Prostate-specific Antigen Concentration Research Articles

Ultrasensitive Detection of Prostate Specific Antigen by an Unlabeled Fluorescence Aptasensor Based on the AIE Effect.

The accurate and sensitive detection of prostate specific antigen (PSA) is vital for the early diagnosis and treatment of prostate cancer. To this end, an unlabeled fluorescent aptasensor was constructed by using a novel Compound B {1,1'-(1,4-phenylene) bis(3-ethyl-1H-imidazol-3-ium) iodide} with aggregation-induced emission (AIE) activity as a fluorescence signal and NH2-Fe3O4 particle as an adsorption platform. Compound B could combine with prostate specific antigen aptamers (PSA-Apt) to form a PSA-Apt/B complex, which further generated the AIE effect. Then, PSA was added to the PSA-Apt/B solution. PSA combined with PSA-Apt/B to form the PSA-Apt/B/PSA complex. Next, NH2-Fe3O4 magnetic particles were added to the solution. Given that PSA-Apt/B/PSA would no longer combine with NH2-Fe3O4 magnetic particles, the PSA-Apt/B/PSA complex remained in the supernate after magnet separation, and the supernate showed strong fluorescence (I). When no PSA was added to the PSA-Apt/B solution, PSA-Apt/B could combine with NH2-Fe3O4 magnetic particles and would be sucked into the bottom of the test tube by magnet, and the supernate would show weak fluorescence (I0). Result showed that the difference between the above-mentioned two fluorescence values (∆I = I - I0) had an excellent linear relationship with the PSA concentration within the concentration range of 0.01-10ng/mL, and its limit of detection was 3pg/mL (S/N = 3). In addition, the sensor has high accuracy and can be directly used to test PSA in actual serum samples.

Can weight-adjusted waist circumference index become a single anthropometric predictor of prostate-specific antigen concentration? A National Health and Nutrition Examination Survey analysis (2003-2010).

Recent studies have introduced the weight-adjusted waist circumference index (WWI) as a viable obesity indicator that may better reflect centripetal obesity and its associated risks. In examining the connection between WWI and prostate-specific antigen (PSA), this study leveraged data from the National Health and Nutrition Examination Survey 2003-2010, including 5732 participants. Our initial analysis indicated a significant positive association between WWI and PSA levels. However, subsequent models that adjusted for covariates such as age, race, and a range of metabolic and cardiovascular health-related factors revealed that the strength and significance of this relationship were attenuated. Model 1 showed a highly significant correlation (p < 0.0001). Yet, in Model 2, which accounted for age and race, the association softened (p = 0.0520). Moreover, when a full spectrum of health covariates was included in Model 3, the association was no longer significant (p = 0.9775). These findings suggest that while an unadjusted correlation exists, its potential use as a diagnostic predictor is limited without considering the broader health context. Therefore, it is crucial to review such data with multiple considerations in mind, and extensive attention should be paid to the evaluation of covariates.

Association between vitamin B2 intake and prostate-specific antigen in American men: 2003–2010 National Health and Nutrition Examination Survey

BackgroundAccumulating evidence suggests a pivotal role of vitamin B2 in the pathogenesis and progression of prostate cancer (PCa). Vitamin B2 intake has been postulated to modulate the screening rate for PCa by altering the concentration of prostate-specific antigen(PSA). However, the relationship between vitamin B2 and PSA remains indeterminate. Hence, we conducted a comprehensive evaluation of the association between vitamin B2 intake and PSA levels, utilizing data from the National Health and Nutrition Examination Survey (NHANES) database.MethodsFrom a pool of 20,371 participants in the NHANES survey conducted between 2003 and 2010, a cohort of 2,323 participants was selected for the present study. The male participants were classified into four distinct groups based on their levels of vitamin B2 intake. We employed a multiple linear regression model and a non-parametric regression method to investigate the relationship between vitamin B2 and PSA levels.ResultsThe study cohort comprised of 2,323 participants with a mean age of 54.95 years (± 11.73). Our findings revealed a statistically significant inverse correlation between vitamin B2 intake (mg) and PSA levels, with a reduction of 0.13 ng/ml PSA concentration for every unit increase in vitamin B2 intake. Furthermore, we employed a fully adjusted model to construct a smooth curve to explore the possible linear relationship between vitamin B2 intake and PSA concentration.ConclusionsOur study in American men has unveiled a notable inverse association between vitamin B2 intake and PSA levels, potentially posing a challenge for the identification of asymptomatic prostate cancer. Specifically, our findings suggest that individuals with higher vitamin B2 intake may be at a greater risk of being diagnosed with advanced prostate cancer in the future, possibly indicating a detection bias. These results may offer a novel explanation for the observed positive correlation between vitamin B2 intake and prostate cancer.

