Prostate specific antigen

The use of PSA as a screening test for prostate cancer remains controversial because no double blind, randomised controlled trial has shown that early detection reduces mortality.1,2 Despite this controversy, PSA provides valuable information for the general practitioner in everyday clinical practice, including monitoring of treated and untreated prostate cancer and prostatitis

The Effect of the Clinical Digital Rectal Exam on the Complexed Prostate-Specific Antigen Versus the Total Prostate-Specific Antigen

Background: The total serum prostate-specific antigen has been used as a screening tool to determine prostate health and is routinely done after a clinical exam which may include a digital rectal exam. The complexed prostate-specific antigen is a portion of the total prostate-specific antigen and may be a better indicator for prostate health. The purpose of this paper is to evaluate the effect that the digital rectal exam has on both the total prostate-specific antigen and the complexed prostate-specific antigen. The evidence will be evaluated using the GRADE system. Method: An exhaustive search of available medical literature was conducted using Medline, Web of Science, Cochrane Systematic Reviews and CINAHL. Results: There were four studies included in the review. The change in total and complexed prostate-specific antigen serum values in ng/mL post digital rectal examination was evaluated across the studies. Due to the fact that the complexed prostate-specific antigen is a subset of the total prostate-specific antigen the consequences of the digital rectal examination was compared using a percent change. Conclusion: The complexed prostate-specific antigen is affected less by the digital rectal exam and would indicate that it may be a more reliable marker for prostate health compared to the total prostate-specific antigen. This recommendation needs to be used with caution as the overall GRADE of evidence was considered low and additional research is likely to have an impact on the confidence of the recommendation[TC1] . [TC1]No references are included in the abstract

Oral ethinylestradiol in castration resistent prostate cancer: 10 year experience

To describe our 10-year experience with the use of oral ethinylestradiol in the treatment of metastatic castration-resistant prostate cancer. METHODS: From February 2000 to April 2010, 116 patients with a metastatic castration-resistant prostate cancer were prospectively submitted to oral ethinylestradiol monotherapy. Inclusion criteria were: diagnosis of castration-resistant prostate cancer after failure of at least two lines of androgen deprivation therapy and radiological evidence of metastases. Exclusion criteria were: symptomatic cases with a European Cooperative Oncology Group score >2 and severe or uncontrolled cardiovascular diseases. At inclusion in the study, all patients discontinued the previous androgen deprivation therapy and started oral ethinylestradiol at the daily dose of 1 mg. Aspirin (100 mg/daily) was concomitantly given. RESULTS: The median ethinylestradiol therapy duration was 15.9 months (range 8-36 months), whereas the median follow up of patients was 28 months (range 13-36 months). During ethinylestradiol therapy, a confirmed prostate-specific antigen response was found in 79 patients (70.5%). The median time to prostate-specific antigen progression was 15.10 months (95% confidence interval 13.24-18.76 months). A toxicity requiring treatment cessation was observed in 26 patients (23.2%) at a median time of 16 months (mainly thromboembolism). CONCLUSIONS: Our 10-year experience shows that ethinylestradiol provides a prostate-specific antigen response in a high percentage of patients with metastatic castration-resistant prostate cancer. Cardiovascular toxicity can be managed through accurate patient selection, close follow up and a concomitant anticoagulation therapy

Components of cell-matrix linkage as potential new markers for prostate cancer

Prostate cancer is one of the most common tumor diseases worldwide. Often being non-aggressive, prostate tumors in these cases do not need immediate treatment. However, about 20% of diagnosed prostate cancers tend to metastasize and require treatment. Existing diagnostic methods may fail to accurately recognize the transition of a dormant, non-aggressive tumor into highly malignant prostate cancer. Therefore, new diagnostic tools are needed to improve diagnosis and therapy of prostate carcinoma. This review evaluates existing methods to diagnose prostate carcinoma, such as the biochemical marker prostate-specific antigen (PSA), but also discusses the possibility to use the altered expression of integrins and laminin-332 in prostate carcinomas as diagnostic tools and therapeutic targets of prostate cancer

Prostate Specific Antigen (PSA) Inisial ? 100 Ng/ml Menggambarkan Stadium Lanjut Dan Rendahnya Survival Kanker Prostat

Prostate Specific Antigen(PSA) merupakanmarkeryang penting dalam diagnosis,follow up, dan menentukan prognosis kanker prostat. Penggunaan PSA sebagai skrining telah menurunkan kejadian kanker prostat stadium lanjut saat terdiagnosis. Tujuan penelitian ini untuk mengetahui hubungan antara PSA inisial dengan stadium dansurvivalpada semua pasien kanker prostat yang berobat di Rumah Sakit Cipto Mangunkusumo (RSCM) dan Rumah Sakit Kanker "Dharmais" (RSKD) pada periode 1995-2007. Pada penelitian ini kami membagi PSA inisial menjadi dua kelompok: kelompok 1, PSA inisial 0-99 ng/ml; dan kelompok 2, PSA inisial > 100 ng/ml.Selama periode Januari sampai Desember 2007, terdapat 610 kasus kanker prostat, rerata PSA inisial adalah 387,48 ng/ml. Sebagian besar pasien dengan PSA inisial 0-99 ng/ml (53,4%). Kejadian stadium IV pada kelompok PSA inisial > 100 ng/ml lebih tinggi dibandingkan kelompok PSA insial 0-99 ng/ml (p 100 ng/ml, namun perbedaan itu tidak bermakna secara statistik (p>0,05).Kesimpulan: Semakin tinggi PSA inisial semakin tinggi stadium dan semakin rendahsurvivalkanker prostat, sedangkan pada stadium lanjut (stadium IV) tidak terdapat hubungan yang bermakna antara PSA inisial dengansurvival

