Rise in Prostate-Specific Antigen in Men with Untreated Low-Grade Prostate Cancer Is Slower During Spring-Summer

Summary Screening of prostate cancer with prostate-specific antigen (PSA) is a highly controversial issue. One part of the controversy is due to the confusion between population screening and early diagnosis, another derives from problems related to the quality of existing screening studies, the results of radical curative treatment for low grade tumors and the complications resulting from treatments that affect the patient’s quality of life. Our review aimed to critically analyze the current recommendations for PSA testing, based on new data provided by the re-evaluation of the ongoing studies and the updated USPSTF recommendation statement, and to propose a more rational and selective use of PSA compared with baseline values obtained at an approximate age of 40 to 50 years.

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Ki-67 in screen-detected, low-grade, low-stage prostate cancer, relation to prostate-specific antigen doubling time, Gleason score and prostate-specific antigen relapse after radical prostatectomy

Scandinavian Journal of Urology and Nephrology ◽

10.1080/00365590802469543 ◽

2009 ◽

Vol 43 (1) ◽

pp. 12-18 ◽

Cited By ~ 24

Author(s):

Ali Khatami ◽

Jonas Hugosson ◽

Wanzhong Wang ◽

Jan-Erik Damber

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Prostate Specific Antigen ◽

Gleason Score ◽

Doubling Time ◽

Specific Antigen ◽

Low Grade ◽

Ki 67

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Comparison of Sensitivity and Specificity of Biparametric versus Multiparametric Prostate MRI in the Detection of Prostate Cancer in 431 Men with Elevated Prostate-Specific Antigen Levels

Diagnostics ◽

10.3390/diagnostics11071223 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1223

Author(s):

Filippo Pesapane ◽

Marzia Acquasanta ◽

Rosario Di Meo ◽

Giorgio Maria Agazzi ◽

Priyan Tantrige ◽

...

Keyword(s):

Prostate Cancer ◽

Prostate Specific Antigen ◽

Sensitivity And Specificity ◽

Specific Antigen ◽

Low Grade ◽

High Grade ◽

Dynamic Contrast Enhancement ◽

Prostate Mri ◽

Endorectal Coil

(1) Background: the study of dynamic contrast enhancement (DCE) has a limited role in the detection of prostate cancer (PCa), and there is a growing interest in performing unenhanced biparametric prostate-MRI (bpMRI) instead of the conventional multiparametric-MRI (mpMRI). In this study, we aimed to retrospectively compare the performance of the mpMRI, which includes DCE study, and the unenhanced bpMRI, composed of only T2-weighted imaging and diffusion-weighted imaging (DWI), in PCa detection in men with elevated prostate-specific-antigen (PSA) levels. (2) Methods: a 1.5 T MRI, with an endorectal-coil, was performed on 431 men (aged 61.5 ± 8.3 years) with a PSA ≥4.0 ng/mL. The bpMRI and mpMRI tests were independently assessed in separate sessions by two readers with 5 (R1) and 3 (R2) years of experience. The histopathology or ≥2 years follow-up served as a reference standard. The sensitivity and specificity were calculated with their 95% CI, and McNemar’s and Cohen’s κ statistics were used. (3) Results: in 195/431 (45%) of histopathologically proven PCa cases, 62/195 (32%) were high-grade PCa (GS ≥ 7b) and 133/195 (68%) were low-grade PCa (GS ≤ 7a). The PCa could be excluded by histopathology in 58/431 (14%) and by follow-up in 178/431 (41%) of patients. For bpMRI, the sensitivity was 164/195 (84%, 95% CI: 79–89%) for R1 and 156/195 (80%, 95% CI: 74–86%) for R2; while specificity was 182/236 (77%, 95% CI: 72–82%) for R1 and 175/236 (74%, 95% CI: 68–80%) for R2. For mpMRI, sensitivity was 168/195 (86%, 95% CI: 81–91%) for R1 and 160/195 (82%, 95% CI: 77–87%) for R2; while specificity was 184/236 (78%, 95% CI: 73–83%) for R1 and 177/236 (75%, 95% CI: 69–81%) for R2. Interobserver agreement was substantial for both bpMRI (κ = 0.802) and mpMRI (κ = 0.787). (4) Conclusions: the diagnostic performance of bpMRI and mpMRI were similar, and no high-grade PCa was missed with bpMRI.

