PSA, PSA derivatives, proPSA and prostate health index in the diagnosis of prostate cancer

Unveiling the intricate connection between per- and polyfluoroalkyl substances and prostate hyperplasia

The presence of perfluoroalkyl and polyfluoroalkyl substances (PFAS) in various everyday products has raised concerns about their potential impact on prostate health. This study aimed to investigate the effects of different types of PFAS on prostate health, including PFDeA, PFOA, PFOS, PFHxS, and PFNA. To assess the relationship between PFAS exposure and prostate injury, machine learning algorithms were employed to analyze prostate-specific antigen (PSA) metrics. The analysis revealed a linear and positive dose-dependent association between PFOS and the ratio of free PSA to total PSA (f/tPSA). Non-linear dose-response relationships were observed between the other four types of PFAS and the f/tPSA ratio. Additionally, the analysis showed a positive association between the mixture of PFAS and prostate hyperplasia, with PFNA having the highest impact followed by PFOS. These findings suggest that elevated serum levels of PFDeA, PFOA, PFOS, and PFNA are linked to prostate hyperplasia. Therefore, this study utilized advanced machine learning techniques to uncover potential hazardous effects of PFAS exposure on prostate health, specifically the positive association between PFAS and prostate hyperplasia.

Multiplexed quantitative proteomics in prostate cancer biomarker development

Prostate cancer (PCa) is the most common non-skin cancer among men in the United States. However, the widely used protein biomarker in PCa, prostate-specific antigen (PSA), while useful for initial detection, its use alone cannot detect aggressive PCa and can lead to overtreatment. This chapter provides an overview of PCa protein biomarker development. It reviews the state-of-the-art liquid chromatography-mass spectrometry-based proteomics technologies for PCa biomarker development, such as enhancing the detection sensitivity of low-abundance proteins through antibody-based or antibody-independent protein/peptide enrichment, enriching post-translational modifications such as glycosylation as well as information-rich extracellular vesicles, and increasing accuracy and throughput using advanced data acquisition methodologies. This chapter also summarizes recent PCa biomarker validation studies that applied those techniques in diverse specimen types, including cell lines, tissues, proximal fluids, urine, and blood, developing novel protein biomarkers for various clinical applications, including early detection and diagnosis, prognosis, and therapeutic intervention of PCa.

Clinical assessment of TGFB1 and HP Relative Gene Expression in the Peripheral Blood of Prostate Cancer Patients

OBJECTIVE

This study aimed to assess the relative gene expression level of transforming growth factor-β1 (TGFB1) and haptoglobin (HP) in the peripheral blood of prostate cancer (PCa) patients and evaluate their diagnostic ability.

METHODS

A total of 125 participants were enrolled in the present study. Among them, 75 PCa patients, 25 benign prostatic hyperplasia (BPH) patients, and 25 healthy volunteers served as the control group. The relative TGFB1 and HP gene expression level was quantified using real-time polymerase chain reaction. Further, free and total PSA levels were determined using electrochemiluminescence assays.

RESULTS

TGFB1 was significantly over-expressed, whereas HP was significantly downregulated in the peripheral blood of PCa patients compared to BPH and control groups (p-value ranges from 0.034 to <0.001). Moreover, the high expression level of TGFB1 was associated with an increased risk of PCa development with OR=1.412 (95%CI: 1.081-1.869, p= 0.012). TGFB1 and HP relative expression levels had lower diagnostic performance to differentiate PCa from normal and BPH individuals compared to PSA, however, the combination of the tested parameters improved the diagnostic efficacy.

CONCLUSIONS

TGFB1 and HP relative expression have moderate diagnostic efficacy in discriminating patients with PCa from BPH and healthy subjects. Furthermore, over-expression of TGFB1 may contribute to the pathogenesis of PCa.

