Prostate-specific Antigen Measurements Research Articles

MP09-18 LONGITUDINAL OUTCOMES FOLLOWING IMPLEMENTATION OF BASELINE PSA RISK STRATIFICATION OF MEN IN THEIR FORTIES

You have accessJournal of UrologyCME1 May 2022MP09-18 LONGITUDINAL OUTCOMES FOLLOWING IMPLEMENTATION OF BASELINE PSA RISK STRATIFICATION OF MEN IN THEIR FORTIES Zoe Michael, Srinath Kotamarti, Rohith Arcot, Kostantinos Morris, Anand Shah, John Anderson, Andrew Armstrong, Rajan Gupta, Glenn M. Preminger, Judd W. Moul, Kevin Oeffinger, Kevin Shah, and Thomas J. Polascik Zoe MichaelZoe Michael More articles by this author , Srinath KotamartiSrinath Kotamarti More articles by this author , Rohith ArcotRohith Arcot More articles by this author , Kostantinos MorrisKostantinos Morris More articles by this author , Anand ShahAnand Shah More articles by this author , John AndersonJohn Anderson More articles by this author , Andrew ArmstrongAndrew Armstrong More articles by this author , Rajan GuptaRajan Gupta More articles by this author , Glenn M. PremingerGlenn M. Preminger More articles by this author , Judd W. MoulJudd W. Moul More articles by this author , Kevin OeffingerKevin Oeffinger More articles by this author , Kevin ShahKevin Shah More articles by this author , and Thomas J. PolascikThomas J. Polascik More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002531.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A baseline prostate-specific antigen (PSA) in a man’s forties can assess risk for lethal prostate cancer (PCa) at a time in life when PSA should be low with few confounders. We examined the initial longitudinal outcomes of young men with an elevated baseline PSA screened within a system-wide primary care network. METHODS: We assessed patients within the Duke Primary Care Network ages 40-49 with a PSA following implementation of an electronic health record (EHR) screening algorithm on 2/2/2017. The outcomes of men with PSA > 1.5 ng/ml were assessed through 7/2021. Statistical analyses compared mean PSAs between groups and identified factors associated with the detection of all PCa and clinically significant PCa (csPCa), defined as Gleason Grade Group (GGG) > 2. RESULTS: Of 49,980 men screened, 11,922 men were ages 40-49, with 564 (4.7%) found to have a PSA >1.5 ng/ml. A total of 330 (58.5%) men were referred to urology for PCa suspicion, while the remaining 234 (41.5%) were either not referred to urology (n=206) or were referred for reasons unrelated to PCa suspicion (n=28). Referred patients had significantly higher mean PSA values (2.97 vs 1.98, p=0.001). In the entire cohort, 49 patients (8.7%) underwent biopsy; of these, 20 (40.8%) returned positive for PCa. A total of 11 men had csPCa, including three patients with > GGG4. Timing of referral and PSA levels were significantly associated with all PCa at biopsy on multivariable analysis. However, a separate analysis for csPCa showed PSA was a significant predictor (OR 1.065, p<0.05), while referral timing was not (p>0.05). CONCLUSIONS: A PSA > 1.5 ng/ml led to PCa diagnosis in a small but important percentage of men in their forties. Overall, this study provides validation for a baseline PSA measurement in younger men to determine those patients harboring lethal cancer who could benefit from potentially lifesaving intervention. Further work is needed to enhance PCP buy-in and optimize coordination between PCPs and urologists to further improve patient care. Source of Funding: Grants from the National Cancer Institute and the Duke Institute for Health Innovation (DIHI) © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e143 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zoe Michael More articles by this author Srinath Kotamarti More articles by this author Rohith Arcot More articles by this author Kostantinos Morris More articles by this author Anand Shah More articles by this author John Anderson More articles by this author Andrew Armstrong More articles by this author Rajan Gupta More articles by this author Glenn M. Preminger More articles by this author Judd W. Moul More articles by this author Kevin Oeffinger More articles by this author Kevin Shah More articles by this author Thomas J. Polascik More articles by this author Expand All Advertisement PDF DownloadLoading ...

The Debate on Prostate Cancer Screening: What Does the Wisdom from the Old Books Whisper?

