Management Of Prostate Cancer Patients Research Articles

Neue präklinische Modelle und Biomarker beim Prostatakarzinom

The ultimate goal of a personalized approach to prostate cancer patient management relies on two prerequisites: the development of preclinical but clinically relevant model systems and robust prognostic and predictive biomarkers. The past several years have shown significant progress towards these two prerequisites which will be highlighted in this review using some notable examples.

Prostate cancer management: Racial disparities in the United States.

e16012 Background: Racial disparities in prostate cancer management have been reported. Black patients with well–differentiated disease were less likely to receive definitive therapy than whites with similar disease according to Underwood et. al., who included 142,340 patients from the Surveillance, Epidemiology and End Result (SEER) registry (J Urol, Vol. 171, 1504 – 1507, April 2004). Our objective was to identify racial disparities in the management of prostate cancer patients from the National Cancer Database. Methods: Prostate cancer treatment according to race in the USA, obtained from the National Cancer Database, was retrospectively reviewed. 1,497,540 patients with prostate cancer in 1397 US teaching and community hospitals between 2000 and 2010 were included. Chi square and Fisher tests were used for statistical analysis. Results: Black patients with stage II disease underwent radical prostatectomy significantly less than white patients (34.3% versus 43%, p<0.05). 10.9% of blacks with stage II disease did not receive any therapy, versus 6.7% of whites (p<0.05). 0.9% of whites with stage III disease didn’t receive any therapy versus 2% of blacks (p<0.05). The disparity was even more accentuated for stage IV disease, where 13.4% of blacks did not receive any form of treatment versus 10.3% of whites (p<0.05). 44% of blacks with localized disease (stage I and II) received radiation therapy, 34% received surgery. Blacks were less likely to receive radical prostatectomy for stage I and II disease compared to whites (34% versus 43%, p<0.05). Stage IV disease at presentation was more common in blacks (7.2%) than in whites (4.7%, p<0.05). Conclusions: This is the largest study which has analyzed ethnicity and prostate cancer management. Significant racial disparities exist in prostate cancer management between whites and blacks in the USA. Our study reveals that blacks are more likely to receive radiation therapy and less likely to get radical prostatectomy for stage I and II disease. A higher percentage of black patients with stage II, III or IV disease do not undergo any treatment as compared to whites. Blacks are also more likely to present with stage IV disease.

Impact of Applied Progressive Deep Muscle Relaxation Training on the Level of Depression, Anxiety and Stress among Prostate Cancer Patients: A Quasi-Experimental Study

The aim of this study was to determine the impact of applied progressive muscle relaxation training on the levels of depression, anxiety and stress among prostate cancer patients. A quasi-experimental study was conducted at the University Malaya Medical Centre (UMMC) and Universiti Kebangsaan Malaysia Medical Centre (UKMMC) over six months. Prostate cancer patients from UMMC received the intervention and patients from UKMMC were taken as controls. The level of depression, anxiety and stress were measured using Depression, Anxiety Stress Scales - 21 (DASS-21). A total of 77 patients from the UMMC and 78 patients from the UKMMC participated. At the end of the study, 90.9% and 87.2% of patients from the UMMC and UKMMC groups completed the study respectively. There were significant improvements in anxiety (p<0.001, partial ?2=0.198) and stress (p<0.001, partial ?2=0.103) at the end of the study in those receiving muscle training. However, there was no improvement in depression (p=0.956). The improvement in anxiety and stress showed the potential of APMRT in the management of prostate cancer patients. Future studies should be carried out over a longer duration to provide stronger evidence for the introduction of relaxation therapy among prostate cancer patients as a coping strategy to improve their anxiety and stress.

