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Magnusson C, Augustsson P, Undvall Anand E, Lenshof A, Josefsson A, Welén K, Bjartell A, Ceder Y, Lilja H, Laurell T. Acoustic Enrichment of Heterogeneous Circulating Tumor Cells and Clusters from Metastatic Prostate Cancer Patients. Anal Chem 2024. [PMID: 38655666 DOI: 10.1021/acs.analchem.3c05371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND There are important unmet clinical needs to develop cell enrichment technologies to enable unbiased label-free isolation of both single cell and clusters of circulating tumor cells (CTCs) manifesting heterogeneous lineage specificity. Here, we report a pilot study based on the microfluidic acoustophoresis enrichment of CTCs using the CellSearch CTC assay as a reference modality. METHODS Acoustophoresis uses an ultrasonic standing wave field to separate cells based on biomechanical properties (size, density, and compressibility), resulting in inherently label-free and epitope-independent cell enrichment. Following red blood cell lysis and paraformaldehyde fixation, 6 mL of whole blood from 12 patients with metastatic prostate cancer and 20 healthy controls were processed with acoustophoresis and subsequent image cytometry. RESULTS Acoustophoresis enabled enrichment and characterization of phenotypic CTCs (EpCAM+, Cytokeratin+, DAPI+, CD45-/CD66b-) in all patients with metastatic prostate cancer and detected CTC-clusters composed of only CTCs or heterogeneous aggregates of CTCs clustered with various types of white blood cells in 9 out of 12 patients. By contrast, CellSearch did not detect any CTC clusters, but detected comparable numbers of phenotypic CTCs as acoustophoresis, with trends of finding a higher number of CTCs using acoustophoresis. CONCLUSION Our preliminary data indicate that acoustophoresis provides excellent possibilities to detect and characterize CTC clusters as a putative marker of metastatic disease and outcomes. Moreover, acoustophoresis enables the sensitive label-free enrichment of cells with epithelial phenotypes in blood and offers opportunities to detect and characterize CTCs undergoing epithelial-to-mesenchymal transitioning and lineage plasticity.
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Affiliation(s)
- Cecilia Magnusson
- Department of Translational Medicine, Lund University, Lund SE-22100, Sweden
| | - Per Augustsson
- Department of Biomedical Engineering, Lund University, Lund SE-22100, Sweden
| | - Eva Undvall Anand
- Department of Biomedical Engineering, Lund University, Lund SE-22100, Sweden
| | - Andreas Lenshof
- Department of Biomedical Engineering, Lund University, Lund SE-22100, Sweden
| | - Andreas Josefsson
- Institute of Clinical Sciences, Department of Urology, Gothenburg University, Gothenburg SE-41345, Sweden
- Wallenberg Center for Molecular Medicine, Umeå University, Umeå SE-90187, Sweden
- Department of Urology and Andrology, Institute of Surgery and Perioperative Sciences, Umeå University, Umeå SE-90185, Sweden
| | - Karin Welén
- Institute of Clinical Sciences, Department of Urology, Gothenburg University, Gothenburg SE-41345, Sweden
| | - Anders Bjartell
- Department of Translational Cancer Research, Lund University, Lund SE-22100, Sweden
| | - Yvonne Ceder
- Department of Laboratory Medicine, Lund University, Lund SE-22100, Sweden
| | - Hans Lilja
- Department of Translational Medicine, Lund University, Lund SE-22100, Sweden
- Department of Pathology and Laboratory Medicine, Surgery (Urology), and Medicine (GU Oncology), Memorial Sloan-Kettering Cancer Center, New York, New York 10065, United States
| | - Thomas Laurell
- Department of Biomedical Engineering, Lund University, Lund SE-22100, Sweden
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Auvinen A, Tammela TLJ, Mirtti T, Lilja H, Tolonen T, Kenttämies A, Rinta-Kiikka I, Lehtimäki T, Natunen K, Nevalainen J, Raitanen J, Ronkainen J, van der Kwast T, Riikonen J, Pétas A, Matikainen M, Taari K, Kilpeläinen T, Rannikko AS. Prostate Cancer Screening With PSA, Kallikrein Panel, and MRI: The ProScreen Randomized Trial. JAMA 2024:2817323. [PMID: 38581254 PMCID: PMC10999002 DOI: 10.1001/jama.2024.3841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Abstract
Importance Prostate-specific antigen (PSA) screening has potential to reduce prostate cancer mortality but frequently detects prostate cancer that is not clinically important. Objective To describe rates of low-grade (grade group 1) and high-grade (grade groups 2-5) prostate cancer identified among men invited to participate in a prostate cancer screening protocol consisting of a PSA test, a 4-kallikrein panel, and a magnetic resonance imaging (MRI) scan. Design, Setting, and Participants The ProScreen trial is a clinical trial conducted in Helsinki and Tampere, Finland, that randomized 61 193 men aged 50 through 63 years who were free of prostate cancer in a 1:3 ratio to either be invited or not be invited to undergo screening for prostate cancer between February 2018 and July 2020. Interventions Participating men randomized to the intervention underwent PSA testing. Those with a PSA level of 3.0 ng/mL or higher underwent additional testing for high-grade prostate cancer with a 4-kallikrein panel risk score. Those with a kallikrein panel score of 7.5% or higher underwent an MRI of the prostate gland, followed by targeted biopsies for those with abnormal prostate gland MRI findings. Final data collection occurred through June 31, 2023. Main Outcomes and Measures In descriptive exploratory analyses, the cumulative incidence of low-grade and high-grade prostate cancer after the first screening round were compared between the group invited to undergo prostate cancer screening and the control group. Results Of 60 745 eligible men (mean [SD] age, 57.2 [4.0] years), 15 201 were randomized to be invited and 45 544 were randomized not to be invited to undergo prostate cancer screening. Of 15 201 eligible males invited to undergo screening, 7744 (51%) participated. Among them, 32 low-grade prostate cancers (cumulative incidence, 0.41%) and 128 high-grade prostate cancers (cumulative incidence, 1.65%) were detected, with 1 cancer grade group result missing. Among the 7457 invited men (49%) who refused participation, 7 low-grade prostate cancers (cumulative incidence, 0.1%) and 44 high-grade prostate cancers (cumulative incidence, 0.6%) were detected, with 7 cancer grade groups missing. For the entire invited screening group, 39 low-grade prostate cancers (cumulative incidence, 0.26%) and 172 high-grade prostate cancers (cumulative incidence, 1.13%) were detected. During a median follow-up of 3.2 years, in the group not invited to undergo screening, 65 low-grade prostate cancers (cumulative incidence, 0.14%) and 282 high-grade prostate cancers (cumulative incidence, 0.62%) were detected. The risk difference for the entire group randomized to the screening invitation vs the control group was 0.11% (95% CI, 0.03%-0.20%) for low-grade and 0.51% (95% CI, 0.33%-0.70%) for high-grade cancer. Conclusions and Relevance In this preliminary descriptive report from an ongoing randomized clinical trial, 1 additional high-grade cancer per 196 men and 1 low-grade cancer per 909 men were detected among those randomized to be invited to undergo a single prostate cancer screening intervention compared with those not invited to undergo screening. These preliminary findings from a single round of screening should be interpreted cautiously, pending results of the study's primary mortality outcome. Trial Registration ClinicalTrials.gov Identifier: NCT03423303.
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Affiliation(s)
- Anssi Auvinen
- Tampere University, Unit of Health Sciences, Faculty of Social Sciences, Tampere, Finland
| | - Teuvo L J Tammela
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
- Department of Urology, Tays Cancer Centre, Tampere University Hospital, Tampere, Finland
| | - Tuomas Mirtti
- Helsinki University Hospital, Department of Pathology, Helsinki, Finland
- University of Helsinki, Faculty of Medicine, Helsinki, Finland
- iCAN-Digital Precision Cancer Medicine Flagship, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Biomedical Engineering, School of Medicine, Emory University, Atlanta, Georgia
| | - Hans Lilja
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Departments of Pathology and Laboratory Medicine, Surgery, and Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Teemu Tolonen
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
- Department of Pathology, FimLab Laboratories, Tampere, Finland
| | - Anu Kenttämies
- Department of Radiology, Helsinki University Hospital, Helsinki, Finland
| | - Irina Rinta-Kiikka
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
- Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - Terho Lehtimäki
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
- Department of Clinical Chemistry, FimLab Laboratories, Tampere, Finland
| | - Kari Natunen
- Tampere University, Unit of Health Sciences, Faculty of Social Sciences, Tampere, Finland
| | - Jaakko Nevalainen
- Tampere University, Unit of Health Sciences, Faculty of Social Sciences, Tampere, Finland
| | - Jani Raitanen
- Tampere University, Unit of Health Sciences, Faculty of Social Sciences, Tampere, Finland
- UKK-Institute for Health Promotion Research, Tampere, Finland
| | - Johanna Ronkainen
- Department of Radiology, Tampere University Hospital, Tampere, Finland
| | | | - Jarno Riikonen
- Department of Urology, Tays Cancer Centre, Tampere University Hospital, Tampere, Finland
| | - Anssi Pétas
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Mika Matikainen
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Kimmo Taari
- University of Helsinki, Faculty of Medicine, Helsinki, Finland
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Tuomas Kilpeläinen
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Antti S Rannikko
- University of Helsinki, Faculty of Medicine, Helsinki, Finland
- iCAN-Digital Precision Cancer Medicine Flagship, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
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3
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Vickers AJ, Lilja H. Eight Misconceptions about Prostate-Specific Antigen. Clin Chem 2024; 70:13-16. [PMID: 38175588 DOI: 10.1093/clinchem/hvad138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/03/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Hans Lilja
- Departments of Pathology and Laboratory Medicine, Surgery, and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Department of Translational Medicine, Lund University, Malmö, Sweden
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Magnusson C, Augustsson P, Anand EU, Lenshof A, Josefsson A, Welén K, Bjartell A, Ceder Y, Lilja H, Laurell T. Acoustic enrichment of heterogenous circulating tumor cells and clusters from patients with metastatic prostate cancer. medRxiv 2023:2023.12.04.23299128. [PMID: 38106097 PMCID: PMC10723509 DOI: 10.1101/2023.12.04.23299128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Background There are important unmet clinical needs to develop cell enrichment technologies to enable unbiased label-free isolation of both single cell and clusters of circulating tumor cells (CTCs) manifesting heterogeneous lineage specificity. Here, we report a pilot study based on microfluidic acoustophoresis enrichment of CTCs using the CellSearch CTC assay as a reference modality. Methods Acoustophoresis uses an ultrasonic standing wave field to separate cells based on biomechanical properties (size, density, and compressibility) resulting in inherently label-free and epitope-independent cell enrichment. Following red blood cell lysis and paraformaldehyde fixation, 6 mL of whole blood from 12 patients with metastatic prostate cancer and 20 healthy controls were processed with acoustophoresis and subsequent image cytometry. Results Acoustophoresis enabled enrichment and characterization of phenotypic CTCs (EpCAM+, Cytokeratin+, DAPI+, CD45-/CD66b-) in all patients with metastatic prostate cancer and detected CTC-clusters composed of only CTCs or heterogenous aggregates of CTCs clustered with various types of white blood cells in 9 out of 12 patients. By contrast, CellSearch did not detect any CTC-clusters, but detected comparable numbers of phenotypic CTCs as acoustophoresis, with trends of finding higher number of CTCs using acoustophoresis. Conclusion Our preliminary data indicate that acoustophoresis provides excellent possibilities to detect and characterize CTC-clusters as a putative marker of metastatic disease and outcomes. Moreover, acoustophoresis enables sensitive label-free enrichment of cells with epithelial phenotype in blood and offers opportunities to detect and characterize CTCs undergoing epithelial-to-mesenchymal transitioning and lineage plasticity.
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Affiliation(s)
| | - Per Augustsson
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | | | - Andreas Lenshof
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Andreas Josefsson
- Intitute of Clinical Sciences, Department of Urology, Gothenburg University, Gothenburg Sweden
- Wallenberg Center for Molecular Medicine, Umeå University, Umeå, Sweden
- Department of Urology and Andrology, Institute of surgery and perioperative Sciences, Umeå University, Umeå, Sweden
| | - Karin Welén
- Intitute of Clinical Sciences, Department of Urology, Gothenburg University, Gothenburg Sweden
| | - Anders Bjartell
- Department of Translational Cancer Research, Lund University, Lund, Sweden
| | - Yvonne Ceder
- Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Hans Lilja
- Department of Translational Medicine, Lund University, Lund, Sweden
- Department of Pathology and Laboratory Medicine, Surgery (Urology), and Medicine (GU Oncology), Memorial Sloan-Kettering Cancer Center, NY, U.S.A
| | - Thomas Laurell
- Department of Biomedical Engineering, Lund University, Lund, Sweden
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Hoffmann TJ, Graff RE, Madduri RK, Rodriguez AA, Cario CL, Feng K, Jiang Y, Wang A, Klein RJ, Pierce BL, Eggener S, Tong L, Blot W, Long J, Rebbeck T, Lachance J, Andrews C, Adebiyi AO, Adusei B, Aisuodionoe-Shadrach OI, Fernandez PW, Jalloh M, Janivara R, Chen WC, Mensah JE, Agalliu I, Berndt SI, Shelley JP, Schaffer K, Machiela MJ, Freedman ND, Huang WY, Li SA, Goodman PJ, Till C, Thompson I, Lilja H, Van Den Eeden SK, Chanock SJ, Mosley JD, Conti DV, Haiman CA, Justice AC, Kachuri L, Witte JS. Genome-wide association study of prostate-specific antigen levels in 392,522 men identifies new loci and improves cross-ancestry prediction. medRxiv 2023:2023.10.27.23297676. [PMID: 37961155 PMCID: PMC10635224 DOI: 10.1101/2023.10.27.23297676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
We conducted a multi-ancestry genome-wide association study of prostate-specific antigen (PSA) levels in 296,754 men (211,342 European ancestry; 58,236 African ancestry; 23,546 Hispanic/Latino; 3,630 Asian ancestry; 96.5% of participants were from the Million Veteran Program). We identified 318 independent genome-wide significant (p≤5e-8) variants, 184 of which were novel. Most demonstrated evidence of replication in an independent cohort (n=95,768). Meta-analyzing discovery and replication (n=392,522) identified 447 variants, of which a further 111 were novel. Out-of-sample variance in PSA explained by our new polygenic risk score reached 16.9% (95% CI=16.1%-17.8%) in European ancestry, 9.5% (95% CI=7.0%-12.2%) in African ancestry, 18.6% (95% CI=15.8%-21.4%) in Hispanic/Latino, and 15.3% (95% CI=12.7%-18.1%) in Asian ancestry, and lower for higher age. Our study highlights how including proportionally more participants from underrepresented populations improves genetic prediction of PSA levels, with potential to personalize prostate cancer screening.
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Yim K, Ma C, Carlsson S, Lilja H, Mucci L, Penney K, Kibel AS, Eggener S, Preston MA. Free PSA and Clinically Significant and Fatal Prostate Cancer in the PLCO Screening Trial. J Urol 2023; 210:630-638. [PMID: 37384841 PMCID: PMC10894656 DOI: 10.1097/ju.0000000000003603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/14/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE We studied whether adding percent free PSA to total PSA improves prediction of clinically significant prostate cancer and fatal prostate cancer. MATERIALS AND METHODS A total of 6,727 men within the intervention arm of PLCO (Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial) had baseline percent free PSA. Of this cohort, 475 had clinically significant prostate cancer and 98 had fatal prostate cancer. Cumulative incidence and Cox analyses were conducted to evaluate the association between percent free PSA/PSA and clinically significant prostate cancer/fatal prostate cancer. Harrell's C index evaluated predictive ability. Kaplan-Meier analysis assessed survival. RESULTS Median follow-up was 19.7 years, median baseline PSA was 1.19 ng/mL, median percent free PSA was 18%. Cumulative incidence of fatal prostate cancer for men with baseline PSA ≥2 ng/mL and percent free PSA ≤10 was 3.2% and 6.1% at 15 and 25 years, respectively, compared to 0.03% and 1.1% for men with percent free PSA >25%. In younger men (55-64 years) with baseline PSA 2-10 ng/mL, C index improved from 0.56 to 0.60 for clinically significant prostate cancer and from 0.53 to 0.64 for fatal prostate cancer with addition of percent free PSA. In older men (65-74 years), C index improved for clinically significant prostate cancer from 0.60 to 0.66, with no improvement in fatal prostate cancer. Adjusting for age, digital rectal exam, family history of prostate cancer, and total PSA, percent free PSA was associated with clinically significant prostate cancer (HR 1.05, P < .001) per 1% decrease. Percent free PSA improved prediction of clinically significant prostate cancer and fatal prostate cancer for all race groups. CONCLUSIONS In a large U.S. screening trial, the addition of percent free PSA to total PSA in men with baseline PSA ≥2 ng/mL improved prediction of clinically significant prostate cancer and fatal prostate cancer. Free PSA should be used to risk-stratify screening and decrease unnecessary prostate biopsies.
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Affiliation(s)
- Kendrick Yim
- Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Chaoran Ma
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sigrid Carlsson
- Departments of Surgery (Urology Service) and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Hans Lilja
- Department of Pathology and Laboratory Medicine, Surgery, and Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Lorelei Mucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kathryn Penney
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Adam S Kibel
- Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Scott Eggener
- Department of Urology, University of Chicago, Chicago, Illinois
| | - Mark A Preston
- Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts
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Kachuri L, Hoffmann TJ, Jiang Y, Berndt SI, Shelley JP, Schaffer KR, Machiela MJ, Freedman ND, Huang WY, Li SA, Easterlin R, Goodman PJ, Till C, Thompson I, Lilja H, Van Den Eeden SK, Chanock SJ, Haiman CA, Conti DV, Klein RJ, Mosley JD, Graff RE, Witte JS. Genetically adjusted PSA levels for prostate cancer screening. Nat Med 2023; 29:1412-1423. [PMID: 37264206 PMCID: PMC10287565 DOI: 10.1038/s41591-023-02277-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 02/27/2023] [Indexed: 06/03/2023]
Abstract
Prostate-specific antigen (PSA) screening for prostate cancer remains controversial because it increases overdiagnosis and overtreatment of clinically insignificant tumors. Accounting for genetic determinants of constitutive, non-cancer-related PSA variation has potential to improve screening utility. In this study, we discovered 128 genome-wide significant associations (P < 5 × 10-8) in a multi-ancestry meta-analysis of 95,768 men and developed a PSA polygenic score (PGSPSA) that explains 9.61% of constitutive PSA variation. We found that, in men of European ancestry, using PGS-adjusted PSA would avoid up to 31% of negative prostate biopsies but also result in 12% fewer biopsies in patients with prostate cancer, mostly with Gleason score <7 tumors. Genetically adjusted PSA was more predictive of aggressive prostate cancer (odds ratio (OR) = 3.44, P = 6.2 × 10-14, area under the curve (AUC) = 0.755) than unadjusted PSA (OR = 3.31, P = 1.1 × 10-12, AUC = 0.738) in 106 cases and 23,667 controls. Compared to a prostate cancer PGS alone (AUC = 0.712), including genetically adjusted PSA improved detection of aggressive disease (AUC = 0.786, P = 7.2 × 10-4). Our findings highlight the potential utility of incorporating PGS for personalized biomarkers in prostate cancer screening.
