with a PRS when measured 10+ years before diagnosis. IMPACT Our multiethnic investigation suggests broad clinical implications on the utility of PSA and PRS for risk stratification in prostate cancer screening practices.
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Affiliation(s)
- Alisha Chou
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, US
| | - Burcu F. Darst
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, US,Present address: Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, U.S.A
| | - Lynne R. Wilkens
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Loïc Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Hans Lilja
- Departments of Laboratory Medicine, Surgery, and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, U.S.A.; and Department of Translational Medicine, Lund University, Malmö, Sweden
| | - David V. Conti
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, US
| | - Christopher A. Haiman
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, US
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22
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Filella X, Rodríguez-Garcia M, Fernández-Galán E. Clinical usefulness of circulating tumor markers. Clin Chem Lab Med 2022; 61:895-905. [PMID: 36394981 DOI: 10.1515/cclm-2022-1090] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022]
Abstract
Abstract
Tumor markers are a heterogeneous group of substances released by cancer cells into bloodstream, but also expressed by healthy tissues. Thus, very small concentrations can be present in plasma and serum from healthy subjects. Cancer patients tend to show increased levels correlating with tumor bulk, but false positive results could be present in patients with benign conditions. The correct interpretation of TM results could be challenging and many factors should be considered, from pre-analytical conditions to patient concomitant diseases. In this line, the Clinical Chemistry and Laboratory Medicine journal has made important contributions though several publications promoting the adequate use of TM and therefore improving patient safety. TM measurement offers valuable information for cancer patient management in different clinical contexts, such as helping diagnosis, estimating prognosis, facilitating early detection of relapse and monitoring therapy response. Our review analyzes the clinical usefulness of tumor markers applied in most frequent epithelial tumors, based on recent evidence and guidelines.
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Affiliation(s)
- Xavier Filella
- Department of Biochemistry and Molecular Genetics (CDB) , Hospital Clínic de Barcelona, IDIBAPS , Barcelona , Catalonia , Spain
| | - María Rodríguez-Garcia
- Department of Biochemistry and Molecular Genetics (CDB) , Hospital Clínic de Barcelona, IDIBAPS , Barcelona , Catalonia , Spain
| | - Esther Fernández-Galán
- Department of Biochemistry and Molecular Genetics (CDB) , Hospital Clínic de Barcelona, IDIBAPS , Barcelona , Catalonia , Spain
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23
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Plym A, Zhang Y, Stopsack KH, Jee YH, Wiklund F, Kibel AS, Kraft P, Giovannucci E, Penney KL, Mucci LA. Family History of Prostate and Breast Cancer Integrated with a Polygenic Risk Score Identifies Men at Highest Risk of Dying from Prostate Cancer before Age 75 Years. Clin Cancer Res 2022; 28:4926-4933. [PMID: 36103261 PMCID: PMC9660541 DOI: 10.1158/1078-0432.ccr-22-1723] [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: 05/31/2022] [Revised: 08/04/2022] [Accepted: 09/12/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Family history of prostate cancer is one of the few universally accepted risk factors for prostate cancer. How much an assessment of inherited polygenic risk for prostate cancer adds to lifetime risk stratification beyond family history is unknown. EXPERIMENTAL DESIGN We followed 10,120 men in the Health Professionals Follow-up Study with existing genotype data for risk of prostate cancer and prostate cancer-specific death. We assessed to what extent family history of prostate or breast cancer, combined with a validated polygenic risk score (PRS) including 269 prostate cancer risk variants, identifies men at risk of prostate cancer and prostate cancer death across the age span. RESULTS During 20 years of follow-up, 1,915 prostate cancer and 166 fatal prostate cancer events were observed. Men in the top PRS quartile with a family history of prostate or breast cancer had the highest rate of both prostate cancer and prostate cancer-specific death. Compared with men at lowest genetic risk (bottom PRS quartile and no family history), the HR was 6.95 [95% confidence interval (CI), 5.57-8.66] for prostate cancer and 4.84 (95% CI, 2.59-9.03) for prostate cancer death. Men in the two upper PRS quartiles (50%-100%) or with a family history of prostate or breast cancer (61.8% of the population) accounted for 97.5% of prostate cancer deaths by age 75 years. CONCLUSIONS Our study shows that prostate cancer risk stratification on the basis of family history and inherited polygenic risk can identify men at highest risk of dying from prostate cancer before age 75 years.
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Affiliation(s)
- Anna Plym
- Urology Division, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Corresponding Author: Anna Plym, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, Stockholm SE-171 77, Sweden. Phone: 468-5248-0000; Fax: 468-314-975; E-mail:
| | - Yiwen Zhang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Konrad H. Stopsack
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yon Ho Jee
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Fredrik Wiklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Adam S. Kibel
- Urology Division, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Peter Kraft
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Edward Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kathryn L. Penney
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lorelei A. Mucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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24
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French AFU Cancer Committee Guidelines - Update 2022-2024: prostate cancer - Diagnosis and management of localised disease. Prog Urol 2022; 32:1275-1372. [DOI: 10.1016/j.purol.2022.07.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022]
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25
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Mason RJ, Marzouk K, Finelli A, Saad F, So AI, Violette PD, Breau RH, Rendon RA. UPDATE - 2022 Canadian Urological Association recommendations on prostate cancer screening and early diagnosis Endorsement of the 2021 Cancer Care Ontario guidelines on prostate multiparametric magnetic resonance imaging. Can Urol Assoc J 2022; 16:E184-E196. [PMID: 35358414 PMCID: PMC9054332 DOI: 10.5489/cuaj.7851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ross J. Mason
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Karim Marzouk
- Windsor General Hospital, Windsor, ON; and Western University, London, ON, Canada
| | - Antonio Finelli
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Fred Saad
- Department of Surgery (Urology), University of Montreal, Montreal, QC, Canada
| | - Alan I. So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Philippe D. Violette
- Department of Surgery, Western University, London, ON, Canada
- Departments of Surgery and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Rodney H. Breau
- Division of Urology, University of Ottawa, Ottawa, ON, Canada
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26
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Nelson WG, Brawley OW, Isaacs WB, Platz EA, Yegnasubramanian S, Sfanos KS, Lotan TL, De Marzo AM. Health inequity drives disease biology to create disparities in prostate cancer outcomes. J Clin Invest 2022; 132:e155031. [PMID: 35104804 PMCID: PMC8803327 DOI: 10.1172/jci155031] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Prostate cancer exerts a greater toll on African American men than on White men of European descent (hereafter referred to as European American men): the disparity in incidence and mortality is greater than that of any other common cancer. The disproportionate impact of prostate cancer on Black men has been attributed to the genetics of African ancestry, to diet and lifestyle risk factors, and to unequal access to quality health care. In this Review, all of these influences are considered in the context of the evolving understanding that chronic or recurrent inflammatory processes drive prostatic carcinogenesis. Studies of inherited susceptibility highlight the contributions of genes involved in prostate cell and tissue repair (BRCA1/2, ATM) and regeneration (HOXB13 and MYC). Social determinants of health appear to accentuate these genetic influences by fueling prostate inflammation and associated cell and genome damage. Molecular characterization of the prostate cancers that arise in Black versus White men further implicates this inflammatory microenvironment in disease behavior. Yet, when Black and White men with similar grade and stage of prostate cancer are treated equally, they exhibit equivalent outcomes. The central role of prostate inflammation in prostate cancer development and progression augments the impact of the social determinants of health on disease pathogenesis. And, when coupled with poorer access to high-quality treatment, these inequities result in a disparate burden of prostate cancer on African American men.