Prostatic stromal tumor of uncertain malignant potential: a case report and literature review.

Prostatic stromal tumors, encompassing prostatic sarcoma and stromal tumors of uncertain malignant potential (STUMP), represent an exceedingly rare category of prostatic diseases, with a prevalence of less than 1%. We present a rare case involving a man in his early 40s diagnosed with STUMP. Despite presenting with normal prostate-specific antigen (PSA) concentrations, the patient experienced persistent dysuria and gross hematuria for >7 months, leading to an initial misdiagnosis of benign prostatic hyperplasia. Persistent symptoms prompted further investigation, with magnetic resonance imaging (MRI) revealing a suspicious lesion on the left side of the prostate, initially thought to be malignant. Transrectal prostatic biopsy subsequently confirmed the presence of mucinous liposarcoma, with no medical history of diabetes, coronary heart disease, or hypertension. The treatment approach comprised robot-assisted laparoscopic radical prostatectomy, culminating in a postoperative pathological definitive diagnosis of STUMP. This case underscores the indispensable role of early MRI in the diagnostic process, highlighting the necessity of detailed pathological examination for a conclusive diagnosis. Our report aims to illuminate the diagnostic challenges and potential treatment pathways for STUMP, emphasizing its consideration in the differential diagnosis of prostatic tumors to advance clinical outcomes in this rare but important condition.

Quantification of biochemical PSA dynamics after radioligand therapy with [177Lu]Lu-PSMA-I&T using a population pharmacokinetic/pharmacodynamic model

BackgroundThere is an unmet need for prediction of treatment outcome or patient selection for [177Lu]Lu-PSMA therapy in patients with metastatic castration-resistant prostate cancer (mCRPC). Quantification of the tumor exposure–response relationship is pivotal for further treatment optimization. Therefore, a population pharmacokinetic (PK) model was developed for [177Lu]Lu-PSMA-I&T using SPECT/CT data and, subsequently, related to prostate-specific antigen (PSA) dynamics after therapy in patients with mCRPC using a pharmacokinetic/pharmacodynamic (PKPD) modelling approach.MethodsA population PK model was developed using quantitative SPECT/CT data (406 scans) of 76 patients who received multiple cycles [177Lu]Lu-PSMA-I&T (± 7.4 GBq with either two- or six-week interval). The PK model consisted of five compartments; central, salivary glands, kidneys, tumors and combined remaining tissues. Covariates (tumor volume, renal function and cycle number) were tested to explain inter-individual variability on uptake into organs and tumors. The final PK model was expanded with a PD compartment (sequential fitting approach) representing PSA dynamics during and after treatment. To explore the presence of a exposure–response relationship, individually estimated [177Lu]Lu-PSMA-I&T tumor concentrations were related to PSA changes over time.ResultsThe population PK model adequately described observed data in all compartments (based on visual inspection of goodness-of-fit plots) with adequate precision of parameters estimates (< 36.1% relative standard error (RSE)). A significant declining uptake in tumors (k14) during later cycles was identified (uptake decreased to 73%, 50% and 44% in cycle 2, 3 and 4–7, respectively, compared to cycle 1). Tumor growth (defined by PSA increase) was described with an exponential growth rate (0.000408 h−1 (14.2% RSE)). Therapy-induced PSA decrease was related to estimated tumor concentrations (MBq/L) using both a direct and delayed drug effect. The final model adequately captured individual PSA concentrations after treatment (based on goodness-of-fit plots). Simulation based on the final PKPD model showed no evident differences in response for the two different dosing regimens currently used.ConclusionsOur population PK model accurately described observed [177Lu]Lu-PSMA-I&T uptake in salivary glands, kidneys and tumors and revealed a clear declining tumor uptake over treatment cycles. The PKPD model adequately captured individual PSA observations and identified population response rates for the two dosing regimens. Hence, a PKPD modelling approach can guide prediction of treatment response and thus identify patients in whom radioligand therapy is likely to fail.

