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Adetunji A, Venishetty N, Gombakomba N, Jeune KR, Smith M, Winer A. Genomics in active surveillance and post-prostatectomy patients: A review of when and how to use effectively. Curr Urol Rep 2024:10.1007/s11934-024-01219-3. [PMID: 38869692 DOI: 10.1007/s11934-024-01219-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE OF REVIEW Prostate cancer (PCa) represents a significant health burden globally, ranking as the most diagnosed cancer among men and a leading cause of cancer-related mortality. Conventional treatment methods such as radiation therapy or radical prostatectomy have significant side effects which often impact quality of life. As our understanding of the natural history and progression of PCa has evolved, so has the evolution of management options. RECENT FINDINGS Active surveillance (AS) has become an increasingly favored approach to the management of very low, low, and properly selected favorable intermediate risk PCa. AS permits ongoing observation and postpones intervention until definitive treatment is required. There are, however, challenges with selecting patients for AS, which further emphasizes the need for more precise tools to better risk stratify patients and choose candidates more accurately. Tissue-based biomarkers, such as ProMark, Prolaris, GPS (formerly Oncotype DX), and Decipher, are valuable because they improve the accuracy of patient selection for AS and offer important information on the prognosis and severity of disease. By enabling patients to be categorized according to their risk profiles, these biomarkers help physicians and patients make better informed treatment choices and lower the possibility of overtreatment. Even with their potential, further standardization and validation of these biomarkers is required to guarantee their broad clinical utility. Active surveillance has emerged as a preferred strategy for managing low-risk prostate cancer, and tissue-based biomarkers play a crucial role in refining patient selection and risk stratification. Standardization and validation of these biomarkers are essential to ensure their widespread clinical use and optimize patient outcomes.
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Affiliation(s)
- Adedayo Adetunji
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Nikit Venishetty
- Paul L. Foster School of Medicine, Texas Tech Health Sciences Center, El Paso, TX, USA
| | - Nita Gombakomba
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Karl-Ray Jeune
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Matthew Smith
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Andrew Winer
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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2
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Bernardino R, Sayyid RK, Leão R, Zlotta AR, van der Kwast T, Klotz L, Fleshner NE. Using active surveillance for Gleason 7 (3+4) prostate cancer: A narrative review. Can Urol Assoc J 2024; 18:135-144. [PMID: 38381936 PMCID: PMC11034964 DOI: 10.5489/cuaj.8539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
The interest in broadening the application of active surveillance (AS) has been increasing, encompassing patients who may not strictly adhere to the conventional criteria for low-risk prostate cancer (PCa), particularly those diagnosed with small-volume Gleason grade group 2 disease. Nonetheless, accurately identifying individuals with low intermediate-risk PCa who can safely undergo AS without facing disease progression remains a challenge.This review aims to delve into the progression of this evolving trend specifically within this cohort of men, while also examining strategies aimed at minimizing irreversible disease advancement. Additionally, we address the criteria for patient selection, recommended followup schedules, and the indicators prompting intervention.
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Affiliation(s)
- Rui Bernardino
- Division of Urology, Department of Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Computational and Experimental Biology Group, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Portugal
| | - Rashid K. Sayyid
- Division of Urology, Department of Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Alexandre R. Zlotta
- Division of Urology, Department of Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Theodorus van der Kwast
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Laurence Klotz
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Neil E. Fleshner
- Division of Urology, Department of Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
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3
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Peyrottes A, Rouprêt M, Fiard G, Fromont G, Barret E, Brureau L, Créhange G, Gauthé M, Baboudjian M, Renard-Penna R, Roubaud G, Rozet F, Sargos P, Ruffion A, Mathieu R, Beauval JB, De La Taille A, Ploussard G, Dariane C. [Early detection of prostate cancer: Towards a new paradigm?]. Prog Urol 2023; 33:956-965. [PMID: 37805291 DOI: 10.1016/j.purol.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/12/2023] [Indexed: 10/09/2023]
Abstract
Prostate cancer (PCa) is a public health issue. The diagnostic strategy for PCa is well codified and assessed by digital rectal examination, PSA testing and multiparametric MRI, which may or may not lead to prostate biopsies. The formal benefit of organized PCa screening, studied more than 10 years ago at an international scale and for all incomers, is not demonstrated. However, diagnostic and therapeutic modalities have evolved since the pivotal studies. The contribution of MRI and targeted biopsies, the widespread use of active surveillance for unsignificant PCa, the improvement of surgical techniques and radiotherapy… have allowed a better selection of patients and strengthened the interest for an individualized approach, reducing the risk of overtreatment. Aiming to enhance coverage and access to screening for the population, the European Commission recently promoted the evaluation of an organized PCa screening strategy, including MRI. The lack of screening programs has become detrimental to the population and must shift towards an early detection policy adapted to the risk of each individual.
