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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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2
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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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Yow KS, Aik J, Tan EYM, Ng LC, Lai YL. Rapid diagnostic tests for the detection of recent dengue infections: An evaluation of six kits on clinical specimens. PLoS One 2021; 16:e0249602. [PMID: 33793682 PMCID: PMC8016316 DOI: 10.1371/journal.pone.0249602] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/17/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Early and rapid confirmation of dengue infections strengthens disease surveillance program and are critical to the success of vector control measures. Rapid diagnostics tests (RDTs) are increasingly used to confirm recent dengue infections due to their ease of use and short turnaround time for results. Several studies undertaken in dengue-endemic Southeast Asia have reported the performance of RDTs against enzyme-linked immunosorbent assay (ELISA), reverse transcriptase polymerase chain reaction (RT-PCR) and virus isolation methods. However, few studies have compared multiple RDTs for the detection of dengue NS1 antigen and IgM antibody in a single combo cassette. We evaluated six RDTs in Singapore for their utility in routine clinical testing to detect recent dengue infections. Methods The evaluation comprised two phases. The first phase sought to determine each RDT’s specificity to dengue NS1 and IgM using zika and chikungunya virus supernatant and zika convalescent samples. RDTs that cross-reacted with zika or chikungunya were not further tested in phase 2. The second phase sought to determine the sensitivity and specificity of the remaining RDTs to dengue NS1 and IgM using pre-characterised dengue specimens and non-dengue/chikungunya febrile clinical specimens. Results None of the RDTs cross-reacted with zika IgM in Phase 1. Truquick and Quickprofile cross reacted with zika and chikungunya viruses and were not evaluated thereafter. Standard Q had the highest dengue NS1 and IgM sensitivity at 87.0% and 84.3% respectively whereas Bioline (68.5%) and Multisure (58.3%) had the lowest dengue NS1 and IgM sensitivity respectively. Combining dengue NS1/IgM detection results greatly improved the RDT ability to detect recent dengue infection; Standard Q had the highest sensitivity at 99.1% while Multisure had the lowest at 92.6%. All the RDTs were highly specific for dengue NS1 and IgM (96.7% to 100%). All the RDTs had high positive predictive values (98.4% to 100%) for NS1, IgM and combined NS1/IgM parameters whereas Standard Q had the highest negative predictive values at 68.2% (NS1), 63.8% (IgM) and 96.8% (NS1/IgM). For the RDTs, detection of NS1 declined from acute to convalescent phase of illness whereas IgM detection rate gradually increased over time. Conclusion In our study, several RDTs were evaluated for their diagnostic accuracy and capability in detecting recent dengue infection. Standard Q demonstrated a high degree of diagnostic accuracy and capability in the detection of NS1 and IgM biomarkers. RDTs can provide rapid and accurate confirmation of recent dengue infections and augment dengue surveillance and control programmes. Further studies are required to assess the usefulness of these RDTs in other epidemiology settings.
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Affiliation(s)
- Kok-Siang Yow
- Environmental Health Institute, National Environment Agency, Singapore, Singapore
- * E-mail:
| | - Joel Aik
- Environmental Health Institute, National Environment Agency, Singapore, Singapore
| | - Eugene Yong-Meng Tan
- Environmental Health Institute, National Environment Agency, Singapore, Singapore
| | - Lee-Ching Ng
- Environmental Health Institute, National Environment Agency, Singapore, Singapore
| | - Yee-Ling Lai
- Environmental Health Institute, National Environment Agency, Singapore, Singapore
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Dittadi R, Fabricio ASC, Rainato G, Peroni E, Di Tonno F, Vezzù B, Mazzariol C, Squarcina E, Tammone L, Gion M. Preanalytical stability of [-2]proPSA in whole blood stored at room temperature before separation of serum and plasma: implications to Phi determination. Clin Chem Lab Med 2019; 57:521-531. [PMID: 30218601 DOI: 10.1515/cclm-2018-0596] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 08/11/2018] [Indexed: 12/26/2022]
Abstract
Background [-2]proPSA seems to outperform free/total prostate-specific antigen (PSA) ratio in prostate cancer diagnosis. However, [-2]proPSA stability remains an underestimated issue. We examined [-2]proPSA stability over time in whole blood before separation of serum and plasma and its implications for prostate health index (Phi) determination. Total PSA (tPSA) and free PSA (fPSA) stabilities were also assessed. Methods Blood was drawn from 26 patients and separated in two tubes for plasma (K2EDTA and K2EDTA plus protease inhibitors - P100) and one for serum (clot activator plus gel separator). Tubes were stored at room temperature before centrifugation 1, 3 and 5 h for serum and EDTA plasma or 1 and 5 h for P100 plasma. To investigate the influence of gel separator on markers' stability, blood was collected from 10 patients in three types of tubes to obtain serum: tubes with clot activator plus gel separator, with silica particles or glass tubes. Biomarkers were assayed with chemiluminescent immunoassays. Results [-2]proPSA and Phi levels significantly and progressively increased over time in serum (+4.81% and +8.2% at 3 h; +12.03% and +14.91% at 5 h, respectively, vs. 1 h; p<0.001). Conversely, [-2]proPSA levels did not change in plasma (EDTA or P100). tPSA levels did not change over time in serum or plasma, whereas fPSA decreased in serum. All markers were higher in plasma than in serum at any time point. This difference did not seem to be attributable to the use of gel for serum preparation. Conclusions EDTA prevented spurious in vitro modifications in PSA-related isoforms, confirming that a stabilized blood sample is a prerequisite for [-2]proPSA measurement and Phi determination.
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Affiliation(s)
- Ruggero Dittadi
- Laboratory Analysis Unit, Department of Clinical Pathology and Transfusion Medicine, Dell'Angelo Hospital, Mestre-Venice (VE), Italy
| | - Aline S C Fabricio
- Regional Center for Biomarkers, Department of Clinical Pathology and Transfusion Medicine, SS Giovanni e Paolo Regional Hospital, Venice (VE), Italy
| | - Giulia Rainato
- Istituto Oncologico Veneto (IOV), IRCCS, Padua (PD), Italy
| | - Edoardo Peroni
- Istituto Oncologico Veneto (IOV), IRCCS, Padua (PD), Italy
| | - Fulvio Di Tonno
- Unit of Urology, dell'Angelo Regional General Hospital, Mestre-Venice (VE), Italy
| | - Beatrice Vezzù
- Unit of Urology, dell'Angelo Regional General Hospital, Mestre-Venice (VE), Italy
| | - Chiara Mazzariol
- Unit of Urology, dell'Angelo Regional General Hospital, Mestre-Venice (VE), Italy
| | - Elisa Squarcina
- Regional Center for Biomarkers, Department of Clinical Pathology and Transfusion Medicine, SS Giovanni e Paolo Regional Hospital, Venice (VE), Italy
| | - Laura Tammone
- Endoscopy Ward, dell'Angelo Hospital, dell'Angelo Regional General Hospital, Mestre-Venice (VE), Italy
| | - Massimo Gion
- Centro Regionale Biomarcatori, AULSS3 Serenissima, Department of Clinical Pathology and Transfusion Medicine, SS Giovanni e Paolo Regional Hospital, Campo SS Giovanni e Paolo 6777, Ospedale Civile, 30122 Venezia, Italy
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Langston ME, Bhalla A, Alderete JF, Nevin RL, Pakpahan R, Hansen J, Elliott D, De Marzo AM, Gaydos CA, Isaacs WB, Nelson WG, Sokoll LJ, Zenilman JM, Platz EA, Sutcliffe S. Trichomonas vaginalis infection and prostate-specific antigen concentration: Insights into prostate involvement and prostate disease risk. Prostate 2019; 79:1622-1628. [PMID: 31376187 PMCID: PMC6715535 DOI: 10.1002/pros.23886] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/08/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND The protist Trichomonas vaginalis causes a common, sexually transmitted infection and has been proposed to contribute to the development of chronic prostate conditions, including benign prostatic hyperplasia and prostate cancer. However, few studies have investigated the extent to which it involves the prostate in the current antimicrobial era. We addressed this question by investigating the relation between T. vaginalis antibody serostatus and serum prostate-specific antigen (PSA) concentration, a marker of prostate infection, inflammation, and/or cell damage, in young, male, US military members. METHODS We measured T. vaginalis serum IgG antibodies and serum total PSA concentration in a random sample of 732 young, male US active duty military members. Associations between T. vaginalis serostatus and PSA were investigated by linear regression. RESULTS Of the 732 participants, 341 (46.6%) had a low T. vaginalis seropositive score and 198 (27.0%) had a high score, with the remainder seronegative. No significant differences were observed in the distribution of PSA by T. vaginalis serostatus. However, slightly greater, nonsignificant differences were observed when men with high T. vaginalis seropositive scores were compared with seronegative men, and when higher PSA concentrations were examined (≥0.70 ng/mL). Specifically, 42.5% of men with high seropositive scores had a PSA concentration greater than or equal to 0.70 ng/mL compared with 33.2% of seronegative men (adjusted P = .125). CONCLUSIONS Overall, our findings do not provide strong support for prostate involvement during T. vaginalis infection, although our suggestive positive findings for higher PSA concentrations do not rule out this possibility entirely. These suggestive findings may be relevant for prostate condition development because higher early- to mid-life PSA concentrations have been found to predict greater prostate cancer risk later in life.
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Affiliation(s)
- Marvin E. Langston
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Ankita Bhalla
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
- School of Dentistry, University of California, San Francisco, San Francisco, CA
| | - John F. Alderete
- School of Molecular Biosciences, College of Veterinary Medicine, Washington State University, Pullman, WA
| | - Remington L. Nevin
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- The Quinism Foundation, White River Junction, VT
| | - Ratna Pakpahan
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Johannah Hansen
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
- Los Angeles County Department of Public Health, Los Angeles, CA
| | - Debra Elliott
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Angelo M. De Marzo
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Charlotte A. Gaydos
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - William B. Isaacs
- Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - William G. Nelson
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
- Department of Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lori J. Sokoll
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Jonathan M. Zenilman
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elizabeth A. Platz
- Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
- Alvin J. Siteman Cancer Center and the Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO
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6
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Preston MA, Gerke T, Carlsson SV, Signorello L, Sjoberg DD, Markt SC, Kibel AS, Trinh QD, Steinwandel M, Blot W, Vickers AJ, Lilja H, Mucci LA, Wilson KM. Baseline Prostate-specific Antigen Level in Midlife and Aggressive Prostate Cancer in Black Men. Eur Urol 2018; 75:399-407. [PMID: 30237027 DOI: 10.1016/j.eururo.2018.08.032] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 08/23/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Prostate-specific antigen (PSA) measurement in midlife predicts long-term prostate cancer (PCa) mortality among white men. OBJECTIVE To determine whether baseline PSA level during midlife predicts risk of aggressive PCa in black men. DESIGN, SETTING, AND PARTICIPANTS Nested case-control study among black men in the Southern Community Cohort Study recruited between 2002 and 2009. A prospective cohort in the southeastern USA with recruitment from community health centers. A total of 197 incident PCa patients aged 40-64 yr at study entry and 569 controls matched on age, date of blood draw, and site of enrollment. Total PSA was measured in blood collected and stored at enrollment. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Total and aggressive PCa (91 aggressive: Gleason ≥7, American Joint Committee on Cancer stage III/IV, or PCa-specific death). Exact conditional logistic regression estimated odds ratios (ORs) with 95% confidence intervals (CIs) for PCa by category of baseline PSA. RESULTS AND LIMITATIONS Median PSA among controls was 0.72, 0.80, 0.94, and 1.03ng/ml for age groups 40-49, 50-54, 55-59, and 60-64 yr, respectively; 90th percentile levels were 1.68, 1.85, 2.73, and 3.33ng/ml. Furthermore, 95% of total and 97% of aggressive cases had baseline PSA above the age-specific median. Median follow-up was 9 yr. The OR for total PCa comparing PSA >90th percentile versus ≤median was 83.6 (95% CI, 21.2-539) for 40-54 yr and 71.7 (95% CI, 23.3-288) for 55-64 yr. For aggressive cancer, ORs were 174 (95% CI, 32.3-infinity) for 40-54 yr and 51.8 (95% CI, 11.0-519) for 55-64 yr. A composite endpoint of aggressive PCa based on stage, grade, and mortality was used and is a limitation. CONCLUSIONS PSA levels in midlife strongly predicted total and aggressive PCa among black men. PSA levels among controls were similar to those among white controls in prior studies. PATIENT SUMMARY Prostate-specific antigen (PSA) level during midlife strongly predicted future development of aggressive prostate cancer among black men. Targeted screening based on a midlife PSA might identify men at high risk while minimizing screening in those men at low risk.
