scholarly journals Promise and Challenge: Markers of Prostate Cancer Detection, Diagnosis and Prognosis

2004 ◽  
Vol 20 (2) ◽  
pp. 117-128 ◽  
Author(s):  
D. A. Troyer ◽  
J. Mubiru ◽  
R. J. Leach ◽  
S. L. Naylor
Keyword(s):  
Prostate Cancer ◽  
At Risk ◽  
Fundamental Problem ◽  
Diagnostic Testing ◽  
Significant Proportion ◽  
Additional Treatment ◽  
Nucleotide Polymorphisms ◽  
Diagnosis And Prognosis ◽  
Psa Testing ◽  
The U.S

Approximately 1 man in 6 will be diagnosed with prostate cancer during his life lifetime, and over 200,000 men in the U.S. are diagnosed with prostate cancer annually. Since the widespread adoption of PSA testing, about 60–70% of men at risk in the U.S. have had a blood test for prostate cancer. With this, prostate cancer death rates have decreased, yet only slightly. Thirty thousand men still die each year from this disease. PSA testing fails to identify a small but significant proportion of aggressive cancers, and only about 30% of men with a “positive” PSA have a positive biopsy. Additionally, of men who are treated for prostate cancer, about 25% require additional treatment, presumably due to disease recurrence. Also of concern is the growing evidence that there are some prostate cancers for which treatment may not be necessary. Very long-term studies from the U.S. and Europe, following men with prostate cancer have found that some tumors do not progress over time. In these individuals, prostate cancer treatment is unnecessary and harmful as these men do not benefit from treatment but will be at risk of treatment-related side effects and complications. They suggest a fundamental problem with prostate cancer: it is not possible, at this time, to predict the natural history of the disease. It is for these reasons that the most important challenge in prostate cancer today is the inability to predict the behavior of an individual tumor in an individual patient. Here we review issues related to performance and validation of biomarkers with a focus on “doing no harm”, and bearing in mind that it is the ultimate goal of early detection to save lives. Improved diagnostic and prognostic biomarkers are needed for prostate cancer, and the use of these markers should ultimately translate into increased life span and quality of life. The ultimate goal would be to not only have accurate biomarkers suitable for early diagnosis, but also biomarkers that identify men at greatest risk of developing aggressive disease. Technology has been brought to bear on this problem, and the major approaches are genomics, expression analysis, and proteomics. Proteomics and DNA methylation assays may soon be used in sensitive and specific diagnostic testing of serum and tissues for cancer. Expression arrays may be used to establish both a more specific diagnosis and prognosis for a particular tumor. The proteome is only beginning to be understood, and alternative splicing and post-translational modifications of proteins such as glycosylation and phosphorylation are challenging areas of study. Finally, risk assessment and prognosis are being pursued through analysis of genomic polymorphisms (single nucleotide polymorphisms, SNPs). This huge task is only beginning, and requires the combined expertise of molecular epidemiologists, oncologists, surgeons, pathologists, and basic scientists.

Impact of U.S. Preventive Services Task Force recommendation on screening for prostate cancer in men age 75 or older.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 216-216
Author(s):  
Michael W. Drazer ◽  
Sandip M. Prasad ◽  
Dezheng Huo ◽  
Mara A Schonberg ◽  
Scott E. Eggener
Keyword(s):  
Prostate Cancer ◽  
Cancer Screening ◽  
Task Force ◽  
Prostate Cancer Screening ◽  
Significant Proportion ◽  
Preventive Services ◽  
Psa Testing ◽  
Interview Survey ◽  
The Impact ◽  
The U.S

216 Background: In 2008, the U.S. Preventive Services Task Force (USPSTF) recommended against screening for prostate cancer in men age 75 years or older. We sought to determine the impact of this statement on utilization of prostate-specific antigen (PSA) testing in this patient group. Methods: Using the 2005 and 2010 National Health Interview Survey, a cross-sectional household interview survey providing a representative sample of the U.S. population, we analyzed the use of PSA testing in men age 40 years or older prior to and following the release of the USPSTF statement on prostate cancer screening. Results: In 2010, there were an estimated 2.0 million PSA tests ordered in men 75 years of age and older. In this group, PSA testing rates did not decline between 2005 and 2010 (40.4% vs. 40.6%). In 2010, PSA testing was more common in men aged 75 years and older than in men aged 40 to 49 (9.2%) and 50 to 59 (26.2%) (p < 0.01 between groups). In both 2005 and 2010, PSA testing rates were lowest in men aged 40-49 and highest in men aged 60-74. Conclusions: Despite the USPSTF recommendation against prostate cancer screening in men age 75 or older, there was no decrease in PSA testing rates in these men. A significant proportion of elderly men continue to receive PSA screening despite a very low likelihood of benefit. [Table: see text]