Impact of applied progressive deep muscle relaxation training on the health related quality of life among prostate cancer patients — A quasi experimental trial

PurposeTo determine the impact of applied progressive muscle relaxation training on health related quality of life among prostate cancer patients. MethodA quasi-experimental study was conducted at the University Malaya Medical Centre (UMMC) and Universiti Kebangsaan Malaysia Medical Centre (UKMMC) over six months. Patients from UMMC received the intervention and patients from UKMMC as a comparison group. The general health related quality of life was measured using Short Form-36 (SF-36). ResultsA total of 77 patients from the intervention group and 78 patients from the comparison group participated in the study. At the end of the study, only 90.9% in intervention group and 87.2% in comparison group completed the study. There were significant differences between intervention and comparison groups for mental component summary (MCS) (p=0.032) and overall health related quality of life (p=0.042) scores. However, there was no significant difference between groups for physical component summary (PCS) (p=0.965). ConclusionThe improvement in MCS and overall QOL showed the potential of APMRT in the management of prostate cancer patients. Future studies should be carried out over a longer duration to provide stronger evidence for the introduction of relaxation therapy among prostate cancer patients as a coping strategy to improve their QOL.

Functional Role of MicroRNAs in Prostate Cancer and Therapeutic Opportunities

Prostate cancer is one of the most common causes of cancer-related death. The management of prostate cancer patients has become increasingly complex, consequently calling on the need for identifying and validating prognostic and predictive biomarkers. Growing evidence indicates that microRNAs play a crucial role in the pathobiology of neoplastic diseases. The deregulation of the cellular "miRNome" in prostate cancer has been connected with multiple tumor-promoting activities such as aberrant activation of growth signals, anti-apoptotic effects, prometastatic mechanisms, alteration of the androgen receptor pathway, and regulation of the cancer stem cell phenotype. With the elucidation of molecular mechanisms controlled by microRNAs, investigations have been conducted in an attempt to exploit these molecules in the clinical setting. Moreover, the multifaceted biological activity of microRNAs makes them an attractive candidate as anticancer agents. This review summarizes the current knowledge on microRNA deregulation in prostate cancer, and the rationale underlying their exploitation as cancer biomarkers and therapeutics.

MicroRNAs and Prostate Cancer

The management of prostate cancer patients is rapidly changing. The extended survival seen in randomized phase III trials with new molecules has significantly enriched the therapeutic armamentarium, and ongoing clinical trials are assessing whether the integration of these active drugs within established therapeutic regimens results in a further benefit for patients. This complex scenario is raising the need for the identification and validation of biomarkers able to drive the decision-making process during the course of the disease. Compelling evidence has documented the role of microRNAs in cancer biology, and their multifaceted biological activity makes them an attractive candidate as diagnostic, prognostic, and predictive biomarkers. This review summarizes the current knowledge about microRNA deregulation in prostate cancer, how these molecules have been investigated in the clinical setting, and strategies investigators should consider for sharpening their potential.

Prospects in radionuclide imaging of prostate cancer

Prostate cancer is the most common malignancy in men in the Western world and represents a major health problem with substantial morbidity and mortality. Sensitivity and specificity of digital rectal examination (DRE) and evaluation of prostate specific antigen (PSA) are excellent methods for diagnosis of prostate cancer, but have limited value for staging. Imaging of prostate cancer has become increasingly important to improve staging and management of prostate cancer patients. Conventional imaging modalities, such as transrectal ultrasound and computed tomography, show limited accuracy for a reliable assessment of prostate cancer. Diagnostic value of magnetic resonance imaging has improved by dynamic contrast enhancement (DCI-MRI) and diffusion-weighted magnetic resonance imaging (DWI). Recently, substantial progress has been made in the development of functional and molecular imaging modalities, such as positron emission tomography using radiolabeled metabolic tracers, receptor-binding ligands, amino acids, peptides, or antibodies. Here, we review the value of these novel radionuclide imaging techniques in the assessment of prostate cancer.