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Affiliation(s)
- Mark A Preston
- Division of Urology, Brigham and Women's Hospital, Boston, MA, USA.
| | - Travis Gerke
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Sigrid V Carlsson
- 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 Göteborg, Göteborg, Sweden; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Lisa Signorello
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Sarah C Markt
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Adam S Kibel
- Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
| | - Quoc-Dien Trinh
- Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
| | - Mark Steinwandel
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William Blot
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Hans Lilja
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA; Departments of Laboratory Medicine and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Lorelei A Mucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kathryn M Wilson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA.
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7
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Scaramuzzino D, Schulte K, Mack B, Soriano T, Fritsche H. Five-Year Stability Study of Free and Total Prostate-Specific Antigen Concentrations in Serum Specimens Collected and Stored at – 70°C or Less. Int J Biol Markers 2018; 22:206-13. [DOI: 10.1177/172460080702200308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The stability of total (t) and free (f) prostate-specific antigen (PSA) in male serum specimens stored at –70°C or lower temperature for 4.7 to 4.9 years was studied. Until now, the stability of these analytes in serum has not been evaluated systematically beyond 2 years of storage at –70°C. Aliquots of frozen serum were thawed in 2001 and 2006 and assayed for tPSA and fPSA using a Dade Behring Dimension(r) RxL analyzer and reagents. tPSA values ranged from 0.07 to 69.94 and 0.00 to 69.83 ng/mL in 2001 and 2006, respectively, whereas fPSA values for the tested specimens ranged from 0.02 to 5.72 and 0.00 to 5.92, respectively. Deming regression analyses showed agreement in assay values over time as tPSA values yielded a slope of 1.0112 and a y-intercept of 0.0195; fPSA values produced a slope 1.0538 and a y-intercept of –0.0442; f/tPSA values yielded a slope of 0.9631 and a y-intercept of 0.1195. A Bland-Altman analysis of the data demonstrated analyte and ratio stability over this time period. We conclude that serum, when collected properly and stored at –70°C or lower temperature, may be used for tPSA and fPSA clinical studies for at least 5 years after collection.
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Affiliation(s)
| | - K. Schulte
- Ellis Hospital Laboratory, Schenectady, NY
| | | | | | - H.A. Fritsche
- Department of Laboratory Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX - USA
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8
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Assel M, Dahlin A, Ulmert D, Bergh A, Stattin P, Lilja H, Vickers AJ. Association Between Lead Time and Prostate Cancer Grade: Evidence of Grade Progression from Long-term Follow-up of Large Population-based Cohorts Not Subject to Prostate-specific Antigen Screening. Eur Urol 2017; 73:961-967. [PMID: 29066048 DOI: 10.1016/j.eururo.2017.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 10/05/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Lead time (LT) is of key importance in early detection of cancer, but cannot be directly measured. We have previously provided LT estimates for prostate cancer (PCa) using archived blood samples from cohorts followed for many years without screening. OBJECTIVE To determine the association between LT and PCa grade at diagnosis to provide an insight into whether grade progresses or is stable over time. DESIGN, SETTING, AND PARTICIPANTS The setting was three long-term epidemiologic studies in Sweden including men not subject to prostate-specific antigen (PSA) screening. The cohort included 1041 men with PSA of 3-10 ng/ml at blood draw and subsequently diagnosed with PCa with grade data available. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariable logistic regression was used to predict high-grade (Gleason grade group ≥2 or World Health Organization grade 3) versus low-grade PCa at diagnosis in terms of LT, defined as the time between the date of elevated PSA and the date of PCa diagnosis with adjustment for cohort and age. RESULTS AND LIMITATIONS The probability that PCa would be high grade at diagnosis increased with LT. Among all men combined, the risk of high-grade disease increased with LT (odds ratio 1.13, 95% confidence interval [CI] 1.10-1.16; p<0.0001), with no evidence of differences in effect by age group or cohort. Higher PSA predicted shorter LT by 0.46 yr (95% CI 0.28-0.64; p<0.0001) per 1 ng/ml increase in PSA. However, there was no interaction between PSA and grade, suggesting that the longer LT for high-grade tumors is not simply related to age. Limitations include the assumption that men with elevated PSA and subsequently diagnosed with PCa would have had biopsy-detectable PCa at the time of PSA elevation. CONCLUSIONS Our data support grade progression, whereby following a prostate over time would reveal transitions from benign to low-grade and then high-grade PCa. PATIENT SUMMARY Men with a longer lead time between elevated prostate-specific antigen and subsequent prostate cancer diagnosis were more likely to have high-grade cancers at diagnosis.
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Affiliation(s)
- Melissa Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anders Dahlin
- Department of Clinical Microbiology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - David Ulmert
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden; Molecular Pharmacology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anders Bergh
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden; Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden
| | - Hans Lilja
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Departments of Laboratory Medicine and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Translational Medicine, Lund University, Malmö, Sweden; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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9
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Zhao L, Wang D, Shi G, Lin L. Dual-labeled chemiluminescence enzyme immunoassay for simultaneous measurement of total prostate specific antigen (TPSA) and free prostate specific antigen (FPSA). LUMINESCENCE 2017. [DOI: 10.1002/bio.3358] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Lixia Zhao
- State Key Laboratory of Environmental Chemistry and Ecotoxicology; Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences; Beijing China
| | - Dan Wang
- State Key Laboratory of Environmental Chemistry and Ecotoxicology; Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences; Beijing China
- University of Chinese Academy of Sciences; Beijing People's Republic of China
| | - Gen Shi
- State Key Laboratory of Environmental Chemistry and Ecotoxicology; Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences; Beijing China
| | - Ling Lin
- The National Center for Nanoscience and Technology (NCNST) of China; Beijing People's Republic of China
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10
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Preston MA, Batista JL, Wilson KM, Carlsson SV, Gerke T, Sjoberg DD, Dahl DM, Sesso HD, Feldman AS, Gann PH, Kibel AS, Vickers AJ, Mucci LA. Baseline Prostate-Specific Antigen Levels in Midlife Predict Lethal Prostate Cancer. J Clin Oncol 2016; 34:2705-11. [PMID: 27298404 DOI: 10.1200/jco.2016.66.7527] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Prostate-specific antigen (PSA) level in midlife predicted future prostate cancer (PCa) mortality in an unscreened Swedish population. Our purpose was to determine if a baseline PSA level during midlife predicts lethal PCa in a US population with opportunistic screening. MATERIALS AND METHODS We conducted a nested case-control study among men age 40 to 59 years who gave blood before random assignment in the Physicians' Health Study, a randomized, placebo-controlled trial of aspirin and β-carotene among 22,071 US male physicians initiated in 1982 and then transitioned into a prospective cohort with 30 years of follow-up. Baseline PSA levels were available for 234 patients with PCa and 711 age-matched controls. Seventy-one participants who developed lethal PCa were rematched to 213 controls. Conditional logistic regression was used to estimate odds ratios and the area under the receiver operating characteristic curve, with 95% CIs, of the association between baseline PSA and risk of lethal PCa. RESULTS Median PSA among controls was 0.68, 0.88, and 0.96 ng/mL for men age 40 to 49, 50 to 54, and 55 to 59 years, respectively. Risk of lethal PCa was strongly associated with baseline PSA in midlife: odds ratios (95% CIs) comparing PSA in the > 90th percentile versus less than or equal to median were 8.7 (1.0 to 78.2) at 40 to 49 years, 12.6 (1.4 to 110.4) at 50 to 54 years, and 6.9 (2.5 to 19.1) at 55 to 59 years. A total of 82%, 71%, and 86% of lethal cases occurred in men with PSA above the median at ages 40 to 49, 50 to 54, and 55 to 59 years, respectively. CONCLUSION PSA levels in midlife strongly predict future lethal PCa in a US cohort subject to opportunistic screening. Risk-stratified screening on the basis of midlife PSA should be considered in men age 45 to 59 years.
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Affiliation(s)
- Mark A Preston
- Mark A. Preston, Julie L. Batista, Howard D. Sesso, and Adam S. Kibel, Brigham and Women's Hospital; Julie L. Batista, Kathryn M. Wilson, Travis Gerke, Howard D. Sesso, and Lorelei A. Mucci, Harvard T. H. Chan School of Public Health; Julie L. Batista, Harvard Medical School; Douglas M. Dahl and Adam S. Feldman, Massachusetts General Hospital, Boston, MA; Sigrid V. Carlsson, Daniel D. Sjoberg, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Sigrid V. Carlsson, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; and Peter H. Gann, University of Illinois at Chicago, Chicago, IL.
| | - Julie L Batista
- Mark A. Preston, Julie L. Batista, Howard D. Sesso, and Adam S. Kibel, Brigham and Women's Hospital; Julie L. Batista, Kathryn M. Wilson, Travis Gerke, Howard D. Sesso, and Lorelei A. Mucci, Harvard T. H. Chan School of Public Health; Julie L. Batista, Harvard Medical School; Douglas M. Dahl and Adam S. Feldman, Massachusetts General Hospital, Boston, MA; Sigrid V. Carlsson, Daniel D. Sjoberg, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Sigrid V. Carlsson, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; and Peter H. Gann, University of Illinois at Chicago, Chicago, IL
| | - Kathryn M Wilson
- Mark A. Preston, Julie L. Batista, Howard D. Sesso, and Adam S. Kibel, Brigham and Women's Hospital; Julie L. Batista, Kathryn M. Wilson, Travis Gerke, Howard D. Sesso, and Lorelei A. Mucci, Harvard T. H. Chan School of Public Health; Julie L. Batista, Harvard Medical School; Douglas M. Dahl and Adam S. Feldman, Massachusetts General Hospital, Boston, MA; Sigrid V. Carlsson, Daniel D. Sjoberg, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Sigrid V. Carlsson, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; and Peter H. Gann, University of Illinois at Chicago, Chicago, IL
| | - Sigrid V Carlsson
- Mark A. Preston, Julie L. Batista, Howard D. Sesso, and Adam S. Kibel, Brigham and Women's Hospital; Julie L. Batista, Kathryn M. Wilson, Travis Gerke, Howard D. Sesso, and Lorelei A. Mucci, Harvard T. H. Chan School of Public Health; Julie L. Batista, Harvard Medical School; Douglas M. Dahl and Adam S. Feldman, Massachusetts General Hospital, Boston, MA; Sigrid V. Carlsson, Daniel D. Sjoberg, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Sigrid V. Carlsson, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; and Peter H. Gann, University of Illinois at Chicago, Chicago, IL
| | - Travis Gerke
- Mark A. Preston, Julie L. Batista, Howard D. Sesso, and Adam S. Kibel, Brigham and Women's Hospital; Julie L. Batista, Kathryn M. Wilson, Travis Gerke, Howard D. Sesso, and Lorelei A. Mucci, Harvard T. H. Chan School of Public Health; Julie L. Batista, Harvard Medical School; Douglas M. Dahl and Adam S. Feldman, Massachusetts General Hospital, Boston, MA; Sigrid V. Carlsson, Daniel D. Sjoberg, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Sigrid V. Carlsson, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; and Peter H. Gann, University of Illinois at Chicago, Chicago, IL
| | - Daniel D Sjoberg
- Mark A. Preston, Julie L. Batista, Howard D. Sesso, and Adam S. Kibel, Brigham and Women's Hospital; Julie L. Batista, Kathryn M. Wilson, Travis Gerke, Howard D. Sesso, and Lorelei A. Mucci, Harvard T. H. Chan School of Public Health; Julie L. Batista, Harvard Medical School; Douglas M. Dahl and Adam S. Feldman, Massachusetts General Hospital, Boston, MA; Sigrid V. Carlsson, Daniel D. Sjoberg, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Sigrid V. Carlsson, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; and Peter H. Gann, University of Illinois at Chicago, Chicago, IL
| | - Douglas M Dahl