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Affiliation(s)
- A Peyrottes
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, membre junior, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université de Paris, 20 rue Leblanc, 75015 Paris, France.
| | - M Rouprêt
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sorbonne university, GRC 5 Predictive Onco-Uro, AP-HP, urology, Pitié-Salpétrière hospital, 75013 Paris, France
| | - G Fiard
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of urology, Grenoble Alpes university hospital, université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - G Fromont
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of pathology, CHRU, 37000 Tours, France
| | - E Barret
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of urology, institut mutualiste Montsouris, Paris, France
| | - L Brureau
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of urology, CHU de Pointe-à-Pitre, university of Antilles, university of Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR S 1085, 97110 Pointe-à-Pitre, Guadeloupe
| | - G Créhange
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of radiotherapy, institut Curie, Paris, France
| | - M Gauthé
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sintep nuclear medicine, 38100 Grenoble, France
| | - M Baboudjian
- Department of urology, La Conception Hospital, Aix-Marseille University, AP-HM, Marseille, France
| | - R Renard-Penna
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sorbonne university, AP-HP, radiology, Pitie-Salpétrière hospital, 75013 Paris, France
| | - G Roubaud
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of medical oncology, institut Bergonié, 33000 Bordeaux, France
| | - F Rozet
- Sorbonne university, GRC 5 Predictive Onco-Uro, AP-HP, urology, Pitié-Salpétrière hospital, 75013 Paris, France; Department of urology, institut mutualiste Montsouris, Paris, France
| | - P Sargos
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of radiotherapy, institut Bergonié, 33000 Bordeaux, France
| | - A Ruffion
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, centre hospitalier Lyon Sud, hospices civils de Lyon, Lyon, France
| | - R Mathieu
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of urology, CHU de Rennes, Rennes, France
| | - J-B Beauval
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of urology, La Croix du Sud Hôpital, Quint-Fonsegrives, France
| | - A De La Taille
- Department of urology, university hospital Henri-Mondor, AP-HP, Créteil, France
| | - G Ploussard
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of urology, La Croix du Sud Hôpital, Quint-Fonsegrives, France
| | - C Dariane
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université de Paris, 20 rue Leblanc, 75015 Paris, France
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4
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Ahmadi E, Wang S, Gouran-Savadkoohi M, Douvi G, Isfahanian N, Tsakiridis N, Faught BE, Cutz JC, Sur M, Chawla S, Pond GR, Steinberg GR, Brown I, Tsakiridis T. Prostate-Specific Membrane Antigen (PSMA) Expression Predicts Need for Early Treatment in Prostate Cancer Patients Managed with Active Surveillance. Int J Mol Sci 2023; 24:16022. [PMID: 38003213 PMCID: PMC10671119 DOI: 10.3390/ijms242216022] [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: 09/24/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
Metabolic dysregulation is an early event in carcinogenesis. Here, we examined the expression of enzymes involved in de novo lipogenesis (ATP-citrate lyase: ACLY), glucose uptake (Glucose Transporter 1: GLUT1), and folate-glutamate metabolism (Prostate-Specific Membrane Antigen: PSMA) as potential biomarkers of risk for early prostate cancer progression. Patients who were managed initially on active surveillance with a Gleason score of 6 or a low-volume Gleason score of 7 (3 + 4) were accrued from a prostate cancer diagnostic assessment program. Patients were asked to donate their baseline diagnostic biopsy tissues and permit access to their clinical data. PSMA, GLUT1, and ACLY expression were examined with immunohistochemistry (IHC) in baseline biopsies, quantitated by Histologic Score for expression in benign and malignant glands, and compared with patient time remaining on active surveillance (time-on-AS). All three markers showed trends for elevated expression in malignant compared to benign glands, which was statistically significant for ACLY. On univariate analysis, increased PSMA and GLUT1 expression in malignant glands was associated with shorter time-on-AS (HR: 5.06, [CI 95%: 1.83-13.94] and HR: 2.44, [CI 95%: 1.10-5.44], respectively). Malignant ACLY and benign gland PSMA and GLUT1 expression showed non-significant trends for such association. On multivariate analysis, overexpression of PSMA in malignant glands was an independent predictor of early PC progression (p = 0.006). This work suggests that the expression of metabolic enzymes determined by IHC on baseline diagnostic prostate biopsies may have value as biomarkers of risk for rapid PC progression. PSMA may be an independent predictor of risk for progression and should be investigated further in systematic studies.