Abstract 688: Radium-223 in combination with darolutamide exhibits synergistic antitumor efficacy in LNCaP prostate cancer models

Abstract Radium-223 dichloride (radium-223) is a targeted alpha therapy that binds to newly formed abnormal bone in bone metastases and induces DNA double-strand breaks (DSBs) in cancer cells, osteoblasts and osteoclasts. Radium-223 is used for the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC). Darolutamide is an androgen receptor inhibitor indicated for patients with metastatic hormone-sensitive prostate cancer or non-metastatic CRPC. We studied the antitumor effects of radium-223 in combination with darolutamide using LNCaP human prostate cancer cells in vitro and an intratibial LNCaP model mimicking prostate cancer metastasized to bone. The in vitro antiproliferative effects of radium-223 and darolutamide were determined using LNCaP cells. Gene set enrichment analysis (GSEA) was conducted on RNA sequencing data from LNCaP cells treated with the synthetic androgen R1881 alone or in combination with darolutamide. LNCaP cells were inoculated into the right tibia of male NOD.scid mice. The mice (n=7-9/group) were randomized based on serum prostate-specific antigen (PSA) and treated with vehicle, radium-223 (330 kBq/kg, Q4Wx2, i.v.), darolutamide (100 mg/kg, BID, p.o.), or with a combination of radium-223 and darolutamide, for 41 days. PSA and the bone turnover markers PINP and CTX-I were measured every second week in serum. Tumor-induced abnormal bone area, bone formation rate and radium-223 uptake in tumor-bearing tibiae were determined by X-ray, histomorphometry and gamma counter, respectively. The combination of radium-223 and darolutamide showed synergistic antiproliferative effects with combination indexes between 0.69-0.75 in vitro. GSEA demonstrated a prominent darolutamide-induced downregulation of DNA damage response (DDR) signaling pathways. In vivo, the combination treatment showed synergistic antitumor efficacy (p=0.04) as demonstrated by lower PSA concentrations when compared with the vehicle, radium-223 or darolutamide monotherapies (p=0.004, p=0.011 and p=0.002, respectively). In the vehicle and combination treatment groups, the mean serum PSA was 541% and 95.9% of the pre-treatment level, respectively. Furthermore, radium-223 alone or in combination with darolutamide inhibited increased bone turnover, tumor-induced abnormal bone growth and trabecular bone formation when compared to vehicle. Concurrent administration of darolutamide did not affect radium-223 uptake in tibiae. Radium-223 in combination with darolutamide exhibited synergistic antitumor efficacy both in vitro and in vivo. The synergistic effects could be due to the radiosensitization of cancer cells by darolutamide-induced downregulation of DDR pathways. Our results suggest that the combination of targeted alpha therapy with an androgen receptor inhibitor is a promising treatment strategy for mCRPC. Citation Format: Christoph A. Schatz, Mari I. Suominen, Andreas Schlicker, Matias Knuuttila, Esa Alhoniemi, Sanna-Maria Käkönen, Bernard Haendler, Urs B. Hagemann, Arne Scholz. Radium-223 in combination with darolutamide exhibits synergistic antitumor efficacy in LNCaP prostate cancer models [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 688.

