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Funari R, Chu KY, Shen AQ. Multiplexed Opto-Microfluidic Biosensing: Advanced Platform for Prostate Cancer Detection. ACS Sens 2024; 9:2596-2604. [PMID: 38683677 DOI: 10.1021/acssensors.4c00312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Cancer stands as a prominent global cause of mortality, necessitating early detection to augment survival rates and alleviate economic burdens on healthcare systems. In particular, prostate cancer (PCa), impacting 1.41 million men globally in 2020, accentuates the demand for sensitive and cost-effective detection methods beyond traditional prostate-specific antigen (PSA) testing. While clinical techniques exhibit limitations, biosensors emerge as compact, user-friendly alternatives to traditional laboratory approaches. However, existing biosensors predominantly concentrate on PSA detection, prompting the necessity for advancing toward multiplex sensing platforms. This study introduces a compact opto-microfluidic sensor featuring a substrate of gold nanospikes, fabricated via electrodeposition, for enhanced sensitivity. Embedded within a microfluidic chip, this nanomaterial enables the precise and concurrent measurement of PSA, alongside two complementary PCa biomarkers, matrix metalloproteinase-2 (MMP-2) and anti-α-methylacyl-CoA racemase (anti-AMACR) in diluted human plasma, offering a comprehensive approach to PSA analysis. Taking advantage of the localized surface plasmon resonance principle, this biosensor offers robustness and sensitivity in real sample analysis without the need for labeling agents. With the limit of detection at 0.22, 0.37, and 0.18 ng/mL for PSA, MMP-2, and anti-AMACR, respectively, this biosensing platform holds promise for point-of-care analysis, underscoring its potential impact on medical diagnostics.
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Affiliation(s)
- Riccardo Funari
- Institute of Mechanical Intelligence, Scuola Superiore Sant'Anna, Via G. Moruzzi, 1, Pisa 56124, Italy
| | - Kang-Yu Chu
- Neurobiology Research Unit, Okinawa Institute of Science and Technology Graduate University, 1919-1 Tancha, Onna-son, Okinawa 904-0495, Japan
| | - Amy Q Shen
- Micro/Bio/Nanofluidics Unit, Okinawa Institute of Science and Technology Graduate University, 1919-1 Tancha, Onna-son, Okinawa 904-0495, Japan
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2
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Kaufmann B, Pellegrino P, Zuluaga L, Ben-David R, Müntener M, Keller EX, Spanaus K, von Eckardstein A, Gorin MA, Poyet C. Interassay Variability and Clinical Implications of Five Different Prostate-specific Antigen Assays. EUR UROL SUPPL 2024; 63:4-12. [PMID: 38558765 PMCID: PMC10981008 DOI: 10.1016/j.euros.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
Background and objective Prostate-specific antigen (PSA) remains a critical marker for prostate cancer (PCa) detection and monitoring. Recognising historical variability in PSA assays and the evolution of assay technology and calibration, this study aims to reassess interassay variability using the latest generation of five assays in a contemporary cohort of men undergoing prostate biopsy. Methods Five different commercially available PSA assays were tested in a blood sample of 76 men before undergoing a prostate biopsy. Total PSA (tPSA) and free-to-total PSA ratio (%fPSA) were compared across assays, using Roche (Basel, Switzerland) as the benchmark, and correlated with biopsy outcome to analyse the impact on PCa diagnosis. The statistical analysis included Passing-Bablok regression and Bland-Altman plots, with a p value threshold of <0.05 for significance. Key findings and limitations Among the 76 men, 28 (36.8%) were diagnosed with significant PCa (defined as International Society of Urological Pathology grade ≥2). A high correlation was observed between tPSA and %fPSA values among the different PSA assays tested (r2 ≥ 0.9). The Passing-Bablok analysis showed that tPSA results varied substantially among the assays, with slopes ranging between 0.78 and 1.04. Compared with the tPSA of Roche, tPSA values were on average 20.7% lower by Beckman (Oststeinbeck, Germany), 15.2% lower by Abbott (Chicago, IL, USA), 6.1% lower by Diasorin (Saluggia, Italy), and 9.6% higher by Brahms (Hennigsdorf, Germany; p < 0.001 for all). The %fPSA values by Abbott and Brahms were higher at 15.7% and 10.6%, respectively (p < 0.001), while the Beckman and Diasorin values had minimal differences of -0.3% and 2.3%, respectively (p > 0.05). The variability across assays would have resulted in discrepancies in both the sensitivity and the specificity for tPSA and %fPSA by at least 14%, depending on the cut-offs applied. Conclusions and clinical implications Despite the use of the latest PSA assays, relevant variability of tPSA and %fPSA results can be observed among different assays. There is an urgent need for standardised calibration methods and greater awareness among practitioners concerning interassay variability. Clinicians should acknowledge that clinically relevant thresholds may depend on the specific PSA assay and that ideally the same assay is applied over time for better clinical decision-making. Patient summary Prostate-specific antigen (PSA) is a critical marker for prostate cancer (PCa) detection and monitoring. However, significant variations were observed in the results of the latest PSA assays. Thus, standardised calibration methods and greater awareness among practitioners concerning interassay variability are needed.
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Affiliation(s)
- Basil Kaufmann
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paloma Pellegrino
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Laura Zuluaga
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Reuben Ben-David
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Müntener
- Department of Urology, Municipal Hospital of Zurich, Zurich, Switzerland
| | - Etienne X. Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Katharina Spanaus
- Institute for Clinical Chemistry, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Arnold von Eckardstein
- Institute for Clinical Chemistry, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Michael A. Gorin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cédric Poyet
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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3
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Gómez Gómez E, Cano Castiñeira R, Burgos J, Rodríguez Antolín A, Miles BJ, Martínez Salamanca JI, Bianco F, Fernández L, Calmarza I, Pastor J, Butler RG, de Pedro N. ProsTAV, a novel blood-based test for biopsy decision management in significant prostate cancer. Prostate 2023; 83:1323-1331. [PMID: 37409738 DOI: 10.1002/pros.24594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/26/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Current pathways in early diagnosis of prostate cancer (PCa) can lead to unnecessary biopsy procedures. Here, we used telomere analysis to develop and evaluate ProsTAV®, a risk model for significant PCa (Gleason score >6), with the objective of improving the PCa diagnosis pathway. METHODS This retrospective, multicentric study analyzed telomeres from patients with serum PSA 3-10 ng/mL. High-throughput quantitative fluorescence in-situ hybridization was used to evaluate telomere-associated variables (TAVs) in peripheral blood mononucleated cells. ProsTAV® was developed by multivariate logistics regression based on three clinical variables and six TAVs. The predictive capacity and accuracy of ProsTAV® were summarized by receiver operating characteristic (ROC) curves and its clinical benefit with decision curves analysis. RESULTS Telomeres from 1043 patients were analyzed. The median age of the patients was 63 years, with a median PSA of 5.2 ng/mL and a percentage of significant PCa of 23.9%. A total of 874 patients were selected for model training and 169 patients for model validation. The area under the ROC curve of ProsTAV® was 0.71 (95% confidence interval [CI], 0.62-0.79), with a sensitivity of 0.90 (95% CI, 0.88-1.0) and specificity of 0.33 (95% CI, 0.24-0.40). The positive predictive value was 0.29 (95% CI, 0.21-0.37) and the negative predictive value was 0.91 (95% CI, 0.83-0.99). ProsTAV® would make it possible to avoid 33% of biopsies. CONCLUSIONS ProsTAV®, a predictive model based on telomere analysis through TAV, could be used to increase the prediction capacity of significant PCa in patients with PSA between 3 and 10 ng/mL.