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27
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Karunasinghe N, Minas TZ, Bao BY, Lee A, Wang A, Zhu S, Masters J, Goudie M, Huang SP, Jenkins FJ, Ferguson LR. Assessment of factors associated with PSA level in prostate cancer cases and controls from three geographical regions. Sci Rep 2022; 12:55. [PMID: 34997089 PMCID: PMC8742081 DOI: 10.1038/s41598-021-04116-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/15/2021] [Indexed: 11/22/2022] Open
Abstract
It is being debated whether prostate-specific antigen (PSA)-based screening effectively reduces prostate cancer mortality. Some of the uncertainty could be related to deficiencies in the age-based PSA cut-off thresholds used in screening. Current study considered 2779 men with prostate cancer and 1606 men without a cancer diagnosis, recruited for various studies in New Zealand, US, and Taiwan. Association of PSA with demographic, lifestyle, clinical characteristics (for cases), and the aldo–keto reductase 1C3 (AKR1C3) rs12529 genetic polymorphisms were analysed using multiple linear regression and univariate modelling. Pooled multivariable analysis of cases showed that PSA was significantly associated with demographic, lifestyle, and clinical data with an interaction between ethnicity and age further modifying the association. Pooled multivariable analysis of controls data also showed that demographic and lifestyle are significantly associated with PSA level. Independent case and control analyses indicated that factors associated with PSA were specific for each cohort. Univariate analyses showed a significant age and PSA correlation among all cases and controls except for the US-European cases while genetic stratification in cases showed variability of correlation. Data suggests that unique PSA cut-off thresholds factorized with demographics, lifestyle and genetics may be more appropriate for prostate cancer screening.
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Affiliation(s)
- Nishi Karunasinghe
- Auckland Cancer Society Research Centre, Faculty of Medical and Health Sciences (FMHS), University of Auckland, Private Bag 92019, Auckland, New Zealand.
| | - Tsion Zewdu Minas
- Molecular Epidemiology Section, Laboratory of Human Carcinogenesis, National Cancer Institute, NIH, Bethesda, MD, 20892, USA
| | - Bo-Ying Bao
- Department of Pharmacy, China Medical University, Taichung, 404, Taiwan
| | - Arier Lee
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Alice Wang
- Auckland Cancer Society Research Centre, Faculty of Medical and Health Sciences (FMHS), University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Shuotun Zhu
- Auckland Cancer Society Research Centre, Faculty of Medical and Health Sciences (FMHS), University of Auckland, Private Bag 92019, Auckland, New Zealand
| | | | - Megan Goudie
- Urology Department, Auckland City Hospital, Auckland, New Zealand
| | - Shu-Pin Huang
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, 807, Taiwan.,Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Frank J Jenkins
- Infectious Diseases and Microbiology and Clinical and Translational Science Institute, The University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, PA, USA
| | - Lynnette R Ferguson
- Emeritus Professor, FMHS, University of Auckland, Private Bag 92019, Auckland, New Zealand
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28
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Ye C, Qin S, Guo F, Yang Y, Wang H, Zhang C, Yang B. LncRNA EIF3J-AS1 functions as an oncogene by regulating MAFG to promote prostate cancer progression. J Cancer 2022; 13:146-152. [PMID: 34976178 PMCID: PMC8692703 DOI: 10.7150/jca.60676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 10/23/2021] [Indexed: 02/07/2023] Open
Abstract
Long non-coding RNAs (lncRNAs) can modulate various biological processes and behaviors in most human cancers. LncRNA EIF3J-AS1 has been reported as an oncogene in various tumors, but whether it exerts functions in malignant progression and gene expression in prostate cancer (PCa) remains unknown. In this study, we investigated the high level of EIF3J‐AS1 in PCa tissues and cells, and used functional assays to show that knocking down EIF3J‐AS1 inhibited PCa cell proliferation and metastatic ability. A preliminary mechanistic investigation also showed that EIF3J‐AS1 may increase the expression of MAF bZIP transcription Factor G (MAFG) in PCa. The expression correlation between EIF3J‐AS1 and MAFG was found to be positive in PCa tissues. Finally, rescue assays showed that MAFG might be involved in the EIF3J-AS1-mediated malignant phenotype in PCa cells. This study demonstrated that EIF3J-AS1/MAFG may play a key role in facilitating PCa progression.