Target-aptamer binding triggered isothermal strand displacement polymerase reaction for prostate specific antigen detection

For the purpose of detecting prostate specific antigen (PSA), a ratiometric electrochemical aptasensor has been developed based on target-aptamer binding triggered isothermal strand displacement polymerase reaction (ISDPR). A ferrocene (Fc)-modified hairpin probe 2 (Fc-HP2) was self-assembled on the modified electrode surface. One terminus of hairpin probe 1 (HP1) bound to PSA and formed the HP1/PSA complex, and the other hybridized with Fc-HP2. Then, the S1 strand hybridized with the stem of Fc-HP2 and was extended with the aid of phi29 DNA polymerase (phi 29) and deoxyribonucleoside triphosphates (dNTPs), and the HP1/PSA complex could be displaced to trigger a new cycle of polymerization reaction. Finally, numerous double-stranded DNAs (dsDNAs) were produced for methylene blue (MB) intercalation. With the raising of PSA concentrations, the electrochemical responses of Fc (IFc) and MB (IMB) decreased and increased, respectively. When IMB/IFc was used as the response signal for quantitative determination of PSA, the proposed strategy possessed a wide linear range (10 pg mL−1–100 ng mL−1) and a low detection limit of 3.2 pg mL−1. Moreover, the proposed aptasensor displayed good performance for PSA determination in spiked human serum samples, showing great application prospects in bioanalysis.

A highly sensitive ratiometric electrochemical aptasensor for prostate specific antigen detection based on toehold-mediated strand displacement reaction

In this work, a novel ratiometric electrochemical aptasensor was designed for prostate specific antigen (PSA) detection based on toehold-mediated strand displacement reaction (TMSDR). For PSA detection, PSA could bind with the aptamer sequence in hairpin probe 1 (HP1), and HP1/PSA complex was obtained. Then, in the presence of S3 DNA, HP1/PSA could trigger two TMSDR processes by hybridizing with Fc-S2/S1 double-stranded DNA, which would generate a large amount of Fc-S2 and recycle HP1/PSA. This enabled the hybridization of Fc-S2 with methylene blue labeled thiolated hairpin probe 2 (MB-HP2) immobilized on the electrode surface, causing MB molecules away from the electrode and Fc close to the electrode. Thus, with the increasing PSA concentrations, the current of MB (IMB) decreased and the current of Fc (IFc) increased. The ratio of IFc/IMB was shown to be linear with the logarithm of PSA concentration from 1 pg mL−1 to 100 ng mL−1, with a detection limit of 0.28 pg mL−1. In addition, the aptasensor had good specificity, reproducibility, repeatability, and stability for PSA detection, and was successfully applied to spiked diluted human serum samples.

68Ga-RM2 PET–MRI versus MRI alone for evaluation of patients with biochemical recurrence of prostate cancer: a single-centre, single-arm, phase 2/3 imaging trial