New treatment paradigm for prostate cancer: abarelix initiation therapy for immediate testosterone suppression followed by a luteinizing hormone‐releasing hormone agonist

Study Type - Therapy (prospective cohort). Level of Evidence 2a. What's known on the subject? and What does the study add? The sequential administration of a GnRH antagonist followed by an LHRH agonist in the management of prostate cancer patients has not been studied, but such a program would provide a more physiologic method of achieving testosterone suppression and avoid the obligatory testosterone surge and need for concomitant antiandrogens that accompany LHRH agonist therapy. The current study which uses abarelix initiation therapy for 12 weeks followed by either leuprolide or goserelin demonstrates the ability to more rapidly achieve testosterone suppression, avoid the obligatory LHRH induced testosterone surge, avoid the necessity of antiandrogens, all of which were accomplished safely, without inducing either additional or novel safety issues. • To demonstrate the safety and endocrinological and biochemical efficacy of initiating treatment with the gonadotropin-releasing hormone (GnRH) antagonist, abarelix, followed by administration of an luteinizing hormone-releasing hormone (LHRH) agonist in patients with advanced and metastatic prostate cancer. • A multicentre, open-label design study was conducted at 22 centres in the US involving patients with: localized, locally advanced or metastatic disease; with a rising prostate-specific antigen (PSA) after definitive local treatment; patients undergoing neoadjuvant hormonal therapy before local therapy (radical prostatectomy, radiation therapy or cryosurgery); and patients in whom intermittent therapy was the planned treatment. • All patients received abarelix for 12 weeks followed by an LHRH agonist (either leuprolide or goserelin) for 8 weeks • The primary efficacy endpoint was achievement and maintenance of castration defined as testosterone <50 ng/dL from day 29 through to day 141 and whether abarelix initiation therapy could eliminate the testosterone surge after two consecutive doses of LHRH agonist therapy. • PSA, LH and follicle-stimulating hormone (FSH) levels were measured and adverse events were monitored. • A total of 176 patients were enrolled into the present study, the majority of whom had localized prostate cancer (82%) and a PSA level <10 ng/mL (62%). • At the end of the abarelix treatment period (day 85), 93.8% of patients achieved castrate levels; during the first week of switch over to the LHRH agonist therapy (days 85-92) the rate was 86.5% and during the week after the second LHRH agonist injection (days 114-12) it was 93.3%. • A small, transient increase in testosterone occurred during the first injection of the LHRH agonist; mean (standard deviation [sd]) values increased from 17 (17.8) ng/dL at day 85 to 37.3 (51.07) ng/dL at day 86. • Mean (sd) PSA levels decreased from 20.5 (56.6) ng/mL at baseline to 3.7 (23.5) ng/mL on day 85 and remained stable throughout the LHRH agonist treatment phase. • Treatment-related adverse events occurred in 84% of patients overall; a similar incidence was reported during the two treatment phases. • Abarelix initiation therapy results in the desired effect of achieving rapid testosterone suppression; testosterone surges after subsequent LHRH agonist therapy are greatly abrogated or completely eliminated. • This treatment paradigm (abarelix initiation followed by agonist maintenance) obviates the need for an antiandrogen. • Abarelix was well tolerated and no clinically meaningful or novel adverse events were observed during abarelix treatment or in the transition to LHRH agonist maintenance therapy.

Circulating and Disseminated Tumor Cells in the Management of Advanced Prostate Cancer

Management of prostate cancer is recognized as one of the most important medical problems. Latest findings concerning the role of circulating (CTC) and disseminated tumor cells (DTC) have provided new insights into the biology of metastasis with important implications for the clinical management of prostate cancer patients. Most of the established methods of circulating/disseminated tumor cell enrichment use density-gradient centrifugation and immunomagnetic procedures. Reverse transcriptase polymerase chain reaction is another used detection technique. Novel methods, the CTC-chip and the epithelial immunospot assay already showed promising results. For localized and metastatic prostate cancer, significant correlations between spreading tumor cells and well-established indicators of disease activity have been demonstrated. Careful randomized prospective trials will be required to justify the routine use of CTCs/DTCs for therapy decision making.