- Mark A. Preston, Julie L. Batista, Howard D. Sesso, and Adam S. Kibel, Brigham and Women's Hospital; Julie L. Batista, Kathryn M. Wilson, Travis Gerke, Howard D. Sesso, and Lorelei A. Mucci, Harvard T. H. Chan School of Public Health; Julie L. Batista, Harvard Medical School; Douglas M. Dahl and Adam S. Feldman, Massachusetts General Hospital, Boston, MA; Sigrid V. Carlsson, Daniel D. Sjoberg, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Sigrid V. Carlsson, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; and Peter H. Gann, University of Illinois at Chicago, Chicago, IL
| | - Howard D Sesso
- Mark A. Preston, Julie L. Batista, Howard D. Sesso, and Adam S. Kibel, Brigham and Women's Hospital; Julie L. Batista, Kathryn M. Wilson, Travis Gerke, Howard D. Sesso, and Lorelei A. Mucci, Harvard T. H. Chan School of Public Health; Julie L. Batista, Harvard Medical School; Douglas M. Dahl and Adam S. Feldman, Massachusetts General Hospital, Boston, MA; Sigrid V. Carlsson, Daniel D. Sjoberg, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Sigrid V. Carlsson, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; and Peter H. Gann, University of Illinois at Chicago, Chicago, IL
| | - Adam S Feldman
- Mark A. Preston, Julie L. Batista, Howard D. Sesso, and Adam S. Kibel, Brigham and Women's Hospital; Julie L. Batista, Kathryn M. Wilson, Travis Gerke, Howard D. Sesso, and Lorelei A. Mucci, Harvard T. H. Chan School of Public Health; Julie L. Batista, Harvard Medical School; Douglas M. Dahl and Adam S. Feldman, Massachusetts General Hospital, Boston, MA; Sigrid V. Carlsson, Daniel D. Sjoberg, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Sigrid V. Carlsson, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; and Peter H. Gann, University of Illinois at Chicago, Chicago, IL
| | - Peter H Gann
- Mark A. Preston, Julie L. Batista, Howard D. Sesso, and Adam S. Kibel, Brigham and Women's Hospital; Julie L. Batista, Kathryn M. Wilson, Travis Gerke, Howard D. Sesso, and Lorelei A. Mucci, Harvard T. H. Chan School of Public Health; Julie L. Batista, Harvard Medical School; Douglas M. Dahl and Adam S. Feldman, Massachusetts General Hospital, Boston, MA; Sigrid V. Carlsson, Daniel D. Sjoberg, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Sigrid V. Carlsson, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; and Peter H. Gann, University of Illinois at Chicago, Chicago, IL
| | - Adam S Kibel
- Mark A. Preston, Julie L. Batista, Howard D. Sesso, and Adam S. Kibel, Brigham and Women's Hospital; Julie L. Batista, Kathryn M. Wilson, Travis Gerke, Howard D. Sesso, and Lorelei A. Mucci, Harvard T. H. Chan School of Public Health; Julie L. Batista, Harvard Medical School; Douglas M. Dahl and Adam S. Feldman, Massachusetts General Hospital, Boston, MA; Sigrid V. Carlsson, Daniel D. Sjoberg, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Sigrid V. Carlsson, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; and Peter H. Gann, University of Illinois at Chicago, Chicago, IL
| | - Andrew J Vickers
- Mark A. Preston, Julie L. Batista, Howard D. Sesso, and Adam S. Kibel, Brigham and Women's Hospital; Julie L. Batista, Kathryn M. Wilson, Travis Gerke, Howard D. Sesso, and Lorelei A. Mucci, Harvard T. H. Chan School of Public Health; Julie L. Batista, Harvard Medical School; Douglas M. Dahl and Adam S. Feldman, Massachusetts General Hospital, Boston, MA; Sigrid V. Carlsson, Daniel D. Sjoberg, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Sigrid V. Carlsson, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; and Peter H. Gann, University of Illinois at Chicago, Chicago, IL
| | - Lorelei A Mucci
- Mark A. Preston, Julie L. Batista, Howard D. Sesso, and Adam S. Kibel, Brigham and Women's Hospital; Julie L. Batista, Kathryn M. Wilson, Travis Gerke, Howard D. Sesso, and Lorelei A. Mucci, Harvard T. H. Chan School of Public Health; Julie L. Batista, Harvard Medical School; Douglas M. Dahl and Adam S. Feldman, Massachusetts General Hospital, Boston, MA; Sigrid V. Carlsson, Daniel D. Sjoberg, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Sigrid V. Carlsson, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden; and Peter H. Gann, University of Illinois at Chicago, Chicago, IL
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11
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Carlsson S, Assel M, Ulmert D, Gerdtsson A, Hugosson J, Vickers A, Lilja H. Screening for Prostate Cancer Starting at Age 50-54 Years. A Population-based Cohort Study. Eur Urol 2016; 71:46-52. [PMID: 27084245 DOI: 10.1016/j.eururo.2016.03.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 03/16/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Current prostate cancer screening guidelines conflict with respect to the age at which to initiate screening. OBJECTIVE To evaluate the effect of prostate-specific antigen (PSA) screening versus zero screening, starting at age 50-54 yr, on prostate cancer mortality. DESIGN, SETTING, AND PARTICIPANTS This is a population-based cohort study comparing 3479 men aged 50 yr through 54 yr randomized to PSA-screening in the Göteborg population-based prostate cancer screening trial, initiated in 1995, versus 4060 unscreened men aged 51-55 yr providing cryopreserved blood in the population-based Malmö Preventive Project in the pre-PSA era, during 1982-1985. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Cumulative incidence and incidence rate ratios of prostate cancer diagnosis, metastasis, and prostate cancer death. RESULTS AND LIMITATIONS At 17 yr, regular PSA-screening in Göteborg of men in their early 50s carried a more than two-fold higher risk of prostate cancer diagnosis compared with the unscreened men in Malmö (incidence rate ratio [IRR] 2.56, 95% confidence interval [CI] 2.18, 3.02), but resulted in a substantial decrease in the risk of metastases (IRR 0.43, 95% CI 0.22, 0.79) and prostate cancer death (IRR 0.29, 95% CI 0.11, 0.67). There were 57 fewer prostate cancer deaths per 10000 men (95% CI 22, 92) in the screened group. At 17 yr, the number needed to invite to PSA-screening and the number needed to diagnose to prevent one prostate cancer death was 176 and 16, respectively. The study is limited by lack of treatment information and the comparison of the two different birth cohorts. CONCLUSIONS PSA screening for prostate cancer can decrease prostate cancer mortality among men aged 50-54 yr, with the number needed to invite and number needed to detect to prevent one prostate cancer death comparable to those previously reported from the European Randomized Study of Screening for Prostate Cancer for men aged 55-69 yr, at a similar follow-up. Guideline groups could consider whether guidelines for PSA screening should recommend starting no later than at ages 50-54 yr. PATIENT SUMMARY Guideline recommendations about the age to start prostate-specific antigen screening could be discussed.
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Affiliation(s)
- Sigrid Carlsson
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Göteborg, Sweden
| | - Melissa Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - David Ulmert
- Molecular Pharmacology and Chemistry Program, Sloan Kettering Institute, New York, NY, USA; Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Axel Gerdtsson
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Jonas Hugosson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Göteborg, Sweden; Sahlgrenska University Hospital, Göteborg, Sweden
| | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA.
| | - Hans Lilja
- Department of Translational Medicine, Lund University, Malmö, Sweden; Departments of Laboratory Medicine, Surgery (Urology Service) and Medicine (Genitourinary Oncology), Memorial Sloan Kettering Cancer Center, New York, USA; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
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12
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McDonald ML, Parsons JK. 4-Kallikrein Test and Kallikrein Markers in Prostate Cancer Screening. Urol Clin North Am 2016; 43:39-46. [DOI: 10.1016/j.ucl.2015.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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13
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Braun K, Sjoberg DD, Vickers AJ, Lilja H, Bjartell AS. A Four-kallikrein Panel Predicts High-grade Cancer on Biopsy: Independent Validation in a Community Cohort. Eur Urol 2015; 69:505-11. [PMID: 25979570 DOI: 10.1016/j.eururo.2015.04.028] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 04/18/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND A statistical model based on four kallikrein markers (total prostate-specific antigen [tPSA], free PSA [fPSA], intact PSA, and human kallikrein-related peptidase 2) in blood can predict risk of Gleason score ≥7 (high-grade) cancer at prostate biopsy. OBJECTIVE To determine the value of this model in predicting high-grade cancer at biopsy in a community-based setting in which referral criteria included percentage of fPSA to tPSA (%fPSA). DESIGN, SETTING, AND PARTICIPANTS We evaluated the model, with or without adding blood levels of microseminoprotein-β (MSMB) in a cohort of 749 men referred for prostate biopsy due to elevated PSA (≥3 ng/ml), low %fPSA (<20%), or suspicious digital rectal examination at Skåne University Hospital, Malmö, Sweden. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The kallikrein markers, with or without MSMB levels, measured in cryopreserved anticoagulated blood were combined with age in a published statistical model (Prostate Testing for Cancer and Treatment [ProtecT]) to predict high-grade cancer at biopsy. Predictive accuracy was compared with a base model. RESULTS AND LIMITATIONS The %fPSA was low (median: 17; interquartile range: 13-22) in this cohort because this marker was used as a referral criterion. The ProtecT model improved discrimination over age and PSA for high-grade cancer (0.777 vs 0.720; p=0.002). At one illustrative cut point, use of the panel would reduce the number of biopsies by 236 per 1000 and detect 195 of 208 (94%) but delay diagnosis of 13 of 208 high-grade cancers. MSMB levels in blood did not improve the accuracy of the panel (p=0.2). CONCLUSIONS The kallikrein model is predictive of high-grade cancer if criteria for biopsy referral also include %fPSA, and it can reduce unnecessary biopsies without missing an undue number of tumors. PATIENT SUMMARY We evaluated a published model to predict biopsy outcome in men biopsied due to low percentage of free to total prostate-specific antigen. The model helps reduce unnecessary biopsies without missing an undue number of high-grade cancers.
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Affiliation(s)
- Katharina Braun
- Department of Urology, University Hospital Ruhr-University Bochum, Marien Hospital Herne, Herne, Germany
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hans Lilja
- Departments of Laboratory Medicine, Medicine (Genitourinary Oncology), and Surgery (Urology), Memorial Sloan Kettering Cancer Center, New York, NY, USA; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Department of Translational Medicine, Lund University, Malmö, Sweden.
| | - Anders S Bjartell
- Department of Translational Medicine, Lund University, Malmö, Sweden
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14
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Bryant RJ, Sjoberg DD, Vickers AJ, Robinson MC, Kumar R, Marsden L, Davis M, Scardino PT, Donovan J, Neal DE, Lilja H, Hamdy FC. Predicting high-grade cancer at ten-core prostate biopsy using four kallikrein markers measured in blood in the ProtecT study. J Natl Cancer Inst 2015; 107:djv095. [PMID: 25863334 PMCID: PMC4554254 DOI: 10.1093/jnci/djv095] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Many men with elevated prostate-specific antigen (PSA) levels in serum do not have aggressive prostate cancer and undergo unnecessary biopsy. Retrospective studies using cryopreserved serum suggest that four kallikrein markers can predict biopsy outcome. Methods: Free, intact and total PSA, and kallikrein-related peptidase 2 were measured in cryopreserved blood from 6129 men with elevated PSA (≥3.0ng/mL) participating in the prospective, randomized trial Prostate Testing for Cancer and Treatment. Marker levels from 4765 men providing anticoagulated plasma were incorporated into statistical models to predict any-grade and high-grade (Gleason score ≥7) prostate cancer at 10-core biopsy. The models were corrected for optimism by 10-fold cross validation and independently validated using markers measured in serum from 1364 men. All statistical tests were two-sided. Results: The four kallikreins enhanced prostate cancer detection compared with PSA and age alone. Area under the curve (AUC) for the four kallikreins was 0.719 (95% confidence interval [CI] = 0.704 to 0.734) vs 0.634 (95% CI = 0.617 to 0.651, P < .001) for PSA and age alone for any-grade cancer, and 0.820 (95% CI = 0.802 to 0.838) vs 0.738 (95% CI = 0.716 to 0.761) for high-grade cancer. Using a 6% risk of high-grade cancer as an illustrative cutoff, for 1000 biopsied men with PSA levels of 3.0ng/mL or higher, the model would reduce the need for biopsy in 428 men, detect 119 high-grade cancers, and delay diagnosis of 14 of 133 high-grade cancers. Models exhibited excellent discrimination on independent validation among men with only serum samples available for analysis. Conclusions: A statistical model based on kallikrein markers was validated in a large prospective study and reduces unnecessary biopsies while delaying diagnosis of high-grade cancers in few men.