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Affiliation(s)
- Chen Ye
- Department of Urology, Shanghai Changhai Hospital, P. R. China, Shanghai 200433, China
| | - Shengfei Qin
- Department of Urology, Shanghai Changhai Hospital, P. R. China, Shanghai 200433, China
| | - Fei Guo
- Department of Urology, Shanghai Changhai Hospital, P. R. China, Shanghai 200433, China
| | - Yue Yang
- Department of Urology, Shanghai Changhai Hospital, P. R. China, Shanghai 200433, China
| | - Huiqing Wang
- Department of Urology, Shanghai Changhai Hospital, P. R. China, Shanghai 200433, China
| | - Chao Zhang
- Department of Urology, Shanghai Changhai Hospital, P. R. China, Shanghai 200433, China
| | - Bo Yang
- Department of Urology, Shanghai Changhai Hospital, P. R. China, Shanghai 200433, China
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Carlsson SV, Murata K, Danila DC, Lilja H. PSA: role in screening and monitoring patients with prostate cancer. Cancer Biomark 2022. [DOI: 10.1016/b978-0-12-824302-2.00001-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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30
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Leapman MS, Wang R, Park H, Yu JB, Sprenkle PC, Cooperberg MR, Gross CP, Ma X. Changes in Prostate-Specific Antigen Testing Relative to the Revised US Preventive Services Task Force Recommendation on Prostate Cancer Screening. JAMA Oncol 2021; 8:41-47. [PMID: 34762100 DOI: 10.1001/jamaoncol.2021.5143] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance In April 2017, the US Preventive Services Task Force (USPSTF) published a draft guideline that reversed its 2012 guidance advising against prostate-specific antigen (PSA)-based screening for prostate cancer in all men (grade D), instead endorsing individual decision-making for men aged 55 to 69 years (grade C). Objective To evaluate changes in rates of PSA testing after revisions in the USPSTF guideline on prostate cancer screening. Design, Setting, and Participants This retrospective cohort study used deidentified claims data from Blue Cross Blue Shield beneficiaries aged 40 to 89 years from January 1, 2013, through December 31, 2019. Exposures Publication of the USPSTF's draft (April 2017) and final (May 2018) recommendation on prostate cancer screening. Main Outcomes and Measures Age-adjusted rates of PSA testing in bimonthly periods were calculated, and PSA testing rates from calendar years before (January 1 to December 31, 2016) and after (January 1 to December 31, 2019) the guideline change were compared. Interrupted time series analyses were used to evaluate the association of the draft (April 2017) and published (May 2018) USPSTF guideline with rates of PSA testing. Changes in rates of PSA testing were further evaluated among beneficiaries within the age categories reflected in the guideline: 40 to 54 years, 55 to 69 years, and 70 to 89 years. Results The median number of eligible beneficiaries for each bimonthly period was 8 087 565 (range, 6 407 602-8 747 308), and the median age of all included eligible beneficiaries was 53 years (IQR, 47-59 years). Between 2016 and 2019, the mean (SD) rate of PSA testing increased from 32.5 (1.1) to 36.5 (1.1) tests per 100 person-years, a relative increase of 12.5% (95% CI, 1.1%-24.4%). During the same period, mean (SD) rates of PSA testing increased from 20.6 (0.8) to 22.7 (0.9) tests per 100 person-years among men aged 40 to 54 years (relative increase, 10.1%; 95% CI, -2.8% to 23.7%), from 49.8 (1.9) to 55.8 (1.8) tests per 100 person-years among men aged 55 to 69 years (relative increase, 12.1%; 95% CI, -0.2% to 25.2%), and from 38.0 (1.4) to 44.2 (1.4) tests per 100 person-years among men aged 70 to 89 years (relative increase, 16.2%; 95% CI, 4.2%-29.0%). Interrupted time series analysis revealed a significantly increasing trend of PSA testing after April 2017 among all beneficiaries (0.30 tests per 100 person-years for each bimonthly period; P < .001). Conclusions and Relevance This large national cohort study found that rates of PSA testing increased after the USPSTF's draft statement in 2017, reversing trends seen after earlier guidance against PSA testing for all patients. Increased testing was also observed among older men, who may be less likely to benefit from prostate cancer screening.
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Affiliation(s)
- Michael S Leapman
- Department of Urology, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
| | - Rong Wang
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Henry Park
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.,Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - James B Yu
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.,Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | | | - Matthew R Cooperberg
- Department of Urology, University of California, San Francisco, San Francisco.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Cary P Gross
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Xiaomei Ma
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
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31
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Hendrix N, Gulati R, Jiao B, Kader AK, Ryan ST, Etzioni R. Clarifying the Trade-Offs of Risk-Stratified Screening for Prostate Cancer: A Cost-Effectiveness Study. Am J Epidemiol 2021; 190:2064-2074. [PMID: 34023874 DOI: 10.1093/aje/kwab155] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 05/13/2021] [Accepted: 05/18/2021] [Indexed: 12/18/2022] Open
Abstract
Cancer risk prediction is necessary for precision early detection, which matches screening intensity to risk. However, practical steps for translating risk predictions to risk-stratified screening policies are not well established. We used a validated population prostate-cancer model to simulate the outcomes of strategies that increase intensity for men at high risk and reduce intensity for men at low risk. We defined risk by the Prompt Prostate Genetic Score (PGS) (Stratify Genomics, San Diego, California), a germline genetic test. We first recalibrated the model to reflect the disease incidence observed within risk strata using data from a large prevention trial where some participants were tested with Prompt PGS. We then simulated risk-stratified strategies in a population with the same risk distribution as the trial and evaluated the cost-effectiveness of risk-stratified screening versus universal (risk-agnostic) screening. Prompt PGS risk-adapted screening was more cost-effective when universal screening was conservative. Risk-stratified strategies improved outcomes at a cost of less than $100,000 per quality-adjusted life year compared with biennial screening starting at age 55 years, but risk stratification was not cost-effective compared with biennial screening starting at age 45. Heterogeneity of risk and fraction of the population within each stratum were also important determinants of cost-effectiveness.
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32
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Altuna-Coy A, Ruiz-Plazas X, Alves-Santiago M, Segarra-Tomás J, Chacón MR. Serum Levels of the Cytokine TWEAK Are Associated with Metabolic Status in Patients with Prostate Cancer and Modulate Cancer Cell Lipid Metabolism In Vitro. Cancers (Basel) 2021; 13:cancers13184688. [PMID: 34572917 PMCID: PMC8465414 DOI: 10.3390/cancers13184688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/01/2021] [Accepted: 09/14/2021] [Indexed: 11/29/2022] Open
Abstract
Simple Summary TWEAK is an inflammatory cytokine related to prostate cancer (PCa) progression that exerts its effects by engaging its cognate receptor Fn14. A soluble form of TWEAK (sTWEAK) has been detected in the PCa microenvironment. Altered levels of circulating sTWEAK are associated with aberrant glucose metabolism. We show that reduced serum levels of sTWEAK are associated with the metabolic status in patients with PCa and that the treatment of PC-3 cells with sTWEAK enhances the expression of genes related to lipid, but not to glucose, metabolism. sTWEAK also increases the lipid uptake and lipid accumulation in PC-3 cells. We corroborated that the observed effects were due to TWEAK/Fn14 engagement by silencing Fn14 expression, which attenuated the aberrant gene and protein expression. Additionally, we observed that the phosphorylation of ERK1/2 and AKT (ser473) were required for TWEAK/Fn14 actions. Thus, the contribution of the sTWEAK/Fn14 axis on PCa metabolism supports its potential as a therapeutic target for PCa. Abstract Soluble TWEAK (sTWEAK) has been proposed as a prognostic biomarker of prostate cancer (PCa). We found that reduced serum levels of sTWEAK, together with higher levels of prostate-specific antigen and a higher HOMA-IR index, are independent predictors of PCa. We also showed that sTWEAK stimulus failed to alter the expression of glucose transporter genes (SLC2A4 and SLC2A1), but significantly reduced the expression of glucose metabolism-related genes (PFK, HK1 and PDK4) in PCa cells. The sTWEAK stimulation of PC-3 cells significantly increased the expression of the genes related to lipogenesis (ACACA and FASN), lipolysis (CPT1A and PNPLA2), lipid transport (FABP4 and CD36) and lipid regulation (SREBP-1 and PPARG) and increased the lipid uptake. Silencing the TWEAK receptor (Fn14) in PC-3 cells confirmed the observed lipid metabolic effects, as shown by the downregulation of ACACA, FASN, CPT1A, PNPLA2, FABP4, CD36, SREBP-1 and PPARG expression, which was paralleled by a reduction of FASN, CPT1A and FABP4 protein expression. Specific-signaling inhibitor assays show that ERK1/2 and AKT (ser473) phosphorylation can regulate lipid metabolism-related genes in PCa cells, pointing to the AKT locus as a possible target for PCa. Overall, our data support sTWEAK/Fn14 axis as a potential therapeutic target for PCa.