Integrating multiparametric prostate MRI into clinical practice

Multifunctional magnetic resonance imaging (MRI) techniques are increasingly being used to address bottlenecks in prostate cancer patient management. These techniques yield qualitative, semi-quantitative and fully quantitative biomarkers that reflect on the underlying biological status of a tumour. If these techniques are to have a role in patient management, then standard methods of data acquisition, analysis and reporting have to be developed. Effective communication by the use of scoring systems, structured reporting and a graphical interface that matches prostate anatomy are key elements. Practical guidelines for integrating multiparametric MRI into clinical practice are presented.

The rising PET: the increasing use of choline PET/CT in prostate cancer

The paper by Castellucci et al. [1] which appears in this issue of the journal is the last contribution, just in terms of time, dealing with the use of choline PET in the evaluation of biochemical relapse from prostate cancer. The paper adds an important voice in the discussion on the management of prostate cancer patients after prostatectomy. In particular, the authors aimed at studying the clinical utility of Ccholine PET/CT in patients with a “mild” serum prostatespecific antigen (PSA) increase after radical prostatectomy. Although “mild” is not a numeric value, they set the PSA cutoff at less than 1.5 ng/ml. One hundred and two patients were enrolled with an increase of serum PSA during follow-up ranging from 0.2 to 1.5 ng/ml. Choline PET/CT was used as the first diagnostic procedure and results were compared to pathology or a 12-month follow-up. Data from PSA kinetics, such as doubling time and velocity, were also evaluated. The study reports positive C-choline PET/CT findings in 29% of patients, including those who had local relapse, positive locoregional nodes or bone metastasis. Notably, the paper also suggested that PSA doubling time and locoregional lymph node involvement at diagnosis were the only significant independent predictive factors for relapse in multivariate analyses. The authors concluded that Ccholine PET/CT is effective in determining the best treatment strategy in patients with early, or mild, PSA relapse, namely below 1.5 ng/ml. This paper stresses again the rising importance of PET/ CT in prostate cancer, a field in which F-FDG is of negligible use, therefore underlining the importance of PET as a technique able to study different entities, using different, specific radiopharmaceuticals. The increasing ageing of the population, particularly in more developed countries, has resulted in an increase of prostate cancer incidence and this disease is now one of the leading causes of death in men [2]. After radical prostatectomy or radical radiation treatment, prostate cancer recurs in 20–50% of patients, and PSA increase is detectable before the disease can be confirmed with any imaging modality. Of course, PSA is not able to distinguish between local relapse, involvement of locoregional nodes or distant metastases; this is why imaging comes into play. Literature data confirmed that, as often occurs, detection of anatomical changes with magnetic resonance (MR), computed tomography (CT) or transrectal ultrasound (TRUS) has limited accuracy for assessment of recurrent disease [3]. In order to tailor a patient’s therapy to the status of the illness, there needs to be an imaging method capable of assessing the real tumour burden and to localize all, or almost all, localizations. Treatment strategies at relapse vary depending on disease extension, including surgery, radiation treatment, hormonal therapy and palliative care. Molecular imaging with PET is able to detect the diffusion of cancer before morphological changes can be identified with other imaging methods, and this is true also for prostate cancer. Different radiopharmaceuticals have been proposed, both for PET and SPECT, as well as potential applications of PET/MR imaging, as summarized in a recent review [4]. A. Chiti (*) Department of Nuclear Medicine, IRCCS Istituto Clinico Humanitas, Via Manzoni 56, 20089, Rozzano, MI, Italy e-mail: arturo.chiti@humanitas.it

Real‐time Virtual Sonography for navigation during targeted prostate biopsy using magnetic resonance imaging data