Accuracy of elastic fusion biopsy in daily practice: results of a multicenter study of 2115 patients

OBJECTIVES: To assess the accuracy of Koelis fusion biopsy for the detection of prostate cancer and clinically significant prostate cancer in the everyday practice. METHODS: We retrospectively enrolled 2115 patients from 15 institutions in four European countries undergoing transrectal Koelis fusion biopsy from 2010 to 2017. A variable number of target (usually 2-4) and random cores (usually 10-14) were carried out, depending on the clinical case and institution habits. The overall and clinically significant prostate cancer detection rates were assessed, evaluating the diagnostic role of additional random biopsies. The cancer detection rate was correlated to multiparametric magnetic resonance imaging features and clinical variables. RESULTS: The mean number of targeted and random cores taken were 3.9 (standard deviation 2.1) and 10.5 (standard deviation 5.0), respectively. The cancer detection rate of Koelis biopsies was 58% for all cancers and 43% for clinically significant prostate cancer. The performance of additional, random cores improved the cancer detection rate of 13% for all cancers (P < 0.001) and 9% for clinically significant prostate cancer (P < 0.001). Prostate cancer was detected in 31%, 66% and 89% of patients with lesions scored as Prostate Imaging Reporting and Data System 3, 4 and 5, respectively. Clinical stage and Prostate Imaging Reporting and Data System score were predictors of prostate cancer detection in multivariate analyses. Prostate-specific antigen was associated with prostate cancer detection only for clinically significant prostate cancer. CONCLUSIONS: Koelis fusion biopsy offers a good cancer detection rate, which is increased in patients with a high Prostate Imaging Reporting and Data System score and clinical stage. The performance of additional, random cores seems unavoidable for correct sampling. In our experience, the Prostate Imaging Reporting and Data System score and clinical stage are predictors of prostate cancer and clinically significant prostate cancer detection; prostate-specific antigen is associated only with clinically significant prostate cancer detection, and a higher number of biopsy cores are not associated with a higher cancer detection rate

Associations of vitamin D pathway genes with circulating 25-hydroxyvitamin-D, 1,25-dihydroxyvitamin-D, and prostate cancer: A nested case-control study

Vitamin D pathway single nucleotide polymorphisms (SNPs) are potentially useful proxies for investigating whether circulating vitamin D metabolites [total 25-hydroxyvitamin-D, 25(OH)D; 1,25-dihydroxyvitamin, 1,25(OH)2D] are causally related to prostate cancer. We investigated associations of sixteen SNPs across seven genes with prostate-specific antigen-detected prostate cancer

Recovery of zeta-chain expression and changes in spontaneous IL-10 production after PSA-based vaccines in patients with prostate cancer.

Circulating T lymphocytes of patients with prostate cancer have been reported to have functional deficits, including low or absent zeta-chain expression. To determine whether these functional impairments could be reversed by prostate specific antigen-based vaccination therapy, 10 patients treated with recombinant human prostate specific antigen plus GM-CSF and eight others receiving prostate specific antigen plus oil emulsion in two pilot clinical trials were evaluated prior to and after vaccination for several immunologic end points, including zeta-chain expression and cytokine production by circulating T cells as well as the frequency of T cells able to respond to prostate specific antigen in ELISPOT assays. The flow cytometry assay for zeta-chain expression was standardized to allow for a reliable comparison of pre- vs post-vaccination samples. Prior to therapy, the patients were found to have significantly lower zeta-chain expression in circulating CD3(+) cells and a higher percentage of zeta-chain negative CD3(+) and CD4(+) cells than normal donors. The patients\u27 peripheral blood mononuclear cells spontaneously produced more IL-10 ex vivo than those of normal controls. After vaccination, recovery of zeta-chain expression was observed in 50% of patients in both clinical trials. Also, spontaneous IL-10 secretion by peripheral blood mononuclear cells decreased following immunotherapy in patients treated with prostate specific antigen and GM-CSF. The frequency of prostate specific antigen-reactive T cells was detectable in 7 out of 18 patients vs 4 out of 18 patients prior to vaccination. Only one of 18 patients was a clinical responder. The vaccine had stimulatory effects on the patients\u27 immune system, but post-vaccine immune recovery could not be correlated to progression-free survival in this small cohort of patients with prostate cancer

All care, but whose responsibility? Community juries reason about expert and patient responsibilities in prostate-specific antigen screening for prostate cancer

General practitioners have implicitly been given responsibility for guiding men’s decisions about prostate-specific antigen–based screening for prostate cancer, but patients’ expectations of the bounds of this responsibility remain unclear. We sought to explore how well-informed members of the public allocate responsibilities in prostate-specific antigen screening decision-making. In 2014, we convened two Community juries in Sydney, Australia, to address questions related to the content and timing of information provision and respective roles of patients and general practitioners in screening decisions. Participants in the first jury were of mixed gender and of all ages (n = 15); the participants in the second jury were all male and of screening age (n = 12). Both juries were presented with balanced factual evidence on the harms and benefits of prostate-specific antigen screening and expert perspectives on ethico-legal aspects of consent in medical practice. In their deliberations, jurors agreed that general practitioners should take responsibility for informing men of the options, risks and benefits of prostate-specific antigen testing, but arrived at different positions on whether or not general practitioners should also guide screening decisions. Jurors also disagreed on how much and when general practitioners should provide detailed information about biopsies and treatments. These responses suggest that for prostate-specific antigen testing, there is a public expectation that both the allocation of responsibility between general practitioners and their male patients, and the level of information provided will be tailored to individual men. In the presence of expert uncertainty, a well-informed public may have reason to embrace or resist shared decision-making processes