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Solitary Lung Metastasis From Primary Prostate Cancer With Normal Prostate Specific Antigen Level: a Case Report and Literature Review

10.21203/rs.3.rs-556113/v1 ◽

2021 ◽

Author(s):

Natsumi Maru ◽

Asako Okabe ◽

Haruaki Hino ◽

Takahiro Utsumi ◽

Hiroshi Matsui ◽

...

Keyword(s):

Prostate Cancer ◽

Literature Review ◽

Prostate Specific Antigen ◽

Lung Metastasis ◽

Specific Antigen ◽

Prostate Specific Antigen Level ◽

Low Grade ◽

Antigen Level ◽

Normal Prostate ◽

Term Survival

Abstract Background: Pulmonary involvement from prostate cancer is a well-known condition, but solitary lung metastasis is rare, with its associated clinical characteristics not yet fully elucidated.Case presentation: A 77-year-old man, with a history of radical prostatectomy for primary prostatic carcinoma 14 years prior, presented to our institution with a low-grade fever. Upon consultation, biochemical recurrence was suspected due to a gradual increase in prostate-specific antigen level. Salvage radiation therapy was considered but not performed since there was no recurrent macroscopic tumor. Computed tomography showed a solitary nodule with spiculation located on the upper lobe of the left lung while positron emission tomography suggested malignancy without metastasis. Based on these findings, primary lung cancer was suspected and thoracoscopic left upper lobectomy with lymph node dissection was performed. Pathological diagnosis of the tumor was a solitary lung metastasis of prostate cancer. The postoperative recovery was uneventful. Conclusion: We report a case with normal prostate-specific antigen level, along with a literature review. According to previous case reports, there are some pitfalls leading misdiagnosis as a primary lung tumor. However, we consider that surgical resection is associated with increased diagnostic accuracy and long-term survival.

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Combination of Prostate Cancer Antigen 3 and Prostate-Specific Antigen Improves Diagnostic Accuracy in Men at Risk of Prostate Cancer

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2017-0185-oa ◽

2018 ◽

Vol 142 (9) ◽

pp. 1106-1112 ◽

Cited By ~ 7

Author(s):

Liyun Cao ◽

Chi Hyun Lee ◽

Jing Ning ◽

Beverly C. Handy ◽

Elizabeth A. Wagar ◽

...

Keyword(s):

Prostate Cancer ◽

At Risk ◽

Prostate Specific Antigen ◽

Specific Antigen ◽

Diagnostic Sensitivity ◽

Study Cohort ◽

Low Grade ◽

Cancer Antigen ◽

Predictive Values ◽

Prostate Cancer Antigen

Context.— Prostate cancer antigen 3 (PCA3) is a noncoding RNA that is highly overexpressed in prostate cancer (PCa) tissue and excreted in urine in patients with PCa. Objective.— To assess the clinical utility of urinary PCA3 in men at risk of PCa. Design.— We retrospectively reviewed a cohort of 271 men (median age, 63 years) with elevated prostate-specific antigen (PSA), and/or strong family history, and/or abnormal digital rectal examination findings. Diagnostic sensitivity, specificity, positive and negative predictive values (PPV, NPV), positive and negative likelihood ratios (LR+, LR−), and diagnostic odds ratio (DOR), and area under the receiver-operating characteristic curves (AUC) were evaluated. Results.— PCA3 score was a significant predictor of prostate biopsy outcome (P < .001). A PCA3 score of 30 was the optimal cutoff for our study cohort, with a diagnostic sensitivity of 72.7%, specificity of 67.5%, PPV of 47.1%, NPV of 86.2%, LR+ of 2.24, LR− of 0.40, and DOR of 5.55. At this cutoff score, the PCA3 assay could avoid 57.4% of unnecessary invasive biopsies in the overall study cohort and 70.3% in the subgroup with PSA level in the “gray zone” (4–10 ng/mL). A logistic regression algorithm combining PCA3 with PSA increased the AUC from 0.571 for PSA-only to 0.729 (P < .001). The logistic combined marker gained the ability to discriminate low-grade from high-grade cancers. Conclusions.— Our data suggest that PCA3 improves the diagnostic sensitivity and specificity of PSA and that the combination of PCA3 with PSA gives better overall performance in identification of PCa than serum PSA alone in the high-risk population.