To evaluate the effectiveness of the medical navigation technique, namely, Real-time Virtual Sonography (RVS), for targeted prostate biopsy. Eighty-five patients with suspected prostate cancer lesions using magnetic resonance imaging (MRI) were included in this study. All selected patients had at least one negative result on the previous transrectal biopsies. The acquired MRI volume data were loaded onto a personal computer installed with RVS software, which registers the volumes between MRI and real-time ultrasound data for real-time display. The registered MRI images were displayed adjacent to the ultrasonographic sagittal image on the same computer monitor. The suspected lesions on T2-weighted images were marked with a red circle. At first suspected lesions were biopsied transperineally under real-time navigation with RVS and then followed by the conventional transrectal and transperineal biopsy under spinal anesthesia. The median age of the patients was 69 years (56-84 years), and the prostate-specific antigen level and prostate volume were 9.9 ng/mL (4.0-34.2) and 37.2 mL (18-141), respectively. Prostate cancer was detected in 52 patients (61%). The biopsy specimens obtained using RVS revealed 45/52 patients (87%) positive for prostate cancer. A total of 192 biopsy cores were obtained using RVS. Sixty-two of these (32%) were positive for prostate cancer, whereas conventional random biopsy revealed cancer only in 75/833 (9%) cores (P < 0.01). Targeted prostate biopsy with RVS is very effective to diagnose lesions detected with MRI. This technique only requires additional computer and RVS software and thus is cost-effective. Therefore, RVS-guided prostate biopsy has great potential for better management of prostate cancer patients.

Disfunción miccional en el cáncer de próstata

Prostate cancer is the urologic neoplasia that has experienced more changes in the last decade, with a great increase in incidence and diagnosis. Prostate cancer patient's management is clearly multidisciplinary, with the participation of urologists mainly, but also specialized pathologists, radiologists, biochemists, medical oncologists, radiation oncologists and others. The expected long survival makes the routine visit for PSA control non sustainable, without paying attention to the presence of urinary symptoms and other functional disorders with great repercussion on the quality of life.To present urinary dysfunction in patients with prostate cancer from a non oncological but urodynamic and quality of life point of view. Secondarily, to pose the clinical features not translated to functional and urodynamic pathology (urinary toxicity, radiation toxicity, bladder hyperactivity...)We review and update voiding dysfunction that may be present in prostate cancer patients. Not only urinary incontinence after radical prostatectomy. We integrated author;s experience with its physiopathology, sphincter electromyography, and urodynamics, and a general review on the topic using the latest bibliography.Surgical techniques have improved very much, resulting in very high continence rates, which do not enable to consider one approach or the use of robotics better than others. Prostate cancer present multiple urodynamic scenarios. Constrictive or compressive lower urinary tract obstruction, detrusor muscle hyperactivity, diminished compliance, stress urinary incontinence due to sphincteric deficit, mixed urinary incontinence, bladder dysfunction. Other scenarios are not defined by urodynamics.Patients with prostate cancer may currently receive a defective evaluation by their urologists in terms of urinary symptoms due to the prevalence of oncological features in their evaluation. Prostate cancer shows a great diversity of urodynamic scenarios subject of study, not only post-radical prostatectomy incontinence.

Psoralidin, an Herbal Molecule, Inhibits Phosphatidylinositol 3-Kinase–Mediated Akt Signaling in Androgen-Independent Prostate Cancer Cells

The protein kinase Akt plays an important role in cell proliferation and survival in many cancers, including prostate cancer. Due to its kinase activity, it serves as a molecular conduit for inhibiting apoptosis and promoting angiogenesis in most cell types. In most of the prostate tumors, Akt signaling is constitutively activated due to the deletion or mutation of the tumor suppressor PTEN, which negatively regulates phosphatidylinositol 3-kinase through lipid phosphatase activity. Recently, we identified a natural compound, psoralidin, which inhibits Akt phosphorylation, and its consequent activation in androgen-independent prostate cancer (AIPC) cells. Furthermore, ectopic expression of Akt renders AIPC cells resistant to chemotherapy; however, psoralidin overcomes Akt-mediated resistance and induces apoptosis in AIPC cells. While dissecting the molecular events, both upstream and downstream of Akt, we found that psoralidin inhibits phosphatidylinositol 3-kinase activation and transcriptionally represses the activation of nuclear factor-kappaB and its target genes (Bcl-2, Survivin, and Bcl-xL, etc.), which results in the inhibition of cell viability and induction of apoptosis in PC-3 and DU-145 cells. Interestingly, psoralidin selectively targets cancer cells without causing any toxicity to normal prostate epithelial cells. In vivo xenograft assays substantiate these in vitro findings and show that psoralidin inhibits prostate tumor growth in nude mice. Our findings are of therapeutic significance in the management of prostate cancer patients with advanced or metastatic disease, as they provide new directions for the development of a phytochemical-based platform for prevention and treatment strategies for AIPC.