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Affiliation(s)
- Linda Kachuri
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Thomas J Hoffmann
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Institute of Human Genetics, University of California, San Francisco, San Francisco, CA, USA
| | - Yu Jiang
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Sonja I Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - John P Shelley
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Mitchell J Machiela
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Wen-Yi Huang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Shengchao A Li
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Ryder Easterlin
- Biological and Medical Informatics, University of California, San Francisco, San Francisco, CA, USA
| | | | - Cathee Till
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ian Thompson
- CHRISTUS Santa Rosa Medical Center Hospital, San Antonio, TX, USA
| | - Hans Lilja
- Departments of Laboratory Medicine, Surgery and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Translational Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | | | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Christopher A Haiman
- Center for Genetic Epidemiology, Department of Population and Preventive Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - David V Conti
- Center for Genetic Epidemiology, Department of Population and Preventive Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Robert J Klein
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan D Mosley
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rebecca E Graff
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
| | - John S Witte
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, USA.
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA.
- Departments of Biomedical Data Science and Genetics, Stanford University, Stanford, CA, USA.
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Pellegrino F, Sjoberg DD, Tin AL, Benfante NE, Briganti A, Montorsi F, Scardino PT, Eastham JA, Vickers AJ, Lilja H, Laudone VP. Predictive value of kallikrein forms and β-microseminoprotein in blood from patients with evidence of detectable levels of PSA after radical prostatectomy. World J Urol 2023; 41:1489-1495. [PMID: 37209144 PMCID: PMC10547122 DOI: 10.1007/s00345-023-04420-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/05/2023] [Indexed: 05/22/2023] Open
Abstract
PURPOSE To determine whether β-microseminoprotein or any of the kallikrein forms in blood-free, total or intact PSA or total hK2-predict metastasis in patients with evidence of detectable levels of PSA in blood after radical prostatectomy. METHOD We determined marker concentrations in blood from 173 men treated with radical prostatectomy and evidence of detectable levels of PSA in the blood (PSA ≥ 0.05) after surgery between 2014 and 2015 and at least 1 year after any adjuvant therapy. We used Cox regression to determine whether any marker was associated with metastasis using both univariate and multivariable models that included standard clinical predictors. RESULTS Overall, 42 patients had metastasis, with a median follow-up of 67 months among patients without an event. The levels of intact and free PSA and free-to-total PSA ratio were significantly associated with metastasis. Discrimination was highest for free PSA (c-index: 0.645) and free-to-total PSA ratio (0.625). Only free-to-total PSA ratio remained associated with overall metastasis (either regional or distant) after including standard clinical predictors (p = 0.025) and increased discrimination from 0.686 to 0.697. Similar results were found using distant metastasis as an outcome (p = 0.011; c-index increased from 0.658 to 0.723). CONCLUSION Our results provide evidence that free-to-total PSA ratio can risk stratifying patients with evidence of detectable levels of PSA in blood after RP. Further research is warranted on the biology of prostate cancer markers in patients with evidence of detectable levels of PSA in blood after radical prostatectomy. Our findings on the free-to-total ratio for predicting adverse oncologic outcomes need to be validated in other cohorts.
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Affiliation(s)
- Francesco Pellegrino
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Division of Oncology/Unit of Urology, IRCCS San Raffaele Hospital, Urological Research Institute, Milan, Italy.
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Amy L Tin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nicole E Benfante
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, IRCCS San Raffaele Hospital, Urological Research Institute, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, IRCCS San Raffaele Hospital, Urological Research Institute, Milan, Italy
| | - Peter T Scardino
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James A Eastham
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hans Lilja
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine (GU-Oncology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Vincent P Laudone
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA
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9
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Bjerner J, Bratt O, Aas K, Albertsen PC, Fosså SD, Kvåle R, Lilja H, Müller C, Müller S, Stensvold A, Thomas O, Røe OD, Vickers A, Walz J, Carlsson SV, Oldenburg J. Baseline Serum Prostate-specific Antigen Value Predicts the Risk of Subsequent Prostate Cancer Death-Results from the Norwegian Prostate Cancer Consortium. Eur Urol 2023:S0302-2838(23)02791-4. [PMID: 37169639 PMCID: PMC10840440 DOI: 10.1016/j.eururo.2023.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/27/2023] [Accepted: 04/25/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Prostate-specific antigen (PSA) levels in midlife are strongly associated with the long-term risk of lethal prostate cancer in cohorts not subject to screening. This is the first study evaluating the association between PSA levels drawn as part of routine medical care in the Norwegian population and prostate cancer incidence and mortality. OBJECTIVE To determine the association between midlife PSA levels <4.0 ng/ml, drawn as part of routine medical care, and long-term risk of prostate cancer death. DESIGN, SETTING, AND PARTICIPANTS The Norwegian Prostate Cancer Consortium collected >8 million PSA results from >1 million Norwegian males ≥40 yr of age. We studied 176 099 men (predefined age strata: 40-54 and 55-69 yr) without a prior prostate cancer diagnosis who had a nonelevated baseline PSA level (<4.0 ng/ml) between January 1, 1995 and December 31, 2005. INTERVENTION Baseline PSA. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We assessed the 16-yr risk of prostate cancer mortality. We calculated the discrimination (C-index) between predefined PSA strata (<0.5, 0.5-0.9, 1.0-1.9, 2.0-2.9, and 3.0-3.9 ng/ml) and subsequent prostate cancer death. Survival curves were plotted using the Kaplan-Meier method. RESULTS AND LIMITATIONS The median follow-up time of men who did not get prostate cancer was 17.9 yr. Overall, 84% of men had a baseline PSA level of <2.0 ng/ml and 1346 men died from prostate cancer, with 712 deaths (53%) occurring in the 16% of men with the highest baseline PSA of 2.0-3.9 ng/ml. Baseline PSA levels were associated with prostate cancer mortality (C-index 0.72 for both age groups, 40-54 and 55-69 yr). The fact that the reason for any given PSA measurement remains unknown represents a limitation. CONCLUSIONS We replicated prior studies that baseline PSA at age 40-69 yr can be used to stratify a man's risk of dying from prostate cancer within the next 15-20 yr. PATIENT SUMMARY A prostate-specific antigen level obtained as part of routine medical care is strongly associated with a man's risk of dying from prostate cancer in the next two decades.
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Affiliation(s)
- Johan Bjerner
- Fürst Laboratories, Department of Clinical Chemistry, Oslo, Norway
| | - Ola Bratt
- Department of Urology, Institute of Clinical Sciences, Gothenburg University, Gothenburg, Sweden; Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kirsti Aas
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Peter C Albertsen
- Division of Urology, Department of Surgery, University of Connecticut Health Center, Farmington, CT, USA
| | - Sophie D Fosså
- National Advisory Unit for Late Effects After Cancer Treatment, Oslo University Hospital, Oslo, Norway; Medical Faculty of University of Oslo, Oslo, Norway
| | - Rune Kvåle
- Department of Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway; Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Hans Lilja
- Departments of Laboratory Medicine, Surgery and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Translational Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | | | - Stig Müller
- Department of Urology, Akershus University Hospital, Lørenskog, Norway
| | | | - Owen Thomas
- Department of Biostatistics, Akershus University Hospital, Lørenskog, Norway
| | - Oluf D Røe
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Cancer Clinic, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway
| | - Andrew Vickers
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jochen Walz
- Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - Sigrid V Carlsson
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jan Oldenburg
- Medical Faculty of University of Oslo, Oslo, Norway; Department of Oncology, Akershus University Hospital, Lørenskog, Norway.
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10
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Chen DM, Dong R, Kachuri L, Hoffmann T, Jiang Y, Berndt SI, Shelley JP, Schaffer KR, Machiela MJ, Freedman ND, Huang WY, Li SA, Lilja H, Van Den Eeden SK, Chanock S, Haiman CA, Conti DV, Klein RJ, Mosley JD, Witte JS, Graff RE. Transcriptome-Wide Association Analysis Identifies Novel Candidate Susceptibility Genes for Prostate-Specific Antigen Levels in Men Without Prostate Cancer. medRxiv 2023:2023.05.04.23289526. [PMID: 37205487 PMCID: PMC10187439 DOI: 10.1101/2023.05.04.23289526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Deciphering the genetic basis of prostate-specific antigen (PSA) levels may improve their utility to screen for prostate cancer (PCa). We thus conducted a transcriptome-wide association study (TWAS) of PSA levels using genome-wide summary statistics from 95,768 PCa-free men, the MetaXcan framework, and gene prediction models trained in Genotype-Tissue Expression (GTEx) project data. Tissue-specific analyses identified 41 statistically significant (p < 0.05/12,192 = 4.10e-6) associations in whole blood and 39 statistically significant (p < 0.05/13,844 = 3.61e-6) associations in prostate tissue, with 18 genes associated in both tissues. Cross-tissue analyses that combined associations across 45 tissues identified 155 genes that were statistically significantly (p < 0.05/22,249 = 2.25e-6) associated with PSA levels. Based on conditional analyses that assessed whether TWAS associations were attributable to a lead GWAS variant, we found 20 novel genes (11 single-tissue, 9 cross-tissue) that were associated with PSA levels in the TWAS. Of these novel genes, five showed evidence of colocalization (colocalization probability > 0.5): EXOSC9, CCNA2, HIST1H2BN, RP11-182L21.6, and RP11-327J17.2. Six of the 20 novel genes are not known to impact PCa risk. These findings yield new hypotheses for genetic factors underlying PSA levels that should be further explored toward improving our understanding of PSA biology.
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Affiliation(s)
- Dorothy M. Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - Ruocheng Dong
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, 94305, USA
| | - Linda Kachuri
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, 94305, USA
- Stanford Cancer Institute, Stanford University, Stanford, CA, 94305, USA
| | - Thomas Hoffmann
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, 94158, USA
- Institute for Human Genetics, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Yu Jiang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - Sonja I. Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, 20814, USA
| | - John P. Shelley
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Kerry R. Schaffer
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Mitchell J. Machiela
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, 20814, USA
| | - Neal D. Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, 20814, USA
| | - Wen-Yi Huang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, 20814, USA
| | - Shengchao A. Li
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, 20814, USA
| | - Hans Lilja
- Departments of Pathology and Laboratory Medicine, Surgery, Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
- Department of Translational Medicine, Lund University, Malmö, 21428, Sweden
| | | | - Stephen Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, 20814, USA
| | - Christopher A. Haiman
- Center for Genetic Epidemiology, Department of Population and Preventive Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90032, USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - David V. Conti
- Center for Genetic Epidemiology, Department of Population and Preventive Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90032, USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Robert J. Klein
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Jonathan D. Mosley
- Departments of Internal Medicine and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - John S. Witte
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, 94158, USA
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, 94305, USA
- Departments of Biomedical Data Science and Genetics (by courtesy), Stanford University, Stanford, CA, 94305, USA
| | - Rebecca E. Graff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, 94158, USA
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11
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Storey CM, Altai M, Bicak M, Veach DR, Lückerath K, Adrian G, McDevitt MR, Kalidindi T, Park JE, Herrmann K, Abou D, Zedan W, Peekhaus N, Klein RJ, Damoiseaux R, Larson SM, Lilja H, Thorek D, Ulmert D. Quantitative In Vivo Imaging of the Androgen Receptor Axis Reveals Degree of Prostate Cancer Radiotherapy Response. Mol Cancer Res 2023; 21:307-315. [PMID: 36608299 PMCID: PMC10355285 DOI: 10.1158/1541-7786.mcr-22-0736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/13/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
Noninvasive biomarkers for androgen receptor (AR) pathway activation are urgently needed to better monitor patient response to prostate cancer therapies. AR is a critical driver and mediator of resistance of prostate cancer but currently available noninvasive prostate cancer biomarkers to monitor AR activity are discordant with downstream AR pathway activity. External beam radiotherapy (EBRT) remains a common treatment for all stages of prostate cancer, and DNA damage induced by EBRT upregulates AR pathway activity to promote therapeutic resistance. [89Zr]11B6-PET is a novel modality targeting prostate-specific protein human kallikrein 2 (hK2), which is a surrogate biomarker for AR activity. Here, we studied whether [89Zr]11B6-PET can accurately assess EBRT-induced AR activity.Genetic and human prostate cancer mouse models received EBRT (2-50 Gy) and treatment response was monitored by [89Zr]11B6-PET/CT. Radiotracer uptake and expression of AR and AR target genes was quantified in resected tissue.EBRT increased AR pathway activity and [89Zr]11B6 uptake in LNCaP-AR and 22RV1 tumors. EBRT increased prostate-specific [89Zr]11B6 uptake in prostate cancer-bearing mice (Hi-Myc x Pb_KLK2) with no significant changes in uptake in healthy (Pb_KLK2) mice, and this correlated with hK2 protein levels. IMPLICATIONS hK2 expression in prostate cancer tissue is a proxy of EBRT-induced AR activity that can noninvasively be detected using [89Zr]11B6-PET; further clinical evaluation of hK2-PET for monitoring response and development of resistance to EBRT in real time is warranted.
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Affiliation(s)
- Claire M Storey
- Department of Molecular & Medical Pharmacology, University of California Los Angeles (UCLA), Los Angeles, USA
| | - Mohamed Altai
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Mesude Bicak
- Hasso Plattner Institute for Digital Health, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Darren R Veach
- Department of Radiology, Memorial Sloan Kettering Cancer Center (MSKCC), New York, USA
| | - Katharina Lückerath
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, DKTK, Essen, Germany
| | - Gabriel Adrian
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Michael R McDevitt
- Department of Radiology, Memorial Sloan Kettering Cancer Center (MSKCC), New York, USA
| | - Teja Kalidindi
- Department of Radiology, Memorial Sloan Kettering Cancer Center (MSKCC), New York, USA
| | - Julie E Park
- Department of Molecular & Medical Pharmacology, University of California Los Angeles (UCLA), Los Angeles, USA
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, DKTK, Essen, Germany
| | - Diane Abou
- Department of Radiology, Washington University School of Medicine, St. Louis, USA
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, USA
| | - Wahed Zedan
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Norbert Peekhaus
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Robert J Klein
- Icahn Institute for Genomics and Multiscale Biology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Robert Damoiseaux
- Department of Molecular & Medical Pharmacology, University of California Los Angeles (UCLA), Los Angeles, USA
- California NanoSystems Institute, UCLA, Los Angeles, USA
| | - Steven M Larson
- Department of Radiology, Memorial Sloan Kettering Cancer Center (MSKCC), New York, USA
- Department of Radiology, Weill Cornell Medical College, New York, USA
| | - Hans Lilja
- Genitourinary Oncology Service, Department of Medicine, MSKCC, New York, USA
- Urology Service, Department of Surgery, MSKCC, New York, USA
- Department of Laboratory Medicine, MSKCC, New York, USA
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Daniel Thorek
- Department of Radiology, Washington University School of Medicine, St. Louis, USA
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, USA
- Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, USA
| | - David Ulmert
- Department of Molecular & Medical Pharmacology, University of California Los Angeles (UCLA), Los Angeles, USA
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
- California NanoSystems Institute, UCLA, Los Angeles, USA
- Department of Urology, Institute of Urologic Oncology, UCLA, Los Angeles, USA
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, UCLA, Los Angeles, USA
- Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, UCLA, Los Angeles, USA
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12
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Srinivasan S, Kryza T, Bock N, Tse BWC, Sokolowski KA, Panchadsaram J, Moya L, Stephens C, Dong Y, Röhl J, Alinezhad S, Vela I, Perry-Keene JL, Buzacott K, Gago-Dominguez M, Schleutker J, Maier C, Muir K, Tangen CM, Gronberg H, Pashayan N, Albanes D, Wolk A, Stanford JL, Berndt SI, Mucci LA, Koutros S, Cussenot O, Sorensen KD, Grindedal EM, Key TJ, Haiman CA, Giles GG, Vega A, Wiklund F, Neal DE, Kogevinas M, Stampfer MJ, Nordestgaard BG, Brenner H, Gamulin M, Claessens F, Melander O, Dahlin A, Stattin P, Hallmans G, Häggström C, Johansson R, Thysell E, Rönn AC, Li W, Brown N, Dimeski G, Shepherd B, Dadaev T, Brook MN, Spurdle AB, Stenman UH, Koistinen H, Kote-Jarai Z, Klein RJ, Lilja H, Ecker RC, Eeles R, Clements J, Batra J. Biochemical activity induced by a germline variation in KLK3 (PSA) associates with cellular function and clinical outcome in prostate cancer. Res Sq 2023:rs.3.rs-2650312. [PMID: 37034758 PMCID: PMC10081352 DOI: 10.21203/rs.3.rs-2650312/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Genetic variation at the 19q13.3 KLK locus is linked with prostate cancer susceptibility. The non-synonymous KLK3 SNP, rs17632542 (c.536T>C; Ile163Thr-substitution in PSA) is associated with reduced prostate cancer risk, however, the functional relevance is unknown. Here, we identify that the SNP variant-induced change in PSA biochemical activity as a previously undescribed function mediating prostate cancer pathogenesis. The 'Thr' PSA variant led to small subcutaneous tumours, supporting reduced prostate cancer risk. However, 'Thr' PSA also displayed higher metastatic potential with pronounced osteolytic activity in an experimental metastasis in-vivo model. Biochemical characterization of this PSA variant demonstrated markedly reduced proteolytic activity that correlated with differences in in-vivo tumour burden. The SNP is associated with increased risk for aggressive disease and prostate cancer-specific mortality in three independent cohorts, highlighting its critical function in mediating metastasis. Carriers of this SNP allele had reduced serum total PSA and a higher free/total PSA ratio that could contribute to late biopsy decisions and delay in diagnosis. Our results provide a molecular explanation for the prominent 19q13.3 KLK locus, rs17632542 SNP, association with a spectrum of prostate cancer clinical outcomes.