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Affiliation(s)
- Enrique Gómez Gómez
- Department of Urology, Hospital Universitario Reina Sofía, Universidad de Córdoba, Investigación Biomédica de Córdoba, Córdoba, Spain
| | | | - Javier Burgos
- Department of Urology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | | | - Brian J Miles
- Urologic Oncology, Houston Methodist Hospital, Houston, Texas, USA
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4
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Hsieh TF, Chen HL, Hsia YF, Lin CC, Chiang HY, Wu MY, Chen SH, Hsieh PF, Wu HC, Chang H, Kuo CC. Age-specific percentile-based prostate-specific antigen cutoff values predict the risk of prostate cancer: A single hospital observation. Biomedicine (Taipei) 2023; 13:9-24. [PMID: 37937061 PMCID: PMC10627214 DOI: 10.37796/2211-8039.1415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/18/2023] [Accepted: 06/28/2023] [Indexed: 11/09/2023] Open
Abstract
Background Testing for prostate-specific antigen (PSA) is often recommended for men with a potential risk of prostate cancer (PCa) before requiring advanced examination. However, the best PSA cutoff value remains controversial. Object We compared the predictive performance of age-specific percentile-based PSA thresholds with a conventional cutoff of >4 ng/mL for the risk of PCa. Methods We included men who received PSA measurements between 2003 and 2017 in a medical center in Taiwan. Logistic regression modeling was used to assess the association between age-specific percentile-based PSA thresholds and PCa risk in age subgroups. We further applied C-statistic and decision curve analysis to compare the predictive performance of age-specific percentile-based PSA with that of a conventional cutoff PSA. Results We identified 626 patients with PCa and 40 836 patients without PCa. The slope of PSA in patients >60-year-old was almost 3 times that of those <60-year-old (0.713 vs 0.259). The risk effect sizes of the 75th percentile PSA cutoff (<60-year-old: 2.19; 60-70-year-old: 4.36; >70-year-old: 5.84 ng/mL) were comparable to those observed based on the conventional cutoff in all age groups. However, the discrimination performance of the 75th percentile PSA cutoff was better than that of the conventional cutoff among patients aged <60-year-old (C-statistic, 0.783 vs. 0.729, p < 0.05). The 75th percentile cutoffs also correctly identified an additional 2 patients with PCa for every 100 patients with PSA screening at the threshold probability of 20%. Conclusions Our data support the use of the 75th percentile PSA cutoff to facilitate individualized risk assessment, particularly for patients aged <60-year-old.
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Affiliation(s)
- Teng-Fu Hsieh
- Division of Urology, Department of Surgery, Taichung Tzu Chi Hospital, Taichung,
Taiwan
| | - Hung-Lin Chen
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
| | - Ying-Fang Hsia
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
| | - Che-Chen Lin
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
| | - Min-Yen Wu
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
| | - Sheng-Hsuan Chen
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
| | - Po-Fan Hsieh
- Department of Urology, China Medical University Hospital, Taichung,
Taiwan
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung,
Taiwan
- Department of Urology, China Medical University Beigang Hospital, Beigang, Yunlin,
Taiwan
| | - Hsi-Chin Wu
- Department of Urology, China Medical University Hospital, Taichung,
Taiwan
- Department of Urology, China Medical University Beigang Hospital, Beigang, Yunlin,
Taiwan
| | - Han Chang
- Department of Pathology, China Medical University Hospital, Taichung,
Taiwan
| | - Chin-Chi Kuo
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
- College of Medicine, China Medical University, Taichung,
Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung,
Taiwan
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung,
Taiwan
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5
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Tosoian JJ, Sessine MS, Trock BJ, Ross AE, Xie C, Zheng Y, Samora NL, Siddiqui J, Niknafs Y, Chopra Z, Tomlins S, Kunju LP, Palapattu GS, Morgan TM, Wei JT, Salami SS, Chinnaiyan AM. MyProstateScore in men considering repeat biopsy: validation of a simple testing approach. Prostate Cancer Prostatic Dis 2023; 26:563-567. [PMID: 36585434 PMCID: PMC10310885 DOI: 10.1038/s41391-022-00633-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 11/16/2022] [Accepted: 12/09/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Men with persistent risk of Grade Group (GG) ≥ 2 cancer after a negative biopsy present a unique clinical challenge. The validated MyProstateScore test is clinically-available for pre-biopsy risk stratification. In biopsy-naïve patients, we recently validated a straightforward testing approach to rule-out GG ≥ 2 cancer with 98% negative predictive value (NPV) and 97% sensitivity. In the current study, we established a practical MPS-based testing approach in men with a previous negative biopsy being considered for repeat biopsy. METHODS Patients provided post-digital rectal examination urine prior to repeat biopsy. MyProstateScore was calculated using the validated, locked model including urinary PCA3 and TMPRSS2:ERG scores with serum PSA. In a clinically-appropriate primary (i.e., training) cohort, we identified a lower (rule-out) threshold approximating 90% sensitivity and an upper (rule-in) threshold approximating 80% specificity for GG ≥ 2 cancer. These thresholds were applied to an external validation cohort, and performance measures and clinical outcomes associated with their use were calculated. RESULTS MyProstateScore thresholds of 15 and 40 met pre-defined performance criteria in the primary cohort (422 patients; median PSA 6.4, IQR 4.3-9.1). In the 268-patient validation cohort, 25 men (9.3%) had GG ≥ 2 cancer on repeat biopsy. The rule-out threshold of 15 provided 100% NPV and sensitivity for GG ≥ 2 cancer and would have prevented 23% of unnecessary biopsies. Use of MyProstateScore >40 to rule-in biopsy would have prevented 67% of biopsies while maintaining 95% NPV. In the validation cohort, the prevalence of GG ≥ 2 cancer was 0% for MyProstateScore 0-15, 6.5% for MyProstateScore 15-40, and 19% for MyProstateScore >40. CONCLUSIONS In patients who previously underwent a negative prostate biopsy, the MyProstateScore values of 15 and 40 yielded clinically-actionable rule-in and rule-out risk groups. Using this straightforward testing approach, MyProstateScore can meaningfully inform patients and physicians weighing the need for repeat biopsy.
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Affiliation(s)
- Jeffrey J Tosoian
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA.
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA.
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA.
| | - Michael S Sessine
- Department of Urology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Bruce J Trock
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ashley E Ross
- Department of Urology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Cassie Xie
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Yingye Zheng
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Nathan L Samora
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Javed Siddiqui
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Yashar Niknafs
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Zoey Chopra
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Scott Tomlins
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Lakshmi P Kunju
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Ganesh S Palapattu
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - John T Wei
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Simpa S Salami
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Arul M Chinnaiyan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
- Howard Hughes Medical Institute, University of Michigan, Ann Arbor, MI, USA
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Filella X, Izquierdo L, Mases J, Youngren KA, Escolar G. Discrepancies in PSA values among laboratories: the case of a traveling patient. Clin Chem Lab Med 2023; 61:e179-e181. [PMID: 36872637 DOI: 10.1515/cclm-2023-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/21/2023] [Indexed: 03/07/2023]
Affiliation(s)
- Xavier Filella
- Department of Biochemistry and Molecular Genetics (CDB), Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Laura Izquierdo
- Department of Urology (ICNU), Hospital Clinic, Barcelona, Spain
| | - Joel Mases
- Department of Oncologic Radiotherapy (ICMHO), Hospital Clinic, Barcelona, Spain
| | - Kjell A Youngren
- Morristown Medical Center, Department of Surgery, Section of Urology, Morristown, NJ, USA
| | - Gines Escolar
- Department of Pathology (CDB), Hospital Clinic, Barcelona, Spain
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7
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Ferraro S, Cereda C, Zuccotti G, Marcovina S, Plebani M, Biganzoli EM. Striving for a pragmatic contribution of biomarkers results to lifelong health care. Clin Chem Lab Med 2023; 61:1395-1403. [PMID: 36798037 DOI: 10.1515/cclm-2022-1294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/07/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND The increased role of preventive medicine in healthcare and the rapid technological advancements, have deeply changed the landscape of laboratory medicine. In particular, increased investments in newborn screening tests and policies have been observed. Aim of this paper is to characterize how laboratory professionals engaged in clinical chemistry or newborn screening, in collaboration with experts in econometric, bioinformatics, and biostatistics may address a pragmatic use of laboratory results in the decision-making process oriented toward improvement of health care outcomes. CONTENT The effectiveness of biomarkers on healthcare depends on several factors such as analytical performance, prevalence of the disease, integration of the test within the diagnostic algorithm, associated costs, and social/economic impact of false positive and false negative results. Cost-effectiveness analysis needs to be performed and reliability achieved, by overcoming analytical pitfalls and by improving interpretative criteria. These are challenging issues common to clinical chemistry and newborn screening tests. Following the experience in clinical chemistry, one of the main issues to be approached in newborn screening tests, is the lack of harmonization of results obtained by different methods and the limited healthcare effectiveness. SUMMARY The focus on prevention is a crucial opportunity for laboratory medicine to change how to approach the effectiveness of biomarkers on healthcare. The consolidation within clinical laboratories of professionals with different technical and methodological expertise coupled with the need to produce and manage large sets of data, require the cooperation of professionals from other disciplines to characterize the impact of the tests on epidemiological outcomes for health care policy making process.