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Affiliation(s)
- Antonio Altuna-Coy
- Disease Biomarkers and Molecular Mechanisms Group, IISPV, Joan XXIII University Hospital, Universitat Rovira i Virgili, 43007 Tarragona, Spain; (A.A.-C.); (X.R.-P.); (M.A.-S.)
| | - Xavier Ruiz-Plazas
- Disease Biomarkers and Molecular Mechanisms Group, IISPV, Joan XXIII University Hospital, Universitat Rovira i Virgili, 43007 Tarragona, Spain; (A.A.-C.); (X.R.-P.); (M.A.-S.)
- Urology Unit, Joan XXIII University Hospital, 43005 Tarragona, Spain
| | - Marta Alves-Santiago
- Disease Biomarkers and Molecular Mechanisms Group, IISPV, Joan XXIII University Hospital, Universitat Rovira i Virgili, 43007 Tarragona, Spain; (A.A.-C.); (X.R.-P.); (M.A.-S.)
- Urology Unit, Joan XXIII University Hospital, 43005 Tarragona, Spain
| | - José Segarra-Tomás
- Disease Biomarkers and Molecular Mechanisms Group, IISPV, Joan XXIII University Hospital, Universitat Rovira i Virgili, 43007 Tarragona, Spain; (A.A.-C.); (X.R.-P.); (M.A.-S.)
- Urology Unit, Joan XXIII University Hospital, 43005 Tarragona, Spain
- Correspondence: (J.S.-T.); (M.R.C.); Tel.: +34-977295500 (ext. 3406) (J.S.-T. & M.R.C.)
| | - Matilde R. Chacón
- Disease Biomarkers and Molecular Mechanisms Group, IISPV, Joan XXIII University Hospital, Universitat Rovira i Virgili, 43007 Tarragona, Spain; (A.A.-C.); (X.R.-P.); (M.A.-S.)
- Correspondence: (J.S.-T.); (M.R.C.); Tel.: +34-977295500 (ext. 3406) (J.S.-T. & M.R.C.)
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Xu W, Gao Y, Zhang J, Zhang R, Chen Q. AKR1B10 expression in benign prostatic hyperplasia and its related mechanism. Oncol Lett 2021; 22:683. [PMID: 34434282 PMCID: PMC8335732 DOI: 10.3892/ol.2021.12944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 11/24/2020] [Indexed: 12/31/2022] Open
Abstract
The aim of the present study was to investigate the expression of aldo-keto reductase family 1 member B10 (AKR1B10) in benign prostatic hyperplasia (BPH) and its related mechanism. In total, 142 BPH patients admitted from March 2017 to March 2019 at the First Hospital of Hunan University of Chinese Medicine and 140 healthy people undergoing physical examination were selected as the research subjects. The clinical value of AKR1B10 in BPH was analyzed. Twenty clean SD rats were selected, and 10 were selected to establish the prostate hyperplasia model, while the remaining 10 were set as the control group. Ten days after the model was established, AKR1B10 and NF-κB expression in prostate tissues of rats in both groups was detected by PCR and immunohistochemistry. The primary cells in prostate hyperplasia were cultured, and then they were transfected with AKR1B10 to observe the changes of cell biological behavior. AKR1B10 and NF-κB mRNA significantly increased in peripheral blood of BPH patients and prostate tissue of BPH model rats (P<0.001), and AKR1B10 had good diagnostic value for BPH (P<0.001). In addition, it was positively correlated with PSA, EGF, IL-6 and TNF-α (P<0.001). After transfection with AKR1B10-inhibitor, it was revealed that the proliferation of prostate hyperplasia cells decreased, while the apoptosis of prostate hyperplasia cells increased and the NF-κB protein expression decreased (P<0.001). Collectively, high expression of AKR1B10 in BPH promoted the proliferation of prostate cells and reduced their apoptosis, and the mechanism may be through regulation of NF-κB.
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Affiliation(s)
- Wenjing Xu
- First Clinical College of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan 410208, P.R. China
| | - Ya Gao
- Department of Proctology, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan 410007, P.R. China
| | - Jiaqi Zhang
- First Clinical College of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan 410208, P.R. China
| | - Rong Zhang
- First Clinical College of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan 410208, P.R. China
| | - Qihua Chen
- Department of Surgery and Male Disease, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan 410007, P.R. China
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Gulati R, Carlsson SV, Etzioni R. When to Discuss Prostate Cancer Screening With Average-Risk Men. Am J Prev Med 2021; 61:294-298. [PMID: 33966938 PMCID: PMC8319088 DOI: 10.1016/j.amepre.2021.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 11/21/2022]
Affiliation(s)
- Roman Gulati
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Sigrid V Carlsson
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
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35
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A 25-year perspective on evaluation and understanding of biomarkers in urologic cancers. Urol Oncol 2021; 39:602-617. [PMID: 34315659 DOI: 10.1016/j.urolonc.2021.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 12/15/2022]
Abstract
The past 25 years have witnessed an explosion of investigative attempts to identify clinically useful biomarkers which can have meaningful impacts for patients with urologic cancers. However, in spite of the enormous amount of research aiming to identify markers with the hope of impacting patient care, only a handful have proven to have true clinical utility. Improvements in targeted imaging, pan-omics evaluation, and genetic sequencing at the tissue and single-cell levels have yielded many potential targets for continued biomarker investigation. This article, as one in this series for the 25th Anniversary Issue of Urologic Oncology: Seminars and Original Investigations, serves to give a perspective on our progress and failures over the past quarter-century in our highest volume urologic cancers: prostate, bladder, and kidney cancers.
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36
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Rao D, Mei K, Yan T, Wang Y, Wu W, Chen Y, Wang J, Zhang Q, Wu S. Nanomechanical sensor for rapid and ultrasensitive detection of tumor markers in serum using nanobody. NANO RESEARCH 2021; 15:1003-1012. [PMID: 34221250 PMCID: PMC8240779 DOI: 10.1007/s12274-021-3588-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 05/27/2023]
Abstract
UNLABELLED Early cancer diagnosis requires ultrasensitive detection of tumor markers in blood. To this end, we develop a novel microcantilever immunosensor using nanobodies (Nbs) as receptors. As the smallest antibody (Ab) entity comprising an intact antigen-binding site, Nbs achieve dense receptor layers and short distances between antigen-binding regions and sensor surfaces, which significantly elevate the generation and transmission of surface stress. Owing to the inherent thiol group at the C-terminus, Nbs are covalently immobilized on microcantilever surfaces in directed orientation via one-step reaction, which further enhances the stress generation. For microcantilever-based nanomechanical sensor, these advantages dramatically increase the sensor sensitivity. Thus, Nb-functionalized microcantilevers can detect picomolar concentrations of tumor markers with three orders of magnitude higher sensitivity, when compared with conventional Ab-functionalized microcantilevers. This proof-of-concept study demonstrates an ultrasensitive, label-free, rapid, and low-cost method for tumor marker detection. Moreover, interestingly, we find Nb inactivation on sensor interfaces when using macromolecule blocking reagents. The adsorption-induced inactivation is presumably caused by the change of interfacial properties, due to binding site occlusion upon complex coimmobilization formations. Our findings are generalized to any coimmobilization methodology for Nbs and, thus, for the construction of high-performance immuno-surfaces. ELECTRONIC SUPPLEMENTARY MATERIAL Supplementary material (experimental section, HER2 detection using anti-HER2-mAb-functionalized microcantilevers) is available in the online version of this article at 10.1007/s12274-021-3588-4.