National Comprehensive Cancer Network guidelines include prostate-specific membrane antigen (PSMA)-targeted PET for detection of biochemical recurrence of prostate cancer. However, targeting a single tumour characteristic might not be sufficient to reflect the full extent of disease. Gastrin releasing peptide receptors (GRPR) have been shown to be overexpressed in prostate cancer. In this study, we aimed to evaluate the diagnostic performance of the GRPR-targeting radiopharmaceutical 68Ga-RM2 in patients with biochemical recurrence of prostate cancer. This single-centre, single-arm, phase 2/3 trial was done at Stanford University (USA). Adult patients (aged ≥18 years) with biochemical recurrence of prostate cancer, a Karnofsky performance status of 50 or higher, increasing prostate-specific antigen concentration 0·2 ng/mL or more after prostatectomy or 2 ng/mL or more above nadir after radiotherapy, and non-contributory conventional imaging (negative CT or MRI, and bone scan) were eligible. All participants underwent 68Ga-RM2 PET-MRI. The primary outcome was the proportion of patients with PET-positive findings on 68Ga-RM2 PET-MRI compared with MRI alone after initial therapy, at a per-patient and per-lesion level. The primary outcome would be considered met if at least 30% of patients had one or more lesions detected by 68Ga-RM2 PET-MRI and the detection by 68Ga-RM2 PET-MRI was significantly greater than for MRI. Each PET scan was interpreted by three independent masked readers using a standardised evaluation criteria. This study is registered with ClinicalTrials.gov, NCT02624518, and is complete. Between Dec 12, 2015, and July 27, 2021, 209 men were screened for eligibility, of whom 100 were included in analyses. Median follow-up was 49·3 months (IQR 36·7-59·2). The primary endpoint was met; 68Ga-RM2 PET-MRI was positive in 69 (69%) patients and MRI alone was positive in 40 (40%) patients (p<0·0001). In the per-lesion analysis 68Ga-RM2 PET-MRI showed significantly higher detection rates than MRI alone (143 vs 96 lesions; p<0·0001). No grade 1 or worse events were reported. 68Ga-RM2 PET-MRI showed better diagnostic performance than MRI alone in patients with biochemical recurrence of prostate cancer. Further prospective comparative studies with PSMA-targeted PET are needed to gain a better understanding of GRPR and PSMA expression patterns in these patients. The US Department of Defense.

Exposure to heavy metal elements may significantly increase serum prostate-specific antigen levels with overdosed dietary zinc

BackgroundSerum prostate-specific antigen (PSA) is a primary metric for diagnosis and prognosis of prostate cancer (PCa). Exposure to heavy metals, such as lead, cadmium, mercury, and zinc can impact PSA levels in PCa patients. However, it is unclear whether this effect also occurs in men without PCa, which may lead to the overdiagnosis of PCa. MethodData on a total of 5089 American men who had never been diagnosed with PCa were obtained from the National Health and Nutrition Examination Survey performed from 2003–2010. The relationship between serum PSA levels (dependent variable) and concentrations of lead (μmol/L), cadmium (nmol/L), and mercury (μmol/L) were investigated with dietary zinc intake being used as a potential modifier or covariate in a weighted linear regression model and a generalized additive model. A series of bootstrapping analyses were performed to evaluate sensitivity and specificity using these models. ResultsRegression analyses suggested that, in general, lead, cadmium, or mercury did not show an association with PSA levels, which was consistent with the results of the bootstrapping analyses. However, in a subgroup of participants with a high level of dietary zinc intake (≥14.12 mg/day), a significant positive association between cadmium and serum PSA was identified (1.06, 95% CI, P = 0.0268, P for interaction=0.0249). ConclusionsWith high-level zinc intake, serum PSA levels may rise in PCa-free men as the exposure to cadmium increases, leading to a potential risk of an overdiagnosis of PCa and unnecessary treatment. Therefore, environmental variables should be factored in the current diagnostic model for PCa that is solely based on PSA measurements. Different criteria for PSA screening are necessary based on geographical variables. Further investigations are needed to uncover the biological and biochemical relationship between zinc, cadmium, and serum PSA levels to more precisely diagnose PCa.

Development of gold nanospikes-modified quartz crystal microbalance biosensor for prostate specific antigen detection

Prostate-specific antigen (PSA) screening is vital for the early detection and assessment of prostate cancer treatment efficacy. Integrating nanotechnology into biosensor development allows for targeted biomarker detection. In this study, we present the fabrication of gold nanospikes (AuNS) structures on a quartz crystal microbalance (QCM) using the pulse current electrodeposition (PCD) technique. By varying the duty cycles of PCD, we achieved the desired nanostructure. The characteristics of the AuNS-modified QCM electrode were thoroughly investigated using various micro-structural characterization techniques such as x-ray diffraction (XRD), field emission scanning electron microscope (FESEM), atomic force microscope (AFM), X-ray photoelectron spectroscopy (XPS) and cyclic voltammetry (CV). Prior to biomolecule immobilization, each chemical treatment was verified through contact angle and FT-IR analyses. The performance of the developed QCM biosensor was evaluated using PSA at various concentrations. The results revealed that the frequency variation of the QCM biosensor was directly proportional to the PSA concentration. Notably, the AuNS-modified QCM biosensor exhibited the highest frequency shift at a 20 % duty cycle, demonstrating a linear detection range of 0.1–100 ng mL−1 and a limit of detection (LOD) of 24 pg mL−1. The developed QCM biosensor significantly enhances detection efficiency by increasing the number of binding sites for biomolecules through an enlarged surface area. The demonstrated sensitivity of the AuNS-modified QCM biosensor indicates its potential to address the increasing demand for early diagnosis and screening in healthcare systems. This innovative biosensor technology holds promise for improving prostate cancer detection and has broader implications for the development of highly sensitive biosensors for various biomarkers.

