Studies explore appropriateness of PSA testing for prostate cancer

Mass prostatic specific antigen (PSA) testing (population-based PSA screening) has remained controversial, nevertheless there are men cohorts likely to benefit from PSA screening. Heritable factors contribute to 60 % risk for developing familial prostate cancer. Despite the fact that its clinical application is challenging due to polygenic inheritance, advances in new generation sequencing technologies permit identifying highly penetrant germline mutations in genes BRCA1, BRCA2, CHEK2, HOXB13 and MMR associated with tremendous increase in risk of developing the prostate cancer. Several germline mutations are associated with clinically aggressiveness of disease and shortened survival. Targeted screening that is based on family history and genomic aberrations should be the next step towards the precision medicine. Men at elevated risk should been performed for early detection are those with familiar history of prostate cancer, or BRCA1, BRCA2, CHEK2, HOXB13 and MMR pathogenic germline mutation carriers, or first line relatives diagnosed with certain types of cancer. Systematic PSA testing in 1–2 years among germline mutation carriers men beginning at age 45 years would contribute to increase in early detection of localized prostate cancer resulting in more chance of curative treatment and improve survival rates

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Hormonal therapy of prostate cancer

Oxford Textbook of Endocrinology and Diabetes ◽

10.1093/med/9780199235292.003.1149 ◽

2011 ◽

pp. 1622-1634

Author(s):

Ciara O’Hanlon Brown ◽

Jonathan Waxman

Keyword(s):

Prostate Cancer ◽

Androgen Receptor ◽

Specific Antigen ◽

Intraepithelial Neoplasia ◽

Peripheral Zone ◽

Molecular Feature ◽

Molecular Defects ◽

Psa Testing ◽

Seer Data ◽

Prostate Cancers

Prostate cancer is the most common cancer to effect men and the second most common cause of cancer-related death. Premalignant change or prostatic intraepithelial neoplasia has been detected within the prostate glands of men under 30 years of age. The incidence of prostate cancer remains negligible until men reach their 40s from whence it rises steadily and by 80 years 70% of men have detectable tumours at autopsy (1). A majority of prostate cancers arise from the peripheral zone of the prostate and rarely cause obstructive symptoms. Consequently, prostate cancers have historically presented late, with symptoms of metastatic disease. The advent of prostate-specific antigen (PSA) testing has produced a stage shift so that at present over 90% of prostate cancers are diagnosed as organ-confined disease. PSA diagnosis has unmasked a subset of prostate tumours that exhibit an indolent growth pattern and appear destined to remain organ-confined tumours the patient dies with, and not from. US SEER data estimates a 50-year-old man has a 42% chance of developing prostate cancer but only a 3.6% chance of dying from the disease. Features, either clinical or molecular, which would allow clinicians to clearly differentiate indolent from aggressive disease while still at the organ-confined stage, have yet to be identified (1). Adenocarcinoma is the predominant histological subtype of prostate cancer, accounting for 95% of tumours. Prostatic adenocarcinomas arise from androgen receptor-positive epithelial cells. On histological examination, prostate cancers appear multifocal and demonstrate heterogeneity both within individual tumours and across populations. This has created an obstacle as researchers attempt to subclassify prostate cancer and identify the molecular defects responsible for driving prostatic carcinogenesis (1). Of prostate cancers, 80–90% are androgen receptor-positive at diagnosis (2), thus to date the androgen–androgen receptor axis is the sole molecular feature of this disease that has been successfully harnessed as a therapeutic target.

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Accuracy of Tumour-Associated Circulating Endothelial Cells as a Screening Biomarker for Clinically Significant Prostate Cancer

Cancers ◽

10.3390/cancers11081064 ◽

2019 ◽

Vol 11 (8) ◽

pp. 1064 ◽

Cited By ~ 2

Author(s):

Sebastian Chakrit Bhakdi ◽

Prapat Suriyaphol ◽

Ponpan Thaicharoen ◽

Sebastian Tobias Karl Grote ◽

Chulaluk Komoltri ◽

...

Keyword(s):

Prostate Cancer ◽

Endothelial Cells ◽

Predictive Value ◽

Specific Antigen ◽

Transrectal Ultrasound ◽

Circulating Endothelial Cells ◽

Index Test ◽

Psa Testing ◽

Diagnostic Potential ◽

Clinically Significant

Even though more than 350,000 men die from prostate cancer every year, broad-based screening for the disease remains a controversial topic. Guidelines demand that the only commonly accepted screening tool, prostate-specific antigen (PSA) testing, must be followed by prostate biopsy if results are elevated. Due to the procedure’s low positive predictive value (PPV), however, over 80% of biopsies are performed on healthy men or men with clinically insignificant cancer—prompting calls for new ways of vetting equivocal PSA readings prior to the procedure. Responding to the challenge, the present study investigated the diagnostic potential of tumour-associated circulating endothelial cells (tCECs), which have previously been described as a novel, blood-based biomarker for clinically significant cancers. Specifically, the objective was to determine the diagnostic accuracy of a tCEC-based blood test to detect clinically significant prostate cancer (defined as Gleason score ≥ 3 + 4) in high-risk patients. Performed in a blinded, prospective, single-centre set-up, it compared a novel tCEC index test with transrectal ultrasound-guided biopsy biopsy as a reference on a total of 170 patients and found that a tCEC add-on test will almost double the PPV of a standalone PSA test (32% vs. 17%; p = 0.0012), while retaining a negative predictive value above 90%.