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Affiliation(s)
- Srilakshmi Srinivasan
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT)
- Translational Research Institute, Queensland University of Technology, Woolloongabba, Brisbane, Queensland (QLD), Australia
| | - Thomas Kryza
- Mater Research Institute - The University of Queensland, Translational Research Institute, Woolloongabba, Brisbane, QLD, Australia
| | - Nathalie Bock
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT)
- Translational Research Institute, Queensland University of Technology, Woolloongabba, Brisbane, Queensland (QLD), Australia
| | - Brian WC Tse
- Preclinical Imaging Facility, Translational Research Institute, Woolloongabba, Brisbane, QLD, Australia
| | - Kamil A. Sokolowski
- Preclinical Imaging Facility, Translational Research Institute, Woolloongabba, Brisbane, QLD, Australia
| | - Janaththani Panchadsaram
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT)
- Translational Research Institute, Queensland University of Technology, Woolloongabba, Brisbane, Queensland (QLD), Australia
| | - Leire Moya
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT)
- Translational Research Institute, Queensland University of Technology, Woolloongabba, Brisbane, Queensland (QLD), Australia
| | - Carson Stephens
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT)
- Translational Research Institute, Queensland University of Technology, Woolloongabba, Brisbane, Queensland (QLD), Australia
| | - Ying Dong
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT)
| | - Joan Röhl
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT)
| | - Saeid Alinezhad
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT)
- Translational Research Institute, Queensland University of Technology, Woolloongabba, Brisbane, Queensland (QLD), Australia
| | - Ian Vela
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT)
- Department of Urology, Princess Alexandra Hospital, Brisbane, Woolloongabba, Brisbane, QLD, Australia
| | - Joanna L. Perry-Keene
- Pathology Queensland, Sunshine Coast University Hospital Laboratory, Birtinya, Sunshine Coast, QLD, Australia
| | - Katie Buzacott
- Pathology Queensland, Sunshine Coast University Hospital Laboratory, Birtinya, Sunshine Coast, QLD, Australia
| | - The IMPACT Study
- The Institute of Cancer Research, London, SM2 5NG, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Manuela Gago-Dominguez
- Genomic Medicine Group, Galician Foundation of Genomic Medicine, IDIS, Complejo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - The PROFILE Study Steering Committee
- The Institute of Cancer Research, London, SM2 5NG, UK
- Royal Marsden NHS Foundation Trust, London, UK
- Ronald and Rita McAulay Foundation, London, UK
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, UK
- University of Oxford, Oxford, UK
- Queen Mary University of London, London, UK
| | - Johanna Schleutker
- Institute of Biomedicine, Kiinamyllynkatu 10, FI-20014 University of Turku, Finland
- Department of Medical Genetics, Genomics, Laboratory Division, Turku University Hospital, PO Box 52, 20521 Turku, Finland
| | - Christiane Maier
- Humangenetik Tuebingen, Paul-Ehrlich-Str 23, D-72076 Tuebingen, Germany
| | - Kenneth Muir
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, M13 9PL, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Catherine M. Tangen
- SWOG Statistical Center, Division of Public Health Sciences
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Henrik Gronberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Nora Pashayan
- Department of Applied Health Research, University College London, London, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Strangeways Laboratory, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Demetrius Albanes
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, USA
| | - Alicja Wolk
- Division of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Janet L. Stanford
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, 98109-1024, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Sonja I. Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, USA
| | - Lorelei A. Mucci
- Department of Epidemiology,Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Stella Koutros
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, USA
| | - Olivier Cussenot
- CeRePP and Sorbonne Universite, GRC N°5 AP-HP, Tenon Hospital, Paris, France
| | - Karina Dalsgaard Sorensen
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University & Department of Molecular Medicine (MOMA), Aarhus University Hospital, DK-8200 Aarhus N., Denmark
| | | | - Timothy J. Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Christopher A. Haiman
- Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, USA
| | - Graham G. Giles
- Cancer Epidemiology & Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ana Vega
- Fundación Pública Galega de Medicina Xenómica-SERGAS, Instituto de Investigación Sanitaria (IDIS), Santiago de Compostela, Spain
- Biomedical Network on Rare Diseases (CIBERER), Santiago de Compostela, Spain
| | - Fredrik Wiklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - David E. Neal
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, England
- Department of Oncology, Addenbrooke’s Hospital, University of Cambridge, England
| | - Manolis Kogevinas
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Meir J. Stampfer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Børge G. Nordestgaard
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Copenhagen, Denmark
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marija Gamulin
- Division of Medical Oncology, Urogenital Unit, Department of Oncology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Frank Claessens
- Molecular Endocrinology Laboratory, Department of Cellular and Molecular Medicine, KU Leuven, Belgium
| | - Olle Melander
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Anders Dahlin
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Göran Hallmans
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden
| | - Christel Häggström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Biobank Research, Umeå University, Umeå, Sweden
| | | | - Elin Thysell
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Ann-Charlotte Rönn
- Clinical Research Center, Karolinska University Hospital, Huddinge, Sweden
| | - Weiqiang Li
- Icahn Institute for Data Science and Genome Technology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nigel Brown
- Department of Chemical Pathology, Pathology Queensland, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, Australia
| | - Goce Dimeski
- Department of Chemical Pathology, Pathology Queensland, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, Australia
| | - Benjamin Shepherd
- Department of Anatomical Pathology, Pathology Queensland, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, Australia
| | - Tokhir Dadaev
- The Institute of Cancer Research, London, SM2 5NG, UK
| | - Mark N. Brook
- The Institute of Cancer Research, London, SM2 5NG, UK
| | - Amanda B. Spurdle
- Molecular Cancer Epidemiology Laboratory, QIMR Berghofer Medical Research Institute, Herston, Brisbane, QLD, Australia
| | - Ulf-Håkan Stenman
- Department of Clinical Chemistry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Hannu Koistinen
- Department of Clinical Chemistry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Zsofia Kote-Jarai
- The Institute of Cancer Research, London, SM2 5NG, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Robert J. Klein
- Icahn Institute for Data Science and Genome Technology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hans Lilja
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, England
- Departments of Laboratory Medicine, Surgery (Urology Service) and Medicine (Genitourinary Oncology), Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Rupert C. Ecker
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT)
- Translational Research Institute, Queensland University of Technology, Woolloongabba, Brisbane, Queensland (QLD), Australia
- TissueGnostics GmbH, Vienna, Austria
| | - Rosalind Eeles
- The Institute of Cancer Research, London, SM2 5NG, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | | | - The Australian Prostate Cancer BioResource
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT)
- Translational Research Institute, Queensland University of Technology, Woolloongabba, Brisbane, Queensland (QLD), Australia
| | - Judith Clements
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT)
- Translational Research Institute, Queensland University of Technology, Woolloongabba, Brisbane, Queensland (QLD), Australia
| | - Jyotsna Batra
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT)
- Translational Research Institute, Queensland University of Technology, Woolloongabba, Brisbane, Queensland (QLD), Australia
- Centre for Genomic and Personalised Health, Queensland University of Technology, Brisbane, QLD
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Carlsson SV, Godtman RA, Pihl CG, Vickers A, Lilja H, Hugosson J, Månsson M. Corrigendum to "Young Age on Starting Prostate-specific Antigen Testing Is Associated with a Greater Reduction in Prostate Cancer Mortality: 24-Year Follow-up of the Göteborg Randomized Population-based Prostate Cancer Screening Trial" [Eur Urol (2022)]. Eur Urol 2023; 83:e88. [PMID: 36503643 PMCID: PMC10787585 DOI: 10.1016/j.eururo.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Sigrid V Carlsson
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Rebecka Arnsrud Godtman
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden
| | | | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hans Lilja
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Jonas Hugosson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Marianne Månsson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
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Ma C, Ericsson C, Carlsson SV, Lilja H, Kibel A, Graff RE, Plym A, Giovannucci E, Mucci LA, Preston MA, Penney KL. Addition of a Genetic Risk Score for Identification of Men with a Low Prostate-specific Antigen Level in Midlife at Risk of Developing Lethal Prostate Cancer. EUR UROL SUPPL 2023; 50:27-30. [PMID: 36861107 PMCID: PMC9969275 DOI: 10.1016/j.euros.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 02/22/2023] Open
Abstract
Men with a low prostate-specific antigen (PSA) level (<1 ng/ml) in midlife may extend the rescreening interval (if aged 40-59 yr) or forgo future PSA screening (if aged >60 yr) owing to their low risk of aggressive prostate cancer (PCa). However, there is a subset of men who develop lethal PCa despite low baseline PSA. We investigated how a PCa polygenic risk score (PRS) in addition to baseline PSA impacts the prediction of lethal PCa among 483 men aged 40-70 yr from the Physicians' Health Study followed over a median of 33 yr. We examined the association of the PRS with the risk of lethal PCa (lethal cases vs controls) using logistic regression adjusted for baseline PSA. The PCa PRS was associated with risk of lethal PCa (odds ratio per 1 standard deviation in PRS [OR] 1.79, 95% confidence interval [CI] 1.28-2.49). The association between the PRS and lethal PCa was stronger for those with PSA <1 ng/ml (OR 2.23, 95% CI 1.19-4.21) than for men with PSA ≥1 ng/ml (OR 1.61, 95% CI 1.07-2.42). Our PCa PRS improved the identification of men with PSA <1 ng/ml at greater risk of future lethal PCa who should consider ongoing PSA testing. Patient summary A subset of men develop fatal prostate cancer despite having low prostate-specific antigen (PSA) levels in middle age. A risk score based on multiple genes can help in predicting men who may be at risk of developing lethal prostate cancer and who should be advised to have regular PSA measurements.
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Affiliation(s)
- Chaoran Ma
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Caroline Ericsson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sigrid V. Carlsson
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Hans Lilja
- Department of Pathology and Laboratory Medicine and Medicine, GU-Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Adam Kibel
- Division of Urology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Rebecca E. Graff
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, USA
| | - Anna Plym
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Division of Urology, Brigham and Women’s Hospital, Boston, MA, USA,Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Edward Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lorelei A. Mucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mark A. Preston
- Division of Urology, Brigham and Women’s Hospital, Boston, MA, USA,Corresponding authors. Division of Urology, Brigham and Women’s Hospital, 45 Francis Street, Boston, MA 02115, USA. Tel. +1 617 5258274. E-mail address: (M.A. Preston). Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115, USA. Tel. +1 617 5250860. E-mail address: (K.L. Penney).
| | - Kathryn L. Penney
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Corresponding authors. Division of Urology, Brigham and Women’s Hospital, 45 Francis Street, Boston, MA 02115, USA. Tel. +1 617 5258274. E-mail address: (M.A. Preston). Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115, USA. Tel. +1 617 5250860. E-mail address: (K.L. Penney).
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15
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Hugosson J, Frånlund M, Arnsrud Godtman R, Aus G, Grenabo Bergdahl A, Khatami A, Lodding P, Pihl CG, Stranne J, Månsson M, Lilja H. Prostate cancer incidence and mortality after stop age in the Göteborg branch of ERSPC. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00935-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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16
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Carlsson SV, Arnsrud Godtman R, Pihl CG, Vickers A, Lilja H, Hugosson J, Månsson M. Young Age on Starting Prostate-specific Antigen Testing Is Associated with a Greater Reduction in Prostate Cancer Mortality: 24-Year Follow-up of the Göteborg Randomized Population-based Prostate Cancer Screening Trial. Eur Urol 2023; 83:103-109. [PMID: 36334968 PMCID: PMC10481420 DOI: 10.1016/j.eururo.2022.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/15/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The risk of death from prostate cancer (PC) depends on age, but the age at which to start prostate-specific antigen (PSA) screening remains uncertain. OBJECTIVE To study the relationship between risk reduction for PC mortality and age at first PSA screening. DESIGN, SETTING, AND PARTICIPANTS The randomized Göteborg-1 trial invited men for biennial PSA screening between the ages of 50 and 70 yr (screening, n = 10 000) or no invitation but exposure to opportunistic PSA testing (control, n = 10 000). INTERVENTION Regular versus opportunistic PSA screening or no PSA. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We modeled the nonlinear association between starting age and the absolute risk reduction in PC mortality in three settings: (1) intention-to-screen (randomized arms); (2) historical control (screening group and 1990-1994 registry data); and (3) attendees only (screening attendees and matched controls). We tested whether the effect of screening on PC mortality depends on the age at starting screening by comparing survival models with and without an interaction between trial arm and age (intention-to-screen and attendees only). RESULTS AND LIMITATIONS Younger age on starting PSA testing was associated with a greater reduction in PC mortality. Starting screening at age 55 yr approximately halved the risk of PC death compared to first PSA at age 60 yr. The test of association between starting age and the effect of screening on PC mortality was slightly greater than the conventional level of statistical significance (p = 0.052) for the entire cohort, and statistically significant among attendees (p = 0.002). This study is limited by the low number of disease-specific deaths for men starting screening before age 55 yr and the difficulty in discriminating between the effect of starting age and screening duration. CONCLUSIONS Given that prior screening trials included men aged up to 70 yr on starting screening, our results suggest that the effect size reported in prior trials underestimates that of currently recommended programs starting at age 50-55 yr. PATIENT SUMMARY In this study from the Göteborg-1 trial, we looked at the effect of prostate-specific antigen (PSA) screening in reducing men's risk of dying from prostate cancer given the age at which they begin testing. Starting at a younger age reduced the risk of prostate cancer death by a greater amount. We recommend that PSA screening should start no later than at age 55 yr.
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Affiliation(s)
- Sigrid V Carlsson
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Rebecka Arnsrud Godtman
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden
| | | | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hans Lilja
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Jonas Hugosson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Marianne Månsson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
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17
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Chou A, Darst BF, Wilkens LR, Le Marchand L, Lilja H, Conti DV, Haiman CA. Association of Prostate-Specific Antigen Levels with Prostate Cancer Risk in a Multiethnic Population: Stability Over Time and Comparison with Polygenic Risk Score. Cancer Epidemiol Biomarkers Prev 2022; 31:2199-2207. [PMID: 36126957 PMCID: PMC9729398 DOI: 10.1158/1055-9965.epi-22-0443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/01/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Studies in men of European ancestry suggest prostate-specific antigen (PSA) as a marker of early prostate cancer development that may help to risk-stratify men earlier in life. METHODS We examined PSA levels in men measured up to 10+ years before a prostate cancer diagnosis in association with prostate cancer risk in 2,245 cases and 2,203 controls of African American, Latino, Japanese, Native Hawaiian, and White men in the Multiethnic Cohort. We also compared the discriminative ability of PSA to polygenic risk score (PRS) for prostate cancer. RESULTS Excluding cases diagnosed within 2 and 10 years of blood draw, men with PSA above the median had a prostate cancer OR (95% CIs) of 9.12 (7.66-10.92) and 3.52 (2.50-5.03), respectively, compared with men with PSA below the median. A PSA level above the median identified 90% and 75% of cases diagnosed more than 2 and 10 years after blood draw, respectively. The associations were significantly greater for Gleason ≤7 versus 8+ disease. At 10+ years, the association of prostate cancer with PSA was comparable with that with the PRS [OR per SD increase: 1.88 (1.45-2.46) and 2.12 (1.55-2.93), respectively]. CONCLUSIONS We found PSA to be an informative marker of prostate cancer risk at least a decade before diagnosis across multiethnic populations. This association was diminished with increasing time, greater for low grade tumors, and comparable with a PRS when measured 10+ years before diagnosis. IMPACT Our multiethnic investigation suggests broad clinical implications on the utility of PSA and PRS for risk stratification in prostate cancer screening practices.
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Affiliation(s)
- Alisha Chou
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, US
| | - Burcu F. Darst
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, US,Present address: Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, U.S.A
| | - Lynne R. Wilkens
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Loïc Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Hans Lilja
- Departments of Laboratory Medicine, Surgery, and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, U.S.A.; and Department of Translational Medicine, Lund University, Malmö, Sweden
| | - David V. Conti
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, US
| | - Christopher A. Haiman
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, US
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Fredsøe J, Rasmussen M, Tin AL, Vickers AJ, Borre M, Sørensen KD, Lilja H. Predicting Grade group 2 or higher cancer at prostate biopsy by 4Kscore in blood and uCaP microRNA model in urine. Sci Rep 2022; 12:15193. [PMID: 36071094 PMCID: PMC9452554 DOI: 10.1038/s41598-022-19460-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/30/2022] [Indexed: 11/09/2022] Open
Abstract
Elevated prostate-specific antigen (PSA) levels often lead to unnecessary and possibly harmful transrectal ultrasound guided biopsy, e.g. when the biopsy is negative or contains only low-grade insignificant cancer, unlikely to become symptomatic in the man's normal lifespan. A model based on four-kallikrein markers in blood (commercialized as 4Kscore) predicts risk of Grade group 2 or higher prostate cancer at biopsy, reducing unnecessary biopsies. We assessed whether these results extend to a single institution prostate biopsy cohort of Danish men and are enhanced by three microRNAs from urine (referred to as uCaP). The 4Kscore measured in cryopreserved blood from 234 men referred for 10+ core biopsy to Aarhus University Hospital, 29 with PSA > 25 ng/ml. We explored uCaP in urine from 157 of these men. Combined with age and DRE findings, both 4Kscore and uCaP could accurately predict Grade group 2 or higher prostate cancer (all patients: AUC = 0.802 and 0.797; PSA ≤ 25: AUC = 0.763 and 0.759). There was no additive effect when combining the 4Kscore and uCaP. Limitations include a study cohort with higher risk than commonly reported for biopsy cohorts. Our findings further support the clinical use of the 4Kscore to predict Grade group 2 or higher cancers in men being considered for biopsy.
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Affiliation(s)
- Jacob Fredsøe
- Department of Molecular Medicine, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Martin Rasmussen
- Department of Molecular Medicine, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Amy L Tin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael Borre
- Department of Urology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Karina D Sørensen
- Department of Molecular Medicine, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Hans Lilja
- Departments of Pathology and Laboratory Medicine, Surgery, and Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA. .,Department of Translational Medicine, Lund University, Malmö, Sweden.
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19
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Magnusson C, Charan MR, Lilja H, Augustsson P. Abstract 5994: Separating cancer cells from neutrophils by gradient acoustic focusing. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-5994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: A subset of aggressive prostate cancers (PCa) progress to invade surrounding tissue to form distant metastases and shed of circulating tumor cells (CTCs). However, due to a scarcity of CTC among the millions of nucleated blood cells, there is an unmet need to improve CTC assays. Acoustophoresis uses standing ultrasound waves in a flow-through microfluidic chamber to discriminate cells based on the size, density, and compressibility. The technique is label-free as opposed to assays that rely on the cell surface marker EpCAM to detect CTCs. We will use label-free two-step acoustophoresis method as the initial separation step followed by a density medium purging step, to obtain efficient recovery of CTC of very high purity.
Experimental procedure: Acoustic cell separation of CTCs from blood is challenging in reference to overlap of acoustic properties between small-sized CTCs and densely granular WBC. To obtain high recovery of CTC, we must apply a sufficiently large acoustic focusing amplitude which leads to a contaminating cell population comprising 2% white blood cells, (WBCs) that mainly contain eosinophil cells. To obtain high purity cancer cell fractions there is a critical need for an additional cleaning step. Therefore, we used the density medium iodixanol in a purging step where the optimal iodixanol medium concentration is intended to provide one cell type with positive, and the other with negative acoustic contrast.
Preliminary results: show that the granulocytes can be transferred by the ultrasound field into the high-density medium (iodixanol) and can thereby be removed through a first outlet. The cancer cells do not transfer into the iodixanol medium and will be collected in a pure PCa cell fraction in the low-density medium through a second outlet. The samples were processed at a flow rate of 75 μl/min. The limiting factor regarding flow rate when purging the sample from granulocytes is overheating caused by the ultrasound transducer. The separation efficiency for cancer cells was 99.5% with 2.2% contaminating granulocytes. Theoretically, by combining the two separation steps only 0,044% of the WBC would remain in the cancer cell fraction.
