Prostate Health Index (Phi) and Prostate Cancer Antigen 3 (PCA3) Significantly Improve Prostate Cancer Detection at Initial Biopsy in a Total PSA Range of 2-10 ng/ml

Many efforts to reduce prostate specific antigen (PSA) overdiagnosis and overtreatment have been made. To this aim, Prostate Health Index (Phi) and Prostate Cancer Antigen 3 (PCA3) have been proposed as new more specific biomarkers. We evaluated the ability of phi and PCA3 to identify prostate cancer (PCa) at initial prostate biopsy in men with total PSA range of 2-10 ng/ml. The performance of phi and PCA3 were evaluated in 300 patients undergoing first prostate biopsy. ROC curve analyses tested the accuracy (AUC) of phi and PCA3 in predicting PCa. Decision curve analyses (DCA) were used to compare the clinical benefit of the two biomarkers. We found that the AUC value of phi (0.77) was comparable to those of %p2PSA (0.76) and PCA3 (0.73) with no significant differences in pairwise comparison (%p2PSA vs phi p = 0.673, %p2PSA vs. PCA3 p = 0.417 and phi vs. PCA3 p = 0.247). These three biomarkers significantly outperformed fPSA (AUC = 0.60), %fPSA (AUC = 0.62) and p2PSA (AUC = 0.63). At DCA, phi and PCA3 exhibited a very close net benefit profile until the threshold probability of 25%, then phi index showed higher net benefit than PCA3. Multivariable analysis showed that the addition of phi and PCA3 to the base multivariable model (age, PSA, %fPSA, DRE, prostate volume) increased predictive accuracy, whereas no model improved single biomarker performance. Finally we showed that subjects with active surveillance (AS) compatible cancer had significantly lower phi and PCA3 values (p < 0.001 and p = 0.01, respectively). In conclusion, both phi and PCA3 comparably increase the accuracy in predicting the presence of PCa in total PSA range 2-10 ng/ml at initial biopsy, outperforming currently used %fPSA

Kaempferol, myricetin and fisetin in prostate and bladder cancer: A systematic review of the literature

Prostate and bladder cancer represent the two most frequently diagnosed genito-urinary malignancies. Diet has been implicated in both prostate and bladder cancer. Given their prolonged latency and high prevalence rates, both prostate and bladder cancer represent attractive candidates for dietary preventive measures, including the use of nutritional supplements. Flavonols, a class of flavonoids, are commonly found in fruit and vegetables and are known for their protective effect against diabetes and cardiovascular diseases. Furthermore, a higher dietary intake of flavonols was associated with a lower risk of both bladder and prostate cancer in epidemiological studies. In this systematic review, we gathered all available evidence supporting the anti-cancer potential of selected flavonols (kaempferol, fisetin and myricetin) against bladder and prostate cancer. A total of 21, 15 and 7 pre-clinical articles on bladder or prostate cancer reporting on kaempferol, fisetin and myricetin, respectively, were found, while more limited evidence was available from animal models and epidemiological studies or clinical trials. In conclusion, the available evidence supports the potential use of these flavonols in prostate and bladder cancer, with a low expected toxicity, thus providing the rationale for clinical trials that explore dosing, settings for clinical use as well as their use in combination with other pharmacological and non-pharmacological interventions

Defining Health Service Eco-System “Infection”: A Critical Analysis of Patient Surveys

Purpose – This paper focuses on the analysis of the most common tools that health care organizations use to assess the quality of the delivered services, the patient surveys. In line with the results of a systematic literature review on the issue, the study embraces service ecosystem perspective to understand why these surveys are unable to grasp actors’ disposition to co-create value for the health care system. Methodology – An in-depth literature review based on PRISMA framework explored 34 works on the topic of patient surveys in order to trace the evolution of the relationship users/providers and to highlight the criticalities related to the adoption of patient surveys in service-oriented era. The study discusses critically their efficacy to understand how they can affect (positively or negatively) the viability of a health care service eco-system. Findings – The literature review highlights patient surveys inability in grasping the real perception that patients have of experienced services and in involving them in value co-creation, through their engagement in service design and delivery. Moreover, the results reveal the need to adopt Service Dominant (S-D) Logic and service eco-system perspective to reread the traditional tools to measure quality in healthcare. For this reason, the metaphor of health service eco-system “infection” is launched, depicting the negative influence of patient satisfaction surveys on value co-creation and the subsequent service eco-system viability. Practical implications – The study shows that assuming a service eco-system perspective based on S-D logic, health care system should boost and preserve value co-creation processes. Moreover, institutions should foster those “rules of the game” that institutionalize the contribution of health providers to value co-creation, defining specific strategies to avoid the “infections” of health care service eco-system, e.g. investing and promoting non-detrimental tools. Originality – This study represents one of the first attempts to reread the tools used to assess patient embracing a service eco-system perspective. Interesting implications have been presented in terms of the negative effect that traditional assessment tools have on providers, patients and the whole society