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Affiliation(s)
- Elham Ahmadi
- Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada; (E.A.); (S.W.); (M.G.-S.); (G.D.); (N.I.); (G.R.P.)
- Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada;
- Center for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Simon Wang
- Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada; (E.A.); (S.W.); (M.G.-S.); (G.D.); (N.I.); (G.R.P.)
- Center for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Mohammad Gouran-Savadkoohi
- Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada; (E.A.); (S.W.); (M.G.-S.); (G.D.); (N.I.); (G.R.P.)
| | - Georgia Douvi
- Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada; (E.A.); (S.W.); (M.G.-S.); (G.D.); (N.I.); (G.R.P.)
| | - Naghmeh Isfahanian
- Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada; (E.A.); (S.W.); (M.G.-S.); (G.D.); (N.I.); (G.R.P.)
| | - Nicole Tsakiridis
- Department of Health Sciences, Brock University, St. Catharines, ON L2S 3A1, Canada; (N.T.); (B.E.F.)
| | - Brent E. Faught
- Department of Health Sciences, Brock University, St. Catharines, ON L2S 3A1, Canada; (N.T.); (B.E.F.)
| | - Jean-Claude Cutz
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada; (J.-C.C.); (M.S.)
| | - Monalisa Sur
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada; (J.-C.C.); (M.S.)
| | - Satish Chawla
- Department of Laboratory Medicine, Niagara Health System, St. Catharines, ON L2S 0A9, Canada;
| | - Gregory R. Pond
- Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada; (E.A.); (S.W.); (M.G.-S.); (G.D.); (N.I.); (G.R.P.)
| | - Gregory R. Steinberg
- Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada;
- Center for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Ian Brown
- Department of Surgery, Niagara Health System, St. Catharines, ON L2S 0A9, Canada;
| | - Theodoros Tsakiridis
- Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada; (E.A.); (S.W.); (M.G.-S.); (G.D.); (N.I.); (G.R.P.)
- Center for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON L8S 4L8, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada; (J.-C.C.); (M.S.)
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5
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Zhan N, Wang J, Zhang S, Wu H, Li Z, Hu M. Development and Validation of a Urinary microRNA Biomarker Panel as a Tool for Early Detection of Prostate Cancer in a Chinese Population. Biomarkers 2023:1-11. [PMID: 37185057 DOI: 10.1080/1354750x.2023.2166587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Introduction: Urinary microRNAs (miRNAs) may serve as promising biomarkers for non-invasive early detection of prostate cancer (PCa). We aimed to identify multi-miRNA urinary biomarker panel for early detection of PCa. Methods: Urine samples from 83 PCa patients and 88 healthy control subjects in a Chinese population were collected for miRNA profiling. The absolute expression of 360 unique miRNAs were measured in each sample using a highly sensitive and robust RT-qPCR workflow. Candidate urinary miRNA biomarkers were identified based on differential expression between PCa patients and healthy controls. Multi-miRNA biomarker panels were optimized for detection of PCa using three regression algorithms (Lasso, Stepwise, Exhaustive) to identify an optimal biomarker panel with best detection performance and least number of miRNAs. Results: A total of 312 miRNAs were detected in urine samples, 10 candidate urinary miRNA biomarkers differentially expressed between PCa and healthy samples were identified. A panel comprising these 10 miRNAs detected PCa with an area under the curve (AUC) of 0.738. Optimization of multi-miRNA panels resulted in a 6-miRNA biomarker panel (hsa-miR-375, hsa-miR-520d-5p, hsa-miR-199b-5p, hsa-miR-518e-5p, hsa-miR-31-3p and hsa-miR-4306) that had an AUC of 0.750. Conclusion: We identified a urinary miRNA biomarker panel for early detection of PCa in a Chinese population.