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Affiliation(s)
- Depeng Rao
- CAS Key Laboratory of Mechanical Behavior and Design of Material, Department of Modern Mechanics, University of Science and Technology of China, Hefei, 230027 China
| | - Kainan Mei
- CAS Key Laboratory of Mechanical Behavior and Design of Material, Department of Modern Mechanics, University of Science and Technology of China, Hefei, 230027 China
| | - Tianhao Yan
- CAS Key Laboratory of Mechanical Behavior and Design of Material, Department of Modern Mechanics, University of Science and Technology of China, Hefei, 230027 China
| | - Yu Wang
- CAS Key Laboratory of Mechanical Behavior and Design of Material, Department of Modern Mechanics, University of Science and Technology of China, Hefei, 230027 China
| | - Wenjie Wu
- CAS Key Laboratory of Mechanical Behavior and Design of Material, Department of Modern Mechanics, University of Science and Technology of China, Hefei, 230027 China
| | - Ye Chen
- CAS Key Laboratory of Mechanical Behavior and Design of Material, Department of Modern Mechanics, University of Science and Technology of China, Hefei, 230027 China
| | - Jianye Wang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, First Affiliated Hospital of Anhui Medical University, Hefei, 230022 China
| | - Qingchuan Zhang
- CAS Key Laboratory of Mechanical Behavior and Design of Material, Department of Modern Mechanics, University of Science and Technology of China, Hefei, 230027 China
| | - Shangquan Wu
- CAS Key Laboratory of Mechanical Behavior and Design of Material, Department of Modern Mechanics, University of Science and Technology of China, Hefei, 230027 China
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37
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Knowledge and Attitudes of Men in Bahrain Toward Prostate Cancer. Semin Oncol Nurs 2021; 37:151158. [PMID: 34030908 DOI: 10.1016/j.soncn.2021.151158] [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: 01/12/2021] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Bahrain has one of the highest rates of prostate cancer in the Middle East, when compared to neighboring countries. Therefore, a seminal study was undertaken, investigating the knowledge and attitudes of Arabic men over 50 years and older, who are in the highest risk group for prostate cancer. A secondary objective was to apply inter-professional student learning of research though the inclusion of medical and nursing students in the research team. DATA SOURCES A descriptive research design with data collection through a researcher-administered questionnaire. Study participants included 74 men, predominantly of Arabic origin. CONCLUSION Whereas the results of this study are generally reflective of the international literature, the study also provides some new and interesting insights into the perspectives of Arabic men. The findings highlight the importance of a culturally sensitive, health awareness programme for men's health and prostate cancer in Bahrain. IMPLICATIONS FOR NURSING PRACTICE The study supports the important role of nurses in men's health promotion and disease prevention. An expansion in community nursing roles could facilitate the development of nursing specialist roles in the area of prostate disease prevention. An enhancement of undergraduate nursing student research learning occurs through active engagement with researchers in research projects, where students participate in preparing for research ethics approval, data collection, data analysis and writing for publication. Inter-professional learning is a very valuable experience in lowering traditional barriers between medicine and nursing.
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38
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Heijnsdijk EAM, Gulati R, Tsodikov A, Lange JM, Mariotto AB, Vickers AJ, Carlsson SV, Etzioni R. Lifetime Benefits and Harms of Prostate-Specific Antigen-Based Risk-Stratified Screening for Prostate Cancer. J Natl Cancer Inst 2021; 112:1013-1020. [PMID: 32067047 PMCID: PMC7566340 DOI: 10.1093/jnci/djaa001] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/03/2019] [Accepted: 12/12/2019] [Indexed: 12/23/2022] Open
Abstract
Background Studies conducted in Swedish populations have shown that men with lowest prostate-specific antigen (PSA) levels at ages 44–50 years and 60 years have very low risk of future distant metastasis or death from prostate cancer. This study investigates benefits and harms of screening strategies stratified by PSA levels. Methods PSA levels and diagnosis patterns from two microsimulation models of prostate cancer progression, detection, and mortality were compared against results of the Malmö Preventive Project, which stored serum and tracked subsequent prostate cancer diagnoses for 25 years. The models predicted the harms (tests and overdiagnoses) and benefits (lives saved and life-years gained) of PSA-stratified screening strategies compared with biennial screening from age 45 years to age 69 years. Results Compared with biennial screening for ages 45–69 years, lengthening screening intervals for men with PSA less than 1.0 ng/mL at age 45 years led to 46.8–47.0% fewer tests (range between models), 0.9–2.1% fewer overdiagnoses, and 3.1–3.8% fewer lives saved. Stopping screening when PSA was less than 1.0 ng/mL at age 60 years and older led to 12.8–16.0% fewer tests, 5.0–24.0% fewer overdiagnoses, and 5.0–13.1% fewer lives saved. Differences in model results can be partially explained by differences in assumptions about the link between PSA growth and the risk of disease progression. Conclusion Relative to a biennial screening strategy, PSA-stratified screening strategies investigated in this study substantially reduced the testing burden and modestly reduced overdiagnosis while preserving most lives saved. Further research is needed to clarify the link between PSA growth and disease progression.