A current role status of micro-ultrasound imaging in prostate cancer diagnosis

 Recently diagnostic field in medicine was enriched by advances in ultrasonography (US) technology, which led to establishment of novel modalities, one of which is micro-ultrasound. Results demonstrated by early studies have been promising, simultaneously rising a question if those new modalities could become an alternative in diagnosis of prostatic carcinoma (PCa). To answer this question, several studies have been conducted where micro-ultrasound have been compared to standard diagnostic tools, such as conventional TRUS or mpMRI. Nevertheless, new technology presents with some limitations, which include inconsistent results, necessity for specialized equipment, need of training for investigators to understand the findings, and external validation. In this publication, we have identified studies that provided evaluation of the accuracy and efficiency of the micro-ultrasound technology. Additionally, analysis of the results provided a better understanding of the novel imaging tool when compared standard modalities in diagnosis of PCa. Increasing number of studies demonstrated that micro-ultrasound carries high detection rate of PCa and clinically significant prostatic cancer (csPCa), suggesting a similar performance to mpMRI and even showing superiority over conventional TRUS. Recent studies have also showed that micro-ultrasound takes active role in improving the detection of csPCa and guidance for prostate biopsy (PBx) as well as further treatment. Moreover, certain practical aspects such as lower costs, decreased waiting time, real-time imaging and application of the imaging tool for patients that are not suitable for mpMRI (contrast allergy, prosthetics etc.) are significant advantages. Analysis of the results still does not provide clear answer whether micro-ultrasound outperforms mpMRI. Further studies are necessary in order to completely understand the potential of this new technology.

Machine learning-based prediction model and visual interpretation for prostate cancer

BACKGROUND

Most prostate cancers(PCa) rely on serum prostate-specific antigen (PSA) testing for biopsy confirmation, but the accuracy needs to be further improved. We need to continue to develop PCa prediction model with high clinical application value.

METHODS

Benign prostatic hyperplasia (BPH) and prostate cancer data were obtained from the Chinese National Clinical Medical Science Data Center for retrospective analysis. The model was constructed using the XGBoost algorithm, and patients' age, body mass index (BMI), PSA-related parameters and serum biochemical parameters were used as model variables. Using decision analysis curve (DCA) to evaluate the clinical utility of the models. The shapley additive explanation (SHAP) framework was used to analyze the importance ranking and risk threshold of the variables.

RESULTS

A total of 1915 patients were included in this study, including 823 (43.0%) were BPH patients and 1092 (57.0%) were PCa patients. The XGBoost model provided better performance (AUC 0.82) compared with f/tPSA (AUC 0.75),tPSA (AUC 0.68) and fPSA (AUC 0.61), respectively. Based on SHAP values, f/tPSA was the most important variable, and the top five most important biochemical parameter variables were inorganic phosphorus (P), potassium (K), creatine kinase MB isoenzyme (CKMB), low-density lipoprotein cholesterol (LDL-C), and creatinine (Cre). PCa risk thresholds for these risk markers were f/tPSA (0.13), P (1.29 mmol/L), K (4.29 mmol/L), CKMB ( 11.6U/L), LDL-C (3.05mmol/L) and Cre (74.5-99.1umol/L).

CONCLUSION

The present model has advantages of wide-spread availability and high net benefit, especially for underdeveloped countries and regions. Furthermore, these risk thresholds can assist in the diagnosis and screening of prostate cancer in clinical practice.

Comparison of Serum Gamma Glutamyl Transferase Levels between Prostate Cancer Patients and Their Healthy Peers

Background

Prostate cancer (PCa) is the most common cancer affecting men, apart from cutaneous cancers. Serum prostate specific antigen (PSA) levels are frequently used to predict prostate cancer diagnosis. However, many causes (e.g., prostatitis, benign prostate obstruction, urethral catheterization) may cause elevated PSA, in addition to PCa. We aimed to investigate the gamma glutamyl transferase (GGT) levels, a serum biomarker not affected by situations other than cancer causing elevated PSA.

Methods

The study evaluated male patients with prostate biopsy due to high serum PSA levels and/or abnormal digital rectal examination (DRE) examined in Ordu University Education and Research Hospital, Ordu/Turkey urology clinic from April 2019 to April 2021. The patient group in the study included 261 men with PCa diagnosis and the control group included 245 healthy men with normal PSA levels, and no PCa and/or benign prostate obstruction (BPO). The two groups were compared in terms of serum GGT levels.