Prostate cancer is a prevalent problem in male healthcare. The previous decades have witnessed some significant improvements in the knowledge of aetiology and pathology, as well as practice of screening, treatment, and follow-up of the disease. A downstaging at the time of the diagnosis and increase in the survival were vivid with the advancements, albeit the screening of the disease using regular prostate specific antigen measurements was previously debated. In this paper, the authors aimed to inform the reader on the course of the prostate cancer along a century by sailing along the chapters of the old urology textbooks.

Effects of Saw Palmetto Therapy on some Inflammatory Biomarkers in a Sample of Iraqi Male with Symptomatic Benign Prostatic Hyperplasia

Background Saw palmetto contains powerful anti-inflammatory components commonly used in Benign prostatic hyperplasia (BPH) patients with symptoms. The current study was designed to assess the effectiveness of saw palmetto alone or supplementation&#x0D; &#x0D; therapy with tamsulosin via measurement of some inflammatory biomarker in male with lower urinary tract symptoms (LUTS) consistent with (BPH).&#x0D; Methods The present study is an interventional prospective randomized enrolled newly diagnosed patients with moderate to severe symptomatic BPH. The eligible 60 patients were allocated into (3) groups, each group with (20) patients; Group (1) treated with Saw palmetto cap (320 mg); Group (2) treated with Saw palmetto cap (320 mg) and tamsulosin (0.4mg); Group (3) treated with tamsulosin (0.4mg), protocols to be given once daily for 12 weeks. Measurement of prostate specific antigen (PSA), C-reactive protein (CRP), and interleukin 6 (IL-6) was done.&#x0D; Results There was significant decrease in the serum PSA, CRP and IL-6 level (P&lt;0.01) in group1 and 2 patients only after treatment when compared to pretreatment. Patients on combination therapy presented with high percent of change compared to other groups. No change in CRP and IL-6 level in patients on tamsulosin alone.&#x0D; Conclusion From the findings of the present study, phytotherapy with Saw Palmetto alone or as supplement produced significant 3 months drop in both inflammatory markers, the total CRP level and IL-6 level. Also produced significant decrease in PSA level, and may substitute the conventional therapy in mild disease status.

Testosterone Deficiency is Not Protective Against the Development of Adenocarcinoma of the Prostate in a Type1 Diabetic Patient.

We present a case of prostate cancer (PC) developing in a hypogonadal patient with well-controlled type 1 diabetes. The purpose of reporting this case is to emphasize that regular prostate examinations and prostate-specific antigen (PSA) measurements should be preformed in the diabetic male, even though the incidence of PC is lower in this group of patients. In addition, these examinations and tests need to be preformed even in the hypogonadal patient with diabetes since the presence of a low serum testosterone (T) level does not preclude the development of PC. This is because the development of PC is not related to serum androgen levels but to the androgen levels within the prostate, and dihydrotestosterone (DHT) levels and not T levels within the prostate gland are responsible for the development of PC. In the hypogonadal male, intraprostatic DHT may be high since DHT can be formed from adrenal androgens, particularly androstenedione, through activation of 5α-reductase 2, which is the minority enzyme in the normal prostate but becomes the major enzyme in the formation and growth of PC.

Clinical and pathological features associated with circulating tumor DNA content in real-world patients with metastatic prostate cancer.