Editorial Comment on: Combined Magnetic Resonance Imaging and Magnetic Resonance Spectroscopy Imaging in the Diagnosis of Prostate Cancer: A Systematic Review and Meta-analysis

Magnetic resonance imaging (MRI) has been evaluated as a diagnostic procedure for the detection, localization, and staging of prostate cancer due to the technique’s high-resolution imaging of soft tissue. The meta-analysis by Engelbrecht et al [1] of MRI in prostate cancer staging (T2 vs T3) with a summary receiver operating characteristic (ROC) curve with a joint maximum sensitivity and specificityof71% was the firstgoal-oriented attempt to determine the diagnostic properties of MRI. Both MRI and magnetic resonance spectroscopy imaging (MRSI) have shown promise for improving the detection and characterization of prostate cancer; however, the exact role of combined MRI/ MRSI in the management of prostate cancer patients remains to be established. Thus, the aim of the present manuscript by Umbehr et al [2] was the systematic review of the diagnostic accuracy of combined MRI/MRSI in prostate cancer. The authors included a total of 16 studies with rather heterogeneous study protocols and study populations. Even though Umbehr et al [2] found little evidence indicating a potential role for this technique for prostate cancer detection, the meta-analysis revealed a pooled mean sensitivity of 68% in men with confirmed cancer and specificity of 85%, while the pooled sensitivity and specificity with suspected prostate cancer was 82% and 88%, respectively. The risk of clinically relevant cancer could be determined with a sensitivity of 75% and a specificity of 91% in lowrisk patients. Due to the fact that a substantial number of patients with prostate cancer are still being overtreated by definitive cancer therapy, active surveillance (AS) has been proposed as an alternative strategy with excellent long-term results, entailing regular prostate-specific antigen (PSA) testing, serial digital rectal examination (DRE), and periodic repeat prostate biopsy. Based on the high pooled mean specificity rates of combined MRI/MRSI, functional MRI techniques may be incorporated in AS programs to reduce rebiopsies and sampling errors. Additionally, higher field strengths will lead to better spatial resolution, and other combinations of existing functional magnetic resonance techniques such as diffusion weighted imaging and dynamic contrast-enhanced MRI may provide additional information on tumor grade and aggressiveness [3]. Despiteall existing limitations,ongoing advances in imaging modalities may offer the potential to equal the gold standard of pathologic evaluation in the future diagnosis of prostate cancer.

Current topics and perspectives relating to hormone therapy for prostate cancer

Prostate cancer is androgen-dependent, and hormone therapy, mainly achieved by androgen deprivation, has been one of the main treatment modalities in the clinical management of prostate cancer patients for more than six decades. In the 1980s, luteinizing hormone-releasing hormone agonists, which reduce testosterone to castration levels, were introduced Also, after the 1980s, nonsteroidal antiandrogens were developed in addition to steroidal antiandrogens. Since then, so-called maximum androgen blockade (MAB)/combined androgen blockade (CAB), which is a combination of surgical or medical castration and oral antiandrogens, has been developed. More recently, novel treatment modalities have been developed, such as intermittent androgen suppression, nonsteroidal antiandrogen monotherapy, and alternative antiandrogen therapy after relapse from initial MAB/CAB, The present article focuses on these treatment modalities to review current topics and perspectives with respect to hormone therapy for prostate cancer.

Follow-up Management of Prostate Cancer Patients after Intensity Modulated Radiotherapy using Dynamic MRI: Which Parameter is Relevant?