Conclusion: It is unclear which are the functional properties that enable a primary tumor to shed CTCs, and comprehensive characterization is urgently needed to identify key features of these processes. CTC fractions of high purity will enable single cell analysis with validated Fluidigm-based RT-PCR panels, mass spectrometry, and RNA-sequencing. We propose to use a two-step acoustic separation method, with a primary acoustic separation step and a second high-density medium purging step.
Citation Format: Cecilia Magnusson, Mahdi Rezayati Charan, Hans Lilja, Per Augustsson. Separating cancer cells from neutrophils by gradient acoustic focusing [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5994.
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Oldenburg J, Bjerner JL, Lilja H, Aas K, Fossa SD, Mueller C, Mueller S, Thomas O, Stensvold A, Walz J, Røe OD, Bratt O, Carlsson SV. Long-term predictive value of serum PSA values obtained in clinical practice: Results from the Norwegian Prostate Cancer Consortium (NPCC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5021 Background: A baseline prostate-specific antigen (PSA) level in midlife is strongly associated with risk of lethal prostate cancer several decades later. In most prior studies, PSA was measured in archived blood from men participating in cohort studies unrelated to prostate cancer. In clinical practice, however, men commonly obtain a PSA test because of lower urinary tract symptoms. Here, we study the association between PSA values when a first PSA test was obtained as part of clinical care – and subsequent risks of prostate cancer diagnosis and death. Methods: The NPCC database contained laboratory results from 1995-2006 of the first (“baseline”) PSA test below 4.0 ng/mL in 157,836 men aged 40-69 years without prior prostate cancer (PCa) diagnosis. PSA strata were pre-defined: < 1, 1-1.99, 2-2.99, 3-3.99 ng/ml and analyses were split in two age groups based on a prior risk: 40-54 (“younger”) and 55-69 (“older”). Predictive accuracy was assessed with Harrell’s concordance (C) index. The Kaplan-Meier method was used to visualize risk of PCa death as reported on the death certificate by PSA strata for the two age groups. Results: Among 157,836 men with a PSA below 4.0 ng/mL, 83% had < 2.0 ng/mL. Risk of prostate cancer and death from prostate cancer were strongly associated with PSA-levels and age: Harrell’s C-index 0.75 and 0.72 for diagnosis of younger and older group, respectively and 0.72 for PCa death for both age groups. In the younger age group 196 deaths among 75,446 men (0.26%) were registered, in the older 943 deaths among 82,390 men (1.14%). The risk of PCa death in lowest (< 1) and highest (3-3.99) strata were 0.23% and 3.22%, respectively (189 deaths among 81,982 vs. 274 deaths among 8517 men). Conclusions: This population-based NPCC study shows as strong predictive impact of the different strata of the initial PSA measurement in routine clinical care as prior studies based on cryopreserved blood samples. [Table: see text]
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Affiliation(s)
- Jan Oldenburg
- Department of Oncology, Akershus University Hospital (Ahus), Lørenskog, Norway
| | | | - Hans Lilja
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kirsti Aas
- Dept. of Urology, Oslo University Hospital, Oslo, Norway
| | - Sophie D. Fossa
- National Advisory Unit on Late Effects after Cancer Treatment, Radiumhospitalet, Oslo University Hospital, Oslo, Norway
| | | | | | - Owen Thomas
- Dept of Health Services Research, Ahus, Lørenskog, Norway
| | | | | | | | - Ola Bratt
- Dept of urology, Sahlgrenska academy, University of Gothenborg, Gothenborg, Sweden
| | - Sigrid V. Carlsson
- Departments of Surgery (Urology Service) and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
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Rasmussen M, Fredsøe J, Tin AL, Vickers AJ, Ulhøi B, Borre M, Eastham J, Ehdaie B, Guillonneau B, Laudone V, Scardino PT, Touijer K, Sørensen KD, Lilja H. Independent validation of a pre-specified four-kallikrein marker model for prediction of adverse pathology and biochemical recurrence. Br J Cancer 2022; 126:1004-1009. [PMID: 34903844 PMCID: PMC8980060 DOI: 10.1038/s41416-021-01661-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/18/2021] [Accepted: 12/01/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Accurate markers for prostate cancer (PC) risk stratification could aid decision-making for initial management strategies. The 4Kscore has an undefined role in predicting outcomes after radical prostatectomy (RP). METHODS We included 1476 patients with 4Kscore measured prior to RP at two institutions. The 4Kscore was assessed for prediction of adverse pathology at RP and biochemical recurrence (BCR) relative to a clinical model. We pre-specified that all analyses would be assessed in biopsy Grade Group 1 (GG1) or 2 (GG2) PC patients, separately. RESULTS The 4Kscore increased discrimination for adverse pathology in all patients (delta area under the receiver operative curve (AUC) 0.009, 95% confidence interval (CI) 0.002, 0.016; clinical model AUC 0.767), driven by GG1 (delta AUC 0.040, 95% CI 0.006, 0.073) rather than GG2 patients (delta AUC 0.005, 95% CI -0.012, 0.021). Adding 4Kscore improved prediction of BCR in all patients (delta C-index 0.014, 95% CI 0.007, 0.021; preop-BCR nomogram C-index 0.738), again with larger changes in GG1 than in GG2. CONCLUSIONS This study validates prior investigations on the use of 4Kscore in men with biopsy-confirmed PC. Men with GG1 PC and a high 4Kscore may benefit from additional testing to guide treatment selection. Further research is warranted regarding the value of the 4Kscore in men with biopsy GG2 PC.
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Affiliation(s)
- Martin Rasmussen
- grid.154185.c0000 0004 0512 597XDepartment of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jacob Fredsøe
- grid.154185.c0000 0004 0512 597XDepartment of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Amy L. Tin
- grid.51462.340000 0001 2171 9952Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Andrew J. Vickers
- grid.51462.340000 0001 2171 9952Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Benedicte Ulhøi
- grid.154185.c0000 0004 0512 597XDepartment of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Borre
- grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark ,grid.154185.c0000 0004 0512 597XDepartment of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - James Eastham
- grid.51462.340000 0001 2171 9952Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Behfar Ehdaie
- grid.51462.340000 0001 2171 9952Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Bertrand Guillonneau
- grid.51462.340000 0001 2171 9952Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY USA ,grid.6363.00000 0001 2218 4662Uro-Oncology Department, Charité University Hospital, Berlin, Germany
| | - Vincent Laudone
- grid.51462.340000 0001 2171 9952Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Peter T. Scardino
- grid.51462.340000 0001 2171 9952Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Karim Touijer
- grid.51462.340000 0001 2171 9952Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Karina D. Sørensen
- grid.154185.c0000 0004 0512 597XDepartment of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Hans Lilja
- grid.51462.340000 0001 2171 9952Departments of Laboratory Medicine, Surgery, and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA ,grid.4514.40000 0001 0930 2361Department of Translational Medicine, Lund University, Malmö, Sweden
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22
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Carlsson SV, Murata K, Danila DC, Lilja H. PSA: role in screening and monitoring patients with prostate cancer. Cancer Biomark 2022. [DOI: 10.1016/b978-0-12-824302-2.00001-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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23
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Abstract
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There is an unmet
clinical need to extract living circulating tumor
cells (CTCs) for functional studies and in vitro expansion
to enable drug testing and predict responses to therapy in metastatic
cancer. Here, we present a novel two-step acoustophoresis (A2) method for isolation of unfixed, viable cancer cells from red blood
cell (RBC) lysed whole blood. The A2 method uses an initial
acoustofluidic preseparation step to separate cells based on their
acoustic mobility. This acoustofluidic step enriches viable cancer
cells in a central outlet, but a significant number of white blood
cells (WBCs) remain in the central outlet fraction due to overlapping
acoustophysical properties of these viable cells. A subsequent purging
step was employed to remove contaminating WBCs through negative selection
acoustophoresis with anti-CD45-functionalized negative acoustic contrast
particles. We processed 1 mL samples of 1:1 diluted RBC lysed whole
blood mixed with 10 000 DU145 cells through the A2 method. Additional experiments were performed using 1000 DU145 cells
spiked into 1.5 × 106 WBCs in 1 mL of buffer to further
elucidate the dynamic range of the method. Using samples with 10 000
DU145 cells, we obtained 459 ± 188-fold depletion of WBC and
42% recovery of viable cancer cells. Based on spiked samples with
1000 DU145 cells, our cancer cell recovery was 28% with 247 ±
156-fold WBC depletion corresponding to a depletion efficacy of ≥99.5%.
The novel A2 method provides extensive elimination of WBCs
combined with the gentle recovery of viable cancer cells suitable
for downstream functional analyses and in vitro culture.
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Affiliation(s)
- Eva Undvall Anand
- Department of Biomedical Engineering, Lund University, 221 00 Lund, Sweden
| | - Cecilia Magnusson
- Department of Translational Medicine, Lund University, 205 02 Malmö, Sweden
| | - Andreas Lenshof
- Department of Biomedical Engineering, Lund University, 221 00 Lund, Sweden
| | - Yvonne Ceder
- Department of Laboratory Medicine, Lund University, 221 00 Lund, Sweden
| | - Hans Lilja
- Department of Translational Medicine, Lund University, 205 02 Malmö, Sweden.,Department of Laboratory Medicine, Surgery (Urology), and Medicine (GU Oncology), Memorial Sloan-Kettering Cancer Center, New York, New York 10065, United States
| | - Thomas Laurell
- Department of Biomedical Engineering, Lund University, 221 00 Lund, Sweden
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24
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Rannikko A, Leht M, Mirtti T, Kenttämies A, Tolonen T, Rinta‐Kiikka I, Kilpeläinen TP, Natunen K, Lilja H, Lehtimäki T, Raitanen J, Kujala P, Ronkainen J, Matikainen M, Petas A, Taari K, Tammela T, Auvinen A. Population‐based randomized trial of screening for clinically significant prostate cancer ProScreen: pilot study. BJU Int 2021; 130:193-199. [PMID: 34958531 PMCID: PMC9327584 DOI: 10.1111/bju.15683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives To evaluate the feasibility of a population‐based screening trial using prostate‐specific antigen (PSA), a kallikrein panel and multiparametric magnetic resonance imaging (MRI) aimed at minimizing overdiagnosis, while retaining mortality benefit. Patients and Methods Feasibility of the screening algorithm was evaluated in terms of participation, screening test results and cancer detection. A random sample of 400 men aged 65 years was identified from the population registry and invited for screening with three stepwise tests (PSA, kallikrein panel and MRI). Men with PSA levels ≥3 ng/mL were further tested with the kallikrein panel, and those with positive findings (risk >7.5%) were referred for prostate MRI. Men with positive MRI (Prostate Imaging Reporting and Data System [PI‐RADS] score 3–5) had targeted biopsies only. Men with negative MRI, but PSA density ≥0.15 underwent systematic biopsies. Results Of the 399 men invited, 158 (40%) participated and 27 had PSA levels ≥3 ng/mL (7% of the invited and 17% of the participants). Of these, 22 had a positive kallikrein panel (6% of the invited and 81% of the PSA‐positive men). Finally, 10 men (3% of the invited and 45% of 4Kscore [kallikrein panel]‐positive) had a suspicious MRI finding (PI‐RADS score ≥3) and five were diagnosed with a clinically significant prostate cancer (Gleason Grade Group [GG] ≥2) at fusion biopsy (3% of the participants), with two GG 1 cases (1%). Additional testing (kallikrein panel and MRI) after PSA reduced biopsies by 56%. Conclusion The findings constitute proof of principle for our screening protocol, as we achieved a substantial detection rate for clinically significant cancer with few clinically insignificant cases. Participation, however, was suboptimal.
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Affiliation(s)
- Antti Rannikko
- University of Helsinki Faculty of Medicine and Helsinki University Hospital, Department of Urology Helsinki Finland
- Research Program in Systems Oncology Faculty of Medicine University of Helsinki Helsinki Finland
| | - Mare Leht
- Tampere University Faculty of Medicine and Health Technology Tampere Finland
- Helsinki and Uusimaa Hospital District Hyvinkää Hospital Department of Urology Hyvinkää Finland
| | - Tuomas Mirtti
- Research Program in Systems Oncology Faculty of Medicine University of Helsinki Helsinki Finland
- HUS Diagnostic Centre HUS Medical Imaging Centre Pathology Helsinki Finland
| | - Anu Kenttämies
- HUS Diagnostic Centre HUS Medical Imaging Centre Radiology Helsinki Finland
| | - Teemu Tolonen
- Fimlab Laboratories Department of Pathology Tampere Finland
| | - Irina Rinta‐Kiikka
- University of Helsinki Faculty of Medicine and Helsinki University Hospital, Department of Urology Helsinki Finland
- Tampere University Hospital Department of Radiology Tampere Finland
| | - Tuomas P. Kilpeläinen
- University of Helsinki Faculty of Medicine and Helsinki University Hospital, Department of Urology Helsinki Finland
- Research Program in Systems Oncology Faculty of Medicine University of Helsinki Helsinki Finland
| | - Kari Natunen
- Tampere University Faculty of Social Sciences Tampere Finland
| | - Hans Lilja
- Departments of Laboratory Medicine, Surgery, and Medicine Memorial Sloan Kettering Cancer Center New York NY USA
- Department of Translational Medicine Lund University Malmö Sweden
| | - Terho Lehtimäki
- University of Helsinki Faculty of Medicine and Helsinki University Hospital, Department of Urology Helsinki Finland
- Fimlab Laboratories Department of Clinical Chemistry Tampere Finland
| | - Jani Raitanen
- Tampere University Faculty of Social Sciences Tampere Finland
- UKK Institute for Health Promotion Research Tampere Finland
| | - Paula Kujala
- Fimlab Laboratories Department of Pathology Tampere Finland
| | | | - Mika Matikainen
- University of Helsinki Faculty of Medicine and Helsinki University Hospital, Department of Urology Helsinki Finland
| | - Anssi Petas
- University of Helsinki Faculty of Medicine and Helsinki University Hospital, Department of Urology Helsinki Finland
| | - Kimmo Taari
- University of Helsinki Faculty of Medicine and Helsinki University Hospital, Department of Urology Helsinki Finland
| | - Teuvo Tammela
- Tampere University Faculty of Medicine and Health Technology Tampere Finland
- Tampere University Hospital Department of Urology Tampere Finland
| | - Anssi Auvinen
- Tampere University Faculty of Social Sciences Tampere Finland
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25
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Vertosick EA, Zappala S, Punnen S, Hugosson J, Boorjian SA, Haese A, Carroll P, Cooperberg M, Bjartell A, Lilja H, Vickers AJ. Individual Patient Data Meta-analysis of Discrimination of the Four Kallikrein Panel Associated With the Inclusion of Prostate Volume. Urology 2021; 157:102-106. [PMID: 34450175 PMCID: PMC8671182 DOI: 10.1016/j.urology.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess whether adding prostate volume to the kallikrein panel improves discrimination for ISUP Grade Group 2 or higher (GG2+) disease, as some men may have volume measurements available at the time of blood draw. While prostate volume predicts biopsy outcome, it requires an imaging procedure for measurement. The four kallikrein panel - commercially available as the 4Kscore - predicts risk of GG2+ disease and requires only a blood draw. MATERIALS AND METHODS A total of 9131 patients with available prostate volume and total PSA ≤25 ng/ml from 5 historical (sextant biopsy, pre-ISUP 2005 grading) and 4 contemporary cohorts (10+ cores, ISUP 2005 grading). Previously published kallikrein panel models were used to predict risk of GG2+. Volume was added to the model in each cohort and change in discrimination was meta-analyzed. RESULTS Increased prostate volume was associated with decreased risk of GG2+ disease after controlling for the kallikrein panel in 7/9 cohorts. However, kallikrein panel discrimination (0.817, 95% CI 0.802, 0.831) was not improved after including volume (AUC difference 0.002, 95% CI -0.003, 0.006). Heterogeneity (P <.0001) was driven by an AUC increase in 1 cohort of academic cancer centers (0.044, 95% CI 0.025, 0.064), with no evidence of heterogeneity after excluding this cohort (P = .15). CONCLUSION The kallikrein panel provides a non-invasive approach to assess the risk of high-grade prostate cancer. Our results do not justify the inclusion of prostate volume in the four kallikrein panel. There is some evidence that the predictive value of prostate volume is provider dependent: further research is needed to address this question.