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Affiliation(s)
- Richard J Bryant
- Nuffield Department of Surgical Sciences, University of Oxford, UK (RJB, RK, LM, HL, FCH); Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (DDS, AJV); Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK (MCR); School of Social and Community Medicine, University of Bristol, UK (MD); Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center (PTS, HL); Department of Oncology, University of Cambridge, UK (DEN); Departments of Laboratory Medicine (Clinical Chemistry Service) and Medicine (Genitourinary Oncology Service), Memorial Sloan Kettering Cancer Center, New York, NY (HL); Department of Laboratory Medicine and Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden; and Institute of Biomedical Technology, University of Tampere, Finland (HL)
| | - Daniel D Sjoberg
- Nuffield Department of Surgical Sciences, University of Oxford, UK (RJB, RK, LM, HL, FCH); Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (DDS, AJV); Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK (MCR); School of Social and Community Medicine, University of Bristol, UK (MD); Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center (PTS, HL); Department of Oncology, University of Cambridge, UK (DEN); Departments of Laboratory Medicine (Clinical Chemistry Service) and Medicine (Genitourinary Oncology Service), Memorial Sloan Kettering Cancer Center, New York, NY (HL); Department of Laboratory Medicine and Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden; and Institute of Biomedical Technology, University of Tampere, Finland (HL)
| | - Andrew J Vickers
- Nuffield Department of Surgical Sciences, University of Oxford, UK (RJB, RK, LM, HL, FCH); Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (DDS, AJV); Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK (MCR); School of Social and Community Medicine, University of Bristol, UK (MD); Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center (PTS, HL); Department of Oncology, University of Cambridge, UK (DEN); Departments of Laboratory Medicine (Clinical Chemistry Service) and Medicine (Genitourinary Oncology Service), Memorial Sloan Kettering Cancer Center, New York, NY (HL); Department of Laboratory Medicine and Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden; and Institute of Biomedical Technology, University of Tampere, Finland (HL)
| | - Mary C Robinson
- Nuffield Department of Surgical Sciences, University of Oxford, UK (RJB, RK, LM, HL, FCH); Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (DDS, AJV); Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK (MCR); School of Social and Community Medicine, University of Bristol, UK (MD); Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center (PTS, HL); Department of Oncology, University of Cambridge, UK (DEN); Departments of Laboratory Medicine (Clinical Chemistry Service) and Medicine (Genitourinary Oncology Service), Memorial Sloan Kettering Cancer Center, New York, NY (HL); Department of Laboratory Medicine and Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden; and Institute of Biomedical Technology, University of Tampere, Finland (HL)
| | - Rajeev Kumar
- Nuffield Department of Surgical Sciences, University of Oxford, UK (RJB, RK, LM, HL, FCH); Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (DDS, AJV); Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK (MCR); School of Social and Community Medicine, University of Bristol, UK (MD); Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center (PTS, HL); Department of Oncology, University of Cambridge, UK (DEN); Departments of Laboratory Medicine (Clinical Chemistry Service) and Medicine (Genitourinary Oncology Service), Memorial Sloan Kettering Cancer Center, New York, NY (HL); Department of Laboratory Medicine and Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden; and Institute of Biomedical Technology, University of Tampere, Finland (HL)
| | - Luke Marsden
- Nuffield Department of Surgical Sciences, University of Oxford, UK (RJB, RK, LM, HL, FCH); Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (DDS, AJV); Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK (MCR); School of Social and Community Medicine, University of Bristol, UK (MD); Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center (PTS, HL); Department of Oncology, University of Cambridge, UK (DEN); Departments of Laboratory Medicine (Clinical Chemistry Service) and Medicine (Genitourinary Oncology Service), Memorial Sloan Kettering Cancer Center, New York, NY (HL); Department of Laboratory Medicine and Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden; and Institute of Biomedical Technology, University of Tampere, Finland (HL)
| | - Michael Davis
- Nuffield Department of Surgical Sciences, University of Oxford, UK (RJB, RK, LM, HL, FCH); Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (DDS, AJV); Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK (MCR); School of Social and Community Medicine, University of Bristol, UK (MD); Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center (PTS, HL); Department of Oncology, University of Cambridge, UK (DEN); Departments of Laboratory Medicine (Clinical Chemistry Service) and Medicine (Genitourinary Oncology Service), Memorial Sloan Kettering Cancer Center, New York, NY (HL); Department of Laboratory Medicine and Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden; and Institute of Biomedical Technology, University of Tampere, Finland (HL)
| | - Peter T Scardino
- Nuffield Department of Surgical Sciences, University of Oxford, UK (RJB, RK, LM, HL, FCH); Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (DDS, AJV); Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK (MCR); School of Social and Community Medicine, University of Bristol, UK (MD); Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center (PTS, HL); Department of Oncology, University of Cambridge, UK (DEN); Departments of Laboratory Medicine (Clinical Chemistry Service) and Medicine (Genitourinary Oncology Service), Memorial Sloan Kettering Cancer Center, New York, NY (HL); Department of Laboratory Medicine and Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden; and Institute of Biomedical Technology, University of Tampere, Finland (HL)
| | - Jenny Donovan
- Nuffield Department of Surgical Sciences, University of Oxford, UK (RJB, RK, LM, HL, FCH); Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (DDS, AJV); Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK (MCR); School of Social and Community Medicine, University of Bristol, UK (MD); Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center (PTS, HL); Department of Oncology, University of Cambridge, UK (DEN); Departments of Laboratory Medicine (Clinical Chemistry Service) and Medicine (Genitourinary Oncology Service), Memorial Sloan Kettering Cancer Center, New York, NY (HL); Department of Laboratory Medicine and Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden; and Institute of Biomedical Technology, University of Tampere, Finland (HL)
| | - David E Neal
- Nuffield Department of Surgical Sciences, University of Oxford, UK (RJB, RK, LM, HL, FCH); Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (DDS, AJV); Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK (MCR); School of Social and Community Medicine, University of Bristol, UK (MD); Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center (PTS, HL); Department of Oncology, University of Cambridge, UK (DEN); Departments of Laboratory Medicine (Clinical Chemistry Service) and Medicine (Genitourinary Oncology Service), Memorial Sloan Kettering Cancer Center, New York, NY (HL); Department of Laboratory Medicine and Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden; and Institute of Biomedical Technology, University of Tampere, Finland (HL)
| | - Hans Lilja
- Nuffield Department of Surgical Sciences, University of Oxford, UK (RJB, RK, LM, HL, FCH); Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (DDS, AJV); Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK (MCR); School of Social and Community Medicine, University of Bristol, UK (MD); Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center (PTS, HL); Department of Oncology, University of Cambridge, UK (DEN); Departments of Laboratory Medicine (Clinical Chemistry Service) and Medicine (Genitourinary Oncology Service), Memorial Sloan Kettering Cancer Center, New York, NY (HL); Department of Laboratory Medicine and Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden; and Institute of Biomedical Technology, University of Tampere, Finland (HL).
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, UK (RJB, RK, LM, HL, FCH); Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (DDS, AJV); Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK (MCR); School of Social and Community Medicine, University of Bristol, UK (MD); Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center (PTS, HL); Department of Oncology, University of Cambridge, UK (DEN); Departments of Laboratory Medicine (Clinical Chemistry Service) and Medicine (Genitourinary Oncology Service), Memorial Sloan Kettering Cancer Center, New York, NY (HL); Department of Laboratory Medicine and Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden; and Institute of Biomedical Technology, University of Tampere, Finland (HL)
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15
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Carlsson S, Assel M, Sjoberg D, Ulmert D, Hugosson J, Lilja H, Vickers A. Influence of blood prostate specific antigen levels at age 60 on benefits and harms of prostate cancer screening: population based cohort study. BMJ 2014; 348:g2296. [PMID: 24682399 PMCID: PMC3968958 DOI: 10.1136/bmj.g2296] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the relative risks of prostate cancer incidence, metastasis, and mortality associated with screening by serum prostate specific antigen (PSA) levels at age 60. DESIGN Population based cohort study. SETTING General male population of Sweden taking part in a screening trial in Gothenburg or participating in a cardiovascular study, the Malmö Preventive Project. PARTICIPANTS The screened group consisted of 1756 men aged 57.5-62.5 participating in the screening arm of the Gothenburg randomized prostate cancer screening trial since 1995. The unscreened group consisted of 1162 men, born in 1921, participating in the Malmö Preventive Project, with PSA levels measured retrospectively in stored blood samples from 1981. INTERVENTION PSA screening versus no screening. MAIN OUTCOME MEASURES Incidence rate ratios for the effect of screening on prostate cancer diagnosis, metastasis, and death by PSA levels at age 60. RESULTS The distribution of PSA levels was similar between the two cohorts. Differences in benefits by baseline PSA levels were large. Among men with baseline levels measured, 71.7% (1646/2295) had a PSA level <2 ng/mL. For men aged 60 with PSA level <2 ng/mL, there was an increase in incidence of 767 cases per 10,000 without a decrease in prostate cancer mortality. For men with PSA levels ≥ 2 ng/mL, the reduction in cancer mortality was large, with only 23 men needing to be screened and six diagnosed to avoid one prostate cancer death by 15 years. CONCLUSIONS The ratio of benefits to harms of PSA screening varies noticeably with blood PSA levels at age 60. For men with a PSA level <1 ng/mL at age 60, no further screening is recommended. Continuing to screen men with PSA levels >2 ng/mL at age 60 is beneficial, with the number needed to screen and treat being extremely favourable. Screening men with a PSA level of 1-2 ng/mL is an individual decision to be based on a discussion between patient and doctor.
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Affiliation(s)
- Sigrid Carlsson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden
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16
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Igawa T, Takehara K, Onita T, Ito K, Sakai H. Stability of [-2]Pro-PSA in whole blood and serum: analysis for optimal measurement conditions. J Clin Lab Anal 2014; 28:315-9. [PMID: 24578247 DOI: 10.1002/jcla.21687] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 08/21/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The clinical usefulness of [-2]pro-PSA (where PSA is prostate-specific antigen) in prostate cancer diagnosis has been emphasized in recent studies. To determine proper blood sample handling conditions for [-2]pro-PSA evaluation, we analyzed the preanalytical stability of [-2]pro-PSA. METHODS Blood samples from 22 Japanese males were stored under various conditions before total PSA (tPSA), free PSA, and [-2]pro-PSA concentrations were measured, and the preanalytical stability of [-2]pro-PSA and the changes in the Prostate Health Index (phi) were assessed. RESULTS [-2]Pro-PSA was stable in serum for at least 24 hr at both room temperature (RT) and at 4°C. However, [-2]pro-PSA levels in whole blood increased rapidly over time, particularly at RT. Mean recovery (%) of [-2]pro-PSA in whole blood at RT was >110% at 1 hr after drawing of blood. The phi tended to increase over time in a pattern similar to the change in[-2]pro-PSA. CONCLUSIONS Preanalytical stability was lower for [-2]pro-PSA than for free PSA or tPSA. Whole-blood [-2]pro-PSA increased in a time-dependent manner, particularly at RT. Thus, whole blood samples collected at RT should be centrifuged within 1 hr after drawing. The [-2]pro-PSA in serum is stable for at least 24 hr at both RT and at 4°C.
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Affiliation(s)
- Tsukasa Igawa
- Department of Nephro-urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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17
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Abstract
This article updates advances in prostate cancer screening based on prostate-specific antigen, its derivatives, and human kallikrein markers. Many men are diagnosed with indolent disease not requiring treatment. Although there is evidence of a survival benefit from screening, the numbers needed to screen and treat remain high. There is risk of exposing men to the side effects of treatment for nonthreatening disease. A screening test is needed with sufficiently good performance characteristics to detect disease at an early stage so treatment may be offered with curative intent, while reducing the number of negative or unnecessary biopsies.
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Affiliation(s)
- Richard J Bryant
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Hans Lilja
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Headley Way, Headington, Oxford OX3 9DU, UK; Department of Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue (Mailbox 213), New York, NY 10065, USA; Department of Surgery (Urology), Memorial Sloan-Kettering Cancer Center, 1275 York Avenue (Mailbox 213), New York, NY 10065, USA; Department of Medicine (GU-Oncology), Memorial Sloan-Kettering Cancer Center, 1275 York Avenue (Mailbox 213), New York, NY 10065, USA.
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18
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Vickers AJ, Sjoberg DD, Ulmert D, Vertosick E, Roobol MJ, Thompson I, Heijnsdijk EAM, De Koning H, Atoria-Swartz C, Scardino PT, Lilja H. Empirical estimates of prostate cancer overdiagnosis by age and prostate-specific antigen. BMC Med 2014; 12:26. [PMID: 24512643 PMCID: PMC3922189 DOI: 10.1186/1741-7015-12-26] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 01/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prostate cancer screening depends on a careful balance of benefits, in terms of reduced prostate cancer mortality, and harms, in terms of overdiagnosis and overtreatment. We aimed to estimate the effect on overdiagnosis of restricting prostate specific antigen (PSA) testing by age and baseline PSA. METHODS Estimates of the effects of age on overdiagnosis were based on population based incidence data from the US Surveillance, Epidemiology and End Results database. To investigate the relationship between PSA and overdiagnosis, we used two separate cohorts subject to PSA testing in clinical trials (n = 1,577 and n = 1,197) and a population-based cohort of Swedish men not subject to PSA-screening followed for 25 years (n = 1,162). RESULTS If PSA testing had been restricted to younger men, the number of excess cases associated with the introduction of PSA in the US would have been reduced by 85%, 68% and 42% for age cut-offs of 60, 65 and 70, respectively. The risk that a man with screen-detected cancer at age 60 would not subsequently lead to prostate cancer morbidity or mortality decreased exponentially as PSA approached conventional biopsy thresholds. For PSAs below 1 ng/ml, the risk of a positive biopsy is 65 (95% CI 18.2, 72.9) times greater than subsequent prostate cancer mortality. CONCLUSIONS Prostate cancer overdiagnosis has a strong relationship to age and PSA level. Restricting screening in men over 60 to those with PSA above median (>1 ng/ml) and screening men over 70 only in selected circumstances would importantly reduce overdiagnosis and change the ratio of benefits to harms of PSA-screening.