BackgroundLiquid biopsy is a powerful tool that can enable treatment decisions for metastatic prostate cancer patients with difficult‐to‐biopsy tumors. However, the detection of genomic alterations via liquid biopsy is limited by the fraction (tumor fraction [TF]) of circulating tumor DNA (ctDNA) within the total cell‐free DNA content. While prior work has preliminarily correlated TF with clinical features of prostate cancer, we sought to validate and provide additional resolution, such that a clinical practitioner might anticipate the probability of successful liquid biopsy profiling leveraging commonly assessed clinical and laboratory features.MethodsA total of 813 liquid biopsy specimens were assessable, with 545 associated with a PSA prostate specific antigen measurement, collected in standard‐of‐care settings across approximately 280 US academic or community‐based cancer clinics from September 2018 to July 2021. Deidentified data were captured into a real‐world clinico‐genomic database (CGDB). Comprehensive genomic profiling (CGP) was performed on extracted cell‐free DNA from liquid biopsy samples.ResultsIn multivariable models, higher PSA level, lower hemoglobin, lower albumin, higher alkaline phosphatase (all p < 0.001), and collection of liquid biopsy blood draw within 60 days of new treatment initiation (p = 0.002) were the most strongly associated features with higher TF. At PSA levels of <5 ng/ml, 43% of patients had a TF of <1% indicating an increased likelihood of unevaluable results. Conversely, at PSA levels of >5 ng/ml, 78% of patients had a TF of at least 1% and 46% had a TF of ≥10%, suggesting improved sensitivity for detection of targetable alterations.ConclusionsUniversal genomic profiling of prostate cancers will require complementary use of liquid biopsy and tumor tissue profiling for suitable patients. The likelihood of adequate ctDNA shedding into plasma is one consideration when deciding whether to pursue CGP via liquid biopsy versus tumor profiling. Our real‐world data suggest that PSA < 5 ng/ml is associated with lower ctDNA yield on liquid biopsy, potentially increasing the incidence of negative results or a need for confirmation with tissue testing.

Increasing the uptake in a general practice prostate cancer screening programme

BackgroundProstate cancer (PC) is the second most common cause of cancer deaths among males worldwide. Prostate-specific antigen (PSA) is a predictive indicator of prostate pathology. Men with elevated PSA levels...

Identification of Urine Biomarkers to Improve Eligibility for Prostate Biopsy and Detect High-Grade Prostate Cancer.

Simple SummaryThe screening of prostate cancer (PCa), based on the serum prostate specific antigen (PSA), is characterized by a high number of false positives, leading to overdiagnosis of healthy men and overtreatment of indolent PCa. This clinical problem severely affects the quality of life of patients, who would benefit from more specific risk stratification models. By performing a mass spectrometry (MS) screening on urine samples collected prior to prostate biopsy, we identified novel biomarkers and validated them by ELISA. Here, we show that an upfront urine test, based on quantitative biomarkers and patient age, has a higher performance compared to PSA (AUC = 0.6020) and is a feasible method to improve the eligibility criteria for prostate biopsy, to detect healthy men (AUC = 0.8196) and clinically significant PCa, thereby reducing the number of unnecessary prostate biopsies.PCa screening is based on the measurements of the serum prostate specific antigen (PSA) to select men with higher risks for tumors and, thus, eligible for prostate biopsy. However, PSA testing has a low specificity, leading to unnecessary biopsies in 50–75% of cases. Therefore, more specific screening opportunities are needed to reduce the number of biopsies performed on healthy men and patients with indolent tumors. Urine samples from 45 patients with elevated PSA were collected prior to prostate biopsy, a mass spectrometry (MS) screening was performed to identify novel biomarkers and the best candidates were validated by ELISA. The urine quantification of PEDF, HPX, CD99, CANX, FCER2, HRNR, and KRT13 showed superior performance compared to PSA. Additionally, the combination of two biomarkers and patient age resulted in an AUC of 0.8196 (PSA = 0.6020) and 0.7801 (PSA = 0.5690) in detecting healthy men and high-grade PCa, respectively. In this study, we identified and validated novel urine biomarkers for the screening of PCa, showing that an upfront urine test, based on quantitative biomarkers and patient age, is a feasible method to reduce the number of unnecessary prostate biopsies and detect both healthy men and clinically significant PCa.

Attainment of early, deep prostate-specific antigen response in metastatic castration-sensitive prostate cancer: A comparison of patients initiated on apalutamide or enzalutamide.