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Affiliation(s)
- Simona Ferraro
- Department of Pediatrics, Center of Functional Genomics and Rare Diseases, Buzzi Children's Hospital, Milan, Italy
- Department of Pediatrics, Center of Functional Genomics and Rare Diseases, Buzzi Children's Hospital, Milan, Italy
| | - Cristina Cereda
- Department of Pediatrics, Center of Functional Genomics and Rare Diseases, Buzzi Children's Hospital, Milan, Italy
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | | | - Mario Plebani
- Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Elia Mario Biganzoli
- Department of Biomedical and Clinical Sciences L. Sacco, Medical Statistics Unit, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
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Ferraro S, Biganzoli D, Rossi RS, Palmisano F, Bussetti M, Verzotti E, Gregori A, Bianchi F, Maggioni M, Ceriotti F, Cereda C, Zuccotti G, Kavsak P, Plebani M, Marano G, Biganzoli EM. Individual risk prediction of high grade prostate cancer based on the combination between total prostate-specific antigen (PSA) and free to total PSA ratio. Clin Chem Lab Med 2023; 61:1327-1334. [PMID: 36704961 DOI: 10.1515/cclm-2023-0008] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/19/2023] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Clinical practice guidelines endorse the stratification of prostate cancer (PCa) risk according to individual total prostate-specific antigen (tPSA) values and age to enhance the individual risk-benefit ratio. We defined two nomograms to predict the individual risk of high and low grade PCa by combining the assay of tPSA and %free/tPSA (%f/tPSA) in patients with a pre-biopsy tPSA between 2 and 10 μg/L. METHODS The study cohort consisted of 662 patients that had fPSA, tPSA, and a biopsy performed (41.3% with a final diagnosis of PCa). Logistic regression including age, tPSA and %f/tPSA was used to model the probability of having high or low grade cancer by defining 3 outcome levels: no PCa, low grade (International Society of Urological Pathology grade, ISUP<3) and high grade PCa (ISUP≥3). RESULTS The nomogram identifying patients with: (a) high vs. those with low grade PCa and without the disease showed a good discriminating capability (∼80%), but the calibration showed a risk of underestimation for predictive probabilities >30% (a considerable critical threshold of risk), (b) ISUP<3 vs. those without the disease showed a discriminating capability of 63% and overestimates predictive probabilities >50%. In ISUP 5 a possible loss of PSA immunoreactivity has been observed. CONCLUSIONS The estimated risk of high or low grade PCa by the nomograms may be of aid in the decision-making process, in particular in the case of critical comorbidities and when the digital rectal examinations are inconclusive. The improved characterization of the risk of ISUP≥3 might enhance the use for magnetic resonance imaging in this setting.
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Affiliation(s)
- Simona Ferraro
- Center of Functional Genomics and Rare Diseases, Department of Pediatrics, Buzzi Children's Hospital, Milan, Italy
| | - Davide Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Roberta Simona Rossi
- Unità Operativa Anatomia Patologica, ASST Fatebenefratelli-Sacco, Ospedale 'Luigi Sacco', Milan, Italy
| | - Franco Palmisano
- Urologia, ASST Fatebenefratelli-Sacco, Ospedale 'Luigi Sacco', Milan, Italy
| | - Marco Bussetti
- Immunoematologia e Medicina trasfusionale Ospedale Castelli, Verbania, Italy
| | - Enrica Verzotti
- Urologia, ASST Fatebenefratelli-Sacco, Ospedale 'Luigi Sacco', Milan, Italy
| | - Andrea Gregori
- Urologia, ASST Fatebenefratelli-Sacco, Ospedale 'Luigi Sacco', Milan, Italy
| | - Filippo Bianchi
- Unità Operativa Anatomia Patologica, ASST Fatebenefratelli-Sacco, Ospedale Fatebenefratelli, Milan, Italy
| | - Marco Maggioni
- Unità Operativa Anatomia Patologica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ferruccio Ceriotti
- Laboratorio Analisi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristina Cereda
- Center of Functional Genomics and Rare Diseases, Department of Pediatrics, Buzzi Children's Hospital, Milan, Italy
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Peter Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Mario Plebani
- Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Giuseppe Marano
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Elia Mario Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
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9
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Myint ZW, St. Clair WH, Strup SE, Yan D, Li N, Allison DB, McLouth LE, Ellis CS, Wang P, James AC, Hensley PJ, Otto DE, Arnold SM, DiPaola RS, Kolesar JM. A Phase I Dose Escalation and Expansion Study of Epidiolex (Cannabidiol) in Patients with Biochemically Recurrent Prostate Cancer. Cancers (Basel) 2023; 15:2505. [PMID: 37173971 PMCID: PMC10177512 DOI: 10.3390/cancers15092505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/09/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
PURPOSE Cannabinoids (CBD) have anti-tumor activity against prostate cancer (PCa). Preclinical studies have demonstrated a significant decrease in prostate specific antigen (PSA) protein expression and reduced tumor growth in xenografts of LNCaP and DU-145 cells in athymic mice when treated with CBD. Over-the-counter CBD products may vary in activity without clear standardization, and Epidiolex is a standardized FDA-approved oral CBD solution for treatment of certain types of seizures. We aimed to assess the safety and preliminary anti-tumor activity of Epidiolex in patients with biochemically recurrent (BCR) PCa. EXPERIMENTAL DESIGN This was an open-label, single center, phase I dose escalation study followed by a dose expansion in BCR patients after primary definitive local therapy (prostatectomy +/- salvage radiotherapy or primary definitive radiotherapy). Eligible patients were screened for urine tetrahydrocannabinol prior to enrollment. The starting dose level of Epidiolex was 600 mg by mouth once daily and escalated to 800 mg daily with the use of a Bayesian optimal interval design. All patients were treated for 90 days followed by a 10-day taper. The primary endpoints were safety and tolerability. Changes in PSA, testosterone levels, and patient-reported health-related quality of life were studied as secondary endpoints. RESULTS Seven patients were enrolled into the dose escalation cohort. There were no dose-limiting toxicities at the first two dose levels (600 mg and 800 mg). An additional 14 patients were enrolled at the 800 mg dose level into the dose expansion cohort. The most common adverse events were 55% diarrhea (grade 1-2), 25% nausea (grade 1-2), and 20% fatigue (grade 1-2). The mean PSA at baseline was 2.9 ng/mL. At the 12-week landmark time-point, 16 out of 18 (88%) had stable biochemical disease, one (5%) had partial biochemical response with the greatest measurable decline being 41%, and one (5%) had PSA progression. No statistically significant changes were observed in patient-reported outcomes (PROs), but PROs changed in the direction of supporting the tolerability of Epidiolex (e.g., emotional functioning improved). CONCLUSION Epidiolex at a dose of 800 mg daily appears to be safe and tolerable in patients with BCR prostate cancer supporting a safe dose for future studies.