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Affiliation(s)
- Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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Chambers AG, Percy AJ, Simon R, Borchers CH. MRM for the verification of cancer biomarker proteins: recent applications to human plasma and serum. Expert Rev Proteomics 2014; 11:137-48. [PMID: 24476379 DOI: 10.1586/14789450.2014.877346] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Accurate cancer biomarkers are needed for early detection, disease classification, prediction of therapeutic response and monitoring treatment. While there appears to be no shortage of candidate biomarker proteins, a major bottleneck in the biomarker pipeline continues to be their verification by enzyme linked immunosorbent assays. Multiple reaction monitoring (MRM), also known as selected reaction monitoring, is a targeted mass spectrometry approach to protein quantitation and is emerging to bridge the gap between biomarker discovery and clinical validation. Highly multiplexed MRM assays are readily configured and enable simultaneous verification of large numbers of candidates facilitating the development of biomarker panels which can increase specificity. This review focuses on recent applications of MRM to the analysis of plasma and serum from cancer patients for biomarker verification. The current status of this approach is discussed along with future directions for targeted mass spectrometry in clinical biomarker validation.
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Affiliation(s)
- Andrew G Chambers
- University of Victoria - Genome British Columbia Proteomics Centre, Vancouver Island Technology Park, #3101 - 4464 Markham St, Victoria, BC V8Z 7X8, Canada
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Vucetic Z, Dnistrian A, Nilsson O, Lilja HG, Plebani M. Suitability of quality control materials for prostate-specific antigen (PSA) measurement: inter-method variability of common tumor marker control materials. Clin Chem Lab Med 2013; 51:873-80. [PMID: 23314549 DOI: 10.1515/cclm-2012-0660] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 12/05/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Quality control materials with minimal inter-assay differences and clinically relevant proportions of different molecular forms of the analyte are needed to optimize intra- and inter-laboratory accuracy and precision. METHODS We assessed if clinically relevant total prostate-specific antigen (tPSA) levels were present in seven commercially available Multi Constituent Tumor Marker Controls (MC-TMC). Further, we determined the concentration of free PSA (fPSA) and calculated the percentage of free PSA (%fPSA) in all materials. Finally, we determined variability of TMC materials across several commonly used PSA platforms. RESULTS All MC-TMC materials contained at least one concentration of tPSA in normal and pathologic range. Control materials varied in the amount of fPSA and %fPSA, with most controls consisting of fPSA only and only one MC-TMC containing medically relevant levels of around 35% fPSA. Only a minority of MC-TMC materials showed minimal variability across four PSA methods while the majority of PSA controls showed wide inter-method differences. CONCLUSIONS Use of many commercially available controls for PSA could lead to biased PSA measurements because they contain medically irrelevant proportions of fPSA and show significant variation among different PSA assay platforms.
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21
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Larsen SB, Brasso K, Iversen P, Christensen J, Christiansen M, Carlsson S, Lilja H, Friis S, Tjønneland A, Dalton SO. Baseline prostate-specific antigen measurements and subsequent prostate cancer risk in the Danish Diet, Cancer and Health cohort. Eur J Cancer 2013; 49:3041-8. [PMID: 23684783 DOI: 10.1016/j.ejca.2013.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 04/05/2013] [Accepted: 04/18/2013] [Indexed: 10/26/2022]
Abstract
AIM Although prostate-specific antigen (PSA) screening reduces mortality from prostate cancer, substantial over-diagnosis and subsequent overtreatment are concerns. Early screening of men for PSA may serve to stratify the male population by risk of future clinical prostate cancer. METHODS AND MATERIAL Case-control study nested within the Danish 'Diet, Cancer and Health' cohort of 27,179 men aged 50-64 at enrolment. PSA measured in serum collected at cohort entry in 1993-1997 was used to evaluate prostate cancer risk diagnosed up to 14 years after. We identified 911 prostate cancer cases in the Danish Cancer Registry through 31st December 2007 1:1 age-matched with cancer-free controls. Aggressive cancer was defined as ≥ T3 or Gleason score ≥ 7 or N1 or M1. Statistical analyses were based on conditional logistic regression with age as underlying time axis. RESULTS Total PSA and free-to-total PSA ratio at baseline were strongly associated with prostate cancer risk up to 14 years later. PSA was grouped in quintiles and free-to-total PSA ratio divided in three risk groups. The incidence rate ratio for prostate cancer was 150 (95% confidence interval, 72-310) among men with a total PSA in the highest quintile (> 5.1 ng/ml) compared to the lowest (< 0.80 ng/ml). The risk of aggressive cancer was highly elevated in men with a PSA level in the highest quintile. The results indicate that one-time measurement of PSA could be used in an individualised screening strategy, sparing a large proportion of men from further PSA-based screening.
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Affiliation(s)
- Signe Benzon Larsen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark.
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Vickers AJ, Ulmert D, Sjoberg DD, Bennette CJ, Björk T, Gerdtsson A, Manjer J, Nilsson PM, Dahlin A, Bjartell A, Scardino PT, Lilja H. Strategy for detection of prostate cancer based on relation between prostate specific antigen at age 40-55 and long term risk of metastasis: case-control study. BMJ 2013; 346:f2023. [PMID: 23596126 PMCID: PMC3933251 DOI: 10.1136/bmj.f2023] [Citation(s) in RCA: 179] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To determine the association between concentration of prostate specific antigen (PSA) at age 40-55 and subsequent risk of prostate cancer metastasis and mortality in an unscreened population to evaluate when to start screening for prostate cancer and whether rescreening could be risk stratified. DESIGN Case-control study with 1:3 matching nested within a highly representative population based cohort study. SETTING Malmö Preventive Project, Sweden. PARTICIPANTS 21,277 Swedish men aged 27-52 (74% of the eligible population) who provided blood at baseline in 1974-84, and 4922 men invited to provide a second sample six years later. Rates of PSA testing remained extremely low during median follow-up of 27 years. MAIN OUTCOME MEASURES Metastasis or death from prostate cancer ascertained by review of case notes. RESULTS Risk of death from prostate cancer was associated with baseline PSA: 44% (95% confidence interval 34% to 53%) of deaths occurred in men with a PSA concentration in the highest 10th of the distribution of concentrations at age 45-49 (≥ 1.6 µg/L), with a similar proportion for the highest 10th at age 51-55 (≥ 2.4 µg/L: 44%, 32% to 56%). Although a 25-30 year risk of prostate cancer metastasis could not be ruled out by concentrations below the median at age 45-49 (0.68 µg/L) or 51-55 (0.85 µg/L), the 15 year risk remained low at 0.09% (0.03% to 0.23%) at age 45-49 and 0.28% (0.11% to 0.66%) at age 51-55, suggesting that longer intervals between screening would be appropriate in this group. CONCLUSION Measurement of PSA concentration in early midlife can identify a small group of men at increased risk of prostate cancer metastasis several decades later. Careful surveillance is warranted in these men. Given existing data on the risk of death by PSA concentration at age 60, these results suggest that three lifetime PSA tests (mid to late 40s, early 50s, and 60) are probably sufficient for at least half of men.
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Affiliation(s)
- Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
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Carlsson SV, Peltola MT, Sjoberg D, Schröder FH, Hugosson J, Pettersson K, Scardino PT, Vickers AJ, Lilja H, Roobol MJ. Can one blood draw replace transrectal ultrasonography-estimated prostate volume to predict prostate cancer risk? BJU Int 2013; 112:602-9. [PMID: 23448270 DOI: 10.1111/j.1464-410x.2012.11690.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore whether a panel of kallikrein markers in blood: total, free and intact prostate-specific antigen (PSA) and kallikrein-related peptidase 2, could be used as a non-invasive alternative for predicting prostate cancer on biopsy in a screening setting. SUBJECTS AND METHODS The study cohort comprised previously unscreened men who underwent sextant biopsy owing to elevated PSA (≥3 ng/mL) in two different centres of the European Randomized Study of Screening for Prostate Cancer, Rotterdam (n = 2914) and Göteborg (n = 740). A statistical model, based on kallikrein markers, was compared with one based on established clinical factors for the prediction of biopsy outcome. RESULTS The clinical tests were found to be no better than blood markers, with an area under the curve in favour of the blood measurements of 0.766 vs. 0.763 in Rotterdam and 0.809 vs. 0.774 in Göteborg. Adding digital rectal examination (DRE) or DRE plus transrectal ultrasonography (TRUS) volume to the markers improved discrimination, although the increases were small. Results were similar for predicting high-grade cancer. There was a strong correlation between the blood measurements and TRUS-estimated prostate volume (Spearman's correlation 0.60 in Rotterdam and 0.57 in Göteborg). CONCLUSIONS In previously unscreened men, each with indication for biopsy, a statistical model based on kallikrein levels was similar to a clinical model in predicting prostate cancer in a screening setting, outside the day-to-day clinical practice. Whether a clinical approach can be replaced by laboratory analyses or used in combination with decision models (nomograms) is a clinical judgment that may vary from clinician to clinician depending on how they weigh the different advantages and disadvantages (harms, costs, time, invasiveness) of both approaches.
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Affiliation(s)
- Sigrid V Carlsson
- Department of Surgery (Urology Service), Memorial Sloan-Kettering Cancer Center, New York, USA; Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg
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Matharoo-Ball B, Ratcliffe L, Lancashire L, Ugurel S, Miles AK, Weston DJ, Rees R, Schadendorf D, Ball G, Creaser CS. Diagnostic biomarkers differentiating metastatic melanoma patients from healthy controls identified by an integrated MALDI-TOF mass spectrometry/bioinformatic approach. Proteomics Clin Appl 2012; 1:605-20. [PMID: 21136712 DOI: 10.1002/prca.200700022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The prognosis of advanced metastatic melanoma (American Joint Committee on Cancer (AJCC) stage IV) remains dismal with a 5-year survival rate of 6-18%. In the present study, an integrated MALDI mass spectrometric approach combined with artificial neural networks (ANNs) analysis and modeling has been used for the identification of biomarker ions in serum from stage IV melanoma patients allowing the discrimination of metastatic disease from healthy status with high specificities of 92% for protein ions and 100% for peptide biomarkers. Our ANNs model also correctly classified 98% of a blind validation set of AJCC stage I melanoma samples as nonstage IV samples, emphasizing the power of the newly defined biomarkers to identify patients with late-stage metastatic melanoma. Sequence analysis identified peptides derived from metastasis-associated proteins; alpha 1-acid glycoprotein precursor-1/2 (AAG-1/2) and complement C3 component precursor-1 (CCCP-1). Furthermore, quantitation of serum AAG by an immunoassay showed a significant (p<0.001) increase in AAG serum concentration in stage IV patients in comparison with healthy volunteers; moreover; the quantity of AAG plotted against MALDI-MS peak intensity classified the groups into two distinct clusters. Ongoing studies of other disease stages will provide evidence whether our strategy is sufficiently robust to give rise to stage-specific protein/peptide signatures in melanoma.
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Affiliation(s)
- Balwir Matharoo-Ball
- Interdisciplinary Biomedical Research Centre, School of Biomedical and Natural Sciences, Nottingham Trent University, Clifton Lane, Nottingham, UK
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Vickers AJ, Lilja H. Predicting prostate cancer many years before diagnosis: how and why? World J Urol 2011; 30:131-5. [PMID: 22101902 DOI: 10.1007/s00345-011-0795-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 11/01/2011] [Indexed: 11/26/2022] Open
Abstract
Evidence of reduced prostate cancer mortality from randomized trials in Europe supports early detection of prostate cancer with prostate-specific antigen (PSA). Yet PSA screening has generated considerable controversy: it is far from clear that the benefits outweigh risks, in terms of overdiagnosis and overtreatment. One way to shift the ratio of benefits to harm is to focus on men at highest risk, who have more to benefit than average. Neither family history nor any of the currently identified genomic markers offer sufficient risk stratification for practical use. However, there is considerable evidence that the levels of PSA in blood are strongly prognostic of the long-term risk of aggressive prostate cancer. Specifically, it is difficult to justify continuing to screen men aged 60 or older if they have a PSA less than 1 or 2 ng/ml; for men 45-60, intervals between PSA tests can be based on PSA levels, with 2-4-year retesting interval for men with PSA of 1 ng/ml or higher, and tests every 6-8 years for men with PSA <1 ng/ml. Men with the top 10% of PSAs at a young age (PSA ~1.5 ng/ml or higher below 50) are at particularly high risk and should be subject to intensive monitoring.