43 Background: Deep prostate-specific antigen (PSA) response, defined as a ≥90% decline in PSA (PSA90), is an important early prognostic factor for achieving radiographic progression free survival and overall survival in patients with metastatic castration-sensitive prostate cancer (mCSPC) treated with a next generation androgen receptor inhibitor (ARI) or androgen biosynthesis inhibitor. This study compared PSA90 responses among patients with mCSPC at first use of a next generation ARI. Methods: Clinical data from 69 community urology practices in the United States were evaluated. Patients with mCSPC were classified into treatment cohorts based on their first filled prescription (index date) for apalutamide (APA) or enzalutamide (ENZ) after 12/16/2019. Patients were followed from index date until the earliest of index regimen discontinuation, treatment switch, end of clinical activity or end of data availability (03/05/2021). Included patients had ≥12 months of clinical activity to assess baseline characteristics. Inverse probability of treatment weighting (IPTW) was used to reduce baseline confounding by controlling for age, race, index year, androgen deprivation therapy (ADT) use ≥6 months, first-generation antiandrogen use, most recent PSA level, most recent testosterone level, Gleason score, and time between metastasis and the index date. PSA90 was defined as the earliest attainment of ≥90% decline in PSA relative to baseline PSA (most recent value within 13 weeks pre-index). The proportion of patients achieving a PSA90 and the time to PSA90 was compared using a weighted Kaplan-Meier (KM) analysis and weighted Cox proportional hazards models. Results: A total of 186 APA patients and 165 ENZ patients met the study criteria. Patients’ characteristics were generally well balanced after IPTW (Table). By 6 months, 73.6% of APA and 69.5% of ENZ patients had a post index PSA measurement. At 6 months, significantly more mCSPC patients initiated on APA attained PSA90 response than patients initiated on ENZ (p=0.014; Table). This result continued to remain significant at 9 months and at the end of the follow-up (Table). The median time to PSA90 was 3.1 months for APA patients and 5.2 months for ENZ patients. Conclusions: This real-world study of mCSPC cohorts demonstrates that initiation of APA leads to significantly more patients achieving a deep PSA response more rapidly than patients initiating ENZ. [Table: see text]

Initial Longitudinal Outcomes of Risk-Stratified Men in Their Forties Screened for Prostate Cancer Following Implementation of a Baseline Prostate-Specific Antigen.

Prostate cancer (PCa) screening can lead to potential over-diagnosis/over-treatment of indolent cancers. There is a need to optimize practices to better risk-stratify patients. We examined initial longitudinal outcomes of mid-life men with an elevated baseline prostate-specific antigen (PSA) following initiation of a novel screening program within a system-wide network. We assessed our primary care network patients ages 40 to 49 years with a PSA measured following implementation of an electronic health record screening algorithm from 2/2/2017-2/21/2018. The multidisciplinary algorithm was developed taking factors including age, race, family history, and PSA into consideration to provide a personalized approach to urology referral to be used with shared decision-making. Outcomes of men with PSA ≥1.5 ng/mL were evaluated through 7/2021. Statistical analyses identified factors associated with PCa detection. Clinically significant PCa (csPCa) was defined as Gleason Grade Group (GGG) ≥2 or GGG1 with PSA ≥10 ng/mL. The study cohort contained 564 patients, with 330 (58.5%) referred to urology for elevated PSA. Forty-nine (8.7%) underwent biopsy; of these, 20 (40.8%) returned with PCa. Eleven (2.0% of total cohort and 55% of PCa diagnoses) had csPCa. Early referral timing (odds ratio [OR], 4.58) and higher PSA (OR, 1.07) were significantly associated with PCa at biopsy on multivariable analysis (both p<0.05), while other risk factors were not. Referred patients had higher mean PSAs (2.97 vs. 1.98, p=0.001). Preliminary outcomes following implementation of a multidisciplinary screening algorithm identified PCa in a small, important percentage of men in their forties. These results provide insight into baseline PSA measurement to provide early risk stratification and detection of csPCa in patients with otherwise extended life expectancy. Further follow-up is needed to possibly determine the prognostic significance of such mid-life screening and optimize primary care physician-urologist coordination.