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Affiliation(s)
- Zin W. Myint
- Department of Medicine, Division of Medical Oncology, University of Kentucky, Lexington, KY 40536, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
| | - William H. St. Clair
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- Department of Radiation Medicine, University of Kentucky, Lexington, KY 40536, USA
| | - Stephen E. Strup
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- Department of Urology, University of Kentucky, Lexington, KY 40536, USA
| | - Donglin Yan
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY 40536, USA
| | - Ning Li
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY 40536, USA
| | - Derek B. Allison
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, KY 40536, USA
| | - Laurie E. McLouth
- Department of Behavioral Science, University of Kentucky, Lexington, KY 40536, USA
| | - Carleton S. Ellis
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- College of Pharmacy, University of Kentucky, Lexington, KY 40536, USA
| | - Peng Wang
- Department of Medicine, Division of Medical Oncology, University of Kentucky, Lexington, KY 40536, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
| | - Andrew C. James
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- Department of Urology, University of Kentucky, Lexington, KY 40536, USA
| | - Patrick J. Hensley
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- Department of Urology, University of Kentucky, Lexington, KY 40536, USA
| | - Danielle E. Otto
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- College of Pharmacy, University of Kentucky, Lexington, KY 40536, USA
| | - Susanne M. Arnold
- Department of Medicine, Division of Medical Oncology, University of Kentucky, Lexington, KY 40536, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
| | - Robert S. DiPaola
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
| | - Jill M. Kolesar
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- College of Pharmacy, University of Kentucky, Lexington, KY 40536, USA
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Sugino F, Nakane K, Kawase M, Ueda S, Tomioka M, Takeuchi Y, Tomioka-Inagawa R, Yamada T, Namiki S, Kumada N, Takeuchi S, Kawase K, Kato D, Takai M, Iinuma K, Tobisawa Y, Koie T. Efficacy and Safety of Neoadjuvant Luteinizing Hormone-Releasing Hormone Antagonist and Tegafur-Uracil Chemohormonal Therapy for High-Risk Prostate Cancer. Life (Basel) 2023; 13:life13051072. [PMID: 37240717 DOI: 10.3390/life13051072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND This retrospective single-center cohort study evaluated the efficacy and safety of a combination of neoadjuvant luteinizing hormone-releasing hormone (LHRH) antagonist and tegafur-uracil (UFT) therapy (NCHT) and investigated the medical records of patients with high-risk PCa who underwent robot-assisted radical prostatectomy (RARP). The therapy was followed by RARP for high-risk PCa. MATERIALS AND METHODS The enrolled patients were divided into two groups: low-intermediate-risk PCa patients who underwent RARP without neoadjuvant therapy (non-high-risk) and those who underwent NCHT followed by RARP (high-risk group). This study enrolled 227 patients (126: non-high-risk and 101: high-risk group). Patients in the high-risk-group had high-grade cancer compared to those in the non-high-risk-group. RESULTS At the median follow-up period of 12.0 months, there were no PCa deaths; two patients (0.9%) died of other causes. Twenty patients developed biochemical recurrence (BCR); the median time until BCR was 9.9 months after surgery. The 2-year biochemical recurrence-free survival rates were 94.2% and 91.1% in the non-high-risk and high-risk-group, respectively (p = 0.465). Grade ≥3 NCHT-related adverse events developed in nine patients (8.9%). CONCLUSIONS This study indicates that combining neoadjuvant LHRH antagonists and UFT followed by RARP may improve oncological outcomes in patients with high-risk PCa.
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Affiliation(s)
- Fumiya Sugino
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Keita Nakane
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Makoto Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Shota Ueda
- Department of Urology, Japanese Red Cross Takayama Hospital, Takayama 5068550, Japan
| | - Masayuki Tomioka
- Department of Urology, Chuno Kosei Hospital, Seki 5013802, Japan
| | - Yasumichi Takeuchi
- Department of Urology, Japanese Red Cross Gifu Hospital, Gifu 5028511, Japan
| | - Risa Tomioka-Inagawa
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Toyohiro Yamada
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Sanae Namiki
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Naotaka Kumada
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Shinichi Takeuchi
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Kota Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Daiki Kato
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Manabu Takai
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Koji Iinuma
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Yuki Tobisawa
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki 0358562, Japan
| | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
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11
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Ogbonnaya CN, Alsaedi BSO, Alhussaini AJ, Hislop R, Pratt N, Nabi G. Radiogenomics Reveals Correlation between Quantitative Texture Radiomic Features of Biparametric MRI and Hypoxia-Related Gene Expression in Men with Localised Prostate Cancer. J Clin Med 2023; 12:jcm12072605. [PMID: 37048688 PMCID: PMC10095552 DOI: 10.3390/jcm12072605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVES To perform multiscale correlation analysis between quantitative texture feature phenotypes of pre-biopsy biparametric MRI (bpMRI) and targeted sequence-based RNA expression for hypoxia-related genes. MATERIALS AND METHODS Images from pre-biopsy 3T bpMRI scans in clinically localised PCa patients of various risk categories (n = 15) were used to extract textural features. The genomic landscape of hypoxia-related gene expression was obtained using post-radical prostatectomy tissue for targeted RNA expression profiling using the TempO-sequence method. The nonparametric Games Howell test was used to correlate the differential expression of the important hypoxia-related genes with 28 radiomic texture features. Then, cBioportal was accessed, and a gene-specific query was executed to extract the Oncoprint genomic output graph of the selected hypoxia-related genes from The Cancer Genome Atlas (TCGA). Based on each selected gene profile, correlation analysis using Pearson's coefficients and survival analysis using Kaplan-Meier estimators were performed. RESULTS The quantitative bpMR imaging textural features, including the histogram and grey level co-occurrence matrix (GLCM), correlated with three hypoxia-related genes (ANGPTL4, VEGFA, and P4HA1) based on RNA sequencing using the TempO-Seq method. Further radiogenomic analysis, including data accessed from the cBioportal genomic database, confirmed that overexpressed hypoxia-related genes significantly correlated with a poor survival outcomes, with a median survival ratio of 81.11:133.00 months in those with and without alterations in genes, respectively. CONCLUSION This study found that there is a correlation between the radiomic texture features extracted from bpMRI in localised prostate cancer and the hypoxia-related genes that are differentially expressed. The analysis of expression data based on cBioportal revealed that these hypoxia-related genes, which were the focus of the study, are linked to an unfavourable survival outcomes in prostate cancer patients.
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Affiliation(s)
- Chidozie N Ogbonnaya
- Division of Imaging Science and Technology, University of Dundee, Dundee DD1 4HN, UK
- College of Basic Medical Sciences, Abia State University, Uturu 441103, Nigeria
| | - Basim S O Alsaedi
- Statistics Department, University of Tabuk, Tabuk 47512, Saudi Arabia
| | - Abeer J Alhussaini
- Division of Imaging Science and Technology, University of Dundee, Dundee DD1 4HN, UK
- Department of Medical Imaging, Al-Amiri Hospital, Ministry of Health, Sulaibikhat 1300, Kuwait
| | - Robert Hislop
- Cytogenetic, Human Genetics Unit, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - Norman Pratt
- Cytogenetic, Human Genetics Unit, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - Ghulam Nabi
- Division of Imaging Science and Technology, University of Dundee, Dundee DD1 4HN, UK
- School of Medicine, Ninewells Hospital, Dundee DD1 9SY, UK
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12
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Sandúa A, Sanmamed MF, Rodríguez M, Ancizu-Marckert J, Gúrpide A, Perez-Gracia JL, Alegre E, González Á. PSA reactivity in extracellular microvesicles to commercial immunoassays. Clin Chim Acta 2023; 543:117303. [PMID: 36948237 DOI: 10.1016/j.cca.2023.117303] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 03/24/2023]
Abstract
AIMS Characterization of PSA in extracellular microvesicles (EVs) and its reactivity to commercial methods. MATERIALS AND METHODS EVs derived from serum of 47 prostate cancer (PCa) patients, 27 benign prostatic hyperplasia (BPH) patients and 42 healthy controls were analyzed. EVs isolation and quantification of PSA immunoreactive to total (ev-T-PSA) or free (ev-F-PSA) PSA immunoassays, were performed using commercial assays. PSA in CD81+ or CD63+ EVs was determined directly in serum by an immunocapture-ELISA (IC-ELISA). RESULTS Ev-T-PSA immunoreactive to Elecsys assay was detected in all samples. Median T-PSA ev/srm ratio was 2.20% (Q1-Q3: 0.80-4.00%), although in some samples this ratio reached 59%. T-PSA ev/srm ratio was higher in those samples with serum T-PSA below 4 µg/L than in those exceeding that cut-off (p<0.001). T-PSA ev/srm ratio was lower in PCa patients compared to healthy controls and BPH patients (p<0.001). Elecsys immunoassays detected higher concentrations of ev-T-PSA and ev-F-PSA than Immulite (p<0.001). PSA was detected by IC-ELISA more intensely in CD81+ EVs than in CD63+ EVs, and ev-T-PSA correlated with PSA+CD63+ (p<0.001) but not with PSA+CD81+. CONCLUSION EVs-bound PSA is another form of circulating PSA whose measurement could be easily performed in clinical laboratories by automated immunoassays.