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Affiliation(s)
- Andrew J Vickers
- Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
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26
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Sutcliffe S, Nevin RL, Pakpahan R, Elliott DJ, Cole SR, De Marzo AM, Gaydos CA, Isaacs WB, Nelson WG, Sokoll LJ, Zenilman JM, Cersovsky SB, Platz EA. Prostate involvement during sexually transmitted infections as measured by prostate-specific antigen concentration. Br J Cancer 2011; 105:602-5. [PMID: 21792196 PMCID: PMC3188942 DOI: 10.1038/bjc.2011.271] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: We investigated prostate involvement during sexually transmitted infections by measuring serum prostate-specific antigen (PSA) as a marker of prostate infection, inflammation, and/or cell damage in young, male US military members. Methods: We measured PSA before and during infection for 299 chlamydia, 112 gonorrhoea, and 59 non-chlamydial, non-gonococcal urethritis (NCNGU) cases, and 256 controls. Results: Chlamydia and gonorrhoea, but not NCNGU, cases were more likely to have a large rise (⩾40%) in PSA than controls (33.6%, 19.1%, and 8.2% vs 8.8%, P<0.0001, 0.021, and 0.92, respectively). Conclusion: Chlamydia and gonorrhoea may infect the prostate of some infected men.
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Affiliation(s)
- S Sutcliffe
- Division of Public Health Sciences and the Alvin J. Siteman Cancer Center, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Box 8100, Room 5026, St Louis, MO 63110, USA.
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Peltola MT, Niemelä P, Alanen K, Nurmi M, Lilja H, Pettersson K. Immunoassay for the discrimination of free prostate-specific antigen (fPSA) forms with internal cleavages at Lys(₁₄₅) or Lys(₁₄₆) from fPSA without internal cleavages at Lys(₁₄₅) or Lys(₁₄₆). J Immunol Methods 2011; 369:74-80. [PMID: 21554885 DOI: 10.1016/j.jim.2011.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 04/12/2011] [Accepted: 04/19/2011] [Indexed: 11/26/2022]
Abstract
Total levels of circulating prostate-specific antigen (tPSA) are strongly associated with prostate cancer (PCa) risk and outcome but benign prostate disease is the most frequent cause of a moderately elevated PSA level. Free PSA (fPSA) forms are independently associated with PCa risk and contribute modest diagnostic enhancements above and beyond tPSA alone. We developed an immunoassay for fPSA subfractions containing internal cleavages at Lys(145) or Lys(146) (fPSA-N). The assay was based on blocking intact single-chain fPSA (fPSA-I) with antibody 4D4 which does not detect PSA containing internal cleavages at Lys(145) or Lys(146). We also measured fPSA-N in blood from healthy volunteers and in anti-coagulated plasma from 76 men with or without evidence of PCa at biopsy. The analytical and functional detection limits of this assay were 0.016 ng/mL and 0.10 ng/mL, respectively. The median recovery of male fPSA-N from female plasma was 95.0%. All 12 female samples (average age 28 years) had fPSA-N concentrations at or below the analytical detection limit. The median fPSA-N concentration (0.050 ng/mL) in 9 healthy male volunteers (age<40 years) was below the functional detection limit, 0.420 ng/mL in 27 patients with benign prostate conditions and 0.239 ng/mL in 49 patients with PCa. Deming regression analysis of the patient samples showed that the measured fPSA-N concentrations were generally 23% lower than the previously calculated (fPSA minus fPSA-I) concentrations, likely due to differences in the antibody combinations used. In conclusion, we have developed a sensitive, specific and direct immunoassay for fPSA-N which can be used to study the clinical relevance of this PSA isoform.
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Affiliation(s)
- Mari T Peltola
- Department of Biotechnology, University of Turku, Tykistökatu 6 A 6th floor, FIN-20520 Turku, Finland.
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Gupta A, Lilja H. Editorial comment. Urology 2011; 77:903-4; author reply 904. [PMID: 21477718 DOI: 10.1016/j.urology.2010.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 08/11/2010] [Accepted: 08/21/2010] [Indexed: 10/18/2022]
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Vickers AJ, Gupta A, Savage CJ, Pettersson K, Dahlin A, Bjartell A, Manjer J, Scardino PT, Ulmert D, Lilja H. A panel of kallikrein marker predicts prostate cancer in a large, population-based cohort followed for 15 years without screening. Cancer Epidemiol Biomarkers Prev 2010; 20:255-61. [PMID: 21148123 DOI: 10.1158/1055-9965.epi-10-1003] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Prostate-specific antigen (PSA) has modest specificity for prostate cancer. A panel of four kallikrein markers (total PSA, free PSA, intact PSA, and kallikrein-related peptidase 2) is a highly accurate predictor of biopsy outcome. The clinical significance of biopsy-detectable cancers in men classified as low-risk by this panel remains unclear. METHODS The Malmö Diet and Cancer study is a population-based cohort of 11,063 Swedish men aged 45 to 73 providing a blood sample at baseline during 1991-1996. The Swedish Cancer Registry was used to identify 943 men diagnosed with prostate cancer by December 31, 2006. PSA testing was low. We assessed the predictive accuracy of our published statistical model to predict subsequent prostate cancer diagnosis in men with a total PSA level of 3.0 ng/mL or more at baseline. RESULTS Compared with total PSA and age, the full kallikrein panel enhanced the predictive accuracy for clinically diagnosed prostate cancer (concordance index 0.65 vs. 0.75; P < 0.001). For every 1,000 men with a total PSA level of 3 ng/mL or more at baseline, the model would classify as high-risk 131 of 152 (86%) of the cancer cases diagnosed clinically within 5 years; 421 men would be classified as low-risk by the panel and recommended against biopsy. Of these, only 2 would be diagnosed with advanced prostate cancer (clinical T3-T4 or metastases) within 5 years. CONCLUSIONS Men with a PSA level of 3 ng/mL or more but defined as low-risk by the panel of four kallikrein markers are unlikely to develop incurable prostate cancer. IMPACT Use of the panel to determine referral to biopsy could substantially reduce the number of unnecessary prostate biopsies.
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Affiliation(s)
- Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Delobel J, Rubin O, Prudent M, Crettaz D, Tissot JD, Lion N. Biomarker analysis of stored blood products: emphasis on pre-analytical issues. Int J Mol Sci 2010; 11:4601-17. [PMID: 21151459 PMCID: PMC3000103 DOI: 10.3390/ijms11114601] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 11/10/2010] [Accepted: 11/14/2010] [Indexed: 12/28/2022] Open
Abstract
Millions of blood products are transfused every year; many lives are thus directly concerned by transfusion. The three main labile blood products used in transfusion are erythrocyte concentrates, platelet concentrates and fresh frozen plasma. Each of these products has to be stored according to its particular components. However, during storage, modifications or degradation of those components may occur, and are known as storage lesions. Thus, biomarker discovery of in vivo blood aging as well as in vitro labile blood products storage lesions is of high interest for the transfusion medicine community. Pre-analytical issues are of major importance in analyzing the various blood products during storage conditions as well as according to various protocols that are currently used in blood banks for their preparations. This paper will review key elements that have to be taken into account in the context of proteomic-based biomarker discovery applied to blood banking.
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Affiliation(s)
- Julien Delobel
- Service Régional Vaudois de Transfusion Sanguine, route de la Corniche 2, CH-1066 Epalinges, Switzerland; E-Mails: (J.D.); (O.R.); (M.P.); (D.C.); (N.L.)
- Faculté de Biologie et Médecine, Université de Lausanne, rue du Bugnon 21, CH-1011 Lausanne, Switzerland
| | - Olivier Rubin
- Service Régional Vaudois de Transfusion Sanguine, route de la Corniche 2, CH-1066 Epalinges, Switzerland; E-Mails: (J.D.); (O.R.); (M.P.); (D.C.); (N.L.)
- Faculté de Biologie et Médecine, Université de Lausanne, rue du Bugnon 21, CH-1011 Lausanne, Switzerland
| | - Michel Prudent
- Service Régional Vaudois de Transfusion Sanguine, route de la Corniche 2, CH-1066 Epalinges, Switzerland; E-Mails: (J.D.); (O.R.); (M.P.); (D.C.); (N.L.)
| | - David Crettaz
- Service Régional Vaudois de Transfusion Sanguine, route de la Corniche 2, CH-1066 Epalinges, Switzerland; E-Mails: (J.D.); (O.R.); (M.P.); (D.C.); (N.L.)
| | - Jean-Daniel Tissot
- Service Régional Vaudois de Transfusion Sanguine, route de la Corniche 2, CH-1066 Epalinges, Switzerland; E-Mails: (J.D.); (O.R.); (M.P.); (D.C.); (N.L.)
| | - Niels Lion
- Service Régional Vaudois de Transfusion Sanguine, route de la Corniche 2, CH-1066 Epalinges, Switzerland; E-Mails: (J.D.); (O.R.); (M.P.); (D.C.); (N.L.)
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Lilja H, Cronin AM, Dahlin A, Manjer J, Nilsson PM, Eastham JA, Bjartell AS, Scardino PT, Ulmert D, Vickers AJ. Prediction of significant prostate cancer diagnosed 20 to 30 years later with a single measure of prostate-specific antigen at or before age 50. Cancer 2010; 117:1210-9. [PMID: 20960520 DOI: 10.1002/cncr.25568] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 04/09/2010] [Accepted: 04/12/2010] [Indexed: 11/11/2022]
Abstract
BACKGROUND We previously reported that a single prostate-specific antigen (PSA) measured at ages 44-50 was highly predictive of subsequent prostate cancer diagnosis in an unscreened population. Here we report an additional 7 years of follow-up. This provides replication using an independent data set and allows estimates of the association between early PSA and subsequent advanced cancer (clinical stage ≥T3 or metastases at diagnosis). METHODS Blood was collected from 21,277 men in a Swedish city (74% participation rate) during 1974-1986 at ages 33-50. Through 2006, prostate cancer was diagnosed in 1408 participants; we measured PSA in archived plasma for 1312 of these cases (93%) and for 3728 controls. RESULTS At a median follow-up of 23 years, baseline PSA was strongly associated with subsequent prostate cancer (area under the curve, 0.72; 95% CI, 0.70-0.74; for advanced cancer, 0.75; 95% CI, 0.72-0.78). Associations between PSA and prostate cancer were virtually identical for the initial and replication data sets, with 81% of advanced cases (95% CI, 77%-86%) found in men with PSA above the median (0.63 ng/mL at ages 44-50). CONCLUSIONS A single PSA at or before age 50 predicts advanced prostate cancer diagnosed up to 30 years later. Use of early PSA to stratify risk would allow a large group of low-risk men to be screened less often but increase frequency of testing on a more limited number of high-risk men. This is likely to improve the ratio of benefit to harm for screening.
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Affiliation(s)
- Hans Lilja
- Department of Clinical Laboratories, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
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Christensson A, Bruun L, Björk T, Cronin AM, Vickers AJ, Savage CJ, Lilja H. Intra-individual short-term variability of prostate-specific antigen and other kallikrein markers in a serial collection of blood from men under evaluation for prostate cancer. BJU Int 2010; 107:1769-74. [PMID: 20955263 DOI: 10.1111/j.1464-410x.2010.09761.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
STUDY TYPE Diagnostic (exploratory cohort). LEVEL OF EVIDENCE 2b. OBJECTIVE To assess variation of total prostate-specific antigen (tPSA), free PSA (fPSA), percent fPSA, human glandular kallikrein 2 (hK2) and intact PSA measured three times within 2 weeks. Knowledge of the variation in an individual's PSA level is important for clinical decision-making. PATIENTS AND METHODS Study participants were 149 patients referred for prostate biopsy, of which 97 had benign disease and 52 had prostate cancer. Three blood samples were drawn with a median of 4 h between first and second samples and 12 days between first and third samples. Variability was described by absolute differences, ratios and intra-individual coefficients of variation. Total PSA, fPSA, hK2 and intact PSA were measured in anticoagulated blood plasma. RESULTS At baseline, the median tPSA was 6.8 (interquartile range, 4.5-9.6) ng/mL. The intra-individual variation was low for all biomarkers, and lowest for tPSA. For 80% of participants, the ratio between first and second time points for tPSA was in the range 0.91-1.09 and the ratio for percent fPSA was in the range 0.89-1.15. Total coefficients of variation between time 1 and 2 for tPSA, fPSA, percent fPSA, hK2 and intact PSA were 4.0%, 6.6%, 6.0%, 9.2% and 9.5%, respectively. The measurements taken several days apart varied more than those taken on the same day, although the variation between both time points was not large. CONCLUSIONS The intra-individual variation for all the kallikrein-like markers studied was relatively small, especially for samples drawn the same day. Few cases are reclassified between the time points. This indicates the high short-term biological and technical reproducibility of the tests in clinical use.
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Affiliation(s)
- Anders Christensson
- Division of Nephrology, Department of Clinical Sciences, Lund University, University Hospital, Malmö, Sweden.