Results

GGT was significantly low in the PCa group and might be a predictor in terms of PCa (P=0.000). In the malignant (PCa) group, the GGT cut-off value was identified as 21.5 (sensitivity 68.6%, specificity 54.4%).

Conclusion

Serum GGT levels might assist in diagnosis of PCa. However, diagnostic power is weak due to low specificity. There is a need for studies investigating the efficacy of GGT levels for prediction of PCa diagnosis and assessing other parameters alongside GGT.

Ki67 and the apparent diffusion coefficient in postoperative prostate cancer with endocrine therapy

Background

Prostate-specific antigen (PSA) is a critical part of prostate cancer (PCa) screening, diagnosis, staging, and prognosis. However, elevated PSA levels can also be caused by several external factors. To improve the specificity and sensitivity of PSA in clinical practice, we explored whether markers or parameters may be used as prognostic targets for PCa by long-term follow-up.

Methods

A total of 121 PCa patients who underwent laparoscopic radical prostatectomy (LRP) were included in our study, all of whom underwent imaging and preoperative pathological diagnosis. Endocrine therapy has long been applied to treat postoperative patients. The prognosis of enrolled patients was followed, and statistics were collected. Spearman's correlation analysis was applied to examine the relationship and clinical parameters. Kaplan–Meier analysis was used to process the clinical variables of PCa patients. Cox proportional hazards regression analysis was applied to examine univariate and multivariate variables.

Results

The Gleason score (GS), PSA, clinical stage, nerve infiltration, organ confinement, Ki67 and apparent diffusion coefficient (ADC) were significantly associated with prognosis (all P &lt; 0.05). The GS, PSA, clinical stage, organ confined, Ki67, nerve infiltration and ADC were included in the multivariate analysis (all P &lt; 0.05). Ultimately, Ki67 and the ADC were found to provide meaningful predictive information (both P &lt; 0.05).

Conclusions

Ki67 and the ADC may be clinically and analytically valid prognostic biomarkers and imaging parameters in PCa. They may be useful for predicting the prognosis and risk of PCa patients undergoing postoperative routine endocrine therapy.

The Role and Significance of Bioumoral Markers in Prostate Cancer

The prostate is one of the most clinically accessible internal organs of the genitourinary tract in men. For decades, the only method of screening for prostate cancer (PCa) has been digital rectal examination of 1990s significantly increased the incidence and prevalence of PCa and consequently the morbidity and mortality associated with this disease. In addition, the different types of oncology treatment methods have been linked to specific complications and side effects, which would affect the patient's quality of life. In the first two decades of the 21st century, over-detection and over-treatment of PCa patients has generated enormous costs for health systems, especially in Europe and the United States. The Prostate Specific Antigen (PSA) is still the most common and accessible screening blood test for PCa, but with low sensibility and specificity at lower values (<10 ng/mL). Therefore, in order to avoid unnecessary biopsies, several screening tests (blood, urine, or genetic) have been developed. This review analyzes the most used bioumoral markers for PCa screening and also those that could predict the evolution of metastases of patients diagnosed with PCa.

Tissue- and Liquid-Based Biomarkers in Prostate Cancer Precision Medicine

Worldwide, prostate cancer (PC) is the second-most-frequently diagnosed male cancer and the fifth-most-common cause of all cancer-related deaths. Suspicion of PC in a patient is largely based upon clinical signs and the use of prostate-specific antigen (PSA) levels. Although PSA levels have been criticised for a lack of specificity, leading to PC over-diagnosis, it is still the most commonly used biomarker in PC management. Unfortunately, PC is extremely heterogeneous, and it can be difficult to stratify patients whose tumours are unlikely to progress from those that are aggressive and require treatment intensification. Although PC-specific biomarker research has previously focused on disease diagnosis, there is an unmet clinical need for novel prognostic, predictive and treatment response biomarkers that can be used to provide a precision medicine approach to PC management. In particular, the identification of biomarkers at the time of screening/diagnosis that can provide an indication of disease aggressiveness is perhaps the greatest current unmet clinical need in PC management. Largely through advances in genomic and proteomic techniques, exciting pre-clinical and clinical research is continuing to identify potential tissue, blood and urine-based PC-specific biomarkers that may in the future supplement or replace current standard practices. In this review, we describe how PC-specific biomarker research is progressing, including the evolution of PSA-based tests and those novel assays that have gained clinical approval. We also describe alternative diagnostic biomarkers to PSA, in addition to biomarkers that can predict PC aggressiveness and biomarkers that can predict response to certain therapies. We believe that novel biomarker research has the potential to make significant improvements to the clinical management of this disease in the near future.