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Affiliation(s)
- Eveline A M Heijnsdijk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Roman Gulati
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Institute, Seattle, WA, USA
| | - Alex Tsodikov
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Jane M Lange
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Institute, Seattle, WA, USA
| | - Angela B Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sigrid V Carlsson
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Institute, Seattle, WA, USA
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Lundgren PO, Kjellman A, Norming U, Gustafsson O. Association between one-time prostate-specific antigen (PSA) test with free/total PSA ratio and prostate cancer mortality: A 30-year prospective cohort study. BJU Int 2021; 128:490-496. [PMID: 33811738 DOI: 10.1111/bju.15417] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 03/01/2021] [Accepted: 03/17/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To explore if there is a long-term association between baseline prostate-specific antigen (PSA), including free/total PSA ratio and long-term (30-year) risk for prostate cancer death. SUBJECTS AND METHODS In all, 1782 men were screened for prostate cancer through PSA analysis. Some years later, frozen plasma samples were used to calculate the ratio of free to total PSA (f/t PSA). At 30-year follow-up, baseline PSA and f/t PSA were compared with recent data extracts from the Swedish Cause of Death Registry and Swedish Cancer Registry. PSA values and f/t PSA values were treated as continuous variables in a multivariable analysis and also stratified according to their distribution and useful clinical thresholds. RESULTS Risk of death from prostate cancer after 30 years of follow-up was significantly increased with a higher baseline PSA level, with the hazard ratio being 1.04 (95% confidence interval 1.03-1.09) per increase of one unit of PSA. Adding f/t PSA increased the model's ability to discriminate (concordance index 0.84-0.88). Men with PSA levels <1.0 ng/mL had a very low long-term risk of prostate cancer death (1.2% risk). An f/t PSA ≥ 0.25 extended the low-risk range to PSA < 2.0 ng/mL (1.5% risk). CONCLUSION Prostate-specific antigen testing can be carried out less frequently or can be discontinued in men aged 55-70 years if their PSA levels are <2.0 ng/mL and the f/t PSA is ≥0.25.
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Affiliation(s)
- Per-Olof Lundgren
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Anders Kjellman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ulf Norming
- Department of Clinical Science and Education, Karolinska Institutet and Södersjukhuset, Stockholm, Sweden
| | - Ove Gustafsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Plym A, Penney KL, Kalia S, Kraft P, Conti DV, Haiman C, Mucci LA, Kibel AS. Evaluation of a Multiethnic Polygenic Risk Score Model for Prostate Cancer. J Natl Cancer Inst 2021; 114:771-774. [PMID: 33792693 PMCID: PMC9086757 DOI: 10.1093/jnci/djab058] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/17/2021] [Accepted: 03/29/2021] [Indexed: 11/14/2022] Open
Abstract
Polygenic risk scores (PRSs) of common genetic variants have shown promise in prostate cancer risk stratification, but their validity across populations has yet to be confirmed. We evaluated a multiethnic PRS model based on 269 germline genetic risk variants (261 were available for analysis) using an independent population of 13 628 US men. The PRS was strongly associated with prostate cancer but not with any other disease. Comparing men in the top PRS decile with those at average risk (40%-60%), the odds ratio of prostate cancer was 3.89 (95% confidence interval = 3.24 to 4.68) for men of European ancestry and 3.81 (95% confidence interval = 1.48 to 10.19) for men of African ancestry. By age 85 years, the cumulative incidence of prostate cancer for European American men was 7.1% in the bottom decile and 54.1% in the top decile. This suggests that the PRS can be used to identify a substantial proportion of men at high risk for prostate cancer.
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Affiliation(s)
- Anna Plym
- Urology Division, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kathryn L Penney
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sarah Kalia
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Peter Kraft
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Program in Genetic Epidemiology and Statistical Genetics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - David V Conti
- Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, California
| | - Christopher Haiman
- Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, California
| | - Lorelei A Mucci
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Adam S Kibel
- Urology Division, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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41
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Shah A, Polascik TJ, George DJ, Anderson J, Hyslop T, Ellis AM, Armstrong AJ, Ferrandino M, Preminger GM, Gupta RT, Lee WR, Barrett NJ, Ragsdale J, Mills C, Check DK, Aminsharifi A, Schulman A, Sze C, Tsivian E, Tay KJ, Patierno S, Oeffinger KC, Shah K. Implementation and Impact of a Risk-Stratified Prostate Cancer Screening Algorithm as a Clinical Decision Support Tool in a Primary Care Network. J Gen Intern Med 2021; 36:92-99. [PMID: 32875501 PMCID: PMC7858708 DOI: 10.1007/s11606-020-06124-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/07/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Implementation methods of risk-stratified cancer screening guidance throughout a health care system remains understudied. OBJECTIVE Conduct a preliminary analysis of the implementation of a risk-stratified prostate cancer screening algorithm in a single health care system. DESIGN Comparison of men seen pre-implementation (2/1/2016-2/1/2017) vs. post-implementation (2/2/2017-2/21/2018). PARTICIPANTS Men, aged 40-75 years, without a history of prostate cancer, who were seen by a primary care provider. INTERVENTIONS The algorithm was integrated into two components in the electronic health record (EHR): in Health Maintenance as a personalized screening reminder and in tailored messages to providers that accompanied prostate-specific antigen (PSA) results. MAIN MEASURES Primary outcomes: percent of men who met screening algorithm criteria; percent of men with a PSA result. Logistic repeated measures mixed models were used to test for differences in the proportion of individuals that met screening criteria in the pre- and post-implementation periods with age, race, family history, and PSA level included as covariates. KEY RESULTS During the pre- and post-implementation periods, 49,053 and 49,980 men, respectively, were seen across 26 clinics (20.6% African American). The proportion of men who met screening algorithm criteria increased from 49.3% (pre-implementation) to 68.0% (post-implementation) (p < 0.001); this increase was observed across all races, age groups, and primary care clinics. Importantly, the percent of men who had a PSA did not change: 55.3% pre-implementation, 55.0% post-implementation. The adjusted odds of meeting algorithm-based screening was 6.5-times higher in the post-implementation period than in the pre-implementation period (95% confidence interval, 5.97 to 7.05). CONCLUSIONS In this preliminary analysis, following implementation of an EHR-based algorithm, we observed a rapid change in practice with an increase in screening in higher-risk groups balanced with a decrease in screening in low-risk groups. Future efforts will evaluate costs and downstream outcomes of this strategy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ariel Schulman
- Duke University, Durham, NC, USA.,Maimonides Medical Center, New York, NY, USA
| | - Christina Sze
- Duke University, Durham, NC, USA.,Weill Cornell Medical College, New York, NY, USA
| | | | - Kae Jack Tay
- Duke University, Durham, NC, USA.,SingHealth, Duke-NUS, Singapore, Singapore
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Dalela D, Sood A, Keeley J, Rogers C, Menon M, Abdollah F. Generalizability of Prostate-Specific Antigen (PSA) Screening Trials in a "Real World" Setting: A Nationwide Survey Analysis. Urology 2020; 148:1-3. [PMID: 33221417 DOI: 10.1016/j.urology.2020.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Deepansh Dalela
- VUI Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Akshay Sood
- VUI Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Jacob Keeley
- VUI Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Craig Rogers
- VUI Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Mani Menon
- VUI Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Firas Abdollah
- VUI Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI.
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Abstract
This article gives an overview of the current state of the evidence for prostate cancer early detection with prostate-specific antigen (PSA) and summarizes current recommendations from guideline groups. The article reviews the global public health burden and risk factors for prostate cancer with clinical implications as screening tools. Screening studies, novel biomarkers, and MRI are discussed. The article outlines 7 key practice points for primary care physicians and provides a simple schema for facilitating shared decision-making conversations.
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Affiliation(s)
- Sigrid V Carlsson
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY 10065, USA.