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Affiliation(s)
- Emily A Vertosick
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephen Zappala
- Andover Urology, Andover, MA, Tufts University School of Medicine, Boston, MA
| | - Sanoj Punnen
- Department of Urology, University of Miami and Sylvester Comprehensive Cancer Center, Miami, FL
| | - Jonas Hugosson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Göteborg, Göteborg, Sweden
| | | | - Alexander Haese
- Martini-Clinic Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Carroll
- Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Matthew Cooperberg
- Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Department of Epidemiology and Statistics, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Anders Bjartell
- Department of Urology, Skåne University Hospital Malmö, Lund University, Lund, Sweden
| | - Hans Lilja
- Departments of Laboratory Medicine, Surgery, and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Andrew J Vickers
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
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26
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Bancroft EK, Page EC, Brook MN, Thomas S, Taylor N, Pope J, McHugh J, Jones AB, Karlsson Q, Merson S, Ong KR, Hoffman J, Huber C, Maehle L, Grindedal EM, Stormorken A, Evans DG, Rothwell J, Lalloo F, Brady AF, Bartlett M, Snape K, Hanson H, James P, McKinley J, Mascarenhas L, Syngal S, Ukaegbu C, Side L, Thomas T, Barwell J, Teixeira MR, Izatt L, Suri M, Macrae FA, Poplawski N, Chen-Shtoyerman R, Ahmed M, Musgrave H, Nicolai N, Greenhalgh L, Brewer C, Pachter N, Spigelman AD, Azzabi A, Helfand BT, Halliday D, Buys S, Ramon Y Cajal T, Donaldson A, Cooney KA, Harris M, McGrath J, Davidson R, Taylor A, Cooke P, Myhill K, Hogben M, Aaronson NK, Ardern-Jones A, Bangma CH, Castro E, Dearnaley D, Dias A, Dudderidge T, Eccles DM, Green K, Eyfjord J, Falconer A, Foster CS, Gronberg H, Hamdy FC, Johannsson O, Khoo V, Lilja H, Lindeman GJ, Lubinski J, Axcrona K, Mikropoulos C, Mitra AV, Moynihan C, Ni Raghallaigh H, Rennert G, Collier R, Offman J, Kote-Jarai Z, Eeles RA. A prospective prostate cancer screening programme for men with pathogenic variants in mismatch repair genes (IMPACT): initial results from an international prospective study. Lancet Oncol 2021; 22:1618-1631. [PMID: 34678156 PMCID: PMC8576477 DOI: 10.1016/s1470-2045(21)00522-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/19/2021] [Accepted: 08/27/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Lynch syndrome is a rare familial cancer syndrome caused by pathogenic variants in the mismatch repair genes MLH1, MSH2, MSH6, or PMS2, that cause predisposition to various cancers, predominantly colorectal and endometrial cancer. Data are emerging that pathogenic variants in mismatch repair genes increase the risk of early-onset aggressive prostate cancer. The IMPACT study is prospectively assessing prostate-specific antigen (PSA) screening in men with germline mismatch repair pathogenic variants. Here, we report the usefulness of PSA screening, prostate cancer incidence, and tumour characteristics after the first screening round in men with and without these germline pathogenic variants. METHODS The IMPACT study is an international, prospective study. Men aged 40-69 years without a previous prostate cancer diagnosis and with a known germline pathogenic variant in the MLH1, MSH2, or MSH6 gene, and age-matched male controls who tested negative for a familial pathogenic variant in these genes were recruited from 34 genetic and urology clinics in eight countries, and underwent a baseline PSA screening. Men who had a PSA level higher than 3·0 ng/mL were offered a transrectal, ultrasound-guided, prostate biopsy and a histopathological analysis was done. All participants are undergoing a minimum of 5 years' annual screening. The primary endpoint was to determine the incidence, stage, and pathology of screening-detected prostate cancer in carriers of pathogenic variants compared with non-carrier controls. We used Fisher's exact test to compare the number of cases, cancer incidence, and positive predictive values of the PSA cutoff and biopsy between carriers and non-carriers and the differences between disease types (ie, cancer vs no cancer, clinically significant cancer vs no cancer). We assessed screening outcomes and tumour characteristics by pathogenic variant status. Here we present results from the first round of PSA screening in the IMPACT study. This study is registered with ClinicalTrials.gov, NCT00261456, and is now closed to accrual. FINDINGS Between Sept 28, 2012, and March 1, 2020, 828 men were recruited (644 carriers of mismatch repair pathogenic variants [204 carriers of MLH1, 305 carriers of MSH2, and 135 carriers of MSH6] and 184 non-carrier controls [65 non-carriers of MLH1, 76 non-carriers of MSH2, and 43 non-carriers of MSH6]), and in order to boost the sample size for the non-carrier control groups, we randomly selected 134 non-carriers from the BRCA1 and BRCA2 cohort of the IMPACT study, who were included in all three non-carrier cohorts. Men were predominantly of European ancestry (899 [93%] of 953 with available data), with a mean age of 52·8 years (SD 8·3). Within the first screening round, 56 (6%) men had a PSA concentration of more than 3·0 ng/mL and 35 (4%) biopsies were done. The overall incidence of prostate cancer was 1·9% (18 of 962; 95% CI 1·1-2·9). The incidence among MSH2 carriers was 4·3% (13 of 305; 95% CI 2·3-7·2), MSH2 non-carrier controls was 0·5% (one of 210; 0·0-2·6), MSH6 carriers was 3·0% (four of 135; 0·8-7·4), and none were detected among the MLH1 carriers, MLH1 non-carrier controls, and MSH6 non-carrier controls. Prostate cancer incidence, using a PSA threshold of higher than 3·0 ng/mL, was higher in MSH2 carriers than in MSH2 non-carrier controls (4·3% vs 0·5%; p=0·011) and MSH6 carriers than MSH6 non-carrier controls (3·0% vs 0%; p=0·034). The overall positive predictive value of biopsy using a PSA threshold of 3·0 ng/mL was 51·4% (95% CI 34·0-68·6), and the overall positive predictive value of a PSA threshold of 3·0 ng/mL was 32·1% (20·3-46·0). INTERPRETATION After the first screening round, carriers of MSH2 and MSH6 pathogenic variants had a higher incidence of prostate cancer compared with age-matched non-carrier controls. These findings support the use of targeted PSA screening in these men to identify those with clinically significant prostate cancer. Further annual screening rounds will need to confirm these findings. FUNDING Cancer Research UK, The Ronald and Rita McAulay Foundation, the National Institute for Health Research support to Biomedical Research Centres (The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Oxford; Manchester and the Cambridge Clinical Research Centre), Mr and Mrs Jack Baker, the Cancer Council of Tasmania, Cancer Australia, Prostate Cancer Foundation of Australia, Cancer Council of Victoria, Cancer Council of South Australia, the Victorian Cancer Agency, Cancer Australia, Prostate Cancer Foundation of Australia, Asociación Española Contra el Cáncer (AECC), the Instituto de Salud Carlos III, Fondo Europeo de Desarrollo Regional (FEDER), the Institut Català de la Salut, Autonomous Government of Catalonia, Fundação para a Ciência e a Tecnologia, National Institutes of Health National Cancer Institute, Swedish Cancer Society, General Hospital in Malmö Foundation for Combating Cancer.
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Affiliation(s)
- Elizabeth K Bancroft
- Oncogenetics Team, Institute of Cancer Research, London, UK; Cancer Genetics Unit & Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | | | - Mark N Brook
- Oncogenetics Team, Institute of Cancer Research, London, UK
| | - Sarah Thomas
- Cancer Genetics Unit & Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Natalie Taylor
- Cancer Genetics Unit & Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Jennifer Pope
- Oncogenetics Team, Institute of Cancer Research, London, UK
| | - Jana McHugh
- Oncogenetics Team, Institute of Cancer Research, London, UK
| | | | | | - Susan Merson
- Oncogenetics Team, Institute of Cancer Research, London, UK
| | - Kai Ren Ong
- Clinical Genetics Unit, Birmingham Women's Hospital, Birmingham, UK
| | - Jonathan Hoffman
- Clinical Genetics Unit, Birmingham Women's Hospital, Birmingham, UK
| | - Camilla Huber
- Clinical Genetics Unit, Birmingham Women's Hospital, Birmingham, UK
| | - Lovise Maehle
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | | | - Astrid Stormorken
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - D Gareth Evans
- Genomic Medicine, Division of Evolution and Genomic Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jeanette Rothwell
- Genomic Medicine, Division of Evolution and Genomic Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Fiona Lalloo
- Genomic Medicine, Division of Evolution and Genomic Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Angela F Brady
- North West Thames Regional Genetics Service, London North West University Healthcare NHS Trust, Harrow, UK
| | - Marion Bartlett
- North West Thames Regional Genetics Service, London North West University Healthcare NHS Trust, Harrow, UK
| | | | | | - Paul James
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia; Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Joanne McKinley
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Lyon Mascarenhas
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Sapna Syngal
- Division of Population Sciences, Dana Farber Cancer Institute, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA
| | - Chinedu Ukaegbu
- Division of Population Sciences, Dana Farber Cancer Institute, Boston, MA, USA
| | - Lucy Side
- University Hospital Southampton, Southampton, UK; Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Tessy Thomas
- University Hospital Southampton, Southampton, UK; Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Julian Barwell
- Department of Genetics, University of Leicester, Leicester, UK; University Hospitals Leicester, Leicester, UK
| | - Manuel R Teixeira
- Genetics Department and Research Center, Portuguese Oncology Institute (IPO Porto), Porto, Portugal; Biomedical Sciences Institute (ICBAS), Porto University, Porto, Portugal
| | - Louise Izatt
- Clinical Genetics Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mohnish Suri
- Clinical Genetics Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Finlay A Macrae
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia; Parkville Familial Cancer Centre, The Royal Melbourne Hospital, Parkville, VIC, Australia; Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Nicola Poplawski
- Adult Genetics Unit, Royal Adelaide Hospital, Adelaide, SA, Australia; Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Rakefet Chen-Shtoyerman
- The Genetic Institute, Kaplan Medical Center, Rehovot, Israel; Biology Department, Ariel University, Ariel, Israel
| | - Munaza Ahmed
- North East Thames Regional Genetics Service, Institute of Child Health, London, UK
| | - Hannah Musgrave
- Yorkshire Regional Genetics Service, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nicola Nicolai
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Lynn Greenhalgh
- Clinical Genetics Service, Liverpool Women's Hospital, Liverpool, UK
| | - Carole Brewer
- Peninsular Genetics, Derriford Hospital, Plymouth, UK; Royal Devon and Exeter Hospital, Exeter, UK
| | - Nicholas Pachter
- Genetic Services of Western Australia, King Edward Memorial Hospital, Subiaco, WA, Australia; Department of Paediatrics, University of Western Australia, Perth, WA, Australia
| | - Allan D Spigelman
- Hunter Family Cancer Service, Waratah, NSW, Australia; University of New South Wales, St Vincent's Clinical School, NSW, Australia; Cancer Genetics Clinic, The Kinghorn Cancer Centre, St Vincent's Hospital, Sydney, NSW, Australia
| | - Ashraf Azzabi
- Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Brian T Helfand
- John and Carol Walter Center for Urological Health, Division of Urology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Dorothy Halliday
- Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Saundra Buys
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | | | - Kathleen A Cooney
- Duke Cancer Institute and Duke University School of Medicine, Durham, NC, USA
| | - Marion Harris
- Monash Health, Clayton, VIC, Australia; Monash University, Clayton, VIC, Australia
| | - John McGrath
- Royal Devon and Exeter Hospital, Exeter, UK; University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Rosemarie Davidson
- West of Scotland Genetic Service, Queen Elizabeth University Hospital, Glasgow, UK
| | - Amy Taylor
- East Anglian Medical Genetics Service, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | | | - Kathryn Myhill
- Cancer Genetics Unit & Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Matthew Hogben
- Cancer Genetics Unit & Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Audrey Ardern-Jones
- Cancer Genetics Unit & Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Chris H Bangma
- Department of Urology, Erasmus Cancer Institute, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Elena Castro
- Spanish National Cancer Research Center, Madrid, Spain
| | - David Dearnaley
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, Surrey, UK
| | - Alexander Dias
- Instituto Nacional de Cancer Jose de Alencar Gomes da Silva INCA, Rio de Janeiro, Brazil
| | | | - Diana M Eccles
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK; Faculty of Medicine, University of Southampton, Southampton, UK
| | - Kate Green
- Genomic Medicine, Division of Evolution and Genomic Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jorunn Eyfjord
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | | | | | - Freddie C Hamdy
- Churchill Hospital, Headington, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Oskar Johannsson
- Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
| | - Vincent Khoo
- Cancer Genetics Unit & Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK; St George's Hospital, Tooting, London, UK; Department of Medicine, The University of Melbourne, Parkville, VIC, Australia; Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, Surrey, UK
| | - Hans Lilja
- Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Laboratory Medicine, Department of Surgery, and Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Geoffrey J Lindeman
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia; Parkville Familial Cancer Centre, The Royal Melbourne Hospital, Parkville, VIC, Australia; Cancer Biology and Stem Cells Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Jan Lubinski
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Karol Axcrona
- Department of Urology, Akershus University Hospital, Lørenskog, Norway
| | | | - Anita V Mitra
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Clare Moynihan
- Oncogenetics Team, Institute of Cancer Research, London, UK
| | | | - Gad Rennert
- CHS National Cancer Control Center, Carmel Medical Center, Haifa, Israel
| | - Rebecca Collier
- Clinical Genetics Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Judith Offman
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, Guy's Cancer Centre, Guy's Hospital, London, UK
| | | | - Rosalind A Eeles
- Oncogenetics Team, Institute of Cancer Research, London, UK; Cancer Genetics Unit & Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK.
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27
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Bratt O, Lilja H. Modern prostate cancer diagnostics reduce overdiagnosis - will they open up for population-based screening? Scand J Urol 2021; 55:491-492. [PMID: 34605720 DOI: 10.1080/21681805.2021.1980608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ola Bratt
- Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hans Lilja
- Departments of Laboratory Medicine, Surgery (Urology Service), and Medicine (GU-Oncology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Translational Medicine, Lund University, Malmö, Sweden
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Lonergan PE, Vertosick EA, Assel M, Sjoberg DD, Haese A, Graefen M, Boorjian SA, Klee GG, Cooperberg MR, Pettersson K, Routila E, Vickers AJ, Lilja H. Prospective validation of microseminoprotein-β added to the 4Kscore in predicting high-grade prostate cancer in an international multicentre cohort. BJU Int 2021; 128:218-224. [PMID: 33306251 PMCID: PMC8279428 DOI: 10.1111/bju.15320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To prospectively evaluate the performance of a pre-specified statistical model based on four kallikrein markers in blood (total prostate-specific antigen [PSA], free PSA, intact PSA, and human kallikrein-related peptidase 2), commercially available as the 4Kscore, in predicting Gleason Grade Group (GG) ≥2 prostate cancer at biopsy in an international multicentre study at three academic medical centres, and whether microseminoprotein-β (MSP) adds predictive value. PATIENTS AND METHODS A total of 984 men were prospectively enrolled at three academic centres. The primary outcome was GG ≥2 on prostate biopsy. Three pre-specified statistical models were used: a base model including PSA, age, digital rectal examination and prior negative biopsy; a model that added free PSA to the base model; and the 4Kscore. RESULTS A total of 947 men were included in the final analysis and 273 (29%) had GG ≥2 on prostate biopsy. The base model area under the receiver operating characteristic curve of 0.775 increased to 0.802 with the addition of free PSA, and to 0.824 for the 4Kscore. Adding MSP to the 4Kscore model yielded an increase (0.014-0.019) in discrimination. In decision-curve analysis of clinical utility, the 4Kscore showed a benefit starting at a 7.5% threshold. CONCLUSION A prospective multicentre evaluation of a pre-specified model based on four kallikrein markers (4Kscore) with the addition of MSP improves the predictive discrimination for GG ≥2 prostate cancer on biopsy and could be used to inform biopsy decision-making.
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Affiliation(s)
- Peter E Lonergan
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Emily A Vertosick
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Melissa Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexander Haese
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - George G Klee
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Matthew R Cooperberg
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Kim Pettersson
- Departments of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| | - Erica Routila
- Departments of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hans Lilja
- Departments of Laboratory Medicine, Surgery, and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Translational Medicine, Lund University, Malmö, Sweden
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29
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Carlsson S, Bjerner J, Lilja H, Aas K, Fosså S, Müller C, Müller S, Stensvold A, Thomas O, Røe O, Walz J, Bratt O, Oldenburg J. Long-term predictive value of serum PSA values obtained in clinical practice – Results from the Norwegian Prostate Cancer Consortium (NPCC). Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01366-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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30
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Kuci Emruli V, Liljedahl L, Axelsson U, Richter C, Theorin L, Bjartell A, Lilja H, Donovan J, Neal D, Hamdy FC, Borrebaeck CAK. Identification of a serum biomarker signature associated with metastatic prostate cancer. Proteomics Clin Appl 2021; 15:e2000025. [PMID: 33580906 DOI: 10.1002/prca.202000025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Improved early diagnosis and determination of aggressiveness of prostate cancer (PC) is important to select suitable treatment options and to decrease over-treatment. The conventional marker is total prostate specific antigen (PSA) levels in blood, but lacks specificity and ability to accurately discriminate indolent from aggressive disease. EXPERIMENTAL DESIGN In this study, we sought to identify a serum biomarker signature associated with metastatic PC. We measured 157 analytes in 363 serum samples from healthy subjects, patients with non-metastatic PC and patients with metastatic PC, using a recombinant antibody microarray. RESULTS A signature consisting of 69 proteins differentiating metastatic PC patients from healthy controls was identified. CONCLUSIONS AND CLINICAL RELEVANCE The clinical value of this biomarker signature requires validation in larger independent patient cohorts before providing a new prospect for detection of metastatic PC.
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Affiliation(s)
- Venera Kuci Emruli
- Department of Immunotechnology and CREATE Health Translational Cancer Center, Lund University, Lund, Sweden
| | - Leena Liljedahl
- Department of Immunotechnology and CREATE Health Translational Cancer Center, Lund University, Lund, Sweden
| | - Ulrika Axelsson
- Department of Immunotechnology and CREATE Health Translational Cancer Center, Lund University, Lund, Sweden
| | - Corinna Richter
- Department of Immunotechnology and CREATE Health Translational Cancer Center, Lund University, Lund, Sweden
| | - Lisa Theorin
- Department of Immunotechnology and CREATE Health Translational Cancer Center, Lund University, Lund, Sweden
| | - Anders Bjartell
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Hans Lilja
- Department of Translational Medicine, Lund University, Malmö, Sweden.,Department of Laboratory Medicine, Surgery, and Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,The Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Jenny Donovan
- Bristol Medical School, University of Bristol, Bristol, UK
| | - David Neal
- The Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Freddie C Hamdy
- The Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Carl A K Borrebaeck
- Department of Immunotechnology and CREATE Health Translational Cancer Center, Lund University, Lund, Sweden
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31
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Ku A, Fredsøe J, Sørensen KD, Borre M, Evander M, Laurell T, Lilja H, Ceder Y. High-Throughput and Automated Acoustic Trapping of Extracellular Vesicles to Identify microRNAs With Diagnostic Potential for Prostate Cancer. Front Oncol 2021; 11:631021. [PMID: 33842337 PMCID: PMC8029979 DOI: 10.3389/fonc.2021.631021] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/29/2021] [Indexed: 12/21/2022] Open
Abstract
Molecular profiling of extracellular vesicles (EVs) offers novel opportunities for diagnostic applications, but the current major obstacle for clinical translation is the lack of efficient, robust, and reproducible isolation methods. To bridge that gap, we developed a microfluidic, non-contact, and low-input volume compatible acoustic trapping technology for EV isolation that enabled downstream small RNA sequencing. In the current study, we have further automated the acoustic microfluidics-based EV enrichment technique that enables us to serially process 32 clinical samples per run. We utilized the system to enrich EVs from urine collected as the first morning void from 207 men referred to 10-core prostate biopsy performed the same day. Using automated acoustic trapping, we successfully enriched EVs from 199/207 samples (96%). After RNA extraction, size selection, and library preparation, a total of 173/199 samples (87%) provided sufficient materials for next-generation sequencing that generated an average of 2 × 106 reads per sample mapping to the human reference genome. The predominant RNA species identified were fragments of long RNAs such as protein coding and retained introns, whereas small RNAs such as microRNAs (miRNA) accounted for less than 1% of the reads suggesting that partially degraded long RNAs out-competed miRNAs during sequencing. We found that the expression of six miRNAs was significantly different (Padj < 0.05) in EVs isolated from patients found to have high grade prostate cancer [ISUP 2005 Grade Group (GG) 4 or higher] compared to those with GG3 or lower, including those with no evidence of prostate cancer at biopsy. These included miR-23b-3p, miR-27a-3p, and miR-27b-3p showing higher expression in patients with GG4 or high grade prostate cancer, whereas miR-1-3p, miR-10a-5p, and miR-423-3p had lower expression in the GG4 PCa cases. Cross referencing our differentially expressed miRNAs to two large prostate cancer datasets revealed that the putative tumor suppressors miR-1, miR-23b, and miR-27a are consistently deregulated in prostate cancer. Taken together, this is the first time that our automated microfluidic EV enrichment technique has been found to be capable of enriching EVs on a large scale from 900 μl of urine for small RNA sequencing in a robust and disease discriminatory manner.