Surface endoglin (CD105) expression on acute leukemia blast cells: an extensive flow cytometry study of 1002 patients

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Improving the prediction of pathologic outcomes in patients undergoing radical prostatectomy : the value of prostate cancer antigen 3 (PCA3), prostate health index (Phi) and sarcosine

Background/Aim: Several efforts have been made to find biomarkers that could help clinicians to preoperatively determine prostate cancer (PCa) pathological characteristics and choose the best therapeutic approach, avoiding overtreatment. On this effort, prostate cancer antigen 3 (PCA3), prostate health index (phi) and sarcosine have been presented as promising tools. We evaluated the ability of these biomarkers to predict the pathologic PCa characteristics within a prospectively collected contemporary cohort of patients who underwent radical prostatectomy (RP) for clinically localized PCa at a single high-volume Institution. Materials and Methods: The prognostic performance of PCA3, phi and sarcosine were evaluated in 78 patients undergoing RP for biopsy-proven PCa. Receiver operating characteristic (ROC) curve analyses tested the accuracy (area under the curve (AUC)) in predicting PCa pathological characteristics. Decision curve analyses (DCA) were used to assess the clinical benefit of the three biomarkers. Results: We found that PCA3, phi and sarcosine levels were significantly higher in patients with tumor volume (TV) 650.5 ml, pathologic Gleason sum (GS) 657 and pT3 disease (all p-values 640.01). ROC curve analysis showed that phi is an accurate predictor of high-stage (AUC 0.85 [0.77-0.93]), high-grade (AUC 0.83 [0.73-0.93]) and high-volume disease (AUC 0.94 [0.88-0.99]). Sarcosine showed a comparable AUC (0.85 [0.76-0.94]) only for T3 stage prediction, whereas PCA3 score showed lower AUCs, ranging from 0.74 (for GS) to 0.86 (for TV). Conclusion: PCA3, phi and sarcosine are predictors of PCa characteristics at final pathology. Successful clinical translation of these findings would reduce the frequency of surveillance biopsies and may enhance acceptance of active surveillance (AS)

Incidence of fatigue and low-dose corticosteroid use in prostate cancer patients receiving systemic treatment: a meta-analysis of randomized controlled trials

Background: Cancer-related fatigue (CRF) is a complex condition that is reported in &gt; 50% of cancer patients. In men with castration-resistant prostate cancer (CRPC), CRF was reported in 12\u201321% of patients. Approved systemic therapy against CRPC is commonly administered in combination with androgen-deprivation treatment (ADT) and, in some cases, with daily, low-dose corticosteroids. Importantly, the use of low-dose corticosteroids is associated with multiple negative effects, including reduced muscle mass. On these grounds, we hypothesized that the chronic use of corticosteroids may increase the incidence of fatigue in patients with prostate cancer. Methods: We reviewed all randomized trials published during the last 15&nbsp;years conducted in patients with prostate cancer receiving systemic treatment and we performed a sub-group analysis to gather insights regarding the potential differences in the incidence of fatigue in patients receiving vs. not receiving daily corticosteroids as part of their systemic anti-neoplastic regimen. Results: Overall, 22,734 men enrolled in prospective randomized phase II and III trials were evaluable for fatigue. Estimated pooled incidence of grade 1\u20132 fatigue was 30.89% (95% CI = 25.34\u201336.74), while estimated pooled incidence of grade 3\u20134 fatigue was reported in 3.90% (95% CI = 2.91\u20135.02). Sub-group analysis showed that grade 3\u20134 fatigue was approximately double in patients who received daily corticosteroids as part of their anti-neoplastic treatment (5.58; 95% CI = 4.33\u20136.98) vs. those who did not (2.67%; 95% CI = 1.53\u20134.11). Conclusion: Our findings highlight the need for ad hoc-designed prospective clinical trials to investigate whether the benefits associated with low-dose, daily corticosteroids outweigh the risks associated with corticosteroid-related adverse events such as fatigue

A risk-group classification model in patients with bladder cancer under neoadjuvant cisplatin-based combination chemotherapy

The objective of the current research was to explore the potential prognostic value of readily available clinical and pathologic variables in bladder cancer. The novel association found between cholesterol levels and prognosis may provide the rationale for exploring novel treatments. Patients included had histologically confirmed urothelial bladder cancer and were treated with at least 3 cycles of cisplatin-based neoadjuvant chemotherapy before radical cystectomy with lymphadenectomy. A total of 245 patients at low, intermediate and high risk, presenting with 0-1, 2 or 3-4 risk factors, including positive lymph nodes, Hb &lt;12.8, NLR ≥2.7 and cholesterol levels ≥199, were included. Five-year cancer-specific survival rate was 0.67, 0.78 and 0.94 at high, intermediate and low risk, respectively. Total cholesterol levels at the time of cystectomy may represent a commonly assessable prognostic factor and may be incorporated in a clinically meaningful risk-group classification model