Blood-Derived Biomarkers of Diagnosis, Prognosis and Therapy Response in Prostate Cancer Patients

Prostate cancer is among the most frequent cancers in men worldwide. Despite the fact that multiple therapeutic alternatives are available for its treatment, it is often discovered in an advanced stage as a metastatic disease. Prostate cancer screening is based on physical examination of prostate size and prostate-specific antigen (PSA) level in the blood as well as biopsy in suspect cases. However, these markers often fail to correctly identify the presence of cancer, or their positivity might lead to overdiagnosis and consequent overtreatment of an otherwise silent non-progressing disease. Moreover, these markers have very limited if any predictive value regarding therapy response or individual risk for therapy-related toxicities. Therefore, novel, optimally liquid biopsy-based (blood-derived) markers or marker panels are needed, which have better prognostic and predictive value than the ones currently used in the everyday routine. In this review the role of circulating tumour cells, extracellular vesicles and their microRNA content, as well as cellular and soluble immunological and inflammation- related blood markers for prostate cancer diagnosis, prognosis and prediction of therapy response is discussed. A special emphasis is placed on markers predicting response to radiotherapy and radiotherapy-related late side effects.

Pseudouridine as a novel biomarker in prostate cancer

Epitranscriptomic analysis has recently led to the profiling of modified nucleosides in cancer cell biological matrices, helping to elucidate their functional roles in cancer and reigniting interest in exploring their use as potential markers of cancer development and progression. Pseudouridine, one of the most well-known and the most abundant of the RNA nucleotide modifications, is the C5-glycoside isomer of uridine and its distinctive physiochemical properties allows it to perform many essential functions. Pseudouridine functionally (a) confers rigidity to local RNA structure by enhancing RNA stacking, engaging in a cooperative effect on neighboring nucleosides that overall contributes to RNA stabilization (b) refines the structure of tRNAs, which influences their decoding activity (c) facilitates the accuracy of decoding and proofreading during translation and efficiency of peptide bond formation, thus collectively improving the fidelity of protein biosynthesis and (e) dynamically regulates mRNA coding and translation. Biochemical synthesis of pseudouridine is carried out by pseudouridine synthases. In this review we discuss the evidence supporting an association between elevated pseudouridine levels with the incidence and progression of human prostate cancer and the translational significance of the value of this modified nucleotide as a novel biomarker in prostate cancer progression to advanced disease.

Prognosis of prostate cancer and bone metastasis pattern of patients: a SEER-based study and a local hospital based study from China

Prostate cancer (PCa) is the leading cause of cancer-related death among men worldwide. Knowledge of the prognostic factors of PCa and the bone metastasis pattern of patients would be helpful for patients and doctors. The data of 177,255 patients with prostate cancer diagnosed between 2010 and 2013 with at least five years of follow-up were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Multivariate Cox regression analysis was used to determine the predictive value of patients’ characteristics for survival after adjusting for other variates. Multivariate logistic regression analysis was used to evaluate the odds ratio of bone metastasis in PCa patients. The predictive value of age, race, marital status, and tumor characteristics were compared. The survival of patients with different socioeconomic statuses and bone metastasis statuses was compared by Kaplan–Meier analysis. A total of 1,335 patients with prostate cancer diagnosed between 2009 and 2015 were enrolled from the Second Affiliated Hospital of Zhejiang University School of Medicine. The survival of patients with different prostate-specific antigen (PSA) levels, Gleason scores, marital statuses and bone metastasis statuses was compared by Kaplan-Meier analysis. In SEER database, 96.74% of patients were 50 years of age or older. Multivariate Cox analysis revealed that for PCa patients, age at presentation, older age, single marital status, lower socioeconomic status, higher PSA level, T1 and N0 stage, and bone metastasis were independent risk factors for increased mortality. Multivariate logistic regression analysis revealed that patients who were married, were living in urban areas, had lower PSA levels, underwent surgery, and radiation had lower OR factors for bone metastasis. Asian or Pacific Islander, better socioeconomic status, lived in urban areas, married marital status, lower PSA levels and lower Gleason scores were better prognostic factors in PCa. Additionally, patients with single or divorced marital status, who were living in rural places had higher PSA levels, and T1 and N0 stages have a high OR for bone metastasis.