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Affiliation(s)
- Amaia Sandúa
- Service of Biochemistry. Clínica Universidad de Navarra, Av. Pío XII 36, 31008, Pamplona, Spain.
| | - Miguel F Sanmamed
- Oncology Department. Clínica Universidad de Navarra, Av. Pío XII 36, 31008, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Calle Irunlarrea 3, 31008, Pamplona, Spain
| | - María Rodríguez
- Oncology Department. Clínica Universidad de Navarra, Av. Pío XII 36, 31008, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Calle Irunlarrea 3, 31008, Pamplona, Spain
| | - Javier Ancizu-Marckert
- Urology Department. Clínica Universidad de Navarra, Av. Pío XII 36, 31008, Pamplona, Spain
| | - Alfonso Gúrpide
- Oncology Department. Clínica Universidad de Navarra, Av. Pío XII 36, 31008, Pamplona, Spain
| | - José L Perez-Gracia
- Oncology Department. Clínica Universidad de Navarra, Av. Pío XII 36, 31008, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Calle Irunlarrea 3, 31008, Pamplona, Spain
| | - Estibaliz Alegre
- Service of Biochemistry. Clínica Universidad de Navarra, Av. Pío XII 36, 31008, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Calle Irunlarrea 3, 31008, Pamplona, Spain
| | - Álvaro González
- Service of Biochemistry. Clínica Universidad de Navarra, Av. Pío XII 36, 31008, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Calle Irunlarrea 3, 31008, Pamplona, Spain
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13
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Rao Bommi J, Kummari S, Lakavath K, Sukumaran RA, Panicker LR, Marty JL, Yugender Goud K. Recent Trends in Biosensing and Diagnostic Methods for Novel Cancer Biomarkers. BIOSENSORS 2023; 13:398. [PMID: 36979610 PMCID: PMC10046866 DOI: 10.3390/bios13030398] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 06/18/2023]
Abstract
Cancer is one of the major public health issues in the world. It has become the second leading cause of death, with approximately 75% of cancer deaths transpiring in low- or middle-income countries. It causes a heavy global economic cost estimated at more than a trillion dollars per year. The most common cancers are breast, colon, rectum, prostate, and lung cancers. Many of these cancers can be treated effectively and cured if detected at the primary stage. Nowadays, around 50% of cancers are detected at late stages, leading to serious health complications and death. Early diagnosis of cancer diseases substantially increases the efficient treatment and high chances of survival. Biosensors are one of the potential screening methodologies useful in the early screening of cancer biomarkers. This review summarizes the recent findings about novel cancer biomarkers and their advantages over traditional biomarkers, and novel biosensing and diagnostic methods for them; thus, this review may be helpful in the early recognition and monitoring of treatment response of various human cancers.
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Affiliation(s)
| | - Shekher Kummari
- Department of Chemistry, Indian Institute of Technology Palakkad, Palakkad 678 557, Kerala, India
| | - Kavitha Lakavath
- Department of Chemistry, Indian Institute of Technology Palakkad, Palakkad 678 557, Kerala, India
| | - Reshmi A. Sukumaran
- Department of Chemistry, Indian Institute of Technology Palakkad, Palakkad 678 557, Kerala, India
| | - Lakshmi R. Panicker
- Department of Chemistry, Indian Institute of Technology Palakkad, Palakkad 678 557, Kerala, India
| | - Jean Louis Marty
- Université de Perpignan Via Domitia, 52 Avenue Paul Alduy, 66860 Perpignan, France
| | - Kotagiri Yugender Goud
- Department of Chemistry, Indian Institute of Technology Palakkad, Palakkad 678 557, Kerala, India
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14
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Niu W, Zhang T, Ma L. Correlation analysis between immune-related genes and cell infiltration revealed prostate cancer immunotherapy biomarkers linked to T cells gamma delta. Sci Rep 2023; 13:2459. [PMID: 36774376 PMCID: PMC9922294 DOI: 10.1038/s41598-023-28475-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/19/2023] [Indexed: 02/13/2023] Open
Abstract
Prostate cancer (PCa) is a urological malignancy with poor prognosis. Immune-related genes are associated with immune infiltration in prostate cancer, but their role in immunogenic PCa is less well understood. We assessed the infiltration patterns of 22 immune cells in PCa and the relationship of immune-related differentially expressed genes (IDEGs) with them. The 87 IDEGs are involved in the interaction between the extracellular matrix and the tumor microenvironment. The model, including seven IDEGs (SLPI, DES, IAPP, NPY, ISG15, PLA2G2A, and HLA-DMB), showed a good predictive power. The SLPI expression is positively correlated with the infiltration level of T cells gamma delta. In addition, PCa has high infiltration levels in Macrophages M1 (18.07%) and Dendritic cells activated (17.64%). The correlation analysis between IDEGs and immune cell infiltration suggested that PCa immunotherapy biomarkers may be closely related to T cells gamma delta.
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Affiliation(s)
- Wenkang Niu
- College of Life Science, Shihezi University, Shihezi, Xinjiang, China
| | - Tingting Zhang
- College of Life Science, Shihezi University, Shihezi, Xinjiang, China.
| | - Lei Ma
- College of Life Science, Shihezi University, Shihezi, Xinjiang, China.
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15
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Lamersdorf T, Netsch C, Becker B, Wülfing C, Anheuser P, Engel O, Gross AJ, Rosenbaum CM. Influence of Prostate Cancer on Thulium Vapoenucleation of the Prostate-A Multicentre Analysis. J Clin Med 2023; 12:jcm12031174. [PMID: 36769821 PMCID: PMC9918181 DOI: 10.3390/jcm12031174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/10/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Purpose: Prostate cancer (PCa) and benign prostatic hyperplasia (BPH) are common in elderly men. Data on the laser-based surgery known as thulium vapoenucleation of the prostate (ThuVEP) in PCa patients are rare. Our objective was to analyse the feasibility, safety and functional outcome of ThuVEP in patients with lower urinary tract symptoms (LUTS) and PCa. Methods: Multicentre study, including 1256 men who underwent ThuVEP for LUTS. Maximum urinary flow rate (Qmax) and post-void residual volume (PVR) were measured perioperatively. The International Prostate Symptome Score (IPSS) was measured perioperatively and at follow-up (FU). Perioperative complications were captured. Reoperation rate was captured at FU. Results: Of 994 men with complete data, 286 (28.8%) patients had PCa. The most common Gleason score was 3 + 3 in 142 patients (49.7%). Most common was low-risk PCa (141 pts; 49.3%). PCa patients were older, had smaller prostates and had higher prostate-specific antigen (PSA) values (all p < 0.001). Comparing non-PCa and PCa patients, no differences occurred perioperatively. IPSS, quality of life and PVR decreased (all p < 0.001) and Qmax improved (p < 0.001) in both groups. Reoperation rates did not differ. The results of low- vs. intermediate-/high-risk PCa patients were comparable. Conclusion: ThuVEP is a safe and long-lasting treatment option for patients with LUTS with or without PCa. No differences occurred when comparing low- to intermediate-/high-risk PCa patients.