Emerging Biomarkers for the Diagnosis and Prognosis of Prostate Cancer

2008 ◽  
Vol 54 (12) ◽  
pp. 1951-1960 ◽  
Author(s):  
Girish Sardana ◽  
Barry Dowell ◽  
Eleftherios P Diamandis
Keyword(s):  
Prostate Cancer ◽  
Early Diagnosis ◽  
Specific Antigen ◽  
Cost Effective ◽  
Detection Methods ◽  
Significant Advance ◽  
Specific Method ◽  
Diagnosis And Prognosis ◽  
Psa Testing ◽  
Formidable Challenge

Abstract Background: Early detection of prostate cancer (CaP), the most prevalent cancer and the second-leading cause of death in men, has proved difficult, and current detection methods are inadequate. Prostate-specific antigen (PSA) testing is a significant advance for early diagnosis of patients with CaP. Content: PSA is produced almost exclusively in the prostate, and abnormalities of this organ are frequently associated with increased serum concentrations. Because of PSA’s lack of specificity for CaP, however, many patients undergo unnecessary biopsies or treatments for benign or latent tumors, respectively. Thus, a more specific method of CaP detection is required to augment or replace screening with PSA. The focus recently has been on creating cost-effective assays for circulating protein biomarkers in the blood, but because of the heterogeneity of CaP, it has become clear that this effort will be a formidable challenge. Each marker will require proper validation to ensure clinical utility. Although much work has been done on variations of the PSA test (i.e., velocity, density, free vs bound, proisoforms) with limited usefulness, there are many emerging markers at various stages of development that show some promise for CaP diagnosis. These markers include kallikrein-related peptidase 2 (KLK2), early prostate cancer antigen (EPCA), PCA3, hepsin, prostate stem cell antigen, and α-methylacyl-CoA racemase (AMACR). We review biomarkers under investigation for the early diagnosis and management of prostate cancer. Summary: It is hoped that the use of panels of markers can improve CaP diagnosis and prognosis and help predict the therapeutic response in CaP patients.

scholarly journals Patterns of Prostate-Specific Antigen Testing and Prostate Biopsies During the COVID-19 Pandemic

2021 ◽  
pp. 1028-1033
Author(s):  
Harvey W. Kaufman ◽  
Zhen Chen ◽  
Justin K. Niles ◽  
Jeff Radcliff ◽  
Yuri Fesko
Keyword(s):  
Prostate Cancer ◽  
Prostate Biopsy ◽  
Diagnostic Testing ◽  
Specific Antigen ◽  
International Classification Of Diseases ◽  
Prostate Biopsies ◽  
Psa Testing ◽  
Classification Of Diseases ◽  
Antigen Testing

PURPOSE This study examined changes in prostate disease screening (prostatic-specific antigen [PSA] testing), prostate biopsy testing, and prostate cancer diagnoses during the COVID-19 pandemic through December 2020. MATERIALS AND METHODS This analysis included test results from men ≥ 40 years, without prior International Classification of Diseases-10 record of prostate cancer since January 2016, who received PSA or prostate biopsy testing at Quest Diagnostics during January 2018-December 2020. Monthly trends were evaluated for three periods: prepandemic (January 2018-February 2020), early-pandemic (March-May 2020), and late-pandemic (June-December 2020). RESULTS Meeting inclusion criteria were 16,365,833 PSA and 48,819 prostate biopsy results. The average monthly number of PSA tests declined from 465,187 prepandemic to 295,786 early-pandemic (36.4% decrease; P = .01) before rebounding to 483,374 (3.9% increase; P = .23) late-pandemic. The monthly average number of PSA results ≥ 50 ng/mL (23,356; 0.14% of all PSA results) dipped from 659 prepandemic to 506 early-pandemic (23.2% decrease; P = .02) and rebounded to 674 late-pandemic (2.3% increase; P = .65). The average monthly number of prostate biopsy results decreased from 1,453 prepandemic to 903 early-pandemic (37.9% decrease; P = .01) before rebounding to 1,190 late-pandemic (18.1% decrease; P = .01). The average monthly number for Gleason score ≥ 8 (6,241; 12.8% of all prostate biopsies) declined from 182 prepandemic to 130 early-pandemic (28.6% decrease; P = .02) and decreased to 161 late-pandemic (11.5% decrease; P = .02). CONCLUSION The findings suggest that a substantial number of prostate screening opportunities and cancer diagnoses have been missed. Efforts are needed to bring such patients back for screening and diagnostic testing and to restore appropriate care for non–COVID-19–related medical conditions.