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44
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Recommandations françaises du Comité de cancérologie de l’AFU – actualisation 2020–2022 : cancer de la prostate. Prog Urol 2020; 30:S136-S251. [DOI: 10.1016/s1166-7087(20)30752-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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45
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Vertosick EA, Häggström C, Sjoberg DD, Hallmans G, Johansson R, Vickers AJ, Stattin P, Lilja H. Prespecified 4-Kallikrein Marker Model at Age 50 or 60 for Early Detection of Lethal Prostate Cancer in a Large Population Based Cohort of Asymptomatic Men Followed for 20 Years. J Urol 2020; 204:281-288. [PMID: 32125228 PMCID: PMC8423096 DOI: 10.1097/ju.0000000000001007] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE A prespecified statistical model based on 4 kallikrein markers in blood, commercially available as the 4Kscore®, has been shown to accurately detect high grade (greater than Grade Group 2) prostate cancer in men with moderately elevated prostate specific antigen. We assessed whether the model predicted prostate cancer metastasis or death in men not subject to prostate specific antigen screening. MATERIALS AND METHODS The cohort includes 43,692 unscreened prostate cancer-free men from a Swedish population based cohort with low rates of prostate specific antigen screening (Västerbotten Intervention Project). Using cryopreserved blood collected at ages 50 and 60 years from men in this cohort we analyzed the association between prostate specific antigen and other kallikrein marker levels in blood and risk of prostate cancer metastasis or death. RESULTS There were 308 with metastases and 172 prostate cancer deaths. Baseline prostate specific antigen was strongly associated with 20-year risk of prostate cancer death (c-index at age 50, 0.859, 95% CI 0.799-0.916; age 60, 0.840, 95% CI 0.799-0.878). Men 60 years old with prostate specific antigen below median (less than 1.2 ng/ml) had 0.4% risk of prostate cancer death at 20 years. Among men with moderately elevated prostate specific antigen (2.0 ng/ml or greater) the 4Kscore markedly improved discrimination (c-index 0.767 vs 0.828 and 0.774 vs 0.862 in men age 50 and 60, respectively). Long-term risk of prostate cancer death or metastasis in men with low 4Kscores was very low. CONCLUSIONS Screening should focus on men in top prostate specific antigen quartile at age 60 years. Men with elevated prostate specific antigen but a low 4Kscore can safely be monitored with repeated blood markers in place of immediate biopsy.
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Affiliation(s)
- Emily A. Vertosick
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Christel Häggström
- Department of Biobank Research, Umeå University, Umeå, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Daniel D. Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Göran Hallmans
- Department of Public Heath and Clinical Medicine, Nutritional Research, Umeå University, Umeå
| | | | - Andrew J. Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Hans Lilja
- Department of Surgery (Urology Service), Departments of Laboratory Medicine and Medicine (GU-Oncology Service), Memorial Sloan Kettering Cancer Center, New York, NY, U.S.A.; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; and Department of Translational Medicine, Lund University, Malmö, Sweden
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46
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Wang Y, Yang Z. A Gleason score-related outcome model for human prostate cancer: a comprehensive study based on weighted gene co-expression network analysis. Cancer Cell Int 2020; 20:159. [PMID: 32425694 PMCID: PMC7216484 DOI: 10.1186/s12935-020-01230-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/23/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Prostate cancer (PCa) is the second leading cause of cancer death in men in 2018. Thus, the evaluation of prognosis is crucial for clinical treatment decision of human PCa patients. We aim to establishing an effective and reliable model to predict the outcome of PCa patients. METHODS We first identified differentially expressed genes between prostate cancer and normal prostate in TCGA-PRAD and then performed WGCNA to initially identify the candidate Gleason score related genes. Then, the candidate genes were applied to construct a LASSO Cox regression analysis model. Numerous independent validation cohorts, time-dependent receiver operating characteristic (ROC), univariate cox regression analysis, nomogram were used to test the effectiveness, accuracy and clinical utility of the prognostic model. Furthermore, functional analysis and immune cells infiltration were performed. RESULTS Gleason score-related differentially expressed candidates were identified and used to build up the outcome model in TCGA-PRAD cohort and was validated in MSKCC cohort. We found the 3-gene outcome model (CDC45, ESPL1 and RAD54L) had good performance in predicting recurrence free survival, metastasis free survival and overall survival of PCa patients. Time-dependent ROC and nomogram indicated an ideal predictive accuracy and clinical utility of the outcome model. Moreover, outcome model was enriched in 28 pathways by GSVA and GSEA. In addition, the risk score was positively correlated with memory B cells, native CD4 T cells, activated CD4 memory T cells and eosinophil, and negatively correlated with plasma cells, resting CD4 memory T cells, resting mast cells and neutrophil. CONCLUSIONS In summary, our outcome model proves to be an effective prognostic model for predicting the risk of prognosis in PCa.
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Affiliation(s)
- Yongzhi Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Zhonghua Yang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
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47
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Darst BF, Chou A, Wan P, Pooler L, Sheng X, Vertosick EA, Conti DV, Wilkens LR, Le Marchand L, Vickers AJ, Lilja HG, Haiman CA. The Four-Kallikrein Panel Is Effective in Identifying Aggressive Prostate Cancer in a Multiethnic Population. Cancer Epidemiol Biomarkers Prev 2020; 29:1381-1388. [PMID: 32385116 DOI: 10.1158/1055-9965.epi-19-1560] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/18/2020] [Accepted: 04/24/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The four-kallikrein (4K) panel has been demonstrated to improve prediction of aggressive prostate cancer compared with prostate-specific antigen (PSA) among men with moderately elevated PSA levels. However, the development and testing of the 4K panel has been conducted primarily in White men, with limited data in African Americans and no studies in other racial and ethnic groups. METHODS We evaluated the 4K panel in a nested case-control study among African American, Latino, Japanese, Native Hawaiian, and White men in the Multiethnic Cohort. Prediagnostic blood levels of free, intact, and total PSA and human kallikrein-related peptidase 2 were measured among 1,667 incident prostate cancer cases and 691 controls with PSA ≥2 ng/mL. We evaluated the discriminative ability of the 4K panel within and across all racial/ethnic groups. RESULTS The 4K panel enhanced discrimination of overall prostate cancer compared with free plus total PSA and total PSA alone (AUC 0.748 vs. 0.711 and 0.669, respectively). Discrimination was further enhanced for Gleason 8+ prostate cancer, aggressive prostate cancer, and death due to prostate cancer, and to a lesser degree for nonaggressive prostate cancer. Improvement of the 4K panel over PSA was observed in each population. Adding a prostate cancer polygenic risk score slightly improved upon the discriminative ability of the 4K panel. CONCLUSIONS The superior discriminative ability of the 4K panel over PSA for overall and aggressive prostate cancer across multiethnic populations indicates the broad clinical applicability of the 4K panel. IMPACT Our multiethnic investigation suggests potential for the 4K panel to improve current prostate cancer screening practices.