Immunomagnetic Assay Using Photon-Upconversion Nanoparticles for the Detection of Cancer Biomarkers

Prostatic carcinoma is the most frequently diagnosed type of cancer within the male population worldwide. The most important prostate cancer biomarker is the prostate-specific antigen (PSA). Changes in PSA concentration may occur in very narrow ranges, making ultrasensitive analytical methods necessary. Enzyme-linked immunosorbent assay (ELISA) is considered the gold standard of analytical methods. It utilizes microtiter plates as solid phase and enzyme-based labels. However, ELISAs are often not sensitive enough for early-stage detection of subclinical levels of PSA. To enhance the sensitivity, it is possible to introduce suitable alternatives for both the solid phase and the label. Our work focuses on the use of magnetic microparticles (MBs) and photon-upconversion nanoparticles (MBs) as alternatives for solid phase and the label, respectively. The superparamagnetic properties and higher specific surface of MBs allows for analyte preconcentration and simple magnetic separation of the immunocomplex. UCNPs, on the other hand, are nanocrystals exhibiting anti-Stokes luminescence (converting light in the NIR region to visible light). After surface modification, it is possible to utilize UCNPs as labels in the upconversion-linked immunosorbent assay (ULISA), significantly enhancing the sensitivity. We have developed and optimized ELISA and ULISA assays for the detection of PSA and compared their parameters with the equivalent assays utilizing MBs as solid phase. Moreover, we have developed a novel ULISA method with an additional magnetic preconcentration step to further enhance sensitivity, providing a limit of detection of 0.46 pg mL–1.

Association between platelet‑to‑lymphocyte ratio and serum prostate specific antigen

Association between platelet‑to‑lymphocyte ratio and serum prostate specific antigen

Association of ulcerative colitis and acute gastroenteritis with prostate specific antigen: results from National Health and Nutrition Examination Survey from (2009 to 2010) and Mendelian randomization analyses.

An increasing number of studies have demonstrated that gastrointestinal inflammation may increase prostate cancer risk and raise the prostate-specific antigen (PSA) level. However, the association between ulcerative colitis (UC) and acute gastroenteritis (AGE) with PSA remains unclear and complicated. Herein, we evaluated the relationship between UC and AGE with PSA concentration using the National Health and Nutrition Examination Survey (NHANES) database and Mendelian randomization (MR) analyses. A total of 1,234 participants fit into the study after conducting the screening based on the NHANES survey conducted from 2009 to 2010. UC and AGE were the independent variables, and PSA was the dependent variable. Weighted multiple linear regressions were utilized to estimate the association of UC and AGE with PSA concentration. To detect the causal relationship between UC and AGE with PSA, a two-sample Mendelian randomized analysis was conducted. After controlling for all covariates, PSA (log2 transform) concentrations in the UC group were increased by 0.64 (0.07, 1.21). AGE was not independently associated with PSA levels after adjusting potential confounders. In patients with coronary artery disease, AGE promotes elevated PSA (log2 transform) concentrations (β = 1.20, 95% CI: 0.21-2.20, p < 0.001). Moreover, an IVW MR analysis indicated that genetically predicted UC was associated with increased PSA, and that AGE was not associated with PSA. This study indicated that a positive causal association exists between UC and the PSA level. However, there is no evidence to support the relationship between AGE and the PSA level.