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Affiliation(s)
- Tobias Lamersdorf
- Department of Urology, Asklepios Hospital Barmbek, 22307 Hamburg, Germany
| | - Christopher Netsch
- Department of Urology, Asklepios Hospital Barmbek, 22307 Hamburg, Germany
| | - Benedikt Becker
- Department of Urology, Asklepios Hospital Barmbek, 22307 Hamburg, Germany
| | - Christian Wülfing
- Department of Urology, Asklepios Hospital Altona, 22763 Hamburg, Germany
| | - Petra Anheuser
- Department of Urology, Asklepios Hospital Wandsbek, 22043 Hamburg, Germany
| | - Oliver Engel
- Department of Urology, Asklepios Hospital Harburg, 21075 Hamburg, Germany
| | - Andreas J. Gross
- Department of Urology, Asklepios Hospital Barmbek, 22307 Hamburg, Germany
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16
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Ferraro S, Biganzoli G, Bussetti M, Castaldi S, Biganzoli EM, Plebani M. Managing the impact of inter-method bias of prostate specific antigen assays on biopsy referral: the key to move towards precision health in prostate cancer management. Clin Chem Lab Med 2023; 61:142-153. [PMID: 36322977 DOI: 10.1515/cclm-2022-0874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/23/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES We assessed the inter-method bias of total (tPSA) and free (fPSA) prostate-specific antigen (PSA) immunoassays to establish if tPSA-based risk thresholds for advanced prostate cancer (PCa), obtained from one method (Roche) can be converted into the corresponding concentrations assayed by other methods. Then we evaluated the impact of the bias of tPSA and fPSA on the estimation of the %f/tPSA ratio and performed a re-calibration of the proposed thresholds for the %f/tPSA ratio according to the assay used. METHODS tPSA and fPSA were measured in 135 and 137 serum samples, respectively by Abbott Alinity i, Beckman Access Dxl, Roche Cobas e801, and Siemens Atellica IM analytical platforms. Scatterplots, Bland-Altman diagrams, Passing-Bablok (PB) were used to inspect and estimate the systematic and proportional bias between the methods. The linear equations with confidence intervals of the parameter estimates were used to transform the tPSA risk thresholds for advanced PCa into the corresponding concentrations measurable by the other analytical methods. To construct a correction coefficient for converting the %f/tPSA ratio from one method to the other, PB and non-parametric boostrapping were used. RESULTS The inter-method bias is not constant but strictly linear allowing the conversion of PSA results obtained from Roche into the other assays, which underestimate tPSA vs. Roche. Siemens and Abbott vs. Roche and Beckman assays, being characterized by a positive and a negative proportional bias for tPSA and fPSA measurements, tend to overestimate the %f/tPSA ratio. CONCLUSIONS There is a consistent risk to miss advanced PCa, if appropriate conversion factors are not applied.
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Affiliation(s)
- Simona Ferraro
- Endocrinology Laboratory Unit, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy.,Newborn Screening and Genetic Metabolic Diseases Unit, "V. Buzzi" Children's Hospital, Milan, Italy
| | - Giacomo Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Marco Bussetti
- Immunoematologia e Medicina trasfusionale Ospedale Castelli, Verbania, Italy
| | - Silvana Castaldi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Elia Mario Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Mario Plebani
- Department of Medicine-DIMED, University of Padova, Padova, Italy
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LncRNA/miRNA/mRNA Network Introduces Novel Biomarkers in Prostate Cancer. Cells 2022; 11:cells11233776. [PMID: 36497036 PMCID: PMC9736264 DOI: 10.3390/cells11233776] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/12/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022] Open
Abstract
The construction of a competing endogenous RNA (ceRNA) network is an important step in the identification of the role of differentially expressed genes in cancers. In the current research, we used a number of bioinformatics tools to construct the ceRNA network in prostate cancer and identify the importance of these modules in predicting the survival of patients with this type of cancer. An assessment of microarray data of prostate cancer and normal samples using the Limma package led to the identification of differential expressed (DE) RNAs that we stratified into mRNA, lncRNA, and miRNAs, resulting in 684 DEmRNAs, including 437 downregulated DEmRNAs (such as TGM4 and SCGB1A1) and 241 upregulated DEmRNAs (such as TDRD1 and CRISP3); 6 DElncRNAs, including 1 downregulated DElncRNA (H19) and 5 upregulated DElncRNAs (such as PCA3 and PCGEM1); and 59 DEmiRNAs, including 30 downregulated DEmiRNAs (such as hsa-miR-1274a and hsa-miR-1274b) and 29 upregulated DEmiRNAs (such as hsa-miR-1268 and hsa-miR-1207-5p). The ceRNA network contained a total of 5 miRNAs, 5 lncRNAs, and 17 mRNAs. We identified hsa-miR-17, hsa-miR-93, hsa-miR-150, hsa-miR-25, PART1, hsa-miR-125b, PCA3, H19, RND3, and ITGB8 as the 10 hub genes in the ceRNA network. According to the ROC analysis, the expression levels of 19 hub genes showed a high diagnostic value. Taken together, we introduce a number of novel promising diagnostic biomarkers for prostate cancer.
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18
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Salciccia S, Frisenda M, Bevilacqua G, Viscuso P, Casale P, De Berardinis E, Di Pierro GB, Cattarino S, Giorgino G, Rosati D, Del Giudice F, Sciarra A, Mariotti G, Gentilucci A. Prognostic Value of Albumin to Globulin Ratio in Non-Metastatic and Metastatic Prostate Cancer Patients: A Meta-Analysis and Systematic Review. Int J Mol Sci 2022; 23:11501. [PMID: 36232828 PMCID: PMC9570150 DOI: 10.3390/ijms231911501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 12/05/2022] Open
Abstract
The aim of our meta-analysis is to analyze data available in the literature regarding a possible prognostic value of the albumin to globulin ratio (AGR) in prostate cancer (PC) patients. We distinguished our analysis in terms of PC staging, histologic aggressiveness, and risk of progression after treatments. A literature search process was performed (“prostatic cancer”, “albumin”, “globulin”, “albumin to globulin ratio”) following the PRISMA guidelines. In our meta-analysis, the pooled Event Rate (ER) estimate for each group of interest was calculated using a random effect model. Cases were distinguished in Low and High AGR groups based on an optimal cut-off value defined at ROC analysis. Four clinical trials were enclosed (sample size range from 214 to 6041 cases). The pooled Risk Difference for a non-organ confined PC between High AGR and Low AGR cases was −0.05 (95%CI: −0.12−0.01) with a very low rate of heterogeneity (I2 < 0.15%; p = 0.43) among studies (test of group differences p = 0.21). In non-metastatic PC cases, the pooled Risk Difference for biochemical progression (BCP) between High AGR and Low AGR cases was −0.05 (95%CI: −0.12−0.01) (I2 = 0.01%; p = 0.69) (test of group differences p = 0.12). In metastatic PC cases, AGR showed an independent significant (p < 0.01) predictive value either in terms of progression free survival (PFS) (Odds Ratio (OR): 0.642 (0.430−0.957)) or cancer specific survival (CSS) (OR: 0.412 (0.259−0.654)). Our meta-analysis showed homogeneous results supporting no significant predictive values for AGR in terms of staging, grading and biochemical progression in non-metastatic PC.