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Affiliation(s)
- Anson Ku
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Jacob Fredsøe
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark & Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Karina D Sørensen
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark & Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Michael Borre
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark & Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mikael Evander
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Thomas Laurell
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Hans Lilja
- Department of Translational Medicine, Lund University, Malmö, Sweden.,Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States.,Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States.,Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Yvonne Ceder
- Department of Laboratory Medicine, Lund University, Lund, Sweden
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32
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Veach DR, Storey CM, Lückerath K, Braun K, von Bodman C, Lamminmäki U, Kalidindi T, Strand SE, Strand J, Altai M, Damoiseaux R, Zanzonico P, Benabdallah N, Pankov D, Scher HI, Scardino P, Larson SM, Lilja H, McDevitt MR, Thorek DLJ, Ulmert D. PSA-Targeted Alpha-, Beta-, and Positron-Emitting Immunotheranostics in Murine Prostate Cancer Models and Nonhuman Primates. Clin Cancer Res 2021; 27:2050-2060. [PMID: 33441295 DOI: 10.1158/1078-0432.ccr-20-3614] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/13/2020] [Accepted: 01/07/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE Most patients with prostate cancer treated with androgen receptor (AR) signaling inhibitors develop therapeutic resistance due to restoration of AR functionality. Thus, there is a critical need for novel treatment approaches. Here we investigate the theranostic potential of hu5A10, a humanized mAb specifically targeting free PSA (KLK3). EXPERIMENTAL DESIGN LNCaP-AR (LNCaP with overexpression of wildtype AR) xenografts (NSG mice) and KLK3_Hi-Myc transgenic mice were imaged with 89Zr- or treated with 90Y- or 225Ac-labeled hu5A10; biodistribution and subcellular localization were analyzed by gamma counting, PET, autoradiography, and microscopy. Therapeutic efficacy of [225Ac]hu5A10 and [90Y]hu5A10 in LNCaP-AR tumors was assessed by tumor volume measurements, time to nadir (TTN), time to progression (TTP), and survival. Pharmacokinetics of [89Zr]hu5A10 in nonhuman primates (NHP) were determined using PET. RESULTS Biodistribution of radiolabeled hu5A10 constructs was comparable in different mouse models. Specific tumor uptake increased over time and correlated with PSA expression. Treatment with [90Y]/[225Ac]hu5A10 effectively reduced tumor burden and prolonged survival (P ≤ 0.0054). Effects of [90Y]hu5A10 were more immediate than [225Ac]hu5A10 (TTN, P < 0.0001) but less sustained (TTP, P < 0.0001). Complete responses were observed in 7 of 18 [225Ac]hu5A10 and 1 of 9 mice [90Y]hu5A10. Pharmacokinetics of [89Zr]hu5A10 were consistent between NHPs and comparable with those in mice. [89Zr]hu5A10-PET visualized the NHP-prostate over the 2-week observation period. CONCLUSIONS We present a complete preclinical evaluation of radiolabeled hu5A10 in mouse prostate cancer models and NHPs, and establish hu5A10 as a new theranostic agent that allows highly specific and effective downstream targeting of AR in PSA-expressing tissue. Our data support the clinical translation of radiolabeled hu5A10 for treating prostate cancer.
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Affiliation(s)
- Darren R Veach
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Radiology, Weill Cornell Medical College, New York, New York
| | - Claire M Storey
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California
| | - Katharina Lückerath
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California.,Ahmanson Translational Imaging Division, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.,Department of Urology, David Geffen School of Medicine, Institute of Urologic Oncology, University of California, Los Angeles, Los Angeles, California.,Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Katharina Braun
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | | | - Urpo Lamminmäki
- Department of Biochemistry, University of Turku, Turku, Finland
| | - Teja Kalidindi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sven-Erik Strand
- Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Joanna Strand
- Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Mohamed Altai
- Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Robert Damoiseaux
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California
| | - Pat Zanzonico
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nadia Benabdallah
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Dmitry Pankov
- Immunology Program, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Howard I Scher
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Peter Scardino
- Department of Medicine, Weill Cornell Medical College, New York, New York.,Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Steven M Larson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Radiology, Weill Cornell Medical College, New York, New York
| | - Hans Lilja
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Michael R McDevitt
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Radiology, Weill Cornell Medical College, New York, New York
| | - Daniel L J Thorek
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri.,Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, Missouri
| | - David Ulmert
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California. .,Ahmanson Translational Imaging Division, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.,Department of Urology, David Geffen School of Medicine, Institute of Urologic Oncology, University of California, Los Angeles, Los Angeles, California.,Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.,Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California, Los Angeles, Los Angeles, California
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Li W, Bicak M, Sjoberg DD, Vertosick E, Dahlin A, Melander O, Ulmert D, Lilja H, Klein RJ. Genome-wide association study identifies novel single nucleotide polymorphisms having age-specific effect on prostate-specific antigen levels. Prostate 2020; 80:1405-1412. [PMID: 32914890 PMCID: PMC7606728 DOI: 10.1002/pros.24070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/17/2020] [Accepted: 08/24/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Testing for prostate-specific antigen (PSA) levels in blood are widely used and associated with prostate cancer risk and outcome. After puberty, PSA levels increase by age and multiple single nucleotide polymorphisms (SNPs) have been found to be associated with PSA levels. However, the relationship between the effects of SNPs and age on PSA remains unknown. METHODS To test for SNP × age interaction, we conducted a genome-wide association study using 2394 men without prostate cancer diagnosis from Malmö, Sweden as a discovery set and 2137 men from the eMERGE study (USA) for validation. Linear regression was used to identify significant interactions between SNP and age (p < 1 × 10-4 for discovery, p < .05 for validation). RESULTS The 15 SNPs from three different loci (8p11.22, 8p12, 3q25.31) are found to have age-specific effect on PSA levels. Expression quantitative trait loci (eQTLs) analysis shows that 12 SNPs from 3q25.31 locus affect the expression level of three genes: KCNAB1, SLC33A1, PLCH1. CONCLUSIONS Our results suggest that SNPs may have age-specific effect on PSA levels, which provides new direction to study genetic markers for PSA.
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Affiliation(s)
- Weiqiang Li
- Icahn Institute for Genomics and Multiscale Biology and Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Mesude Bicak
- Icahn Institute for Genomics and Multiscale Biology and Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Daniel D. Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Emily Vertosick
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Anders Dahlin
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Olle Melander
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - David Ulmert
- Molecular pharmacology program, Sloan Kettering Institute, New York, NY USA
| | - Hans Lilja
- Departments of Laboratory Medicine, Surgery, and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA; Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Robert J. Klein
- Icahn Institute for Genomics and Multiscale Biology and Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY USA
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34
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Vertosick EA, Häggström C, Sjoberg DD, Hallmans G, Johansson R, Vickers AJ, Stattin P, Lilja H. Prespecified 4-Kallikrein Marker Model at Age 50 or 60 for Early Detection of Lethal Prostate Cancer in a Large Population Based Cohort of Asymptomatic Men Followed for 20 Years. J Urol 2020; 204:281-288. [PMID: 32125228 PMCID: PMC8423096 DOI: 10.1097/ju.0000000000001007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE A prespecified statistical model based on 4 kallikrein markers in blood, commercially available as the 4Kscore®, has been shown to accurately detect high grade (greater than Grade Group 2) prostate cancer in men with moderately elevated prostate specific antigen. We assessed whether the model predicted prostate cancer metastasis or death in men not subject to prostate specific antigen screening. MATERIALS AND METHODS The cohort includes 43,692 unscreened prostate cancer-free men from a Swedish population based cohort with low rates of prostate specific antigen screening (Västerbotten Intervention Project). Using cryopreserved blood collected at ages 50 and 60 years from men in this cohort we analyzed the association between prostate specific antigen and other kallikrein marker levels in blood and risk of prostate cancer metastasis or death. RESULTS There were 308 with metastases and 172 prostate cancer deaths. Baseline prostate specific antigen was strongly associated with 20-year risk of prostate cancer death (c-index at age 50, 0.859, 95% CI 0.799-0.916; age 60, 0.840, 95% CI 0.799-0.878). Men 60 years old with prostate specific antigen below median (less than 1.2 ng/ml) had 0.4% risk of prostate cancer death at 20 years. Among men with moderately elevated prostate specific antigen (2.0 ng/ml or greater) the 4Kscore markedly improved discrimination (c-index 0.767 vs 0.828 and 0.774 vs 0.862 in men age 50 and 60, respectively). Long-term risk of prostate cancer death or metastasis in men with low 4Kscores was very low. CONCLUSIONS Screening should focus on men in top prostate specific antigen quartile at age 60 years. Men with elevated prostate specific antigen but a low 4Kscore can safely be monitored with repeated blood markers in place of immediate biopsy.
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Affiliation(s)
- Emily A. Vertosick
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Christel Häggström
- Department of Biobank Research, Umeå University, Umeå, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Daniel D. Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Göran Hallmans
- Department of Public Heath and Clinical Medicine, Nutritional Research, Umeå University, Umeå
| | | | - Andrew J. Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Hans Lilja
- Department of Surgery (Urology Service), Departments of Laboratory Medicine and Medicine (GU-Oncology Service), Memorial Sloan Kettering Cancer Center, New York, NY, U.S.A.; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; and Department of Translational Medicine, Lund University, Malmö, Sweden
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35
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Bicak M, Lückerath K, Kalidindi T, Phelps ME, Strand SE, Morris MJ, Radu CG, Damoiseaux R, Peltola MT, Peekhaus N, Ho A, Veach D, Malmborg Hager AC, Larson SM, Lilja H, McDevitt MR, Klein RJ, Ulmert D. Genetic signature of prostate cancer mouse models resistant to optimized hK2 targeted α-particle therapy. Proc Natl Acad Sci U S A 2020; 117:15172-15181. [PMID: 32532924 PMCID: PMC7334567 DOI: 10.1073/pnas.1918744117] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hu11B6 is a monoclonal antibody that internalizes in cells expressing androgen receptor (AR)-regulated prostate-specific enzyme human kallikrein-related peptidase 2 (hK2; KLK2). In multiple rodent models, Actinium-225-labeled hu11B6-IgG1 ([225Ac]hu11B6-IgG1) has shown promising treatment efficacy. In the present study, we investigated options to enhance and optimize [225Ac]hu11B6 treatment. First, we evaluated the possibility of exploiting IgG3, the IgG subclass with superior activation of complement and ability to mediate FC-γ-receptor binding, for immunotherapeutically enhanced hK2 targeted α-radioimmunotherapy. Second, we compared the therapeutic efficacy of a single high activity vs. fractionated activity. Finally, we used RNA sequencing to analyze the genomic signatures of prostate cancer that progressed after targeted α-therapy. [225Ac]hu11B6-IgG3 was a functionally enhanced alternative to [225Ac]hu11B6-IgG1 but offered no improvement of therapeutic efficacy. Progression-free survival was slightly increased with a single high activity compared to fractionated activity. Tumor-free animals succumbing after treatment revealed no evidence of treatment-associated toxicity. In addition to up-regulation of canonical aggressive prostate cancer genes, such as MMP7, ETV1, NTS, and SCHLAP1, we also noted a significant decrease in both KLK3 (prostate-specific antigen ) and FOLH1 (prostate-specific membrane antigen) but not in AR and KLK2, demonstrating efficacy of sequential [225Ac]hu11B6 in a mouse model.
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Affiliation(s)
- Mesude Bicak
- Department of Genetics and Genomic Sciences, Icahn Institute for Data Science and Genome Technology, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Katharina Lückerath
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA 90095
- Ahmanson Translational Imaging Division, David Geffen School of Medicine, University of California, Los Angeles, CA 90095
| | - Teja Kalidindi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Michael E Phelps
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA 90095;
| | - Sven-Erik Strand
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, 223 81 Lund, Sweden
| | - Michael J Morris
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Caius G Radu
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA 90095
- Ahmanson Translational Imaging Division, David Geffen School of Medicine, University of California, Los Angeles, CA 90095
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, CA 90095
| | - Robert Damoiseaux
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA 90095
| | - Mari T Peltola
- Department of Biochemistry-Biotechnology, University of Turku, FI-20014 Turun yliopisto, Finland
| | - Norbert Peekhaus
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA 90095
| | - Austin Ho
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA 90095
| | - Darren Veach
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065
- Radiochemistry and Imaging Sciences Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065
- Diaprost AB, 223 63 Lund, Sweden
| | | | - Steven M Larson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065
- Department of Radiology, Weill Cornell Medical College, New York, NY 10065
| | - Hans Lilja
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065
- Department of Translational Medicine, Lund University, 221 00 Lund, Sweden
- Nuffield Department of Surgical Sciences, University of Oxford, Headington, OX3 7DQ Oxford, United Kingdom
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Michael R McDevitt
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065
- Department of Radiology, Weill Cornell Medical College, New York, NY 10065
| | - Robert J Klein
- Department of Genetics and Genomic Sciences, Icahn Institute for Data Science and Genome Technology, Icahn School of Medicine at Mount Sinai, New York, NY 10029;
| | - David Ulmert
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA 90095;
- Ahmanson Translational Imaging Division, David Geffen School of Medicine, University of California, Los Angeles, CA 90095
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, CA 90095
- Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California, Los Angeles, CA 90095
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Bicak M, Wang X, Gao X, Xu X, Väänänen RM, Taimen P, Lilja H, Pettersson K, Klein RJ. Prostate cancer risk SNP rs10993994 is a trans-eQTL for SNHG11 mediated through MSMB. Hum Mol Genet 2020; 29:1581-1591. [PMID: 32065238 PMCID: PMC7526792 DOI: 10.1093/hmg/ddaa026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/25/2019] [Accepted: 02/12/2020] [Indexed: 02/06/2023] Open
Abstract
How genome-wide association studies-identified single-nucleotide polymorphisms (SNPs) affect remote genes remains unknown. Expression quantitative trait locus (eQTL) association meta-analysis on 496 prostate tumor and 602 normal prostate samples with 117 SNPs revealed novel cis-eQTLs and trans-eQTLs. Mediation testing and colocalization analysis demonstrate that MSMB is a cis-acting mediator for SNHG11 (P < 0.01). Removing rs10993994 in LNCaP cell lines by CRISPR/Cas9 editing shows that the C-allele corresponds with an over 100-fold increase in MSMB expression and 5-fold increase in SNHG11 compared with the T-allele. Colocalization analysis confirmed that the same set of SNPs associated with MSMB expression is associated with SNHG11 expression (posterior probability of shared variants is 66.6% in tumor and 91.4% in benign). These analyses further demonstrate variants driving MSMB expression differ in tumor and normal, suggesting regulatory network rewiring during tumorigenesis.
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Affiliation(s)
- Mesude Bicak
- Department of Genetics and Genomic Sciences, Icahn Institute for Data Science and Genome Technology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Xing Wang
- Department of Genetics and Genomic Sciences, Icahn Institute for Data Science and Genome Technology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Xiaoni Gao
- Department of Genetics and Genomic Sciences, Icahn Institute for Data Science and Genome Technology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Program in Cancer Biology and Genetics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Xing Xu
- Program in Cancer Biology and Genetics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | | | - Pekka Taimen
- Department of Pathology, University of Turku, 20014 Turku, and Turku University Hospital, 20521 Turku, Finland
| | - Hans Lilja
- Department of Laboratory Medicine, Surgery and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX3 7DQ, UK
- Department of Translational Medicine, Lund University, Malmö 205 02, Sweden
| | - Kim Pettersson
- Division of Biotechnology, University of Turku, Turku, Finland
| | - Robert J Klein
- Department of Genetics and Genomic Sciences, Icahn Institute for Data Science and Genome Technology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Program in Cancer Biology and Genetics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Darst BF, Wan P, Chou A, Vertosick E, Conti DV, Wilkens L, Le Marchand L, Vickers A, Lilja H, Haiman CA. Abstract PR01: The four-kallikrein panel discriminates prostate cancer and aggressive disease in a multiethnic population. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp19-pr01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: The four-kallikrein (4K) panel, commercially available as the 4Kscore, has been demonstrated to improve prediction of aggressive prostate cancer (PCa) compared to prostate-specific antigen (PSA) alone or PSA in combination with free PSA. However, the development and testing of the 4K panel has been limited to studies conducted primarily in White men.
Methods: We prospectively evaluated the 4K panel in a nested case-control study among African American (AA), Latino (LA), Japanese (JA), Native Hawaiian (NH), and White (WH) men in the Multiethnic Cohort (MEC). Prediagnostic blood levels of free, intact, and total PSA and human kallikrein-related peptidase 2 (hK2) were measured among 2,227 incident PCa cases and 2,189 controls. We used area under the curve (AUC) calculations to compare the discriminative ability of the 4K panel to PSA for overall PCa, Gleason-Grade Group (GGG) 2 or higher, aggressive PCa (Gleason>7, non-localized disease, or death from PCa), and death due to PCa within and across all racial/ethnic groups.
Results: The mean ages of the cases and controls at blood draw were 68 (range 47–86) and 69 (range 47–87), respectively, and for cases, samples were drawn an average of 4.9 years prior to their PCa diagnosis (range <1–18 years). For men with elevated PSA (≥2.0 ng/ml; 1,669 cases and 663 controls), the AUC for overall PCa was 0.76 (95% CI 0.74–0.78) for the 4K panel compared to 0.72 (95% CI 0.70–0.74) for free plus total PSA and 0.67 (95% CI 0.65–0.70) for total PSA alone. Discrimination was slightly enhanced for the 4K panel for GGG≥2 (1,067 cases; 0.78 for panel versus 0.74 for free plus total PSA and 0.68 for total PSA only) and aggressive PCa (542 cases; 0.79 for panel versus 0.74 for free plus total PSA and 0.68 for total PSA only). Improvement of the 4K panel over total PSA alone was observed in each racial/ethnic group for all four PCa outcomes, most notably for GGG≥2 (AA, 0.71 vs. 0.66; LA, 0.82 vs. 0.71; JA, 0.80 vs. 0.69; NH, 0.90 vs. 0.77; WH, 0.77 vs. 0.69) and aggressive PCa (AA, 0.72 vs. 0.67; LA, 0.81 vs. 0.70; JA, 0.81 vs. 0.69; NH, 0.91 vs. 0.73; WH, 0.77 vs. 0.67).
Conclusion: The superior predictive ability of the 4K panel over PSA for overall and aggressive PCa across multiethnic populations indicates the broad clinical applicability of the 4K panel.
This abstract is also being presented as Poster A068.
Citation Format: Burcu F. Darst, Peggy Wan, Alisha Chou, Emily Vertosick, David V. Conti, Lynne Wilkens, Loic Le Marchand, Andrew Vickers, Hans Lilja, Christopher A. Haiman. The four-kallikrein panel discriminates prostate cancer and aggressive disease in a multiethnic population [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr PR01.