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Vickers AJ, Cronin AM, Björk T, Manjer J, Nilsson PM, Dahlin A, Bjartell A, Scardino PT, Ulmert D, Lilja H. Prostate specific antigen concentration at age 60 and death or metastasis from prostate cancer: case-control study. BMJ 2010; 341:c4521. [PMID: 20843935 PMCID: PMC2939950 DOI: 10.1136/bmj.c4521] [Citation(s) in RCA: 157] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To determine the relation between concentrations of prostate specific antigen at age 60 and subsequent diagnosis of clinically relevant prostate cancer in an unscreened population to evaluate whether screening for prostate cancer and chemoprevention could be stratified by risk. DESIGN Case-control study with 1:3 matching nested within a highly representative population based cohort study. SETTING General population of Sweden taking part in the Malmo Preventive Project. Cancer registry at the National Board of Health and Welfare. PARTICIPANTS 1167 men aged 60 who provided blood samples in 1981 and were followed up to age 85. MAIN OUTCOME MEASURES Metastasis or death from prostate cancer. RESULTS The rate of screening during the course of the study was low. There were 43 cases of metastasis and 35 deaths from prostate cancer. Concentration of prostate specific antigen at age 60 was associated with prostate cancer metastasis (area under the curve 0.86, 95% confidence interval 0.79 to 0.92; P<0.001) and death from prostate cancer (0.90, 0.84 to 0.96; P<0.001). The greater the number for the area under the curve (values from 0 to 1) the better the test. Although only a minority of the men with concentrations in the top quarter (>2 ng/ml) develop fatal prostate cancer, 90% (78% to 100%) of deaths from prostate cancer occurred in these men. Conversely, men aged 60 with concentrations at the median or lower (≤1 ng/ml) were unlikely to have clinically relevant prostate cancer (0.5% risk of metastasis by age 85 and 0.2% risk of death from prostate cancer). CONCLUSIONS The concentration of prostate specific antigen at age 60 predicts lifetime risk of metastasis and death from prostate cancer. Though men aged 60 with concentrations below the median (≤1 ng/ml) might harbour prostate cancer, it is unlikely to become life threatening. Such men could be exempted from further screening, which should instead focus on men with higher concentrations.
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Affiliation(s)
- Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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Vickers AJ, Cronin AM, Roobol MJ, Savage CJ, Peltola M, Pettersson K, Scardino PT, Schröder FH, Lilja H. A four-kallikrein panel predicts prostate cancer in men with recent screening: data from the European Randomized Study of Screening for Prostate Cancer, Rotterdam. Clin Cancer Res 2010; 16:3232-9. [PMID: 20400522 DOI: 10.1158/1078-0432.ccr-10-0122] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE We have developed a statistical prediction model for prostate cancer based on four kallikrein markers in blood: total, free, and intact prostate-specific antigen (PSA), and kallikrein-related peptidase 2 (hK2). Although this model accurately predicts the result of biopsy in unscreened men, its properties for men with a history of PSA screening have not been fully characterized. EXPERIMENTAL DESIGN A total of 1,501 previously screened men with elevated PSA underwent initial biopsy during rounds 2 and 3 of the European Randomized Study of Screening for Prostate Cancer, Rotterdam, with 388 cancers diagnosed. Biomarker levels were measured in serum samples taken before biopsy. The prediction model developed on the unscreened cohort was then applied and predictions compared with biopsy outcome. RESULTS The previously developed four-kallikrein prediction model had much higher predictive accuracy than PSA and age alone (area under the curve of 0.711 versus 0.585, and 0.713 versus 0.557 with and without digital rectal exam, respectively; both P < 0.001). Similar statistically significant enhancements were seen for high-grade cancer. Applying the model with a cutoff of 20% cancer risk as the criterion for biopsy would reduce the biopsy rate by 362 for every 1,000 men with elevated PSA. Although diagnosis would be delayed for 47 cancers, these would be predominately low-stage and low-grade (83% Gleason 6 T(1c)). CONCLUSIONS A panel of four kallikreins can help predict the result of initial biopsy in previously screened men with elevated PSA. Use of a statistical model based on the panel would substantially decrease rates of unnecessary biopsy.
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Affiliation(s)
- Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Vickers AJ, Wolters T, Savage CJ, Cronin AM, O'Brien MF, Pettersson K, Roobol MJ, Aus G, Scardino PT, Hugosson J, Schröder FH, Lilja H. Prostate-specific antigen velocity for early detection of prostate cancer: result from a large, representative, population-based cohort. Eur Urol 2009; 56:753-60. [PMID: 19682790 DOI: 10.1016/j.eururo.2009.07.047] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Accepted: 07/30/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND It has been suggested that changes in prostate-specific antigen (PSA) over time (ie, PSA velocity [PSAV]) aid prostate cancer detection. Some guidelines do incorporate PSAV cut points as an indication for biopsy. OBJECTIVE To evaluate whether PSAV enhances prediction of biopsy outcome in a large, representative, population-based cohort. DESIGN, SETTING, AND PARTICIPANTS There were 2742 screening-arm participants with PSA <3 ng/ml at initial screening in the European Randomized Study of Screening for Prostate Cancer in Rotterdam, Netherlands, or Göteborg, Sweden, and who were subsequently biopsied during rounds 2-6 due to elevated PSA. MEASUREMENTS Total, free, and intact PSA and human kallikrein 2 were measured for 1-6 screening rounds at intervals of 2 or 4 yr. We created logistic regression models to predict prostate cancer based on age and PSA, with or without free-to-total PSA ratio (%fPSA). PSAV was added to each model and any enhancement in predictive accuracy assessed by area under the curve (AUC). RESULTS AND LIMITATIONS PSAV led to small enhancements in predictive accuracy (AUC of 0.569 vs 0.531; 0.626 vs 0.609 if %fPSA was included), although not for high-grade disease. The enhancement depended on modeling a nonlinear relationship between PSAV and cancer. There was no benefit if we excluded men with higher velocities, which were associated with lower risk. These results apply to men in a screening program with elevated PSA; men with prior negative biopsy were not evaluated in this study. CONCLUSIONS In men with PSA of about ≥3 ng/ml, we found little justification for formal calculation of PSAV or for use of PSAV cut points to determine biopsy. Informal assessment of PSAV will likely aid clinical judgment, such as a sudden rise in PSA suggesting prostatitis, which could be further evaluated before biopsy.
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Affiliation(s)
- Andrew J Vickers
- Memorial Sloan-Kettering Cancer Center, Department of Epidemiology and Biostatistics, 307 E. 63rd St., New York, NY 10021, USA.
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Zhu L, Koistinen H, Landegren U, Stenman UH. Proximity ligation measurement of the complex between prostate specific antigen and alpha1-protease inhibitor. Clin Chem 2009; 55:1665-71. [PMID: 19643837 DOI: 10.1373/clinchem.2009.127779] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Prostate specific antigen (PSA)-alpha1-protease inhibitor complex (PSA-API) is a minor form of PSA in serum. It may be useful for prostate cancer (PCa) diagnosis, but its specific detection is hampered by nonspecific background. To avoid this, we developed an immunoassay for PSA-API based on proximity ligation. METHODS We used a monoclonal antibody (mAb) to total PSA (tPSA) to capture PSA, while using another anti-tPSA mAb together with an anti-API mAb as probes. We measured PSA-API by quantification of amplified DNA strands conjugated to the probes. We measured serum PSA-API in 84 controls and 55 men with PCa who had PSA concentrations of 4.0-10 microg/L. RESULTS The detection limit of the assay was 6.6 ng/L. The proportion of PSA-API to tPSA (%PSA-API) tended to be lower in men with PCa (2.8%) than without cancer (3.3%) but was not statistically significant (P = 0.363). When used alone, %PSA-API [area under the curve (AUC) 0.546] did not improve detection of PCa, whereas %fPSA (AUC 0.710) and the sum of %fPSA and %PSA-API (AUC 0.723) did. At 90% diagnostic sensitivity, the diagnostic specificity for cancer was not significantly better for %f PSA + %PSA-API than for %fPSA alone (36% vs 30%). CONCLUSIONS Proximity ligation eliminated nonspecific background, enabling accurate measurement of PSA-API in serum specimens with moderately increased tPSA. The combined use of %PSA-API and %fPSA provided a modest improvement for PCa detection, but based on the current study cohort, it is uncertain whether the improvement has clinical utility. .
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Affiliation(s)
- Lei Zhu
- Department of Clinical Chemistry, Biomedicum Helsinki, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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Early prostate-specific antigen changes and the diagnosis and prognosis of prostate cancer. Curr Opin Urol 2009; 19:221-6. [PMID: 19318948 DOI: 10.1097/mou.0b013e32832a2d10] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To delineate how recent findings on prostate-specific antigen (PSA) can improve prediction of risk, detection, and prediction of clinical endpoints of prostate cancer (PCa). RECENT FINDINGS The widely used PSA cut-point of 4.0 ng/ml increasingly appears arbitrary, but no cut-point achieves both high sensitivity and high specificity. The accuracy of detecting PCa can be increased by additional predictive factors and a combinations of markers. Evidence implies that a panel of kallikrein markers improves the specificity and reduces costs by eliminating unnecessary biopsies. Large, population-based studies have provided evidence that PSA can be used to predict PCa risk many years in advance, improve treatment selection and patient care, and predict the risk of complications and disease recurrence. However, definitive evidence is currently lacking as to whether PSA screening lowers PCa -specific mortality. SUMMARY PSA is still the main tool for early detection, risk stratification, and monitoring of PCa. However, PSA values are affected by many technical and biological factors. Instead of using a fixed PSA cut-point, using statistical prediction models and considering the integration additional markers may be able to improve and individualize PCa diagnostics. A single PSA measurement at early middle age can predict risk of advanced PCa decades in advance and stratify patients for intensity of subsequent screening.
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EL Ezzi AA, EL-Saidi MA. Stability of total and free prostate specific antigen in serum submitted to intermittent cold storage conditions. Indian J Clin Biochem 2009; 24:166-74. [DOI: 10.1007/s12291-009-0030-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Wenske S, Korets R, Cronin AM, Vickers AJ, Fleisher M, Scher HI, Pettersson K, Guillonneau B, Scardino PT, Eastham JA, Lilja H. Evaluation of molecular forms of prostate-specific antigen and human kallikrein 2 in predicting biochemical failure after radical prostatectomy. Int J Cancer 2008; 124:659-63. [PMID: 19003994 DOI: 10.1002/ijc.23983] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Most pretreatment risk-assessment models to predict biochemical recurrence (BCR) after radical prostatectomy (RP) for prostate cancer rely on total prostate-specific antigen (PSA), clinical stage, and biopsy Gleason grade. We investigated whether free PSA (fPSA) and human glandular kallikrein-2 (hK2) would enhance the predictive accuracy of this standard model. Preoperative serum samples and complete clinical data were available for 1,356 patients who underwent RP for localized prostate cancer from 1993 to 2005. A case-control design was used, and conditional logistic regression models were used to evaluate the association between preoperative predictors and BCR after RP. We constructed multivariable models with fPSA and hK2 as additional preoperative predictors to the base model. Predictive accuracy was assessed with the area under the ROC curve (AUC). There were 146 BCR cases; the median follow up for patients without BCR was 3.2 years. Overall, 436 controls were matched to 146 BCR cases. The AUC of the base model was 0.786 in the entire cohort; adding fPSA and hK2 to this model enhanced the AUC to 0.798 (p=0.053), an effect largely driven by fPSA. In the subgroup of men with total PSA<or=10 ng/ml (48% of cases), adding fPSA and hK2 enhanced the AUC of the base model to a similar degree (from 0.720 to 0.726, p=0.2). fPSA is routinely measured during prostate cancer detection. We suggest that the role of fPSA in aiding preoperative prediction should be investigated in further cohorts.
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Affiliation(s)
- Sven Wenske
- Department of Surgery (Urology Service), Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Bruun L, Savage C, Cronin AM, Hugosson J, Lilja H, Christensson A. Increase in percent free prostate-specific antigen in men with chronic kidney disease. Nephrol Dial Transplant 2008; 24:1238-41. [PMID: 19028756 DOI: 10.1093/ndt/gfn632] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Prostate-specific antigen (PSA) occurs in different molecular forms in serum: free PSA (fPSA) and complexed PSA (cPSA), the sum of which corresponds to total PSA (tPSA). In addition to tPSA, percent fPSA is widely used in the detection of prostate cancer. Free PSA, approximately 28 kDa, is eliminated by glomerular filtration. Previous data showed that men with end-stage renal dysfunction requiring chronic dialysis have increased percent fPSA. In this study, we evaluated whether moderate-to-severe chronic renal dysfunction, but with no need for dialysis, also importantly affects percent fPSA. METHODS The study group consisted of 101 men (median age 57 years, interquartile range 46-68) with chronic kidney disease and no diagnosis of prostate cancer. Their median glomerular filtration rate (GFR) was 23 mL/min/1.73 m(2) (interquartile range 16-33; range 8-83), determined by iohexol clearance. Controls included 5264 men (median age 57 years, interquartile range 54-62) attending a prostate cancer screening program with no diagnosis of prostate cancer during 8 years of follow-up. RESULTS With adjustment for age, median fPSA levels and percent fPSA were significantly higher (P < 0.001) in patients with renal dysfunction, 0.45 microg/L and 47.2%, respectively, compared to controls, 0.29 microg/L and 29.9%, respectively. Regression analysis in the study group showed a significant association between GFR and percent fPSA (P = 0.036). CONCLUSIONS The percent fPSA is importantly influenced by moderately impaired renal function in men with chronic kidney disease. For such men, use of the current clinical decision limits for percent fPSA could cause some men with prostate cancer to be misdiagnosed as having benign disease, and therefore fPSA should not be used to diagnose prostate cancer in these patients.