Трансректальная полифокальная биопсия под контролем ультразвуковой навигации в диагностике рака предстательной железы

Background: prostate cancer (PCa) is a topic of special interest in the modern urologic oncology. PCa is associated with high rates of morbidity and mortality among the male population in Russia and worldwide. The current diagnostic algorithm for PCa detection includes a digital rectal examination to check the prostate, and a PSA test to measure levels of prostate specific antigen (PSA) in the blood, and a prostate biopsy followed by morphological verification. Aim: to analyze the results of transrectal ultrasound guided polyfocal biopsies of the prostate, performed from 2021 to 2022 in patients who underwent diagnosis and treatment at the Clinical Hospital "RZD-Meditsina" of the city of Krasnoyarsk. Patients and Methods: in all cases the evaluation of patients included the measurement of a total PSA (PSAtotal) concentration, standard examination, and the preparation for biopsy. The ultrasound guided prostate biopsy was performed in the hospital setting. After the procedure, all patients were followed up to control and prevent possible complications. Histological examination of the biomaterial included the verification of malignant neoplasms or benign lesions in the prostate tissue, Gleason score, and other morphological characteristics. Results: findings of 220 transrectal ultrasound guided prostate biopsies were analyzed. The median age of patients was 64 (44–89) years. Benign prostatic hyperplasia (BPH) was diagnosed in 112 (51%) patients, prostate cancer — in 108 (49%) patients. PSA level varied from 0.48 to 37.9 ng/ml in the BPH patients, and from 4.48 to 100.0 ng/ml in the PCa group. The median prostate volume was 74.61 (10.26–134.80) cm3 in the PCa group, and 153.45 (116.22–185.50) cm3 in the patients with BPH. Most of PCa patients had Gleason score ≤7 representing moderately differentiated tumors. Post-biopsy complications were observed in 141 (64.09%) patients and included hematuria, short-term rectal bleeding, chronic prostatitis exacerbation. All complications were cured successfully treated using conservative therapy. Conclusion: PCa can be diagnosed even in patients with low PSATotal levels or the normal prostate volume . Moderately differentiated tumors (Gleason score ≤7) predominated in the population of patients. These data are consistent with the effective early detection of PCa. Patients should be closely monitored in the early post-operative period after a diagnostic prostate biopsy to prevent potential complications. KEYWORDS: prostate cancer, biopsy, prostate, transrectal puncture biopsy, ultrasound navigation. FOR CITATION: Berezhnoy A.G., Dunaevskaya S.S., Auzina S.I. Ultrasound guided transrectal polyfocal biopsy in prostate cancer diagnosis. Russian Medical Inquiry. 2022;6(6):309–313 (in Russ.). DOI: 10.32364/2587-6821-2022-6-6-309-313.

COVID-19 outbreak may increase mortality rates in genitourinary cancers.

COVID-19 outbreak may increase mortality rates in genitourinary cancers.

Screening for prostate cancer: a study on the free and total prostate specific antigen.

Background: A variety of biomarkers have been developed to monitor growth of cancerous diseases and to detect them at an early stage. Prostate-specific antigen (PSA) is a valuable prostate cancer biomarker that is now widely used for population screening, diagnosis, and monitoring of patients with prostate cancer. Other factors than prostate cancer can cause elevation of PSA levels therefore, free prostate specific antigen measurements in serum have been proposed in order to improve the specificity of laboratory identification of prostate cancer. Aim: The aim of our study was to evaluate the diagnostic significance of both total PSA and Free PSA in discriminating prostate cancer from other prostate diseases. Materials and methods: Our study group consisted of 1201 males admitted at outpatient clinic aged between 35 and 84 years old (mean age 63 years). All laboratory measurements were performed on serum samples. The data were statistically analyzed by using descriptive statistics for Windows. Results: The mean total PSA concentration evaluated among 1038 patients was 16.17 ng/mL whereas only Free PSA concentration was evaluated in 163 serum samples and resulted in a mean value of 2.67 ng/ml. In order to calculate the correlation between total and free PSA, data among 69 /1038 patients were further analyzed through statistical program software package for data analysis. Conclusions: Measuring serum free PSA concentrations along with PSA concentrations may provide higher accuracy for detecting prostate cancer and might eliminate unnecessary biopsies in the men with PSA of more than 4.0 ng/mL

Early PSA Change after [177Lu]PSMA-617 Radioligand Therapy as a Predicator of Biochemical Response and Overall Survival.