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Affiliation(s)
- Nan Zhan
- The second Affiliated Hospital of Medical College of Zhejiang University, No. 88 Jiefang Road, Shangcheng District, Hangzhou, Zhejiang, China
| | - Jianfeng Wang
- Hangzhou Ninth People's Hospital, No. 98 Yilong Road, Yipeng Street, Qiantang District, Hangzhou, Zhejiang, China
| | - Shigeng Zhang
- The second Affiliated Hospital of Medical College of Zhejiang University, No. 88 Jiefang Road, Shangcheng District, Hangzhou, Zhejiang, China
| | - Huifeng Wu
- The second Affiliated Hospital of Medical College of Zhejiang University, No. 88 Jiefang Road, Shangcheng District, Hangzhou, Zhejiang, China
| | - Zhongyi Li
- The second Affiliated Hospital of Medical College of Zhejiang University, No. 88 Jiefang Road, Shangcheng District, Hangzhou, Zhejiang, China
| | - Maolin Hu
- The second Affiliated Hospital of Medical College of Zhejiang University, No. 88 Jiefang Road, Shangcheng District, Hangzhou, Zhejiang, China
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Thankapannair V, Keates A, Barrett T, Gnanapragasam VJ. Prospective Implementation and Early Outcomes of a Risk-stratified Prostate Cancer Active Surveillance Follow-up Protocol. EUR UROL SUPPL 2023; 49:15-22. [PMID: 36874604 PMCID: PMC9975013 DOI: 10.1016/j.euros.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 01/26/2023] Open
Abstract
Background Active surveillance (AS) is a major management option for men with early prostate cancer. Current guidelines however advocate identical AS follow-up for all without considering different disease trajectories. We previously proposed a pragmatic three-tier STRATified CANcer Surveillance (STRATCANS) follow-up strategy based on different progression risks from clinic-pathological and imaging features. Objective To report early outcomes from the implementation of the STRATCANS protocol in our centre. Design setting and participants Men on AS were enrolled into a prospective stratified follow-up programme. Intervention Three tiers of increasing follow-up intensity based on National Institute for Health and Care Excellence (NICE): Cambridge Prognostic Group (CPG) 1 or 2, prostate-specific antigen density, and magnetic resonance imaging (MRI) Likert score at entry. Outcome measurements and statistical analysis Rates of progression to CPG ≥3, any pathological progression, AS attrition, and patient choice for treatment were assessed. Differences in progression were compared with chi-square statistics. Results and limitations Data from 156 men (median age 67.3 yr) were analysed. Of these, 38.4% had CPG2 disease and 27.5% had grade group 2 disease at diagnosis. The median time on AS was 4 yr (interquartile range 3.2-4.9) and 1.5 yr on STRATCANS. Overall, 135/156 (86.5%) men remained on AS or converted to watchful waiting and 6/156 (3.8%) stopped AS by choice by the end of the evaluation period. Of the 156 patients, 66 (42.3%) were allocated to STRATCANS 1 (least intense follow-up), 61 (39.1%) to STRATCANS 2, and 29 (18.6%) to STRATCANS 3 (highest intensity). By increasing STRATCANS tier, progression rates to CPG ≥3 and any progression events were 0% and 4.6%, 3.4% and 8.6%, and 7.4% and 22.2%, respectively (p = 0.019). Modelling resource usage suggested potential reductions in appointments by 22% and MRI by 42% compared with current NICE guideline recommendations (first 12 months of AS). The study is limited by short follow-up, a relatively small cohort, and being single centre. Conclusions A simple risk-tiered AS strategy is possible with early outcomes supporting stratified follow-up intensity. STRATCANS implementation could de-escalate follow-up in men at a low risk of progression while husbanding resources for those who need closer follow-up. Patient summary We report a practical way to personalise follow-up for men on active surveillance for early prostate cancer. Our method may allow reductions in the follow-up burden for men at a low risk of disease change while maintaining vigilance for those at a higher risk.
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Affiliation(s)
- Vineetha Thankapannair
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Alexandra Keates
- Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - Tristan Barrett
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Vincent J Gnanapragasam
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK.,Division of Urology, Department of Surgery, University of Cambridge, Cambridge, UK
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7
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Pattenden TA, Samaranayke D, Morton A, Ong WL, Murphy DG, Pritchard E, Evans S, Millar J, Chalasani V, Rashid P, Winter M, Vela I, Pryor D, Mark S, Lawrentschuk N, Thangasamy IA. Modern Active Surveillance in Prostate Cancer: A Narrative Review. Clin Genitourin Cancer 2023; 21:115-123. [PMID: 36443163 DOI: 10.1016/j.clgc.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 08/29/2022] [Accepted: 09/03/2022] [Indexed: 02/01/2023]
Abstract
The use of PSA screening has led to downstaging and downgrading of prostate cancer at diagnosis, increasing detection of indolent disease. Active surveillance aims to reduce over-treatment by delaying or avoiding radical treatment and its associated morbidity. However, there is not a consensus on the selection criteria and monitoring schedules that should be used. This article aims to summarize the evidence supporting the safety of active surveillance, the current selection criteria recommended and in use, the incidence of active surveillance, barriers existing to its uptake and future developments in patient selection.