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Overdiagnosis and Overtreatment of Prostate Cancer

American Society of Clinical Oncology Educational Book ◽

10.14694/edbook_am.2012.32.98 ◽

2012 ◽

pp. e35-e39 ◽

Cited By ~ 4

Author(s):

Ian M. Thompson

Keyword(s):

Prostate Cancer ◽

Active Surveillance ◽

Specific Antigen ◽

The United States ◽

Assessment Tools ◽

Low Grade ◽

High Grade ◽

Surveillance Strategy ◽

Psa Testing ◽

Prostate Cancer Prevention

Overview: Prostate cancer is a ubiquitous disease, affecting as many as two-thirds of men in their 60s. Through widespread prostate-specific antigen (PSA) testing, increasing rates of prostate biopsy, and increased sampling of the prostate, a larger fraction of low-grade, low-volume tumors have been detected, consistent with tumors often found at autopsy. These tumors have historically been treated in a manner similar to that used for higher-grade tumors but, more recently, it has become evident that with a plan of active surveillance that reserves treatment for only those patients whose tumors show evidence of progression, very high disease-specific survival can be achieved. Unfortunately, the frequency of recommendation of an active surveillance strategy in the United States is low. An alternative strategy to improve prostate cancer detection is through selected biopsy of those men who are at greater risk of harboring high-grade, potentially lethal cancer. This strategy is currently possible through the use of risk assessment tools such as the Prostate Cancer Prevention Trial Risk Calculator ( www.prostate.cancer.risk.calculator.com ) as well as others. These tools can predict with considerable accuracy a man's risk of low-grade and high-grade cancer, allowing informed decision making for the patient with a goal of detection of high-risk disease. Ultimately, other biomarkers including PCA3, TMPRSS2:ERG, and [-2]proPSA will likely aid in discriminating these two types of cancer before biopsy.

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Prostate Cancer Screening in the Workplace

AAOHN Journal ◽

10.1177/216507999804600803 ◽

1998 ◽

Vol 46 (8) ◽

pp. 379-384 ◽

Cited By ~ 6

Author(s):

Claire Snyder ◽

Peggy N. Schrammel ◽

Claudia B. Griffiths ◽

Robert I. Griffiths

Keyword(s):

Prostate Cancer ◽

Cancer Screening ◽

Prostate Cancer Screening ◽

Specific Antigen ◽

Screening Tests ◽

Test Results ◽

Total Cost ◽

Screening Programs ◽

Psa Testing ◽

The Cost

Recognition of the mortality and morbidity associated with prostate cancer has resulted in employer based screening programs. This retrospective cohort study identified the employer costs of prostate cancer screening and referrals due to abnormal test results. The subjects were 385 men enrolled in a workplace screening program at a single employer between 1993 and 1995. Screening consisted of digital rectal examination (DRE) annually for enrolled employees aged 40 years and older, plus annual prostate specific antigen (PSA) testing for those 50 and older, and those 40 and older and considered at high risk. Data related to the health care and lost productivity costs of screening and referrals for abnormal test results were collected and analyzed. The total cost of screening was $44,355, or approximately $56 per screening encounter (788 DREs; 437 PSAs). Abnormal screening tests resulted in 52 referrals. Upon further evaluation, 42% were found to have an enlargement, 29% a node, and 12% benign prostatic hyperplasia. Only one malignancy was found. The total cost of additional referrals was $31,815, or 42% of the cost of screening plus referrals. As the cost per screening encounter was low, prostate cancer screening in the workplace is an efficient alternative.

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Influence of Publication of US and European Prostate Cancer Screening Trials on PSA Testing Practices

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djr007 ◽

2011 ◽

Vol 103 (6) ◽

pp. 520-523 ◽

Cited By ~ 46

Author(s):

S. B. Zeliadt ◽

R. M. Hoffman ◽

R. Etzioni ◽

J. L. Gore ◽

L. G. Kessler ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Screening ◽

Prostate Cancer Screening ◽

Psa Testing ◽

Testing Practices ◽

Screening Trials

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Is Social Support From Family Associated With PSA Testing? An Exploratory Analysis Using the Health Information National Trends Survey (HINTS) 2005

American Journal of Men s Health ◽

10.1177/1557988308328541 ◽

2008 ◽

Vol 4 (1) ◽

pp. 50-59 ◽

Cited By ~ 4

Author(s):

Kamilah B. Thomas ◽

Sean L. Simpson ◽

Will L. Tarver ◽

Clement K. Gwede

Keyword(s):

Prostate Cancer ◽

Social Support ◽

Health Information ◽

Specific Antigen ◽

White Men ◽

The United States ◽

Social Contexts ◽

Psa Testing ◽

Instrumental Social Support ◽

National Trends

African American and White men have the highest rates of prostate cancer in the United States. Families represent important social contexts within which illness occurs.The purpose of this study is to explore whether prostate-specific antigen (PSA) testing is associated with instrumental and informational social support from family members among a sample of Black and White men aged 45 and older. Data from the 2005 Health Information National Trends Survey were analyzed using logistic regression. The dependent variable was having a PSA test within the past year or less. The independent variables consisted of selected demographic and family informational and instrumental social support variables. The statistically significant variables included age and having a family member with cancer. Additional studies to elucidate the mechanisms of social support from family for prostate cancer are needed.

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