scholarly journals Updates in Prostate Cancer Research and Screening in Men at Genetically Higher Risk

2021 ◽  
Author(s):  
Elizabeth K. Bancroft ◽  
Holly Ni Raghallaigh ◽  
Elizabeth C. Page ◽  
Rosalind A. Eeles
Keyword(s):  
Prostate Cancer ◽  
Genetic Predisposition ◽  
Specific Antigen ◽  
Significant Proportion ◽  
Risk Groups ◽  
Western World ◽  
Polygenic Risk Score ◽  
Ongoing Research ◽  
Psa Testing ◽  
Common Genetic Variants

Abstract Purpose of Review Prostate cancer (PrCa) is the most common cancer in men in the western world and is a major source of morbidity and mortality. Currently, general population PrCa screening is not recommended due to the limitations of the prostate-specific antigen (PSA) test. As such, there is increasing interest in identifying and screening higher-risk groups. The only established risk factors for PrCa are age, ethnicity, and having a family history of PrCa. A significant proportion of PrCa cases are caused by genetic factors. Recent Findings Several rare germline variants have been identified that moderately increase risk of PrCa, and targeting screening to these men is proving useful at detecting clinically significant disease. The use of a “polygenic risk score” (PRS) that can calculate a man’s personalized risk based on a number of lower-risk, but common genetic variants is the subject of ongoing research. Research efforts are currently focusing on the utility of screening in specific at-risk populations based on ethnicity, such as men of Black Afro-Caribbean descent. Whilst most screening studies have focused on use of PSA testing, the incorporation of additional molecular and genomic biomarkers alongside increasingly sophisticated imaging modalities is being designed to further refine and individualise both the screening and diagnostic pathway. Approximately 10% of men with advanced PrCa have a germline genetic predisposition leading to the opportunity for novel, targeted precision treatments. Summary The mainstreaming of genomics into the PrCa screening, diagnostic and treatment pathway will soon become standard practice and this review summarises current knowledge on genetic predisposition to PrCa and screening studies that are using genomics within their algorithms to target screening to higher-risk groups of men. Finally, we evaluate the importance of germline genetics beyond screening and diagnostics, and its role in the identification of lethal PrCa and in the selection of targeted treatments for advanced disease.

scholarly journals Associations between LncRNA MALAT1 Polymorphisms and Lymph Node Metastasis in Prostate Cancer

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1692
Author(s):  
Ju-Chuan Hu ◽  
Shian-Shiang Wang ◽  
Ying-Erh Chou ◽  
Kun-Yuan Chiu ◽  
Jian-Ri Li ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Noncoding Rna ◽  
Nodal Metastasis ◽  
Current Evidence ◽  
Gleason Grade ◽  
Nucleotide Polymorphisms ◽  
Grade Group ◽  
Diagnosis And Prognosis ◽  
Lncrna Malat1 ◽  
Robotic Assisted Radical Prostatectomy

Current evidence elucidates that long noncoding RNA metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) could regulate genetic expression and play a crucial role in both the diagnosis and prognosis of prostate cancer. Single-nucleotide polymorphisms (SNPs) of MALAT1 could alter the oncogenesis in various cancers. However, the associations between MALAT1 SNPs and prostate cancer have barely been investigated to date. This study included 579 patients with prostate cancer who received robotic-assisted radical prostatectomy at Taichung Veterans General Hospital from 2012 to 2017. Three SNPs of MALAT1 were analyzed to identify the impacts of SNPs on the clinicopathologic features in Taiwanese prostate cancer. Our results show that patients with a polymorphic G allele at rs619586 had a significantly higher risk of being in an advanced Gleason grade group (AOR: 1.764; 95% CI: 1.011–3.077; p = 0.046). Moreover, individuals with at least one polymorphic A allele at MALAT1 rs1194338 in the PSA >10 ng/mL group were positively associated with node-positive prostate cancer. In conclusion, MALAT1 SNPs are significantly associated with the susceptibility to both advanced Gleason grade and nodal metastasis in prostate cancer. The presence of MALAT1 SNPs rs619586 and rs1194338 seems to enhance oncogenesis in prostate cancer.