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Affiliation(s)
| | - Dhanika Samaranayke
- Department of Urology, Ipswich Hospital, QLD, Australia; Faculty of Medicine, University of Queensland, QLD, Australia
| | - Andrew Morton
- Department of Urology, Ipswich Hospital, QLD, Australia; Faculty of Medicine, University of Queensland, QLD, Australia
| | - Wee Loon Ong
- Alfred Health Radiation Oncology Service, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, VIC, Australia; School of Clinical Medicine, University of Cambridge, UK
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, VIC, Australia
| | - Elizabeth Pritchard
- Department of Epidemiology and Preventive Medicine, Monash University, VIC, Australia
| | - Susan Evans
- Department of Epidemiology and Preventive Medicine, Monash University, VIC, Australia
| | - Jeremy Millar
- Alfred Health Radiation Oncology Service, VIC, Australia; Central Clinical School, Monash University, VIC, Australia
| | - Venu Chalasani
- Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Prem Rashid
- Rural Clinical School, Faculty of Medicine, University of New South Wales, Australia
| | - Matthew Winter
- Nepean Urology Research Group, Nepean Hospital, NSW, Australia
| | - Ian Vela
- Department of Urology, Princess Alexandra Hospital, QLD, Australia; Australian Prostate Cancer Research Centre, Queensland and The Queensland Bladder Cancer Initiative, School of Biomedical Science, Faculty of Health, Queensland University of Technology, QLD, Australia
| | - David Pryor
- Department of Radiation Oncology, Princess Alexandra Hospital, QLD, Australia
| | - Stephen Mark
- Department of Urology, Christchurch Hospital, New Zealand
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, VIC, Australia; EJ Whitten Prostate Cancer Research Centre, Epworth, VIC, Australia
| | - Isaac A Thangasamy
- Faculty of Medicine, University of Queensland, QLD, Australia; Nepean Urology Research Group, Nepean Hospital, NSW, Australia
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8
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Kling A, Dirscherl L, Dittrich PS. Laser-assisted protein micropatterning in a thermoplastic device for multiplexed prostate cancer biomarker detection. LAB ON A CHIP 2023; 23:534-541. [PMID: 36642981 PMCID: PMC9890490 DOI: 10.1039/d2lc00840h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
Immunoassays are frequently used for analysis of protein biomarkers. The specificity of antibodies enables parallel analysis of several target proteins, at the same time. However, the implementation of such multiplexed assays into cost-efficient and mass-producible thermoplastic microfluidic platforms remains difficult due to the lack of suitable immobilization strategies for different capture antibodies. Here, we introduce and characterize a method to functionalize the surfaces of microfluidic devices manufactured in the thermoplastic material cyclic olefin copolymer (COC) by a rapid prototyping process. A laser-induced immobilization process enables the surface patterning of anchor biomolecules at a spatial resolution of 5 μm. We employ the method for the analysis of prostate cancer associated biomarkers by competitive immunoassays in a microchannel with a total volume of 320 nL, and successfully detected the proteins PSA, CRP, CEA and IGF-1 at clinically relevant concentrations. Finally, we also demonstrate the simultaneous analysis of three markers spiked into undiluted human plasma. In conclusion, this method opens the way to transfer multiplexed immunoassays into mass-producible microfluidic platforms that are suitable for point of care applications.
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Affiliation(s)
- André Kling
- Department of Biosystems Science and Engineering, ETH Zurich, Mattenstrasse 26, CH-4058 Basel, Switzerland.
| | - Lorin Dirscherl
- Department of Biosystems Science and Engineering, ETH Zurich, Mattenstrasse 26, CH-4058 Basel, Switzerland.
| | - Petra S Dittrich
- Department of Biosystems Science and Engineering, ETH Zurich, Mattenstrasse 26, CH-4058 Basel, Switzerland.
