The Weight of HLA-DPA1 rs3077 Single Nucleotide Polymorphism in Prostate Cancer, a Multicenter Study

Prostate cancer (PCa) has almost the highest genetic transmission that mimics an autosomal dominance hereditary pattern of cancers in some families. Its incidence in Arab countries was reported to be steadily increasing. Aim. To determine the relevance of HLA-DPA1 rs3077 (A/G) SNP with prostate cancer’s risk and/or severity. Subjects and Methods. Forty PCa patients and forty age matched patients with benign prostatic hyperplasia (BPH), as a control group, were enrolled in the study. Serum levels of urea, creatinine, total prostate-specific antigen (PSA), and free PSA were measured. PSA ratio was determined as well. Genotyping of HLA-DPA1 rs3077 (A/G) SNP was done using real-time PCR. Results. The measured lab parameters, except free PSA, were significantly higher among PCa patients in comparison to controls ( P < 0.001 ∗ ). Moreover, PSA ratio was significantly high among PCa patients ( P < 0.001 ∗ ). HLA-DPA1 rs3077 GG genotype was more frequent in PCa patients and the associated OR was 2.546 ( P = 0.059 ), while AA genotype was more frequent in the control group and the associated OR was 0.145 ( P = 0.081 ). Frequency of G allele was higher among PCa patients than the control group while A allele frequency was significantly decreased ( P = 0.034 ∗ ) (protective allele). On multivariate analysis, there is no significant correlation found between HLA-DPA1 rs3077 SNP and PSA ratio (OR = 4.5, 95% CI = 1.2–17.4, P = 0.856 ). Conclusion. HLA-DPA1 rs3077 G allele could be a risk factor for prostate cancer. However, HLA-DPA1 rs3077 SNP has no relation to PCa severity.

The sensitivity and specificity of the total prostate specific antigen test in prostate cancer screening: A Short report

Objective: The total prostate specific antigen (TPSA) test is still widely used in Ghana for PCa screening due to its simplicity and logistical challenges in the healthcare sector. This study aimed to determine the sensitivity and specificity of TPSA in PCa screening in Ghana. Results: This was a cross-sectional study that was conducted at the Department of Urology of the Komfo Anokye Teaching Hospital between January 2018 and December 2019. The study involved 69 male patients with histologically confirmed BPH or PCa. The study population was between 45 to 104 years. BPH patients constituted 74% (51/69) while 26% (18/69) were PCa patients. Venous blood samples were collected before the prostate examination and analysed for TPSA. The BPH group was statistically compared with the PCa group in terms of age and TPSA levels. The TPSA was significantly elevated in PCa (P=0.001). Univariate [OR: 8.684(1.757-42.927)] and multivariate [aOR:10.544(2.001-55.562)] analysis showed that TPSA was positively associated with PCa; but this association was only moderate (AUC:0.78, P<0.001) with a sensitivity of 83.3%, specificity 64.0% at a cut-off value of 20.0ng/ml. The TPSA test has only moderate performance in PCa screening and should always be complemented by a second screening test.

CAN PROSTATE-SPECIFIC ANTIGEN DENSITY AND FREE / TOTAL PROSTATE-SPECIFIC ANTIGEN RATIO PREDICT CLINICALLY SIGNIFICANT PROSTATE CANCER (GLEASON ≥ 7) IN PATİENTS DIAGNOSED PROSTATE CANCER ON BIOPSY WITH A PROSTATE-SPECIFIC ANTIGEN LEVEL OF 2.5 -10 NG/ML?

Introduction Many men with non-clinically significant PCa (N-CSPCa) will not progress to become symptomatic within their lifetime. If we can predict clinically significant PCa (CSPCa), we can prevent patients from unnecessary biopsies, overdiagnoses, and overtreatment. The purpose of this study was to determine whether PSAD and f/t PSA can predict CSPCa (Gleason ≥ 7) in patients diagnosed with prostate cancer on biopsy with a PSA level of 2.5-10 ng/ml or not. Materials and Methods 78 patients who underwent TRUSG-guided prostate biopsy with PSA 2.5-10.0 in our clinic between March 2017 - August 2020 and whose pathology result was reported as prostate adenocarcinoma, were retrospectively evaluated. In addition to the demographic content of the patients, PSA, free PSA, prostate size (with TRUSG), rectal examination findings and prostate biopsy pathology results were recorded. Clinically significant prostate cancer was defined as a Gleason score 7. Results The mean age of the patients was 66.9 ± 8.4, PSA value was 6.9 ± 1.8, free / total PSA ratio was 18 ± 8.1%, and PSA density was 0.150 ± 0.078. The P values of PSA, free PSA, PSAD, f/t PSA, and prostate volume between CSPCa and N- CSPCa groups were 0.010, 0.780, 0.001, 0.084, and 0.030, respectively. The area under the ROC curve (AUC) of the PSAD for predicting CSPCa was 0.719 with a 95% Cl (0.604–0.835), and the standard errors were 0.062 and 0.059, respectively. When PSAD cutoff was 0.130 for predicting CSPCa, sensitivity and specificity were 75% and 63%, respectively. Conclusion PSAD can be used for predicting CSPCa, but f/t PSA can not. PSAD is not a strong stand-alone tool with its sensitivity and specificity, but we suggest that PSAD can be a part of future nomograms for predicting CSPCa and future protocols for active surveillance. Key words:prostate-specific antigen; clinically significant prostate cancer

Safety and efficacy of prostatic artery embolization for large benign prostatic hyperplasia in elderly patients