Diagnostic benefits of mindin as a prostate cancer biomarker: Dijagnostičke prednosti mindina kao biomarkera raka prostate

Background

It has been shown that decreased expression and activity of extracellular matrix protein mindin correlate with various types of cancers including breast, colon and lung cancers. The aim of the presented study was to investigate the serum mindin levels in prostate cancer.

Methods

Mindin concentrations in serum were measured in 56 patients with prostate cancer (mean age 68 years) and in control group of 29 healthy men (mean age 64 years) using commercially available enzymatic immunoassay (Cusabio, WuHan, China). The patients were divided with respect to the severity of the disease into two groups according to the EAU guidelines (stage 1, 2 - less severe tumours, stage 3, 4 - severe tumours).

Results

Serum mindin concentrations were significantly elevated in the group of healthy individuals unlike in the patients with prostate cancer (2.12 ng/mL vs 0.78 ng/mL, with P=0.0007, AUC=0.705). Patients with less severe tumours (stage 1, 2) and severe tumours (stage 3, 4) had significantly decreased levels of S-mindin as well (P=0.0037), although the difference in serum mindin concentrations between the patients with less severe and severe tumours was not significant.

Conclusions

Concentrations of mindin were decreased in patients with prostate cancer and reduced in patients with less severe prostate cancer as well. Mindin appears to be a promising diagnostic marker useful in the diagnosis of prostate cancer.

Systematic Differences Between Total and Free Prostate-Specific Antigen Immunoassays: Comparison Using Passing and Bablok Regression

Recent studies have shown that there are systematic differences among total and free prostate-specificantigen (PSA) immunoassays. In this study we analyzedintermethod differences in total PSA (tPSA) and free PSA(fPSA) measurement using ARCHITECT i2000SR (Abbott Diagnostics) and COBAS E601 (Roche Diagnostics). A number of 160 blood samples were tested for tPSA and 50 samples for fPSA (selecting only sampleswith tPSA: 4.1-10.0 μg/L). Passing-Bablok regression analysis was used to compare the two analytical methods fortPSA, fPSA and percentage of fPSA (%fPSA). A strong correlation was noticed between ARCHITECT i2000SR and COBAS E601 for tPSA, fPSA and %fPSA (r between 0.94 and 0.99). Concentrations of tPSA and fPSA measured by COBAS E601 were higher thanthose measured by ARCHITECT i2000SR with a bias of 0.8 μg/L for tPSA and 0.14 μg/L for fPSA. Analyzing therelative difference between methods for fPSA and %fPSA, COBAS E601 exceed a 10% relative difference limit. Our study confirms that there are differences in measured concentrations of tPSA and fPSA byvarious commercial methods. Because clinical judgment on subsequent diagnostic procedures, such as prostatebiopsy, is based on tPSA and fPSA results, tests harmonization should be a priority.