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Prostate cancer detection by prostate-specific antigen-based screening in Japanese Hiroshima area shows early stage, low-grade, and low rate of cancer-specific death compared with clinical detection

Canadian Urological Association Journal ◽

10.5489/cuaj.1715 ◽

2014 ◽

Vol 8 (5-6) ◽

pp. 327 ◽

Cited By ~ 4

Author(s):

Jun Teishima ◽

Satoshi Maruyama ◽

Hideki Mochizuki ◽

Kiyotaka Oka ◽

Kenichiro Ikeda ◽

...

Keyword(s):

Prostate Cancer ◽

Prostate Specific Antigen ◽

Early Stage ◽

Clinical Stage ◽

Specific Antigen ◽

Low Grade ◽

Lower Grade ◽

Independent Predictive Factor ◽

Cancer Specific Survival ◽

Psa Screening

Introduction: We investigate the effectiveness of prostate-specific antigen (PSA) screening for prostate cancer. We compare the characteristics of 2 sets of patients: (1) those in whom prostate cancer was detected via PSA screening (the PS group) and (2) those in whom prostate cancer was detected at the outpatient office (the non-PS group).Methods: Between 2002 and 2010, prostate cancer was detected in 315 patients by PSA screening. Their age, initial PSA level, pathological findings in biopsy specimens, clinical stage, and prognosis were compared with those of 497 prostate cancer patients diagnosed at the outpatient office of the Department of Urology, Hiroshima University, in the same period.Results: The rates of patients with initial PSA higher than 50 ng/mL, with a Gleason score of 8 or higher, and with clinical stage D were significantly lower in the PS group than those in the non-PS group. The 5-year overall survival and cancer-specific survival in the PS group was 91.3% and 98.2%, respectively; these results were significantly better than those in the non-PS group (86.4%, p = 0.0178, and 94.9%, p = 0.0112, respectively). A Cox hazard analysis showed that PSA screening was an independent predictive factor for cancer-specific survival.Conclusions: Although our study is limited by its retrospective nature and small size, the present data indicate that prostate cancer detected in the PS group showed earlier stage, lower grade, and better prognosis than in the non-PS group.

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Gene‒Prostate-Specific-Antigen-Guided Personalized Screening for Prostate Cancer

Genes ◽

10.3390/genes10090641 ◽

2019 ◽

Vol 10 (9) ◽

pp. 641 ◽

Cited By ~ 1

Author(s):

Teng-Kai Yang ◽

Pi-Chun Chuang ◽

Amy Ming-Fang Yen ◽

Hsiu-Hsi Chen ◽

Sam Li-Sheng Chen

Keyword(s):

Prostate Cancer ◽

Prostate Specific Antigen ◽

Universal Screening ◽

Screening Program ◽

Specific Antigen ◽

Low Grade ◽

High Grade ◽

Mortality Reduction ◽

Clinical Phase ◽

Psa Testing

(1) Background: A simulation approach for prostate cancer (PrCa) with a prostate-specific antigen (PSA) test incorporating genetic information provides a new avenue for the development of personalized screening for PrCa. Going by the evidence-based principle, we use the simulation method to evaluate the effectiveness of mortality reduction resulting from PSA screening and its utilization using a personalized screening regime as opposed to a universal screening program. (2) Methods: A six-state (normal, over-detected, low-grade, and high-grade PrCa in pre-clinical phase, and low-grade and high-grade PrCa in clinical phase) Markov model with genetic and PSA information was developed after a systematic review of genetic variant studies and dose-dependent PSA studies. This gene‒PSA-guided model was used for personalized risk assessment and risk stratification. A computer-based simulated randomized controlled trial was designed to estimate the reduction of mortality achieved by three different screening methods, personalized screening, universal screening, and a non-screening group. (3) Results: The effectiveness of PrCa mortality reduction for a personalized screening program compared to a non-screening group (22% (9%‒33%)) was similar to that noted in the universal screening group (20% (7%‒21%). However, a personalized screening program could dispense with 26% of unnecessary PSA testing, and avoid over-detection by 2%. (4) Conclusions: Gene‒PSA-guided personalized screening for PrCa leads to fewer unnecessary PSA tests without compromising the benefits of mortality reduction (as happens with the universal screening program).

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