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Affiliation(s)
- Stefano Salciccia
- Department of Maternal-Infant and Urologic Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I Hospital, 00100 Rome, Italy
| | - Marco Frisenda
- Department of Maternal-Infant and Urologic Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I Hospital, 00100 Rome, Italy
| | - Giulio Bevilacqua
- Department of Maternal-Infant and Urologic Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I Hospital, 00100 Rome, Italy
| | - Pietro Viscuso
- Department of Maternal-Infant and Urologic Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I Hospital, 00100 Rome, Italy
| | - Paolo Casale
- Department of Urology, Humanitas, 20089 Milan, Italy
| | - Ettore De Berardinis
- Department of Maternal-Infant and Urologic Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I Hospital, 00100 Rome, Italy
| | - Giovanni Battista Di Pierro
- Department of Maternal-Infant and Urologic Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I Hospital, 00100 Rome, Italy
| | - Susanna Cattarino
- Department of Maternal-Infant and Urologic Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I Hospital, 00100 Rome, Italy
| | - Gloria Giorgino
- Department of Maternal-Infant and Urologic Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I Hospital, 00100 Rome, Italy
| | - Davide Rosati
- Department of Maternal-Infant and Urologic Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I Hospital, 00100 Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urologic Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I Hospital, 00100 Rome, Italy
| | - Alessandro Sciarra
- Department of Maternal-Infant and Urologic Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I Hospital, 00100 Rome, Italy
| | - Gianna Mariotti
- Department of Maternal-Infant and Urologic Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I Hospital, 00100 Rome, Italy
| | - Alessandro Gentilucci
- Department of Maternal-Infant and Urologic Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I Hospital, 00100 Rome, Italy
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19
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Lumbreras B, Parker LA, Alonso-Coello P, Mira-Bernabeu J, Gómez-Pérez L, Caballero-Romeu JP, Pertusa-Martínez S, Cebrián-Cuenca A, Moral-Peláez I, López-Garrigós M, Canelo-Aybar C, Ronda E, Guilabert M, Prieto-González A, Hernández-Aguado I. PROSHADE Protocol: Designing and Evaluating a Decision Aid for Promoting Shared Decision Making in Opportunistic Screening for Prostate Cancer: A Mix-Method Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8904. [PMID: 35897274 PMCID: PMC9330901 DOI: 10.3390/ijerph19158904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022]
Abstract
Background: Opportunistic prostate-specific antigen (PSA) screening may reduce prostate cancer mortality risk but is associated with false positive results, biopsy complications and overdiagnosis. Although different organisations have emphasised the importance of shared decision making (SDM) to assist men in deciding whether to undergo prostate cancer screening, recent evaluations show that the available decision aids fail to facilitate SDM, mainly because they do not consider the patients' perspective in their design. We aim to systematically develop and test a patient decision aid to promote SDM in prostate cancer screening, following the Knowledge to Action framework. Methods: (1) Feasibility study: a quantitative survey evaluating the population and clinician (urologists and general practitioners) knowledge of the benefits and risks derived from PSA determination and the awareness of the available recommendations. Focus groups to explore the challenges patients and clinicians face when discussing prostate cancer screening, the relevance of a decision aid and how best to integrate it into practice. (2) Patient decision aid development: Based on this data, an evidence-based multicomponent SDM patient decision aid will be developed. (3) User-testing: an assessment of the prototype of the initial patient decision aid through a user-testing design based on mix-methods (questionnaire and semi-structured review). The decision aid will be refined through several iterative cycles of feedback and redesign. (4) Validation: an evaluation of the patient decision aid through a cluster-randomised controlled trial. Discussion: The designed patient decision aid will provide balanced information on screening benefits and risks and should help patients to consider their personal preferences and to take a more active role in decision making. Conclusions: The well-designed patient decision aid (PDA) will provide balanced information on screening benefits and risks and help patients consider their personal preferences.
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Affiliation(s)
- Blanca Lumbreras
- Department of Public Health, History of Science and Gynecology, Miguel Hernandez University, 03550 San Juan de Alicante, Spain; (L.A.P.); (I.H.-A.)
- CIBER of Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
| | - Lucy Anne Parker
- Department of Public Health, History of Science and Gynecology, Miguel Hernandez University, 03550 San Juan de Alicante, Spain; (L.A.P.); (I.H.-A.)
- CIBER of Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
| | - Pablo Alonso-Coello
- CIBER of Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
- Iberoamerican Cochrane Centre, Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau, 08001 Barcelona, Spain; (P.A.-C.); (C.C.-A.)
| | - Javier Mira-Bernabeu
- Department of Preventive Medicine, Hospital Universitario de San Juan, 03550 San Juan de Alicante, Spain;
| | - Luis Gómez-Pérez
- Department of Urology, Hospital Universitario de San Juan, 03550 San Juan de Alicante, Spain;
| | | | | | | | - Irene Moral-Peláez
- Unidad de Investigación, Equipo de Atención Primaria Sardenya, Instituto de Investigación Biomédica Sant Pau, 08001 Barcelona, Spain;
| | - Maite López-Garrigós
- CIBER of Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
- Clinical Laboratory, Hospital Universitario de San Juan, 03550 San Juan de Alicante, Spain;
| | - Carlos Canelo-Aybar
- CIBER of Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
- Iberoamerican Cochrane Centre, Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau, 08001 Barcelona, Spain; (P.A.-C.); (C.C.-A.)
| | - Elena Ronda
- CIBER of Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
- Public Health Research Group, Alicante University, 03690 San Vicente del Raspeig, Spain;
| | - Mercedes Guilabert
- Department of Health Psychology, Miguel Hernandez University, 03202 Elche, Spain;
| | | | - Ildefonso Hernández-Aguado
- Department of Public Health, History of Science and Gynecology, Miguel Hernandez University, 03550 San Juan de Alicante, Spain; (L.A.P.); (I.H.-A.)
- CIBER of Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
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20
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Ferraro S, Biganzoli EM, Castaldi S, Plebani M. Health Technology Assessment to assess value of biomarkers in the decision-making process. Clin Chem Lab Med 2022; 60:647-654. [PMID: 35245972 DOI: 10.1515/cclm-2021-1291] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/08/2022] [Indexed: 12/20/2022]
Abstract
Clinical practice guidelines (CPGs) on screening, surveillance, and treatment of several diseases recommend the selective use of biomarkers with central role in clinical decision-making and move towards including patients in this process. To this aim we will clarify the multidisciplinary interactions required to properly measure the cost-effectiveness of biomarkers with regard to the risk-benefit of the patients and how Health Technology Assessment (HTA) approach may assess value of biomarkers integrated within the decision-making process. HTA through the interaction of different skills provides high-quality research information on the effectiveness, costs, and impact of health technologies, including biomarkers. The biostatistical methodology is relevant to HTA but only meta-analysis is covered in depth, whereas proper approaches are needed to estimate the benefit-risk balance ratio. Several biomarkers underwent HTA evaluation and the final reports have pragmatically addressed: 1) a redesign of the screening based on biomarker; 2) a de-implementation/replacement of the test in clinical practice; 3) a selection of biomarkers with potential predictive ability and prognostic value; and 4) a stronger monitoring of the appropriateness of test request. The COVID-19 pandemic has disclosed the need to create a robust and sustainable system to urgently deal with global health concerns and the HTA methodology enables rapid cost-effective implementation of diagnostic tests allowing healthcare providers to make critical patient-management decisions.