Chronic exposure to microcystin-leucine-arginine promoted proliferation of prostate epithelial cells resulting in benign prostatic hyperplasia

Microcystin-leucine-arginine (MC-LR), as a most common and deleterious variant among all structural analogues of Microcystins (MCs), can cause male reproductive dysfunction. However, its toxic effects on prostate in adult mice have not been invested in detail. In this study, we observed that MC-LR could enter prostate tissues and induce focal hyperplasia and prostate inflammation. Moreover, increased levels of prostate specific antigen (PSA) and prostate acid phosphatase (PAP) in serum of mice following chronic exposure to MC-LR were detected. We also examined increased expression of forkhead box protein M1 (FOXM1) and PSA in human prostate epithelial cells (RWPE-1) treated with MC-LR at low levels, and FOXM1 could regulate PSA expression. Furthermore, MC-LR also induced expression of CyclinD1 via FOXM1/Wnt/β-catenin signaling pathways in RWPE-1 cells, promoting proliferation of prostate epithelial cells, resulting in prostatic hyperplasia in vivo. As a foreign substance, MC-LR also induced immune reaction in RWPE-1 cells mediated by NF-κB pathway, promoting production of pro-inflammatory cytokines and chemokines. Collectively, these findings demonstrated that MC-LR may induce prostatic hyperplasia and prostatitis in mice following chronic low-dose exposure to MC-LR. This work may provide new perspectives in developing new diagnosis and treatment strategies for MC-LR-induced prostatic toxicity.

Bioconjugated, Single-Use Biosensor for the Detection of Biomarkers of Prostate Cancer

Prostate cancer is prevalent among cancers in men. A simple method for screening of reliable biomarkers is pivotal for early detection of prostate cancer.  Prostate-specific antigen (PSA) has been a commonly used biomarker for prostate cancer, in spite of its false-positive limitation. On the other hand, alpha-methylacyl-CoA racemase (AMACR), a metabolic enzyme, has been proven to be a highly expressed biomarker in prostate cancer cells. Therefore, a method or tool, which can detect either PSA or AMACR or both simply, cost effectively, and with high sensitivity and selectivity is desirable. We describe a novel bioconjugated, single-use biosensor capable of detecting both PSA and AMACR antigens in undiluted human serum. The preparation of the biosensor by the bioconjugation mechanism occurred within a day, which could be completed prior to actual testing. The effectiveness of the bioconjugation mechanism and the coverage of the electrode surface of the biosensor were experimentally assessed. Measurements of PSA and AMACR antigens and the specificity of the biosensor were carried out using differential pulse voltammetry. This biosensor was single-use and cost-effective and required a small quantity of test medium and relatively short preparation time, providing a very attractive biosensor for the detection of the biomarkers of prostate cancer.

TMPRSS2-ERG gene fusion in Turkish patients with localized prostate cancer: results of radical prostatectomy specimens

OBJECTIVE

Our aim was to evaluate and determine the frequency of Transmembrane protease, serine 2 (TMPRSS2)-ERG fusion in Turkish patients with clinically localized prostate cancer by using immunohistochemistry and reveal its relationship with clinicopathologic variables.

MATERIAL AND METHODS

Radical prostatectomy specimens of 99 patients, who underwent radical retropubic prostatectomy for localized cancer, between January 2002 and December 2011 were analyzed in the study. To detect ERG fusions, monoclonal ERG antibodyclone ID: EPR3864 (Epitomics, San Diego, CA, USA) and monoclonal anti-ERG antibody (9FY) (BiocareMedical, LLC, USA) were used. The immunistochemical expression of ERG protein was assessed as positive or negative regardless of stain intensity. Patients' age, total and primary Gleason scores, PSA levels, prostate volumes, tumor volumes, tumor stages and perineural invasion status were analysed retrospectively. Total fusion rate and correlation between the variables and fusion were evaluated.

RESULTS

Mean age, prostate volume, tumor volume, PSA value of 99 patients were 62.02 years (±5.93), 50.02 cc (±20.67), 3.19 cc (±4.16), and 9.34 ng/mL (±3.37) respectively. TMPRSS2-ERG fusion was seen in 46 (46.5%) of 99 patients. When the variables analysed with independent samples t test to predict fusion (+) status, none of them was found to be statistically significant. When evaluated by logistic regression analysis for (+) or (-) status, only tumor stage was found to be statistically significantly correlated with fusion (p=0.049).

CONCLUSION

The incidence of TMPRSS-ERG fusion in patients with localised prostate cancer in our study with Turkish population was found as 46.5%. Only tumor stage correlated with TMPRSS2-ERG fusion.