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Affiliation(s)
- Burcu F. Darst
- 1Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA,
| | - Peggy Wan
- 1Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA,
| | - Alisha Chou
- 1Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA,
| | - Emily Vertosick
- 2Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY,
| | - David V. Conti
- 1Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA,
| | - Lynne Wilkens
- 3Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI,
| | - Loic Le Marchand
- 3Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI,
| | - Andrew Vickers
- 2Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY,
| | - Hans Lilja
- 4Departments of Laboratory Medicine, Surgery, and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Christopher A. Haiman
- 1Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA,
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Haese A, Tin AL, Carlsson SV, Sjoberg DD, Pehrke D, Steuber T, Huland H, Graefen M, Scardino PT, Schlomm T, Vickers AJ, Lilja H, Sauter G. A pre-specified model based on four kallikrein markers in blood improves predictions of adverse pathology and biochemical recurrence after radical prostatectomy. Br J Cancer 2020; 123:604-609. [PMID: 32467601 PMCID: PMC7434907 DOI: 10.1038/s41416-020-0914-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/17/2020] [Accepted: 05/06/2020] [Indexed: 01/01/2023] Open
Abstract
Background A pre-specified model based on four kallikrein markers in blood, commercially available as 4Kscore, predicts Gleason Grade (GG) 3 + 4 or higher prostate cancer on biopsy. However, sampling error and variation in pathology reporting may miss aggressive disease. Methods The 4Kscore was measured in cryopreserved blood from 2330 men obtained before prostatectomy at a single institution between 2002 and 2010. Adverse surgical pathology and biochemical recurrence (BCR) were pre-specified to be assessed in all men, biopsy GG 3 + 3, and 3 + 4. Results Adjusted for established clinical predictors, the 4Kscore was significantly associated with adverse pathology (OR 1.49; 95% CI 1.32, 1.67; p < 0.0001). Adding 4Kscore increased discrimination from (AUC) 0.672 to 0.718 and 0.644 to 0.659 within biopsy GG 3 + 3 and 3 + 4, respectively. Higher 4Kscore was associated with higher risk of BCR (HR 1.16, 95% CI 1.06, 1.26; p = 0.001). Adding 4Kscore improved the prediction of BCR (C-index 0.630–0.660) within GG 3 + 3, but not GG 3 + 4. Conclusions The 4Kscore can help guide the clinical decision whether additional risk assessment—such as confirmatory biopsy—is needed to decide between active surveillance versus curative therapy. Evidence that the panel could influence management in biopsy GG 3 + 4 is less strong and requires further investigation.
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Affiliation(s)
- Alexander Haese
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Amy L Tin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sigrid V Carlsson
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dirk Pehrke
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Steuber
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hartwig Huland
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter T Scardino
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Thorsten Schlomm
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hans Lilja
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Departments of Laboratory Medicine and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK. .,Department of Translational Medicine, Lund University, Malmö, Sweden.
| | - Guido Sauter
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Kovac E, Carlsson SV, Lilja H, Hugosson J, Kattan MW, Holmberg E, Stephenson AJ. Association of Baseline Prostate-Specific Antigen Level With Long-term Diagnosis of Clinically Significant Prostate Cancer Among Patients Aged 55 to 60 Years: A Secondary Analysis of a Cohort in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. JAMA Netw Open 2020; 3:e1919284. [PMID: 31940039 PMCID: PMC6991265 DOI: 10.1001/jamanetworkopen.2019.19284] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
IMPORTANCE The use of prostate-specific antigen (PSA) screening for prostate cancer is controversial because of the risk of overdiagnosis and overtreatment of indolent cancers. Optimal screening strategies are highly sought. OBJECTIVE To estimate the long-term risk of any prostate cancer and clinically significant prostate cancer based on baseline PSA levels among men aged 55 to 60 years. DESIGN, SETTING, AND PARTICIPANTS This secondary analysis of a cohort in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial uses actuarial analysis to analyze the association of baseline PSA levels with long-term risk of any prostate cancer and of clinically significant prostate cancer among men aged 55 to 60 years enrolled in the screening group of the trial between 1993 and 2001. EXPOSURE Single PSA measurement at study entry. MAIN OUTCOMES AND MEASURES Long-term risk of any prostate cancer and clinically significant prostate cancer diagnoses. RESULTS There were 10 968 men aged 55 to 60 years (median [interquartile range] age, 57 [55-58] years) at study enrollment in the screening group of the PLCO Cancer Screening Trial who had long-term follow-up. Actuarial 13-year incidences of clinically significant prostate cancer diagnosis among participants with a baseline PSA of 0.49 ng/mL or less was 0.4% (95% CI, 0%-0.8%); 0.50-0.99 ng/mL, 1.5% (95% CI, 1.1%-1.9%); 1.00-1.99 ng/mL, 5.4% (95% CI, 4.4%-6.4%); 2.00-2.99 ng/mL, 10.6% (95% CI, 8.3%-12.9%); 3.00-3.99 ng/mL, 15.3% (95% CI, 11.4%-19.2%); and 4.00 ng/mL and greater, 29.5% (95% CI, 24.2%-34.8%) (all pairwise log-rank P ≤ .004). Only 15 prostate cancer-specific deaths occurred during 13 years of follow-up, and 9 (60.0%) were among men with a baseline PSA level of 2.00 ng/mL or higher. CONCLUSIONS AND RELEVANCE In this secondary analysis of a cohort from the PLCO Cancer Screening Trial, baseline PSA levels among men aged 55 to 60 years were associated with long-term risk of clinically significant prostate cancer. These findings suggest that repeated screening can be less frequent among men aged 55 to 60 years with a low baseline PSA level (ie, <2.00 ng/mL) and possibly discontinued among those with baseline PSA levels of less than 1.00 ng/mL.
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Affiliation(s)
- Evan Kovac
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio
- Department of Urology, Montefiore Medical Center, Bronx, New York
| | - Sigrid V. Carlsson
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Hans Lilja
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Jonas Hugosson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Michael W. Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Erik Holmberg
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Andrew J. Stephenson
- Department of Surgery, Division of Urology, Rush Medical College, Chicago, Illinois
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Assel MJ, Ulmert HD, Karnes RJ, Boorjian SA, Hillman DW, Vickers AJ, Klee GG, Lilja H. Kallikrein markers performance in pretreatment blood to predict early prostate cancer recurrence and metastasis after radical prostatectomy among very high-risk men. Prostate 2020; 80:51-56. [PMID: 31603253 PMCID: PMC6944058 DOI: 10.1002/pros.23916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 09/26/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND To assess whether a prespecified statistical model based on the four kallikrein markers measured in blood-total, free, and intact prostate-specific antigen (PSA), together with human kallikrein-related peptidase 2 (hK2)-or any individual marker measured in pretreatment serum were associated with biochemical recurrence-free (BCR) or metastasis-free survival after radical prostatectomy (RP) in a subgroup of men with very high-risk disease. METHODS We identified 106 men treated at Mayo Clinic from 2004 to 2008 with pathological Gleason grade group 4 to 5 or seminal vesicle invasion at RP. Univariable and multivariable Cox models were used to test the association between standard predictors (Kattan nomogram and GPSM [Gleason, PSA, seminal vesicle and margin status] score), kallikrein panel, and individual kallikrein markers with the outcomes. RESULTS BCR and metastasis occurred in 67 and 30 patients, respectively. The median follow-up for patients who did not develop a BCR was 10.3 years (interquartile range = 8.2-11.8). In this high-risk group, neither Kattan risk, GPSM score, or the kallikrein panel model was associated with either outcome. However, after adjusting for Kattan risk and GPSM score, separately, preoperative intact PSA was associated with both outcomes while hK2 was associated with metastasis-free survival. CONCLUSIONS Conventional risk prediction tools were poor discriminators for risk of adverse outcomes after RP (Kattan risk and GPSM risk) in patients with very high-risk disease. Further studies are needed to define the role of individual kallikrein marker forms in the blood to predict adverse prostate cancer outcomes after RP in this high-risk setting.
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Affiliation(s)
- Melissa J. Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hans David Ulmert
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | | | | | - David W. Hillman
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Andrew J. Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - George G. Klee
- Mayo Clinic College of Medicine & Science, Mayo Clinic, Rochester, MN, USA
| | - Hans Lilja
- Departments of Laboratory Medicine, Surgery, and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Corresponding author: Hans Lilja, MD, PhD, 1275 York Ave, BOX 213, New York, NY 10065, (P) 212-639-6982, (F) 646-422-2379,
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Page EC, Bancroft EK, Brook MN, Assel M, Hassan Al Battat M, Thomas S, Taylor N, Chamberlain A, Pope J, Raghallaigh HN, Evans DG, Rothwell J, Maehle L, Grindedal EM, James P, Mascarenhas L, McKinley J, Side L, Thomas T, van Asperen C, Vasen H, Kiemeney LA, Ringelberg J, Jensen TD, Osther PJS, Helfand BT, Genova E, Oldenburg RA, Cybulski C, Wokolorczyk D, Ong KR, Huber C, Lam J, Taylor L, Salinas M, Feliubadaló L, Oosterwijk JC, van Zelst-Stams W, Cook J, Rosario DJ, Domchek S, Powers J, Buys S, O'Toole K, Ausems MGEM, Schmutzler RK, Rhiem K, Izatt L, Tripathi V, Teixeira MR, Cardoso M, Foulkes WD, Aprikian A, van Randeraad H, Davidson R, Longmuir M, Ruijs MWG, Helderman van den Enden ATJM, Adank M, Williams R, Andrews L, Murphy DG, Halliday D, Walker L, Liljegren A, Carlsson S, Azzabi A, Jobson I, Morton C, Shackleton K, Snape K, Hanson H, Harris M, Tischkowitz M, Taylor A, Kirk J, Susman R, Chen-Shtoyerman R, Spigelman A, Pachter N, Ahmed M, Ramon Y Cajal T, Zgajnar J, Brewer C, Gadea N, Brady AF, van Os T, Gallagher D, Johannsson O, Donaldson A, Barwell J, Nicolai N, Friedman E, Obeid E, Greenhalgh L, Murthy V, Copakova L, Saya S, McGrath J, Cooke P, Rønlund K, Richardson K, Henderson A, Teo SH, Arun B, Kast K, Dias A, Aaronson NK, Ardern-Jones A, Bangma CH, Castro E, Dearnaley D, Eccles DM, Tricker K, Eyfjord J, Falconer A, Foster C, Gronberg H, Hamdy FC, Stefansdottir V, Khoo V, Lindeman GJ, Lubinski J, Axcrona K, Mikropoulos C, Mitra A, Moynihan C, Rennert G, Suri M, Wilson P, Dudderidge T, Offman J, Kote-Jarai Z, Vickers A, Lilja H, Eeles RA. Interim Results from the IMPACT Study: Evidence for Prostate-specific Antigen Screening in BRCA2 Mutation Carriers. Eur Urol 2019; 76:831-842. [PMID: 31537406 PMCID: PMC6880781 DOI: 10.1016/j.eururo.2019.08.019] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 08/12/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Mutations in BRCA2 cause a higher risk of early-onset aggressive prostate cancer (PrCa). The IMPACT study is evaluating targeted PrCa screening using prostate-specific-antigen (PSA) in men with germline BRCA1/2 mutations. OBJECTIVE To report the utility of PSA screening, PrCa incidence, positive predictive value of PSA, biopsy, and tumour characteristics after 3 yr of screening, by BRCA status. DESIGN, SETTING, AND PARTICIPANTS Men aged 40-69 yr with a germline pathogenic BRCA1/2 mutation and male controls testing negative for a familial BRCA1/2 mutation were recruited. Participants underwent PSA screening for 3 yr, and if PSA > 3.0 ng/ml, men were offered prostate biopsy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS PSA levels, PrCa incidence, and tumour characteristics were evaluated. Statistical analyses included Poisson regression offset by person-year follow-up, chi-square tests for proportion t tests for means, and Kruskal-Wallis for medians. RESULTS AND LIMITATIONS A total of 3027 patients (2932 unique individuals) were recruited (919 BRCA1 carriers, 709 BRCA1 noncarriers, 902 BRCA2 carriers, and 497 BRCA2 noncarriers). After 3 yr of screening, 527 men had PSA > 3.0 ng/ml, 357 biopsies were performed, and 112 PrCa cases were diagnosed (31 BRCA1 carriers, 19 BRCA1 noncarriers, 47 BRCA2 carriers, and 15 BRCA2 noncarriers). Higher compliance with biopsy was observed in BRCA2 carriers compared with noncarriers (73% vs 60%). Cancer incidence rate per 1000 person years was higher in BRCA2 carriers than in noncarriers (19.4 vs 12.0; p = 0.03); BRCA2 carriers were diagnosed at a younger age (61 vs 64 yr; p = 0.04) and were more likely to have clinically significant disease than BRCA2 noncarriers (77% vs 40%; p = 0.01). No differences in age or tumour characteristics were detected between BRCA1 carriers and BRCA1 noncarriers. The 4 kallikrein marker model discriminated better (area under the curve [AUC] = 0.73) for clinically significant cancer at biopsy than PSA alone (AUC = 0.65). CONCLUSIONS After 3 yr of screening, compared with noncarriers, BRCA2 mutation carriers were associated with a higher incidence of PrCa, younger age of diagnosis, and clinically significant tumours. Therefore, systematic PSA screening is indicated for men with a BRCA2 mutation. Further follow-up is required to assess the role of screening in BRCA1 mutation carriers. PATIENT SUMMARY We demonstrate that after 3 yr of prostate-specific antigen (PSA) testing, we detect more serious prostate cancers in men with BRCA2 mutations than in those without these mutations. We recommend that male BRCA2 carriers are offered systematic PSA screening.
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Affiliation(s)
| | - Elizabeth K Bancroft
- Oncogenetics Team, Institute of Cancer Research, London, UK; Cancer Genetics Unit and Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Mark N Brook
- Oncogenetics Team, Institute of Cancer Research, London, UK
| | - Melissa Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, NY, USA
| | | | - Sarah Thomas
- Cancer Genetics Unit and Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Natalie Taylor
- Cancer Genetics Unit and Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | | | - Jennifer Pope
- Oncogenetics Team, Institute of Cancer Research, London, UK
| | | | - D Gareth Evans
- Genetic Medicine, Manchester Academic Health Sciences Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Jeanette Rothwell
- Genetic Medicine, Manchester Academic Health Sciences Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Lovise Maehle
- Department of medical genetics, Oslo University Hospital, 0424 Oslo, Norway
| | | | - Paul James
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The Sir Peter MacCallum Department of Oncology, University of Melbourne, VIC, Australia; Genetic Medicine, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Lyon Mascarenhas
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Joanne McKinley
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Lucy Side
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Tessy Thomas
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | | | - Hans Vasen
- The Foundation for the Detection of Hereditary Cancer, Leiden, The Netherlands
| | | | - Janneke Ringelberg
- The Foundation for the Detection of Hereditary Cancer, Leiden, The Netherlands
| | | | | | - Brian T Helfand
- John and Carol Walter Center for Urological Health, Division of Urology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Elena Genova
- John and Carol Walter Center for Urological Health, Division of Urology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Rogier A Oldenburg
- Department of clinical genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Cezary Cybulski
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Dominika Wokolorczyk
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Kai-Ren Ong
- Clinical Genetics Unit, Birmingham Women's Hospital, Birmingham, UK
| | - Camilla Huber
- Clinical Genetics Unit, Birmingham Women's Hospital, Birmingham, UK
| | - Jimmy Lam
- Department of Urology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Louise Taylor
- Department of Urology, Repatriation General Hospital, Daw Park, SA, Australia
| | - Monica Salinas
- Hereditary Cancer Program, ICO-IDIBELL (Bellvitge Biomedical Research Institute, Catalan Institute of Oncology), CIBERONC, Barcelona, Spain
| | - Lidia Feliubadaló
- Hereditary Cancer Program, ICO-IDIBELL (Bellvitge Biomedical Research Institute, Catalan Institute of Oncology), CIBERONC, Barcelona, Spain
| | - Jan C Oosterwijk
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Jackie Cook
- Sheffield Clinical Genetics Service, Sheffield Children's Hospital, Sheffield, UK
| | | | - Susan Domchek
- Basser Research Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Jacquelyn Powers
- Basser Research Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Saundra Buys
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Karen O'Toole
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Margreet G E M Ausems
- Division of Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Centre, Utrecht, The Netherlands
| | - Rita K Schmutzler
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Kerstin Rhiem
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Louise Izatt
- Clinical Genetics Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vishakha Tripathi
- Clinical Genetics Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Manuel R Teixeira
- Genetics Department and Research Center, Portuguese Oncology Institute (IPO Porto), Porto, Portugal; Biomedical Sciences Institute (ICBAS), Porto University, Porto, Portugal
| | - Marta Cardoso
- Genetics Department and Research Center, Portuguese Oncology Institute (IPO Porto), Porto, Portugal
| | - William D Foulkes
- Cancer Research Program, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada; Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Armen Aprikian
- Cancer Research Program, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Rosemarie Davidson
- West of Scotland Genetic Service, Queen Elizabeth University Hospital, Glasgow, UK
| | - Mark Longmuir
- West of Scotland Genetic Service, Queen Elizabeth University Hospital, Glasgow, UK
| | | | | | - Muriel Adank
- VU University Medical Center, Amsterdam, The Netherlands
| | - Rachel Williams
- Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia; Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Lesley Andrews
- Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia; Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Declan G Murphy
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, VIC, Australia; Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Dorothy Halliday
- Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Lisa Walker
- Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Annelie Liljegren
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Stefan Carlsson
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Ashraf Azzabi
- Northern Genetics Service, Newcastle upon Tyne Hospitals, UK
| | - Irene Jobson
- Northern Genetics Service, Newcastle upon Tyne Hospitals, UK
| | - Catherine Morton
- Familial Cancer Centre, The Royal Melbourne Hospital, Grattan St, Parkville, VIC, Australia
| | - Kylie Shackleton
- Familial Cancer Centre, The Royal Melbourne Hospital, Grattan St, Parkville, VIC, Australia
| | | | | | - Marion Harris
- Familial Cancer Centre, Monash Health, Clayton, VIC, Australia
| | - Marc Tischkowitz
- East Anglian Medical Genetics Service, Cambridge University Hospitals NHS Trust, Cambridge, UK; Academic Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Level 6 Addenbrooke's Treatment Centre, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Amy Taylor
- East Anglian Medical Genetics Service, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Judy Kirk
- Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Centre for Cancer Research, The Westmead Institute for Medical Research, Westmead, Sydney, NSW, Australia
| | - Rachel Susman
- Genetic Health Queensland, Royal Brisbane & Women's Hospital, Herston, QLD, Australia
| | | | - Allan Spigelman
- Hunter Family Cancer Service, Waratah, NSW, Australia; University of New South Wales, St Vincent's Clinical School, NSW, Australia; Cancer Genetics Clinic, The Kinghorn Cancer Centre, St Vincent's Hospital, Sydney, NSW, Australia
| | - Nicholas Pachter
- Genetic Services of WA, King Edward Memorial Hospital, Subiaco, WA, Australia; Department of Paediatrics, University of Western Australia, Perth, WA, Australia
| | - Munaza Ahmed
- NE Thames Regional Genetics Service, Institute of Child Health, London, UK
| | | | | | - Carole Brewer
- Peninsular Genetics, Derriford Hospital, Plymouth, UK; Royal Devon and Exeter Hospital, Exeter, UK
| | - Neus Gadea
- Hospital Vall d'Hebron, Barcelona, Spain
| | - Angela F Brady
- North West Thames Regional Genetics Service, Kennedy-Galton Centre, London North West University Healthcare NHS Trust, Harrow, UK
| | - Theo van Os
- Academic Medical Center, Amsterdam, The Netherlands
| | | | - Oskar Johannsson
- Landspitali-the National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Julian Barwell
- University of Leicester, Leicester, UK; University Hospitals Leicester, Leicester, UK
| | | | | | - Elias Obeid
- Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Lynn Greenhalgh
- Clinical Genetics Service, Liverpool Women's Hospital, Liverpool, UK
| | | | | | - Sibel Saya
- Oncogenetics Team, Institute of Cancer Research, London, UK
| | - John McGrath
- Royal Devon and Exeter Hospital, Exeter, UK; University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | | | - Karina Rønlund
- Department of Clinical Genetics, Vejle Hospital, Vejle, Denmark
| | - Kate Richardson
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Alex Henderson
- Northern Genetics Service, Newcastle upon Tyne Hospitals, UK; West Cumberland Infirmary, Whitehaven, UK
| | - Soo H Teo
- Cancer Research Initiatives Foundation, Subang Jaya Medical Centre, Selangor, Darul Ehsan, Malaysia
| | - Banu Arun
- The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Karin Kast
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Alexander Dias
- Oncogenetics Team, Institute of Cancer Research, London, UK; Instituto Nacional de Cancer Jose de Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
| | | | - Audrey Ardern-Jones
- Cancer Genetics Unit and Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Chris H Bangma
- Department of urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Elena Castro
- Spanish National Cancer Research Center, Madrid, Spain
| | - David Dearnaley
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, UK
| | - Diana M Eccles
- The University of Southampton Medical School, Southampton, UK; Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Karen Tricker
- Genetic Medicine, Manchester Academic Health Sciences Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Jorunn Eyfjord
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | | | | | - Freddie C Hamdy
- Churchill Hospital, Headington, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Vincent Khoo
- Cancer Genetics Unit and Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK; St George's Hospital, Tooting, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, UK; Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Geoffrey J Lindeman
- Familial Cancer Centre, The Royal Melbourne Hospital, Grattan St, Parkville, VIC, Australia; Department of Medicine, The University of Melbourne, Parkville, VIC, Australia; Cancer Biology and Stem Cells Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Jan Lubinski
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Karol Axcrona
- Department of Urology, Akershus University Hospital, Lørenskog, Norway
| | | | - Anita Mitra
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Clare Moynihan
- Oncogenetics Team, Institute of Cancer Research, London, UK
| | - Gadi Rennert
- CHS National Cancer Control Center, Carmel Medical Center, Haifa, Israel
| | | | | | | | - Judith Offman
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, Guy's Cancer Centre, Guy's Hospital, London, UK
| | | | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Hans Lilja
- Department of Translational Medicine, Lund University, Malmö, Sweden; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Departments of Laboratory Medicine, Surgery, and Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Rosalind A Eeles
- Oncogenetics Team, Institute of Cancer Research, London, UK; Cancer Genetics Unit and Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK.