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Affiliation(s)
- Burcu F Darst
- Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
| | - Alisha Chou
- Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Peggy Wan
- Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Loreall Pooler
- Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Xin Sheng
- Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Emily A Vertosick
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David V Conti
- Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Lynne R Wilkens
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Loïc Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hans G Lilja
- Departments of Laboratory Medicine, Surgery, and Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Christopher A Haiman
- Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
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48
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Landy R, Houghton LC, Berg CD, Grubb RL, Katki HA, Black A. Risk of Prostate Cancer-related Death Following a Low PSA Level in the PLCO Trial. Cancer Prev Res (Phila) 2020; 13:367-376. [PMID: 31996370 PMCID: PMC7339970 DOI: 10.1158/1940-6207.capr-19-0397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/23/2019] [Accepted: 01/23/2020] [Indexed: 01/25/2023]
Abstract
Longer-than-annual screening intervals have been suggested to improve the balance of benefits and harms in prostate cancer screening. Many researchers, societies, and guideline committees have suggested that screening intervals could depend on the prostate-specific antigen (PSA) result. We analyzed data from men (N = 33,897) ages 55-74 years with a baseline PSA test in the intervention arm of the Prostate, Lung, Colorectal and Ovarian Cancer Screening trial (United States, 1993-2001). We estimated 5- and 10-year risks of aggressive cancer (Gleason ≥8 and/or stage III/IV) and 15-year risks of prostate cancer-related mortality for men with baseline PSA ≤ 0.5 ng/mL (N = 4,862), ≤1 ng/mL (N = 15,110), and 1.01-2.5 ng/mL (N = 12,422). A total of 217 men died from prostate cancer through 15 years, although no men with PSA ≤ 1 ng/mL died from prostate cancer within 5 years [95% confidence interval (CI), 0.00%-0.03%]. The 5-year incidence of aggressive disease was low (0.08%; 95% CI, 0.03%-0.12%) for men with PSA ≤ 1 ng/mL, and higher for men with baseline PSA 1.01-2.5 ng/mL (0.51%; 95% CI, 0.38%-0.74%). No men aged ≥65 years with PSA ≤ 0.5 ng/mL died from prostate cancer within 15 years (95% CI, 0.00%-0.32%), and their 10-year incidence of aggressive disease was low (0.25%; 95% CI, 0.00%-0.53%). Compared with white men, black men with PSA ≤ 1 ng/mL had higher 10-year rates of aggressive disease (1.6% vs. 0.4%; P < 0.01). Five-year screening intervals may be appropriate for the 45% of men with PSA ≤ 1 ng/mL. Men ages ≥65 years with PSA ≤ 0.5 ng/mL could consider stopping screening. Substantial risk disparities suggest appropriate screening intervals could depend on race/ethnicity.
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Affiliation(s)
- Rebecca Landy
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland.
| | - Lauren C Houghton
- Mailman School of Public Health, Columbia University, New York, New York
| | - Christine D Berg
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Robert L Grubb
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina
| | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Amanda Black
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland.
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49
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Kensler KH, Rebbeck TR. Cancer Progress and Priorities: Prostate Cancer. Cancer Epidemiol Biomarkers Prev 2020; 29:267-277. [PMID: 32024765 PMCID: PMC7006991 DOI: 10.1158/1055-9965.epi-19-0412] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/10/2019] [Accepted: 12/03/2019] [Indexed: 02/06/2023] Open
Affiliation(s)
- Kevin H Kensler
- Division of Population Sciences, Dana-Farber Cancer Institute and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Timothy R Rebbeck
- Division of Population Sciences, Dana-Farber Cancer Institute and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
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50
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Kovac E, Carlsson SV, Lilja H, Hugosson J, Kattan MW, Holmberg E, Stephenson AJ. Association of Baseline Prostate-Specific Antigen Level With Long-term Diagnosis of Clinically Significant Prostate Cancer Among Patients Aged 55 to 60 Years: A Secondary Analysis of a Cohort in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. JAMA Netw Open 2020; 3:e1919284. [PMID: 31940039 PMCID: PMC6991265 DOI: 10.1001/jamanetworkopen.2019.19284] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
IMPORTANCE The use of prostate-specific antigen (PSA) screening for prostate cancer is controversial because of the risk of overdiagnosis and overtreatment of indolent cancers. Optimal screening strategies are highly sought. OBJECTIVE To estimate the long-term risk of any prostate cancer and clinically significant prostate cancer based on baseline PSA levels among men aged 55 to 60 years. DESIGN, SETTING, AND PARTICIPANTS This secondary analysis of a cohort in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial uses actuarial analysis to analyze the association of baseline PSA levels with long-term risk of any prostate cancer and of clinically significant prostate cancer among men aged 55 to 60 years enrolled in the screening group of the trial between 1993 and 2001. EXPOSURE Single PSA measurement at study entry. MAIN OUTCOMES AND MEASURES Long-term risk of any prostate cancer and clinically significant prostate cancer diagnoses. RESULTS There were 10 968 men aged 55 to 60 years (median [interquartile range] age, 57 [55-58] years) at study enrollment in the screening group of the PLCO Cancer Screening Trial who had long-term follow-up. Actuarial 13-year incidences of clinically significant prostate cancer diagnosis among participants with a baseline PSA of 0.49 ng/mL or less was 0.4% (95% CI, 0%-0.8%); 0.50-0.99 ng/mL, 1.5% (95% CI, 1.1%-1.9%); 1.00-1.99 ng/mL, 5.4% (95% CI, 4.4%-6.4%); 2.00-2.99 ng/mL, 10.6% (95% CI, 8.3%-12.9%); 3.00-3.99 ng/mL, 15.3% (95% CI, 11.4%-19.2%); and 4.00 ng/mL and greater, 29.5% (95% CI, 24.2%-34.8%) (all pairwise log-rank P ≤ .004). Only 15 prostate cancer-specific deaths occurred during 13 years of follow-up, and 9 (60.0%) were among men with a baseline PSA level of 2.00 ng/mL or higher. CONCLUSIONS AND RELEVANCE In this secondary analysis of a cohort from the PLCO Cancer Screening Trial, baseline PSA levels among men aged 55 to 60 years were associated with long-term risk of clinically significant prostate cancer. These findings suggest that repeated screening can be less frequent among men aged 55 to 60 years with a low baseline PSA level (ie, <2.00 ng/mL) and possibly discontinued among those with baseline PSA levels of less than 1.00 ng/mL.
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Affiliation(s)
- Evan Kovac
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio
- Department of Urology, Montefiore Medical Center, Bronx, New York
| | - Sigrid V. Carlsson
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Hans Lilja
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Jonas Hugosson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Michael W. Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Erik Holmberg
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Andrew J. Stephenson
- Department of Surgery, Division of Urology, Rush Medical College, Chicago, Illinois
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