Follow-up Management of Prostate Cancer Patients after Intensity Modulated Radiotherapy using Dynamic MRI: Which Parameter is Relevant?

Disparities and trends in prostate cancer staging over time

5160 Background: Appropriate staging is critical for the successful management of prostate cancer patients. Differences in tumor extent and the likelihood of being appropriately staged exist across racial/ethnic and age groups. This study examined patterns of prostate cancer staging from a nationally representative dataset. Methods: Prostate cancer staging data from the Surveillance, Epidemiology and End Results (SEER) Medicare files were categorized by SEER historic stage, defined as in-situ, localized/regional, distant or unstaged. Differences in staging across age and racial/ethnic categories and trends over time were examined to determine whether disparities persisted from earlier years, starting in 1997, to the most recently available data in 2002. Prostate cancer patients were stratified into 3 age categories (under 65; 65 to 79, and 80 or older) and 4 racial/ethnic groups: Non-Hispanic White [WNH], White Hispanic [HW], African American [AA], and Other. Results: Based on annual samples of 20,301 to 39,626 prostate cancer patients, the overall proportion who were unstaged decreased from more than 7% in 1997–1998 to less than 5% in 2001 and 2002. Significantly more patients were unstaged in the older age groups. Over time, a larger percentage of patients were staged across all racial/ethnic and age groups; however, the proportion of unstaged patients age 80 or older in the most recent year, 2002, remained high for WNH (13%), HW (20%) and AA (12%), compared to the groups under age 65 (2%) and ages 65–79 (3–4%). Of the staged patients, the proportion with localized/regional disease ranged from 94.2% to 95.5% across the six years, with a slight shift from distant to localized/regional staging. Conclusions: Disparities in tumor staging across racial/ethnic and age groups persist but these disparities have decreased somewhat over time. The highest proportion of unstaged patients occurred among AA ages 80+ in 1997 and among HW ages 80+ in 2002. Proportion of Unstaged Prostate Cancer Patients by Race/Ethnicity 1997 <65 65 - 79 80+ WNH 2.08% 5.19% 18.53% HW 4.30% 7.91% 18.18% AA 3.45% 7.39% 22.93% 2002 WNH 1.81% 3.20% 12.82% HW 1.92% 3.37% 20.38% AA 2.09% 3.68% 12.12% WNH=Non-White Hispanic; HW=White Hispanic; AA=African American Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration sanofi-aventis sanofi-aventis sanofi-aventis

Prostate biopsy strategies

Early detection is critical to good management of prostate cancer patients. Markers for detection, such as prostate specific antigen (PSA), and prostate biopsy are paramount for establishing an efficient diagnosis. Patients having an initial biopsy should undergo an extended biopsy scheme incorporating at least 10-12 cores, while in those undergoing a repeat biopsy particular attention should be addressed to the anterior apex. Saturation biopsies should be considered for patients with several prior negative biopsies. The chance of finding cancer on repeat biopsies has diminished in patients harboring high-grade prostatic intraepithelial neoplasia but not in those with atypical small acinar proliferation. This article reviews the history of prostate biopsy strategies with particular attention paid towards the development of extended biopsy schemes. Furthermore, a strategy is recommended for initial and repeat biopsy patients.

Optimierte Standards der Prostatastanzbiopsie

As individual risk assessment mainly depends on the correct prediction of the tumor's biological behavior, primary diagnosis plays a key role in the clinical management of prostate cancer patients. Prostate core needle biopsy, as a primary diagnostic tool, should not only confirm clinical suspicion but also supply the urologist with information which is necessary for risk-adapted therapy. The experience and competence of both the urologist and the pathologist are crucial for the quality of prostate core needle biopsy diagnosis. Optimized handling and submission of prostate core needle biopsy specimens by the urologist to the pathologist are of outstanding importance for improving the number of cancer cases detected. Increasing availability of molecular markers leads to the necessity of developing new tissue sampling procedures which allow prostate core needle biopsy specimens to be simultaneously studied histologically and by molecular approaches.