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Expanding Active Surveillance Criteria for Low- and Intermediate-risk Prostate Cancer: Can We Accurately Predict the Risk of Misclassification for Patients Diagnosed by Multiparametric Magnetic Resonance Imaging–targeted Biopsy? Eur Urol Focus 2022; 9:298-302. [PMID: 36210296 DOI: 10.1016/j.euf.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/29/2022] [Accepted: 09/23/2022] [Indexed: 11/24/2022]
Abstract
Models predicting the risk of adverse pathology (ie, International Society of Urological Pathology [ISUP] grade group ≥3, pT3, and/or pN1) among patients operated by radical prostatectomy (RP) have been proposed to expand active surveillance (AS) inclusion criteria. We aimed to test these models in a set of 1062 low-risk and favorable intermediate-risk prostate cancer (PCa) patients diagnosed by multiparametric magnetic resonance imaging (MRI) and MRI-targeted biopsy. We hypothesized that the inclusion of radiological features into a novel model would improve patient selection. Performance was assessed using discrimination, calibration, and decision curve analysis (DCA). Available models were characterized by poor discrimination (areas under the receiver operating characteristic curve [AUCs] of 59% and 60%), underestimation of predicted risk on calibration plots, and a small amount of net benefit against a probability threshold of 40-50% at the DCA. The development of a novel model slightly improved discrimination (AUC of 63% vs 59%, p = 0.001, and 63% vs 60%, p = 0.07) and net benefit against threshold probabilities of ≥30%. This first multicenter study demonstrated the poor performance of models predicting adverse pathology and that implementation of MRI and MRI-targeted biopsy in this setting was not associated with a clear improvement in patient selection. Patients harboring low-risk or favorable intermediate-risk PCa and candidates for RP cannot be referred accurately to an AS program without a non-negligible risk of misclassification. PATIENT SUMMARY: We tested prediction models that could expand the selection of prostate cancer patients for active surveillance. Models were inaccurate and associated with a high risk of misclassification despite the implementation of multiparametric magnetic resonance imaging and targeted biopsies.
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Active Surveillance in Intermediate-Risk Prostate Cancer: A Review of the Current Data. Cancers (Basel) 2022; 14:cancers14174161. [PMID: 36077698 PMCID: PMC9454661 DOI: 10.3390/cancers14174161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 11/18/2022] Open
Abstract
Simple Summary AS is an option for the initial management of selected patients with intermediate-risk PC. The proper way to predict which men will have an aggressive clinical course or indolent PC who would benefit from AS has not been unveiled. Genetics and MRI can help in the decision-making, but it remains unclear which men would benefit from which tests. In addition, there are several differences between AS protocols in inclusion criteria, monitoring follow-up, and triggers for active treatment. Large series and a few RCTs are under investigation, and more research is needed to establish an optimal therapeutic strategy for patients with intermediate-risk PC. This study summarizes the current data on patients with intermediate-risk PC under AS, recent findings, and discusses future directions. Abstract Active surveillance (AS) is a monitoring strategy to avoid or defer curative treatment, minimizing the side effects of radiotherapy and prostatectomy without compromising survival. AS in intermediate-risk prostate cancer (PC) has increasingly become used. There is heterogeneity in intermediate-risk PC patients. Some of them have an aggressive clinical course and require active treatment, while others have indolent disease and may benefit from AS. However, intermediate-risk patients have an increased risk of metastasis, and the proper way to select the best candidates for AS is unknown. In addition, there are several differences between AS protocols in inclusion criteria, monitoring follow-up, and triggers for active treatment. A few large series and randomized trials are under investigation. Therefore, more research is needed to establish an optimal therapeutic strategy for patients with intermediate-risk disease. This study summarizes the current data on patients with intermediate-risk PC under AS, recent findings, and discusses future directions.