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Park JY, Deutsch MB, Koenig W, Lilja H, Platz EA. Clinical Chemistry's Special Issue on Men's Health. Clin Chem 2019; 65:1-3. [PMID: 30602467 DOI: 10.1373/clinchem.2018.299172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 11/05/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Jason Y Park
- Department of Pathology and the Eugene McDermott Center for Human Growth and Development, UT Southwestern Medical Center, Dallas, TX;
| | - Madeline B Deutsch
- Department of Family and Community Medicine, University of California, San Francisco, CA
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universitat München, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Hans Lilja
- Department of Laboratory Medicine.,Department of Surgery, and.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.,Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Elizabeth A Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.,Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
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Ku A, Ravi N, Yang M, Evander M, Laurell T, Lilja H, Ceder Y. Correction: A urinary extracellular vesicle microRNA biomarker discovery pipeline; from automated extracellular vesicle enrichment by acoustic trapping to microRNA sequencing. PLoS One 2019; 14:e0224604. [PMID: 31648241 PMCID: PMC6812811 DOI: 10.1371/journal.pone.0224604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Wu X, Scott H, Carlsson SV, Sjoberg DD, Cerundolo L, Lilja H, Prevo R, Rieunier G, Macaulay V, Higgins GS, Verrill CL, Lamb AD, Cunliffe VT, Bountra C, Hamdy FC, Bryant RJ. Increased EZH2 expression in prostate cancer is associated with metastatic recurrence following external beam radiotherapy. Prostate 2019; 79:1079-1089. [PMID: 31104332 PMCID: PMC6563086 DOI: 10.1002/pros.23817] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/12/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Enhancer of zeste 2 (EZH2) promotes prostate cancer progression. We hypothesized that increased EZH2 expression is associated with postradiotherapy metastatic disease recurrence, and may promote radioresistance. METHODS EZH2 expression was investigated using immunohistochemistry in diagnostic prostate biopsies of 113 prostate cancer patients treated with radiotherapy with curative intent. Associations between EZH2 expression in malignant and benign tissue in prostate biopsy cores and outcomes were investigated using univariate and multivariate Cox regression analyses. LNCaP and PC3 cell radiosensitivity was investigated using colony formation and γH2AX assays following UNC1999 chemical probe-mediated EZH2 inhibition. RESULTS While there was no significant association between EZH2 expression and biochemical recurrence following radiotherapy, univariate analysis revealed that prostate cancer cytoplasmic and total EZH2 expression were significantly associated with metastasis development postradiotherapy (P = 0.034 and P = 0.003, respectively). On multivariate analysis, the prostate cancer total EZH2 expression score remained statistically significant (P = 0.003), while cytoplasmic EZH2 expression did not reach statistical significance (P = 0.053). No association was observed between normal adjacent prostate EZH2 expression and biochemical recurrence or metastasis. LNCaP and PC3 cell treatment with UNC1999 reduced histone H3 lysine 27 tri-methylation levels. Irradiation of LNCaP or PC3 cells with a single 2 Gy fraction with UNC1999-mediated EZH2 inhibition resulted in a statistically significant, though modest, reduction in cell colony number for both cell lines. Increased γH2AX foci were observed 24 hours after ionizing irradiation in LNCaP cells, but not in PC3, following UNC1999-mediated EZH2 inhibition vs controls. CONCLUSIONS Taken together, these results reveal that high pretreatment EZH2 expression in prostate cancer in diagnostic biopsies is associated with an increased risk of postradiotherapy metastatic disease recurrence, but EZH2 function may only at most play a modest role in promoting prostate cancer cell radioresistance.
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Affiliation(s)
- Xiaoning Wu
- Department of Oncology, CRUK/MRC Oxford Institute for Radiation OncologyUniversity of OxfordOxfordUnited Kingdom
| | - Helen Scott
- Department of Oncology, CRUK/MRC Oxford Institute for Radiation OncologyUniversity of OxfordOxfordUnited Kingdom
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUnited Kingdom
| | - Sigrid V. Carlsson
- Department of Epidemiology & BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkNew York
- Urology Service at the Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkNew York
- Department of UrologyInstitute of Clinical Sciences, Sahlgrenska Academy at Gothenburg UniversityGothenburgSweden
| | - Daniel D. Sjoberg
- Department of Epidemiology & BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Lucia Cerundolo
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUnited Kingdom
| | - Hans Lilja
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUnited Kingdom
- Department of Laboratory Medicine, Surgery (Urology), and Medicine (GU‐Oncology)Memorial Sloan Kettering Cancer CenterNew YorkNew York
- Department of Translational MedicineLund UniversityMalmöSweden
| | - Remko Prevo
- Department of Oncology, CRUK/MRC Oxford Institute for Radiation OncologyUniversity of OxfordOxfordUnited Kingdom
| | | | | | - Geoffrey S. Higgins
- Department of Oncology, CRUK/MRC Oxford Institute for Radiation OncologyUniversity of OxfordOxfordUnited Kingdom
| | - Clare L. Verrill
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUnited Kingdom
- Oxford NIHR Biomedical Research CentreUniversity of OxfordOxfordUnited Kingdom
| | - Alastair D. Lamb
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUnited Kingdom
| | - Vincent T. Cunliffe
- Department of Biomedical ScienceUniversity of SheffieldSheffieldUnited Kingdom
| | - Chas Bountra
- Nuffield Department of Medicine, Structural Genomics ConsortiumUniversity of OxfordOxfordUnited Kingdom
| | - Freddie C. Hamdy
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUnited Kingdom
| | - Richard J. Bryant
- Department of Oncology, CRUK/MRC Oxford Institute for Radiation OncologyUniversity of OxfordOxfordUnited Kingdom
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUnited Kingdom
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Sanmark H, Perez S, Leivo J, Kivimäki L, Batra G, Lilja H, Lamminmäki U. Synthetic antibody phage libraries as tools for generating antibodies against difficult analytes. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Smith Byrne K, Appleby PN, Key TJ, Holmes MV, Fensom GK, Agudo A, Ardanaz E, Boeing H, Bueno-de-Mesquita HB, Chirlaque MD, Kaaks R, Larrañaga N, Palli D, Perez-Cornago A, Quirós JR, Ricceri F, Sánchez MJ, Tagliabue G, Tsilidis KK, Tumino R, Fortner RT, Ferrari P, Riboli E, Lilja H, Travis RC. The role of plasma microseminoprotein-beta in prostate cancer: an observational nested case-control and Mendelian randomization study in the European prospective investigation into cancer and nutrition. Ann Oncol 2019; 30:983-989. [PMID: 31089709 PMCID: PMC6594452 DOI: 10.1093/annonc/mdz121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Microseminoprotein-beta (MSP), a protein secreted by the prostate epithelium, may have a protective role in the development of prostate cancer. The only previous prospective study found a 2% reduced prostate cancer risk per unit increase in MSP. This work investigates the association of MSP with prostate cancer risk using observational and Mendelian randomization (MR) methods. PATIENTS AND METHODS A nested case-control study was conducted with the European Prospective Investigation into Cancer and Nutrition (EPIC) with 1871 cases and 1871 matched controls. Conditional logistic regression analysis was used to investigate the association of pre-diagnostic circulating MSP with risk of incident prostate cancer overall and by tumour subtype. EPIC-derived estimates were combined with published data to calculate an MR estimate using two-sample inverse-variance method. RESULTS Plasma MSP concentrations were inversely associated with prostate cancer risk after adjusting for total prostate-specific antigen concentration [odds ratio (OR) highest versus lowest fourth of MSP = 0.65, 95% confidence interval (CI) 0.51-0.84, Ptrend = 0.001]. No heterogeneity in this association was observed by tumour stage or histological grade. Plasma MSP concentrations were 66% lower in rs10993994 TT compared with CC homozygotes (per allele difference in MSP: 6.09 ng/ml, 95% CI 5.56-6.61, r2=0.42). MR analyses supported a potentially causal protective association of MSP with prostate cancer risk (OR per 1 ng/ml increase in MSP for MR: 0.96, 95% CI 0.95-0.97 versus EPIC observational: 0.98, 95% CI 0.97-0.99). Limitations include lack of complete tumour subtype information and more complete information on the biological function of MSP. CONCLUSIONS In this large prospective European study and using MR analyses, men with high circulating MSP concentration have a lower risk of prostate cancer. MSP may play a causally protective role in prostate cancer.
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Affiliation(s)
| | | | | | - M V Holmes
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford; Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Oxford; National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospital, Oxford; Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | | | - A Agudo
- Unit of Nutrition and Cancer, Catalan Institute of Oncology-IDIBELL, Barcelona
| | - E Ardanaz
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid; Navarra Public Health Institute, Pamplona; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - H Boeing
- Department of Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbrücke, Germany
| | - H B Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Epidemiology and Biostatistics, Imperial College London, London, UK; Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - M D Chirlaque
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid; Department of Epidemiology, IMIB-Arrixaca, Murcia; Department of Health and Social Sciences, University of Murcia, Murcia, Spain
| | - R Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - N Larrañaga
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid; Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Vitoria-Gasteiz, Spain
| | - D Palli
- Cancer Risk Factors and Life-style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | | | - J R Quirós
- Public Health Directorate, Asturias, Spain
| | - F Ricceri
- Unit of Epidemiology, Regional Health Service Azienda Sanitaria Locale Torino 3 (ASL TO3), Grugliasco; Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - M J Sánchez
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid; Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - G Tagliabue
- Department of Preventative and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - K K Tsilidis
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK; Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - R Tumino
- Cancer Registry and Histopathology Unit, "Civic M.P. Arezzo" Hospital, Ragusa, Italy
| | - R T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - P Ferrari
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - E Riboli
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - H Lilja
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Translational Medicine, Lund University, Malmö, Sweden
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Ku A, Ravi N, Yang M, Evander M, Laurell T, Lilja H, Ceder Y. A urinary extracellular vesicle microRNA biomarker discovery pipeline; from automated extracellular vesicle enrichment by acoustic trapping to microRNA sequencing. PLoS One 2019; 14:e0217507. [PMID: 31141544 PMCID: PMC6541292 DOI: 10.1371/journal.pone.0217507] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/12/2019] [Indexed: 12/21/2022] Open
Abstract
Development of a robust automated platform for enrichment of extracellular vesicles from low sample volume that matches the needs for next-generation sequencing could remove major hurdles for genomic biomarker discovery. Here, we document a protocol for urinary EVs enrichment by utilizing an automated microfluidic system, termed acoustic trap, followed by next-generation sequencing of microRNAs (miRNAs) for biomarker discovery. Specifically, we compared the sequencing output from two small RNA library preparations, NEXTFlex and CATS, using only 130 pg of input total RNA. The samples prepared using NEXTflex was found to contain larger number of unique miRNAs that was the predominant RNA species whereas rRNA was the dominant RNA species in CATS prepared samples. A strong correlation was found between the miRNA expressions of the acoustic trap technical replicate in the NEXTFlex prepared samples, as well as between the acoustic trap and ultracentrifugation enrichment methods. Together, these results demonstrate a robust and automated strategy for biomarker discovery from small volumes of urine.
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Affiliation(s)
- Anson Ku
- Department of Translational Medicine, Lund University, Malmö, Sweden
- * E-mail:
| | - Naveen Ravi
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Minjun Yang
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Mikael Evander
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Thomas Laurell
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Hans Lilja
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Yvonne Ceder
- Division of Translational Cancer Research, Department of Laboratory Medicine, Lund University, Lund, Sweden
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Srinivasan S, Stephens C, Wilson E, Panchadsaram J, DeVoss K, Koistinen H, Stenman UH, Brook MN, Buckle AM, Klein RJ, Lilja H, Clements J, Batra J. Prostate Cancer Risk-Associated Single-Nucleotide Polymorphism Affects Prostate-Specific Antigen Glycosylation and Its Function. Clin Chem 2018; 65:e1-e9. [PMID: 30538125 DOI: 10.1373/clinchem.2018.295790] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 11/15/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Genetic association studies have reported single-nucleotide polymorphisms (SNPs) at chromosome 19q13.3 to be associated with prostate cancer (PCa) risk. Recently, the rs61752561 SNP (Asp84Asn substitution) in exon 3 of the kallikrein-related peptidase 3 (KLK3) gene encoding prostate-specific antigen (PSA) was reported to be strongly associated with PCa risk (P = 2.3 × 10-8). However, the biological contribution of the rs61752561 SNP to PCa risk has not been elucidated. METHODS Recombinant PSA protein variants were generated to assess the SNP-mediated biochemical changes by stability and substrate activity assays. PC3 cell-PSA overexpression models were established to evaluate the effect of the SNP on PCa pathogenesis. Genotype-specific correlation of the SNP with total PSA (tPSA) concentrations and free/total (F/T) PSA ratio were determined from serum samples. RESULTS Functional analysis showed that the rs61752561 SNP affects PSA stability and structural conformation and creates an extra glycosylation site. This PSA variant had reduced enzymatic activity and the ability to stimulate proliferation and migration of PCa cells. Interestingly, the minor allele is associated with lower tPSA concentrations and high F/T PSA ratio in serum samples, indicating that the amino acid substitution may affect PSA immunoreactivity to the antibodies used in the clinical immunoassays. CONCLUSIONS The rs61752561 SNP appears to have a potential role in PCa pathogenesis by changing the glycosylation, protein stability, and PSA activity and may also affect the clinically measured F/T PSA ratio. Accounting for these effects on tPSA concentration and F/T PSA ratio may help to improve the accuracy of the current PSA test.
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Affiliation(s)
- Srilakshmi Srinivasan
- Australian Prostate Cancer Research Centre-Queensland and Cancer Program, Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.,Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Carson Stephens
- Australian Prostate Cancer Research Centre-Queensland and Cancer Program, Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.,Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Emily Wilson
- Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Janaththani Panchadsaram
- Australian Prostate Cancer Research Centre-Queensland and Cancer Program, Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.,Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Kerry DeVoss
- Endocrinology, QML Pathology, Mansfield, Queensland, Australia
| | - Hannu Koistinen
- Department of Clinical Chemistry, Biomedicum Helsinki, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Ulf-Håkan Stenman
- Department of Clinical Chemistry, Biomedicum Helsinki, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | | | - Ashley M Buckle
- Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Robert J Klein
- Department of Genetics and Genomic Sciences and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hans Lilja
- Departments of Laboratory Medicine, Surgery (Urology Service) and Medicine (Genitourinary Oncology), Memorial Sloan Kettering Cancer Center, New York, NY.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.,Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Judith Clements
- Australian Prostate Cancer Research Centre-Queensland and Cancer Program, Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.,Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Jyotsna Batra
- Australian Prostate Cancer Research Centre-Queensland and Cancer Program, Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia; .,Translational Research Institute, Woolloongabba, Queensland, Australia
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Affiliation(s)
- Sigrid V Carlsson
- Department of Surgery (Urology), Memorial Sloan Kettering Cancer Center, New York, NY; .,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.,Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Hans Lilja
- Department of Surgery (Urology), Memorial Sloan Kettering Cancer Center, New York, NY.,Departments of Laboratory Medicine and Medicine (GU-Oncology), Memorial Sloan Kettering Cancer Center, New York, NY.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.,Department of Translational Medicine, Lund University, Malmö, Sweden
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Vickers AJ, Lilja H, Assel M. Reply to Kathryn L. Penney, Massimo Loda, and Meir J. Stampfer's Letter to the Editor re: Melissa Assel, Anders Dahlin, David Ulmert, et al. Association Between Lead Time and Prostate Cancer Grade: Evidence of Grade Progression from Long-term Follow-up of Large Population-based Cohorts Not Subject to Prostate-specific Antigen Screening. Eur Urol 2018;73:961-7. Eur Urol 2018; 75:e56. [PMID: 30327273 DOI: 10.1016/j.eururo.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 10/01/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Hans Lilja
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Departments of Laboratory Medicine and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Translational Medicine, Lund University, Malmö, Sweden; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Melissa Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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