Simple SummaryRadioligand therapy with [177Lu]PSMA-617 (PSMA-RLT) is a promising therapeutic option for metastatic castration-resistant prostate cancers (mCRPC), as its clinical relevance has recently been confirmed in the phase III VISION-trial. As prostate-specific antigen (PSA) plays an important role in the response evaluation of this therapy, and the aim of this study was to prospectively assess the prognostic value of early PSA measurements. We found PSA changes as early as four weeks after the first administration of PSMA-RLT to be predictive of both long-term biochemical and PET imaging response, as well as overall survival. We then evaluated relevant predictive thresholds in PSA change at that time point, as the early detection of long-term (non-)response to PSMA-RLT can be of great benefit in the clinical management of terminally ill mCRPC-patients.Purpose: Radioligand therapy with [177Lu]PSMA-617 (PSMA-RLT) is a promising therapeutic option for metastatic castration-resistant prostate cancer (mCPRP). This study assessed the prognostic value of early PSA measurements during PSMA-RLT. Methods: 27 patients with mCRPC scheduled for PSMA-RLT were prospectively enrolled for a serial short-interval PSA-assessment. Change in PSA (∆%PSA) during two treatment cycles was correlated with biochemical response (BR) and change in tumor volume on PET (TV) after 16 weeks (w16), as well as overall survival (OS). PCWG3 criteria and the recently recommended threshold of ∆%PSA ≤ −30% were assessed for their predictive value. Results: ∆%PSA first correlated with BR, TV and OS after 4 weeks (c1w4). At c1w4, ∆%PSA ≤ −30% was associated with the biochemical response at w16 (p = 0.003) and a longer median OS (p = 0.025), whereas the PCWG3-derived threshold of ∆%PSA ≤ −50% showed no such correlation. In contrast, ∆%PSA ≥ 25% at c1w4 was associated with biochemical progression at w16 (p = 0.003) and a shorter median OS (p < 0.001). Conclusion: PSA changes as early as four weeks after PSMA-RLT allow a significant prediction of later biochemical and PET-based imaging response, as well as OS. At this early time point, a more lenient threshold for a PSA decrease of at least 30% appears better-suited for the prediction of a positive biochemical response and longer OS. In contrast, the PCWG3-derived threshold for PSA increase (+25%) reliably anticipates biochemical progression and shorter OS.

Design of Behavioral Economic Applications to Geriatrics Leveraging Electronic Health Records (BEAGLE): A pragmatic cluster randomized controlled trial

BackgroundOvertesting and treatment of older patients is common and may lead to harms. The Choosing Wisely campaign has provided recommendations to reduce overtesting and overtreatment of older adults. Behavioral economics-informed interventions embedded within the electronic health record (EHR) have been shown to reduce overuse in several areas. Our objective is to conduct a parallel arm, pragmatic cluster-randomized trial to evaluate the effectiveness of behavioral-economics-informed clinical decision support (CDS) interventions previously piloted in primary care clinics and designed to reduce overtesting and overtreatment in older adults. Methods/DesignThis trial has two parallel arms: clinician education alone vs. clinician education plus behavioral-economics-informed CDS. There are three co-primary outcomes for this trial: (1) prostate-specific antigen (PSA) screening in older men, (2) urine testing for non-specific reasons in older women, and (3) overtreatment of diabetes in older adults. All eligible primary care clinics from a large regional health system were randomized using a modified constrained randomization process and their attributed clinicians were included. Clinicians were recruited to complete a survey and educational module. We randomized 60 primary care clinics with 374 primary care clinicians and achieved adequate balance between the study arms for prespecified constrained variables. Baseline annual overuse rates for the three co-primary outcomes were 25%, 23%, and 17% for the PSA, urine, and diabetes measures, respectively. DiscussionThis trial is evaluating behavioral-economics-informed EHR-embedded interventions to reduce overuse of specific tests and treatments for older adults. The study will evaluate the effectiveness and safety of these interventions.