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11
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Risk of progression following a negative biopsy in prostate cancer active surveillance. Prostate Cancer Prostatic Dis 2022:10.1038/s41391-022-00582-x. [PMID: 36008540 DOI: 10.1038/s41391-022-00582-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/26/2022] [Accepted: 08/01/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Currently, follow-up protocols are applied equally to men on active surveillance (AS) for prostate cancer (PCa) regardless of findings at their initial follow-up biopsy. To determine whether less intensive follow-up is suitable following negative biopsy findings, we assessed the risk of converting to active treatment, any subsequent upgrading, volume progression (>33% positive cores), and serious upgrading (grade group >2) for negative compared with positive findings on initial follow-up biopsy. METHODS 13,161 men from 24 centres participating in the Global Action Plan Active Surveillance Prostate Cancer [GAP3] consortium database, with baseline grade group ≤2, PSA ≤ 20 ng/mL, cT-stage 1-2, diagnosed after 1995, and ≥1 follow-up biopsy, were included in this study. Risk of converting to treatment was assessed using multivariable mixed-effects survival regression. Odds of volume progression, any upgrading and serious upgrading were assessed using mix-effects binary logistic regression for men with ≥2 surveillance biopsies. RESULTS 27% of the cohort (n = 3590) had no evidence of PCa at their initial biopsy. Over 50% of subsequent biopsies in this group were also negative. A negative initial biopsy was associated with lower risk of conversion (adjusted hazard ratio: 0.45; 95% confidence interval [CI]: 0.42-0.49), subsequent upgrading (adjusted odds ratio [OR]: 0.52; 95%CI: 0.45-0.62) and serious upgrading (OR: 0.74; 95%CI: 0.59-92). Radiological progression was not assessed due to limited imaging data. CONCLUSION Despite heterogeneity in follow-up schedules, findings from this global study indicated reduced risk of converting to treatment, volume progression, any upgrading and serious upgrading among men whose initial biopsy findings were negative compared with positive. Given the low risk of progression and high likelihood of further negative biopsy findings, consideration should be given to decreasing follow-up intensity for this group to reduce unnecessary invasive biopsies.
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12
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Combined miR-486 and GP88 (Progranulin) Serum Levels Are Suggested as Supportive Biomarkers for Therapy Decision in Elderly Prostate Cancer Patients. Life (Basel) 2022; 12:life12050732. [PMID: 35629399 PMCID: PMC9143270 DOI: 10.3390/life12050732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
Abstract
Our study aimed to assess the applicability of miR-486 in combination with soluble GP88 protein as a diagnostic and/or predictive biomarker for prostate cancer (PCa) patients. miR-486 and GP88 levels in serum samples from 136 patients undergoing MRI-guided biopsy of the prostate were assessed by qRT−PCR and ELISA, respectively. Of these, 86 patients received a histologically confirmed diagnosis of PCa. Neither marker showed an association with the diagnosis of cancer. PCa patients were separated based on (i) treatment into patients with active surveillance or patients with any type of curative treatment and (ii) age into elderly (>68 years) patients and younger patients (≤68 years). In elderly patients (N = 41) with the intention of curative treatment at optimized cut-off values, significantly higher GP88 levels (p = 0.018) and lower miR-486 levels (p = 0.014) were observed. The total PSA level and ISUP biopsy grade were used in a baseline model for predicting definitive therapy. The baseline model exhibited an area under the curve (AUC) of 0.783 (p = 0.005). The addition of the serum biomarkers miR-486 and GP88 to the baseline model yielded an improved model with an AUC of 0.808 (p = 0.002). Altogether, combined miR-486 and GP88 serum levels are associated with and are therefore suggested as supportive biomarkers for therapy decisions, particularly in elderly PCa patients.
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Russell JR, Siddiqui MM. Active surveillance in favorable intermediate risk prostate cancer: outstanding questions and controversies. Curr Opin Oncol 2022; 34:219-227. [PMID: 35266907 DOI: 10.1097/cco.0000000000000827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Active surveillance has become the preferred management strategy for patients with low risk prostate cancer, but it is unclear if active surveillance can be safely extended to favorable intermediate risk (FIR) prostate cancer patients. Furthermore, defining a favorable intermediate risk prostate cancer population safe for active surveillance remains elusive due to paucity of high-level data in this population. This article serves to review relevant data, particularly the safety of active surveillance in grade group 2 patients, and what tools are available to aid in selecting a favorable subset of intermediate risk patients. RECENT FINDINGS Active surveillance studies with long-term data appear to report worsened survival outcomes in intermediate risk patients when compared to those undergoing definitive treatment, but there exists a subset of intermediate risk patients with nearly equivalent outcomes to low risk patients on active surveillance. Tools such as percentage and total length of Gleason pattern 4, tumor volume, prostate specific antigen density, magnetic resonance imaging, and genomic modifiers may help to select a favorable subset of intermediate risk prostate cancer appropriate for active surveillance. SUMMARY Active surveillance is a viable strategy in select patients with low volume group grade 2 (GG2) prostate cancer. Prospective and retrospective data in the FIR population appear to be mostly favorable in regards to survival outcomes, but there exists some heterogeneity with respect to long-term outcomes in this patient population.