EMAS position statement: Testosterone replacement therapy in older men.

Late-onset hypogonadism is the clinical entity characterised by low testosterone concentrations associated with clinical symptoms in the absence of organic disease in ageing men. It has been associated with metabolic syndrome, reduced bone mineral density, and increased cardiovascular morbidity and mortality risk. Although testosterone replacement therapy (TRT) reverses most of these conditions in young hypogonadal men, the risk/benefit ratio of TRT in older men is debatable. To update the 2015 EMAS statement on TRT in older men with new research on late-onset hypogonadism and TRT. Literature review and consensus of expert opinion. TRT should be offered only to symptomatic older men with confirmed low testosterone concentrations after explaining the uncertainties regarding the long-term safety of this treatment. TRT may be offered to men with severe hypogonadism and erectile dysfunction to improve sexual desire, erectile, and orgasmic function. It should also be considered in hypogonadal men with severe insulin resistance or pre-diabetes mellitus. TRT may also be considered, in combination with proven treatment strategies, for osteoporosis, or for selected patients with persistent mild depressive symptoms and/or low self-perceived quality of life, combined with standard medical care for each condition. TRT is contraindicated in hypogonadal men actively seeking fertility treatment. Due to a lack of data, TRT should not be routinely used in older men to improve exercise capacity/physical function, improve cognitive function, or prevent cognitive decline. TRT must be avoided in older, frail men with known breast cancer or untreated prostate cancer and all men who have had myocardial infarction or stroke within the last four months, and those with severe or decompensated heart failure. The quality of evidence regarding patients with previous prostate cancer or cardiovascular disease is too low to draw definitive conclusions. Any limits on duration of use are arbitrary, and treatment should continue for as long as the man feels the benefits outweigh the risks for him, and decisions must be made on an individual basis. Withdrawal should be considered when hypogonadism is reversed after the resolution of underlying disorder. Short-acting transdermal preparations should be preferred for TRT initiation in older men, but injectable forms may be considered subsequently. Older men on TRT should be monitored at 3, 6, and 12months after initiation and at least yearly thereafter, or earlier and more frequently if indicated. Evaluation should include assessment of the clinical response, and measurement of total testosterone, haematocrit, and prostate-specific antigen (PSA) concentrations. Bone density and/or quality should also be assessed. Obese and overweight patients should be encouraged to undergo lifestyle modifications, including exercise and weight loss, to increase endogenous testosterone.

The Value of the Prostate Health Index and Derived Indexes in the Diagnosis of Prostate Cancer with PI-RADS-3 Lesions

Introduction: The purpose of this article was to evaluate the diagnostic value of prostate health index (PHI) and its derivatives in prostate cancer (PCa) with prostate imaging reporting and data system (PI-RADS)-3 lesions. Methods: Patients with benign prostatic hyperplasia (BPH) (n = 155) were included in the BPH group, while all patients with PCa (n = 49) were enrolled in the PCa group. Between the groups, the serum concentrations of total prostate-specific antigen (TPSA), percent-free prostate-specific antigen (%fPSA), prostate health index (PHI), prostate health index density (PHID), and prostate-specific antigen density (PSAD) were compared. Results: On average, 49 (24%) of 204 men had PCa on biopsy, with 81.63% of those cases being clinically serious. Age, prostate volume, TPSA, and PSAD did not significantly differ between the PCa group and the BPH group. In contrast, [-2]pro prostate-specific antigen (p2PSA) (17.10 ± 4.77 vs. 13.93 ± 3.22, p < 0.001), PHI (33.88 ± 8.81 vs. 25.83 ± 5.63, p < 0.001), and PHID (0.52 ± 0.15 vs. 0.38 ± 0.11, p < 0.001) showed a statistically significant difference between the two groups. Compared to conventional PSA, PHI (AUC = 0.786, 95% CI: 0.705–0.867) and PHID (AUC = 0.763, 95% CI: 0.684–0.843) were considerably better predictors of all PCa. The TPSA, %fPSA, p2PSA, PHI, PHID, and PSAD areas under the receiver operating characteristic for clinically significant PCa (csPCa) were 0.587, 0.650, 0.696, 0.823, 0.796, and 0.614, respectively. Out of all the various parameters, PHI and PHID performed very well in this cohort’s biopsy outcome prediction. Conclusion: PHI offers the best diagnostic value for detecting PCa in cases of PI-RADS-3 lesions. Additionally, PHID raised the possibility of csPCa PI-RADS-3 lesions. However, more investigation is required to confirm our results by using multicenter collaboration.