Design of a Novel Electrochemical Nanobiosensor for the Detection of Prostate Cancer by Measurement of PSA Using Graphene-based Materials

In this work, an aptamer-based electrochemical nanobiosensor has been developed for early detection of prostate cancer. Prostate-specific antigen (PSA) is the most common marker of prostate cancer, and this study aimes to detect this biomarker through electrochemical nanobiosensor-based aptamer, using nanostructures Graphene Oxide/graphitic Carbon Nitride/Gold nanoparticles (GO/g-C3N4/Au NPs). The aptamer chains are stabilized on the surface of a glassy carbon electrode (GCE) by Reduced Graphene Oxide, graphitic Carbon Nitride, and Gold nanoparticles (rGO/g-C3N4/Au NPs). To ensure the correct operation of the aptamer, a selectivity analysis was taken between five substances, and an electrochemical biosensor designed with good stability and high selectivity, diagnosis the desired analyte (PSA) compared to other materials. For characterization of aptasensor Electrochemical, CV, SQW and, EIS tests were performed to investigate the features of the synthesized nanoparticles, XRD, FTIR, SEM, TEM tests were carried out, and the results indicated that the used nanoparticles were well synthesized. The limit of detection (LOD) is 1.67 pg.ml-1 in hexafrrocyanide ([Fe(CN)6]-3/-4) media, this limit of detection is much lower and demonstrates the high ability of the nanobiosensor in early detection of PSA. The designed biosensor needs a short time (about 30 min) to detect the PSA as a symptom of prostate cancer.

Significance of PSA Screening in Niigata, Japan: Survey of Actual Status of New Cases of Prostate Cancer.

PurposeThis study aims to investigate the utility of prostate-specific antigen (PSA) screening by conducting an all-case survey of newly diagnosed prostate cancer patients at Niigata Prefecture, Japan.Patients and MethodsDepending on whether patients were subjected to screening, information was prospectively collected on all prostate cancer patients newly diagnosed between October 1, 2019, and September 30, 2020, at all institutions in Niigata Prefecture where urologists performing prostate biopsy routinely work and differences in clinical parameters were investigated.ResultsPSA was measured in 478 out of 1332 patients (35.8%) as part of a community health screening. The rate of metastatic carcinoma (M1) in all patients was 14.9%. When patients were divided into three categories of population-based screening (community health screening and workplace health screening), opportunistic screening (PSA measurements at complete medical check-ups or on patient request), and testing triggered by clinical symptoms or findings, the proportion of metastatic cancer was 4.5%, 3.7%, and 30.6%, respectively, demonstrating that the number of distant metastases was significantly lesser in all patients who underwent screening.ConclusionThe one-year all-case survey of newly diagnosed prostate cancer patients demonstrated that PSA screening significantly contributed to the early diagnosis of current prostate cancer in Japan.

Measurement of total and free prostate specific antigen (PSA) in human serum samples using an ultra-microanalytical system

Prostate specific antigen (PSA) is a serine protease used for the screening of prostate cancer. The total portion of PSA (tPSA) can be found in its free form (fPSA), or bound to other proteins forming a stable complex. A heterogeneous sandwich-type UltraMicro Enzyme-Linked ImmunoSorbent Assay (UMELISA) has been developed for the measurement of tPSA and fPSA in human serum samples. Strips coated with a high affinity monoclonal antibody (MAb) directed against PSA are used as solid phase, to ensure the specificity of the assay. Biotinylated MAbs specific for tPSA and fPSA ensured sensitivity, given the high affinity binding to streptavidin. The assay was completed in 1.5 h, with a measuring range 0.019–20 µg/L (tPSA), and 0.009–20 µg/L (fPSA). The intra- and inter-assay CV were lower than 9%. Recovery percentages were 96–105%. High correlations were found between the values of the UMELISA PSA standards and the International Reference Standards 96/670 (R2 = 0.9996) and 96/688 (R2 = 0.9989). The assay did not recognize any of the interfering molecules tested. Regression analysis of serum samples showed a good correlation with Roche Elecsys total PSA (n = 631, R2 = 0.986, ρc = 0.992), BioMérieux VIDAS TPSA (n = 631, R2 = 0.989, ρc = 0.993) and Roche Elecsys free PSA (n = 164, R2 = 0.973, ρc = 0.979), all with a relative difference below 15%, and a p < 0.001. A retrospective study of the use of UMELISA PSA in Cuba was carried out. The analytical performance characteristics of UMELISA PSA support its use for the quantification of tPSA and fPSA in human serum samples in a single kit, making it an affordable diagnostic assay available to Cuban Public Health System and developing countries. Between the years 2014–2020, more than 3 million Cuban patients have benefited from the test for free.