The role of non-oncology specialties in the real world longitudinal journey of prostate cancer patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19255-e19255
Author(s):  
Daniel Carnegie ◽  
Elenee Argentinis ◽  
Dibyajyoti Mazumder ◽  
Indu Dhangar
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Real World ◽  
Index Date ◽  
Diagnostic Testing ◽  
Significant Proportion ◽  
Data Repository ◽  
Electronic Health Record Data ◽  
Source Data ◽  
Electronic Health

e19255 Background: Electronic health records (EHRs) are increasingly being recognized by regulators and researchers as reliable sources of evidence. It is therefore critical that real world evidence databases accurately reflect all diagnostics and interventions that could affect patient outcomes. Some of the commercially available datasets source data solely from oncology clinics, which may not reflect patients’ full care journey. This analysis assessed the contribution of non-oncology specialties to prostate cancer care. Methods: Newly diagnosed prostate cancer patients with encounters between Jan 2014 to Dec 2017 were analyzed from the deidentified Optum Electronic Health Record Data Repository. Diagnostic procedures 6 months prior to the index date (first diagnosis date within the study period) and 1 year post index date were identified. Attending physician specialties were identified. All treatment related encounters up to 1 year post the index dates were mapped by specialty. Codes were verified by certified medical professional. Results: A total of 186,299 prostate cancer patients were identified between Jan 2014 to Dec 2017. In the 6 months prior to index date, biopsy was most commonly ordered by urologists (70%), followed by surgical specialists (14%). Biomarker tests were ordered mostly by general practitioners (40%) followed by urologists (18%). The trend was similar for 1 year post biopsy and other histology procedures. Interestingly, a large portion of treatment encounters was observed outside oncology: 48% of surgical management by urologists (48%), chemotherapy was prescribed by both oncologists (27%) and urologists (31%) in a similar ratio, while radiotherapy was performed predominantly by radiation oncologists (81%). Conclusions: In prostate cancer, a large proportion of care encounters occur outside oncology specialties, with urology conducting a significant proportion of diagnostic testing and early treatment. Restricting source data to oncology specialties may omit key factors affecting patients’ outcomes, therefore data for such studies should reflect the entire care continuum.

Information-Seeking on the Internet

Crisis ◽  
2015 ◽  
Vol 36 (3) ◽  
pp. 211-219 ◽  
Author(s):  
Vinod Singaravelu ◽  
Anne Stewart ◽  
Joanna Adams ◽  
Sue Simkin ◽  
Keith Hawton
Keyword(s):  
At Risk ◽  
Young People ◽  
Information Seeking ◽  
Significant Proportion ◽  
The Internet ◽  
Search Terms ◽  
Specific Advice ◽  
Restriction Sites ◽  
Self Harm ◽  
Negative Tone

Abstract. Background: The Internet is used by young people at risk of self-harm to communicate, find information, and obtain support. Aims: We aimed to identify and analyze websites potentially accessed by these young people. Method: Six search terms, relating to self-harm/suicide and depression, were input into four search engines. Websites were analyzed for access, content/purpose, and tone. Results: In all, 314 websites were included in the analysis. Most could be accessed without restriction. Sites accessed by self-harm/suicide search terms were mostly positive or preventive in tone, whereas sites accessed by the term ways to kill yourself tended to have a negative tone. Information about self-harm methods was common with specific advice on how to self-harm in 15.8% of sites, encouragement of self-harm in 7.0%, and evocative images of self-harm/suicide in 20.7%. Advice on how to get help was given in 56.1% of sites. Conclusion: Websites relating to suicide or self-harm are easily accessed. Many sites are potentially helpful. However, a significant proportion of sites are potentially harmful through normalizing or encouraging self-harm. Enquiry regarding Internet use should be routinely included while assessing young people at risk.

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