Objective To assess the safety and efficacy of prostatic arterial embolization (PAE) for elderly patients with lower urinary tract symptoms secondary to large benign prostatic hyperplasia. Methods Twenty-eight patients (>80 years of age) with prostate volume >80 mL were enrolled from October 2016 to October 2019. PAE was performed using microspheres and functional results were evaluated at 1, 3, 6, and 12 months postoperatively. The following data were recorded: International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urine flow rate (Qmax), post-void residual urine volume, prostate volume and total prostate-specific antigen level. Results Selective prostatic arterial catheterization and embolization were achieved in 27 of 28 patients. Follow-up data were available for those 27 patients until 12 months postoperatively. Significant improvements were found at all postoperative time points in terms of the mean IPSS, mean QoL score, mean Qmax, mean post-void residual urine volume, mean total prostate-specific antigen level, and mean prostate volume. The overall complication rate was 46.4%. Conclusions PAE is an efficacious and safe treatment for elderly patients with large prostate volume; it may offer an effective approach for patients who are not candidates for open or endoscopic surgical procedures because of comorbidities.

Comparative Assessment of the Diagnostic Performance of PCA3 in Urinary Sediments and Exosomes for Prostate Cancer in Chinese Population with the Total PSA range of 4-10 ng/ml.

Background: The diagnostic value of prostate cancer antigen-3 (PCA3) in urine sediment and exosome in Chinese patients with total prostate specific antigen (PSA) ranging from 4-10ng/ml.Methods: Serum and urine samples were collected from consecutive eligible patients. The PCA3 and PSA mRNA were tested by quantitative real-time PCR. Results: Overall 130 patients were involved in this study. 113 cases in urinary sediments group and 103 cases in urinary exosomes group were finally analyzed. 24 of 130 patients (18.5%), 20 of 113 patients (17.7%) and 17 of 103 patients (16.5%) were diagnosed as PCa in the three groups, respectively. The PCA3 score and PSAD of patients with positive biopsy results were significantly higher than those with negative biopsy results in both the urinary sediments and exosomes groups, but no differences between two urinary substrates groups. The ROC analysis showed the higher values of AUC of the PCA3 score in urinary sediments and exosomes than that of serum PSA (0.728 vs 0.540, P = 0.0402; 0.740 vs 0.540, P = 0.0263), but no significant difference in term of AUC of PCA3 between two urinary substrates groups (0.728 vs 0.740, P = 0.9000), as well as when compared the AUC of the PCA3 score with that of %fPSA and PSAD (P > 0.05).Conclusion: The current evidence suggests that diagnostic performances of PCA3 in urinary sediments and exosomes were not significant different, but both were superior to serum PSA in Chinese patients with PSA 4–10ng/ml.

Highly Selective Optical Sensor Eu (TTA)3 Phen Embedded in Poly Methylmethacrylate for Assessment of Total Prostate Specific Antigen Tumor Marker in Male Serum Suffering Prostate Diseases

A low-cost, simple, and highly selective method was used for the assessment of total prostate specific antigen (tPSA) in the serum of prostate cancer patients. This method is based on quenching the intensity of luminescence displayed by the optical sensor Eu (TTA)3 phen/poly methylmethacrylate (PMMA) thin membrane or film upon adding different concentrations of tPSA. The luminescent optical sensor was synthesized and characterized through absorption, emission, scanning electron microscopy (SEM), and x-ray diffraction (XRD), and is tailored to present red luminescence at 614 nm upon excitation at 395 nm in water. The fabricated sensor fluorescence intensity is quenched in the presence of tPSA in aqueous media. The fluorescence resonance energy transfer (FRET) is the main mechanism by which the sensor performs. The sensor was successfully utilized to estimate tPSA in the serum of patients suffering prostate cancer in a time and cost effective way. The statistical results of the method were satisfactory with 0.0469 ng mL−1 as a detection limit and 0.99 as a correlation coefficient.

Inappropriate practice in tumor marker requests at a university hospital in Western Saudi Arabia: A 3-year retrospective study

Objectives: This study assessed the level of appropriateness of tumor marker requests in a teaching hospital and estimated the financial cost associated with inappropriate use. Methods: A retrospective review of patients’ electronic records was conducted over a 3-year period (2015–2017) for tumor marker requests, including carcinoembryonic antigen, alpha-fetoprotein, cancer antigen (CA)15-3, CA125, CA19-9, and total and free prostate-specific antigen (PSA and fPSA), along with the associated clinical data that motivated the requests. Inappropriate use was defined as tumor marker requests without any relevant clinical picture. Costs due to inappropriate tumor marker requests were estimated based on the unit costs applied in the institution. Results: A total of 7128 patients had at least one tumor marker request between 2015 and 2017. The clinical picture that motivated tumor marker requests was absent in 71.5%, while 12.9% of the requests were associated with a malignancy. The most frequent prescribing pattern was total prostate-specific antigen alone (2128; 29.9%), followed by alpha-fetoprotein alone (1185; 16.6%), and carcinoembryonic antigen alone (506; 7.1%). Year-over-year analysis revealed an increasing tendency in requesting carcinoembryonic antigen and CA15-3. The rate of inappropriate use varied by tumor marker and ranged between 56.4% for fPSA and 86.8% for total prostate-specific antigen. The overall costs due to inappropriate tumor marker requests were estimated at $2,785,493 over the 3 years, representing an average of $0.93 million per year. Conclusion: Inappropriate use of tumor marker requests is a major issue regarding its high prevalence and the considerable associated costs. The role of laboratories in the management of tumor marker requests should be emphasized.