Prostate Cancer

Prostate cancer is the most commonly diagnosed noncutaneous malignancy in men in the United States. This chapter discusses the epidemiology, pathogenesis, and diagnosis of prostate cancer, as well as risk factors, the use of digital rectal examination and prostate-specific antigen measurement for screening, and staging for the disease. Also reviewed are the natural history of untreated prostate cancer; the treatment of localized and advanced prostate cancer, including prostatectomy, radiation therapy, and androgen deprivation therapy; and the prevention of prostate cancer. Figures illustrate the incidence rates of prostate cancer by race, age-adjusted and/or age-specific cancer of the prostate, the risk of a diagnosis in 20 years (based on being cancer free at certain ages), the 5-year survival rate, and the overall survival in patients with early prostate cancer treated with observation or radical prostatectomy. Tables in this chapter review the clinical staging definitions and the combined-modality staging approach to prostate cancer. This chapter contains 6 figures, 8 tables and 104 references Keywords: Prostate cancer, digital rectal exam, PSA, prostatectomy, men's health, prostate cancer screening

Overweight and obesity as risk factors for biochemical recurrence of prostate cancer after radical prostatectomy.

Previous studies have shown a relationship between the occurrence and recurrence of prostate cancer; however, this relationship remains controversial. We investigated the relationship between obesity and biochemical recurrence in patients with prostate cancer. Clinicopathological factors were analyzed after dividing the patient population according to the Asian population-specific body mass index (BMI) criteria for "normal" (< 23kg/m2), "overweight" (23-27.5kg/m2), and "obese" (≥ 27.5kg/m2). Among the 389 patients included in this study, 108 were classified as normal, while 227 and 54 patients were classified as overweight and obese, respectively. The relationships between clinicopathological factors and biochemical recurrence were analyzed by univariate and multivariate Cox ≤ proportional hazard models. Biochemical recurrence was defined as two consecutive prostate-specific antigen (PSA) measurements ≥ 0.2ng/mL. In univariate analysis, the categorical variables of "overweight" and "obese" were significant prognostic factors for biochemical recurrence. In multivariate analysis models including PSA density [hazard ratio (HR) 1.8, p = 0.01], extraprostatic extension (HR 2.0, p < 0.001), Gleason score (HR 1.7, p = 0.01), surgical margin positivity (HR 2.46, p < 0.001), and lymphovascular invasion (HR 2.53, p < 0.001), the categorical variables of "overweight" (HR 1.6, p = 0.03) and "obese" (HR 1.76, p = 0.035) were prognostic factors for biochemical recurrence. The obesity status of patients with prostate cancer as "overweight" and "obese" was a risk factor for biochemical recurrence after adjusting for other clinicopathological factors.

Prostate Specific Antigen Dynamics and Features in Prostate Cancer

Abstract Despite the common use of the prostate-specific antigen (PSA) serum level as a tumour marker in diagnosis of prostate cancer, it seems that the PSA doubling time (PSADT) and PSA velocity (PSAV) could be more useful indicators of tumour behaviour and prognosis for patients. The aim of the study was to evaluate the value of PSAV and PSADT in the diagnosis of prostate cancer and their relationship with prostate cancer histopathological characteristics. Eighty-six patients undergoing radical prostatectomy were enrolled in the study. Based on the PSA measurements the PSA dynamic values were calculated: PSADT and PSAV. In addition, clinical and histo-pathological characteristics, including disease stage and prognostic groups were evaluated. The obtained results showed that the first PSA value was 4.29 ng/ml (1.28–13.56), the second PSA value was 7.76 ng/ml (7.60–47.60), and the third PSA value was 9.67 ng/ml (2.56–98.50). The median PSADT was 51.01 months (7.80–311.81) and the median PSAV was 2.66 ng/ml/per year (0.22–4.66). In addition, significant correlations between PSAV and pre- and post-operative Gleason score, and prognostic groups were observed. Significant correlation between PSADT and pre- and pos-toperative Gleason score and prognostic risk groups was demonstrated. This study demonstrated that PSAV and PSADT were significantly correlated with postoperative Gleason score and prognostic risk groups, demonstrating its role in the diagnosis of prostate cancer progression.