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Affiliation(s)
- Laila Bruun
- Department of Nephrology and Transplantation, University Hospital, UMAS, SE-205 02 Malmö, Sweden
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Reed AB, Ankerst DP, Leach RJ, Vipraio G, Thompson IM, Parekh DJ. Total Prostate Specific Antigen Stability Confirmed After Long-Term Storage of Serum at −80C. J Urol 2008; 180:534-7; discussion 537-8. [DOI: 10.1016/j.juro.2008.04.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Amanda Beth Reed
- Department of Urology, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas
| | - Donna Pauler Ankerst
- Department of Urology, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas
| | - Robin J. Leach
- Department of Urology, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas
| | - Gilbert Vipraio
- Department of Urology, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas
| | - Ian M. Thompson
- Department of Urology, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas
| | - Dipen J. Parekh
- Department of Urology, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas
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Vickers AJ, Cronin AM, Aus G, Pihl CG, Becker C, Pettersson K, Scardino PT, Hugosson J, Lilja H. A panel of kallikrein markers can reduce unnecessary biopsy for prostate cancer: data from the European Randomized Study of Prostate Cancer Screening in Göteborg, Sweden. BMC Med 2008; 6:19. [PMID: 18611265 PMCID: PMC2474851 DOI: 10.1186/1741-7015-6-19] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 07/08/2008] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Prostate-specific antigen (PSA) is widely used to detect prostate cancer. The low positive predictive value of elevated PSA results in large numbers of unnecessary prostate biopsies. We set out to determine whether a multivariable model including four kallikrein forms (total, free, and intact PSA, and human kallikrein 2 (hK2)) could predict prostate biopsy outcome in previously unscreened men with elevated total PSA. METHODS The study cohort comprised 740 men in Göteborg, Sweden, undergoing biopsy during the first round of the European Randomized study of Screening for Prostate Cancer. We calculated the area-under-the-curve (AUC) for predicting prostate cancer at biopsy. AUCs for a model including age and PSA (the 'laboratory' model) and age, PSA and digital rectal exam (the 'clinical' model) were compared with those for models that also included additional kallikreins. RESULTS Addition of free and intact PSA and hK2 improved AUC from 0.68 to 0.83 and from 0.72 to 0.84, for the laboratory and clinical models respectively. Using a 20% risk of prostate cancer as the threshold for biopsy would have reduced the number of biopsies by 424 (57%) and missed only 31 out of 152 low-grade and 3 out of 40 high-grade cancers. CONCLUSION Multiple kallikrein forms measured in blood can predict the result of biopsy in previously unscreened men with elevated PSA. A multivariable model can determine which men should be advised to undergo biopsy and which might be advised to continue screening, but defer biopsy until there was stronger evidence of malignancy.
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Affiliation(s)
- Andrew J Vickers
- Memorial Sloan-Kettering Cancer Center, Department of Epidemiology and Biostatistics, East 63rd Street, New York, NY 10021, USA.
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Ferguson RE, Banks RE. Preanalytical Issues in Clinical Proteomic Studies. Clin Proteomics 2008. [DOI: 10.1002/9783527622153.ch1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Lilja H, Ulmert D, Vickers AJ. Prostate-specific antigen and prostate cancer: prediction, detection and monitoring. Nat Rev Cancer 2008; 8:268-78. [PMID: 18337732 DOI: 10.1038/nrc2351] [Citation(s) in RCA: 583] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Testing for prostate-specific antigen (PSA) has profoundly affected the diagnosis and treatment of prostate cancer. PSA testing has enabled physicians to detect prostate tumours while they are still small, low-grade and localized. This very ability has, however, created controversy over whether we are now diagnosing and treating insignificant cancers. PSA testing has also transformed the monitoring of treatment response and detection of disease recurrence. Much current research is directed at establishing the most appropriate uses of PSA testing and at developing methods to improve on the conventional PSA test.
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Affiliation(s)
- Hans Lilja
- Department of Surgery (Urology), Memorial Sloan-Kettering Cancer Center New York, New York 10065, USA.
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45
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Ulmert D, Serio AM, O'Brien MF, Becker C, Eastham JA, Scardino PT, Björk T, Berglund G, Vickers AJ, Lilja H. Long-term prediction of prostate cancer: prostate-specific antigen (PSA) velocity is predictive but does not improve the predictive accuracy of a single PSA measurement 15 years or more before cancer diagnosis in a large, representative, unscreened population. J Clin Oncol 2008; 26:835-41. [PMID: 18281654 DOI: 10.1200/jco.2007.13.1490] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We tested whether total prostate-specific antigen velocity (tPSAv) improves accuracy of a model using PSA level to predict long-term risk of prostate cancer diagnosis. METHODS During 1974 to 1986 in a preventive medicine study in Sweden, 5,722 men aged <or= 50 gave two blood samples about 6 years apart. We measured free (fPSA) and total PSA (tPSA) in archived plasma samples from 4,907 participants. Prostate cancer was subsequently diagnosed in 443 (9%) men. Cox proportional hazards regression was used to evaluate tPSA and tPSAv as predictors of prostate cancer. Predictive accuracy was assessed by the concordance index. RESULTS The median time from second blood draw to cancer diagnosis was 16 years; median follow-up for men without prostate cancer was 21 years. In univariate models, tPSA level at second assessment and tPSAv between first and second assessments were associated with prostate cancer (both P < .001). tPSAv was highly correlated with tPSA level (r = 0.93). Twenty-year probabilities of cancer for men at 50th, 90th, and 95th percentile of tPSA and tPSAv were 10.6%, 17.1%, and 21.2% for tPSA, and 9.1%, 11.8%, and 14.1% for tPSAv, respectively. The concordance index for tPSA level was 0.771. Adding tPSAv, fPSA, %fPSA or velocities of fPSA and %fPSA did not importantly increase accuracy of tPSA to predict prostate cancer. Results were unchanged if the analysis was restricted to patients with advanced cancer at diagnosis. CONCLUSION Although PSA velocity is significantly increased in men with prostate cancer up to two decades before diagnosis, it does not aid long-term prediction of prostate cancer.
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Affiliation(s)
- David Ulmert
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Effect of thrombin tube on PSA determination, a clue for false negative in screening for prostate cancer. J Thromb Thrombolysis 2008; 27:223-6. [PMID: 18297239 DOI: 10.1007/s11239-008-0200-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 01/21/2008] [Indexed: 10/22/2022]
Abstract
Prostate cancer is an important male carcinoma. Laboratory screening for tumor marker is the routine preventive strategy for control of this cancer. For screening, prostate specific antigen (PSA) has been proposed as a marker in the serum. In this article, the author assesses the effect of new blood collection tube, thrombin tube, on the analysis of the PSA by bioinformatics technique. Using GoFigure server, the molecular functions of thrombin, PSA and thrombin-PSA were predicted. A significant change of molecular function due to the interaction between thrombin and PSA can be found. Increased of coagulation due to the synergistic clot activation can be expected. If this occurs, the false negative can be expected and it can bring the underdiagnosis of early prostate cancer. Therefore, the recommendation for usage of thrombin tube for PSA test should be modified from general usage. Shortening of the period between blood collection and sample analysis than general case must be done.
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Ulmert D, Cronin AM, Björk T, O'Brien MF, Scardino PT, Eastham JA, Becker C, Berglund G, Vickers AJ, Lilja H. Prostate-specific antigen at or before age 50 as a predictor of advanced prostate cancer diagnosed up to 25 years later: a case-control study. BMC Med 2008; 6:6. [PMID: 18279502 PMCID: PMC2275744 DOI: 10.1186/1741-7015-6-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Accepted: 02/15/2008] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Based on a large, representative unscreened cohort from Malmö, Sweden, we have recently reported that a single prostate-specific antigen (PSA) measurement at or before age 50 is a strong predictor of prostate cancer occurring up to 25 years subsequently. We aimed to determine whether this association holds for advanced cancers, defined as clinical stage T3 or higher, or skeletal metastasis at the time of the cancer diagnosis. METHODS In 1974-1986 blood samples were obtained from a cohort of 21,277 men aged up to 50. Through 1999, 498 men were diagnosed with prostate cancer, and of these 161 had locally advanced or metastatic prostate cancers. Three controls, matched for age and date of venipuncture, were selected for each case. Conditional logistic regression was used to test associations between molecular markers and advanced cancer. RESULTS Median time from venipuncture to diagnosis was 17 years. Levels of all PSA forms and hK2 were associated with case status. Total PSA was a strong and statistically significant predictor of subsequent advanced cancer (area under the curve 0.791; p < 0.0005). Two-thirds of the advanced cancer cases occurred in men with the top 20% of PSA levels (0.9 ng/ml or higher). CONCLUSION A single PSA test taken at or before age 50 is a very strong predictor of advanced prostate cancer diagnosed up to 25 years later. This suggests the possibility of using an early PSA test to risk-stratify patients so that men at highest risk are the focus of the most intensive screening efforts.
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Affiliation(s)
- David Ulmert
- Departments of Laboratory Medicine and Clinical Sciences in Malmö, Lund University, University Hospital UMAS, Malmö, Sweden.
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Banfi G, Salvagno GL, Lippi G. The role of ethylenediamine tetraacetic acid (EDTA) as in vitro anticoagulant for diagnostic purposes. Clin Chem Lab Med 2007; 45:565-76. [PMID: 17484616 DOI: 10.1515/cclm.2007.110] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Anticoagulants are used to prevent clot formation both in vitro and in vivo. In the specific field of in vitro diagnostics, anticoagulants are commonly added to collection tubes either to maintain blood in the fluid state for hematological testing or to obtain suitable plasma for coagulation and clinical chemistry analyses. Unfortunately, no universal anticoagulant that could be used for evaluation of several laboratory parameters in a sample from a single test tube is available so far. Ethylenediamine tetraacetic acid (EDTA) is a polyprotic acid containing four carboxylic acid groups and two amine groups with lone-pair electrons that chelate calcium and several other metal ions. Calcium is necessary for a wide range of enzyme reactions of the coagulation cascade and its removal irreversibly prevents blood clotting within the collection tube. Historically, EDTA has been recommended as the anticoagulant of choice for hematological testing because it allows the best preservation of cellular components and morphology of blood cells. The remarkable expansion in laboratory test volume and complexity over recent decades has amplified the potential spectrum of applications for this anticoagulant, which can be used to stabilize blood for a variety of traditional and innovative tests. Specific data on the behavior of EDTA as an anticoagulant in hematology, including possible pitfalls, are presented. The use of EDTA for measuring cytokines, protein and peptides, and cardiac markers is described, with an outline of the protection of labile molecules provided by this anticoagulant. The use of EDTA in proteomics and in general clinical chemistry is also described in comparison with other anticoagulants and with serum samples. Finally, the possible uses of alternative anticoagulants instead of EDTA and the potential use of a universal anticoagulant are illustrated.
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Affiliation(s)
- Giuseppe Banfi
- IRCCS Galeazzi and Chair of Clinical Biochemistry, School of Medicine, University of Milan, Milano, Italy.
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Ferguson RE, Hochstrasser DF, Banks RE. Impact of preanalytical variables on the analysis of biological fluids in proteomic studies. Proteomics Clin Appl 2007; 1:739-46. [DOI: 10.1002/prca.200700380] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Indexed: 11/09/2022]
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Sturgeon CM, Ellis AR. Improving the comparability of immunoassays for prostate-specific antigen (PSA): Progress and problems. Clin Chim Acta 2007; 381:85-92. [PMID: 17408608 DOI: 10.1016/j.cca.2007.02.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 02/13/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Commutability of immunoassay test results is an important objective for laboratory medicine. METHODS PSA is a clinically important analyte for which, as a consequence of a number of national and international initiatives over the last decade, considerable progress has been made towards improving method comparability. However, results from different assays are still not interchangeable, a situation that is only likely to improve once broad recommendations can be made about the most clinically relevant antibody combinations. CONCLUSIONS Universal implementation of such recommendations would almost certainly improve between-method agreement substantially, provided careful attention were paid to assay design and use of appropriately pure secondary standards ensured.
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Affiliation(s)
- Catharine M Sturgeon
- Department of Clinical Biochemistry, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom.
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