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Affiliation(s)
- J Ryan Russell
- Division of Urology, Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
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14
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Personalized 3-Gene Panel for Prostate Cancer Target Therapy. Curr Issues Mol Biol 2022; 44:360-382. [PMID: 35723406 PMCID: PMC8929157 DOI: 10.3390/cimb44010027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 11/17/2022] Open
Abstract
Many years and billions spent for research did not yet produce an effective answer to prostate cancer (PCa). Not only each human, but even each cancer nodule in the same tumor, has unique transcriptome topology. The differences go beyond the expression level to the expression control and networking of individual genes. The unrepeatable heterogeneous transcriptomic organization among men makes the quest for universal biomarkers and “fit-for-all” treatments unrealistic. We present a bioinformatics procedure to identify each patient’s unique triplet of PCa Gene Master Regulators (GMRs) and predict consequences of their experimental manipulation. The procedure is based on the Genomic Fabric Paradigm (GFP), which characterizes each individual gene by the independent expression level, expression variability and expression coordination with each other gene. GFP can identify the GMRs whose controlled alteration would selectively kill the cancer cells with little consequence on the normal tissue. The method was applied to microarray data on surgically removed prostates from two men with metastatic PCas (each with three distinct cancer nodules), and DU145 and LNCaP PCa cell lines. The applications verified that each PCa case is unique and predicted the consequences of the GMRs’ manipulation. The predictions are theoretical and need further experimental validation.
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Yue W, Du X, Wang X, Gui N, Zhang W, Sun J, You J, He D, Geng X, Huang Y, Hou J. Prognostic values of the core components of the mammalian circadian clock in prostate cancer. PeerJ 2021; 9:e12539. [PMID: 34966582 PMCID: PMC8667750 DOI: 10.7717/peerj.12539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/04/2021] [Indexed: 12/24/2022] Open
Abstract
Background Prostate cancer (PC) is one of the most common malignancies in males. Extensive and complex connections between circadian rhythm and cancer were found. Nonetheless, in PC, the potential role of the core components of the mammalian circadian clock (CCMCCs) in prognosis prediction has not been fully clarified. Methods We firstly collected 605 patients with PC from The Cancer Genome Atlas (TCGA) and the Gene Expression Omnibus (GEO) databases. Survival analysis was carried out for each CCMCC. Then, we investigated the prognostic ability of CCMCCs by Cox regression analysis. Independent prognostic signatures were extracted for the establishment of the circadian clock-based risk score model. We explored the predictive performance of the risk score model in the TCGA training cohort and the independent GEO dataset. Finally, the relationships between risk score and clinicopathological parameters, biological processes, and signaling pathways were evaluated. Results The expression levels of CCMCCs were widely correlated with age, tumor status, lymph node status, disease-free survival (DFS), progression-free survival (PFS), and overall survival (OS). Nine circadian clock genes, including CSNK1D, BTRC, CLOCK, CSNK1E, FBXL3, PRKAA2, DBP, NR1D2, and RORB, were identified as vital prognostic factors in PC and were used to construct the circadian clock-based risk score model. For DFS, the area under the 3-year or 5-year receiver operating characteristic curves ranged from 0.728 to 0.821, suggesting better predictive performance. When compared with T3-4N1 stage, PC patients at T2N0 stage might be benefited more from the circadian clock-based risk score model. Furthermore, a high circadian clock-based risk score indicated shorter DFS (p < 0.0001), early progression (p < 0.0001), and higher 5-year death rate (p = 0.007) in PC. The risk score was related to tumor status (p < 0.001), lymph node status (p < 0.001), and ribosome-related biogenesis and pathways. Conclusions The vital roles of circadian clock genes in clinical outcomes were fully depicted. The circadian clock-based risk score model could reflect and predict the prognosis of patients with PC.
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Affiliation(s)
- Wenchang Yue
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiao Du
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuhong Wang
- Department of Urology, Tongcheng people's Hospital, Tongcheng, China
| | - Niu Gui
- General Surgery Ward 2, Fengtaixian Hospital of Chinese Medicine, Huainan, China
| | - Weijie Zhang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiale Sun
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiawei You
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Dong He
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xinyu Geng
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuhua Huang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jianquan Hou
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
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