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Affiliation(s)
- Simona Ferraro
- Endocrinology Laboratory Unit, "Luigi Sacco" University Hospital, Milan, Italy
| | - Elia Mario Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Silvana Castaldi
- Fondazione Ca' Granda Ospedale Maggiore Policlinico Research Institute of Milano, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Mario Plebani
- Department of Medicine-DIMED, University of Padova, Padua, Italy
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21
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Dorizzi RM, Maltoni P, Sgarzani C, Torello M, Montanari F. Spurious results for total and free prostate-specific antigen (PSA); sometimes really "a riddle wrapped in a mystery inside an enigma". Clin Chem Lab Med 2022; 60:e91-e94. [PMID: 35246972 DOI: 10.1515/cclm-2022-0036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/22/2022] [Indexed: 12/27/2022]
Affiliation(s)
| | - Paolo Maltoni
- Clinical Pathology Unit, Hub Laboratory, AUSL Romagna, Cesena, Italy
| | - Claudio Sgarzani
- Clinical Pathology Unit, Hub Laboratory, AUSL Romagna, Cesena, Italy
| | - Monica Torello
- Clinical Pathology Unit, Hub Laboratory, AUSL Romagna, Cesena, Italy
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22
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Ferraro S, Biganzoli EM. Association between total prostate-specific antigen (tPSA), free/tPSA, and prostate cancer mortality. BJU Int 2022; 129:418. [PMID: 35297160 DOI: 10.1111/bju.15611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Simona Ferraro
- Department of Laboratory Medicine, ASST Fatebenefratelli-Sacco, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Elia Mario Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
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23
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Merriel SWD, Pocock L, Gilbert E, Creavin S, Walter FM, Spencer A, Hamilton W. Systematic review and meta-analysis of the diagnostic accuracy of prostate-specific antigen (PSA) for the detection of prostate cancer in symptomatic patients. BMC Med 2022; 20:54. [PMID: 35125113 PMCID: PMC8819971 DOI: 10.1186/s12916-021-02230-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/30/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Prostate-specific antigen (PSA) is a commonly used test to detect prostate cancer. Attention has mostly focused on the use of PSA in screening asymptomatic patients, but the diagnostic accuracy of PSA for prostate cancer in patients with symptoms is less well understood. METHODS A systematic database search was conducted of Medline, EMBASE, Web of Science, and the Cochrane library. Studies reporting the diagnostic accuracy of PSA for prostate cancer in patients with symptoms were included. Two investigators independently assessed the titles and abstracts of all database search hits and full texts of potentially relevant studies against the inclusion criteria, and data extracted into a proforma. Study quality was assessed using the QUADAS-2 tool by two investigators independently. Summary estimates of diagnostic accuracy were calculated with meta-analysis using bivariate mixed effects regression. RESULTS Five hundred sixty-three search hits were assessed by title and abstract after de-duplication, with 75 full text papers reviewed. Nineteen studies met the inclusion criteria, 18 of which were conducted in secondary care settings with one from a screening study cohort. All studies used histology obtained by transrectal ultrasound-guided biopsy (TRUS) as a reference test; usually only for patients with elevated PSA or abnormal prostate examination. Pooled data from 14,489 patients found estimated sensitivity of PSA for prostate cancer was 0.93 (95% CI 0.88, 0.96) and specificity was 0.20 (95% CI 0.12, 0.33). The area under the hierarchical summary receiver operator characteristic curve was 0.72 (95% CI 0.68, 0.76). All studies were assessed as having a high risk of bias in at least one QUADAS-2 domain. CONCLUSIONS Currently available evidence suggests PSA is highly sensitive but poorly specific for prostate cancer detection in symptomatic patients. However, significant limitations in study design and reference test reduces the certainty of this estimate. There is very limited evidence for the performance of PSA in primary care, the healthcare setting where most PSA testing is performed.
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Affiliation(s)
- Samuel W D Merriel
- University of Exeter, 1.18 College House, St Luke's Campus, Exeter, Devon, UK.
| | - Lucy Pocock
- University of Exeter, 1.18 College House, St Luke's Campus, Exeter, Devon, UK
| | - Emma Gilbert
- University of Exeter, 1.18 College House, St Luke's Campus, Exeter, Devon, UK
| | - Sam Creavin
- University of Exeter, 1.18 College House, St Luke's Campus, Exeter, Devon, UK
| | - Fiona M Walter
- University of Exeter, 1.18 College House, St Luke's Campus, Exeter, Devon, UK
| | - Anne Spencer
- University of Exeter, 1.18 College House, St Luke's Campus, Exeter, Devon, UK
| | - Willie Hamilton
- University of Exeter, 1.18 College House, St Luke's Campus, Exeter, Devon, UK
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24
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Popiołek A, Brzoszczyk B, Jarzemski P, Chyrek-Tomaszewska A, Wieczór R, Borkowska A, Bieliński M. Prostate-Specific Antigen and Testosterone Levels as Biochemical Indicators of Cognitive Function in Prostate Cancer Survivors and the Role of Diabetes. J Clin Med 2021; 10:jcm10225307. [PMID: 34830590 PMCID: PMC8619514 DOI: 10.3390/jcm10225307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 11/16/2022] Open
Abstract
Prostate cancer (PC) is one of the most common malignancies in men. The increase in the number of PC survivors is associated with many problems including cognitive impairment. Early detection of such problems facilitates timely protective intervention. This study examined the association between prostate-specific antigen (PSA) or testosterone (T) levels and cognitive function in patients undergoing radical prostatectomy. Such a correlation could help identify patient groups at risk of cognitive impairment. Participants underwent clinical (demographic data, medical history, physical examination, and blood analyses) and neuropsychological assessment (cognitive test battery). Preoperative PSA or T levels were not associated with cognitive function. However, long-term follow-up after prostatectomy showed a strong correlation between PSA levels and the results of verbal memory and executive function tests. A trend toward significance was also observed for visuospatial memory. The levels of free T and total T were not correlated with cognitive function. Only the levels of free T after hormonal treatment were significantly correlated with executive functions. Comorbid diabetes affected these correlations. In conclusion, PSA levels at a distant postoperative time and free T level after hormonal treatment may be biomarkers of cognitive function.
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Affiliation(s)
- Alicja Popiołek
- Department of Clinical Neuropsychology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland; (A.C.-T.); (A.B.); (M.B.)
- Department of Internal Diseases, Jan Biziel University Hospital No. 2 in Bydgoszcz, 85-163 Bydgoszcz, Poland;
- Correspondence: ; Tel.: +48-52-585-37-03
| | - Bartosz Brzoszczyk
- Department of Laparoscopic, General, and Oncological Urology, Jan Biziel University Hospital No. 2 in Bydgoszcz, 85-067 Bydgoszcz, Poland; (B.B.); (P.J.)
| | - Piotr Jarzemski
- Department of Laparoscopic, General, and Oncological Urology, Jan Biziel University Hospital No. 2 in Bydgoszcz, 85-067 Bydgoszcz, Poland; (B.B.); (P.J.)
| | - Aleksandra Chyrek-Tomaszewska
- Department of Clinical Neuropsychology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland; (A.C.-T.); (A.B.); (M.B.)
- Department of Internal Diseases, Jan Biziel University Hospital No. 2 in Bydgoszcz, 85-163 Bydgoszcz, Poland;
| | - Radosław Wieczór
- Department of Internal Diseases, Jan Biziel University Hospital No. 2 in Bydgoszcz, 85-163 Bydgoszcz, Poland;
| | - Alina Borkowska
- Department of Clinical Neuropsychology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland; (A.C.-T.); (A.B.); (M.B.)
| | - Maciej Bieliński
- Department of Clinical Neuropsychology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland; (A.C.-T.); (A.B.); (M.B.)
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25
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Ferraro S, Biganzoli EM. The clinical value of assessing the inter-method bias: the lesson from prostate specific antigen measurement. Clin Chem Lab Med 2021; 60:149-151. [PMID: 34751521 DOI: 10.1515/cclm-2021-1125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Simona Ferraro
- Department of Laboratory Medicine in Endocrinology Laboratory Unit, "Luigi Sacco" University Hospital, Milan, Italy
| | - Elia Mario Biganzoli
- Department of Biomedical and Clinical Sciences L. Sacco, Medical Statistics Unit, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
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26
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Ferraro S, Rossi RS, Biganzoli EM. Benefit-harm ratio of the diagnostic workup in patients with prostate cancer of Gleason score from 9 to 10. Cancer 2021; 127:4310-4311. [PMID: 34297849 DOI: 10.1002/cncr.33811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/06/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Simona Ferraro
- Endocrinology Laboratory Unit, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Ospedale Luigi Sacco, Milan, Italy
| | - Roberta S Rossi
- Pathological Anatomy Laboratory Unit, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Ospedale Luigi Sacco, Milan, Italy
| | - Elia M Biganzoli
- Giulio A. Maccacaro Laboratory of Medical Statistics, Biometry, and Epidemiology, Clinical Sciences and Community Health and Data Science Research Center, University of Milan, Milan, Italy
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