Magnetically Modulated Differential Quartz Crystal Microbalances for Rapid, Ultrasensitive, and Direct Probing of Prostate-Specific Antigens Conjugated with Magnetic Beads.

The occurrence and development of diseases are closely related to overexpression of specific biomarkers in the serum of patients. Rapid and sensitive biomarker detection is beneficial for early diagnosis and treatment. However, the current laboratory processes and assays for biomarker detection are expensive and time-consuming, and their operation also requires a large number of professionals. We developed a magnetically modulated differential quartz crystal microbalance (MMD-QCM) method combined with magnetic bead (MB) labels for rapid and highly sensitive quantitative detection of prostate-specific antigen (PSA). Because MBs exhibit magnetized rotation motion under an applied AC magnetic field, a pair of QCMs are utilized to measure the difference between the magnetic motion intensities of the MBs and the MB-PSA immune complex to determine the PSA concentration. Experimental results demonstrate that the proposed method can be adopted to determine the PSA concentration in a wide range of 0.01-1000 ng/mL as well as exhibit a low detection limit of 0.065 ng/mL. In addition, the proposed scheme enables fast detection and low sample consumption. The single detection process takes less than 4 h and requires only 113 μL of sample solution. The proposed detection strategy is superior to the existing detection method and can be effectively used in early screening and prognostic diagnosis of cancer and other related diseases owing to its simplicity, low cost, and high speed.

The relationship between methylation of tumor suppressor genes &lt;i&gt;APC&lt;/i&gt;, &lt;i&gt;GSTP1&lt;/i&gt;, &lt;i&gt;RASSF1A&lt;/i&gt; and content of prostate-specific antigen- associated markers in prostate cancer diagnosis

Despite the improvement of prostate cancer (PCa) diagnostic methods and the introduction of prostate-specific antigen (PSA) monitoring, the incidence of advanced PCa in Russia remains high. New more informative variables are needed for the effective diagnosis of early stage and high-grade PCa. In the field of epigenetics of special interest is the detection of DNA hypermethylation, which can serve as a PCa biomarker, since it is common to find and may induce a stable appropriate gene silencing, leading to significant cell changes. Aim of the study was to analyze the relationship between methylation of the APC, GSTP1 and RASSF1A genes and total PSA and prostate health index (PHI) in PCa. Material and methods. The present study included 54 patients with suspicion of PCa, up to 75-years old, who had an initial total PSA level from 2.5 to 10 ng/ml. To calculate PHI value the concentrations of total PSA, free PSA and pre-mature form of PSA ([–2]proPSA) in blood serum were measured by chemiluminescence immunoassay. Results and discussion. The study has revealed the statistically significant correlation between the degree of methylation in blood plasma samples and biopsy material of only the GSTP1 gene and PSA-associated markers. We found an increase of parameters contingency as Gleason score increased. Conclusions. As a result of this work, statistically significant direct correlations were identified between changes in methylation patterns of the promoter region of the GSTP1 gene and PHI, which allows us to consider them as potential candidates for inclusion in a diagnostic panel for more effective early detection of prostate cancer.

Association between serum 25-hydroxyvitamin D and prostate-specific antigen: a retrospective study in men without prostate pathology.

Recently, vitamin D status has been associated with prostate cancer risk. However, some studies argue that there is no association of vitamin D with prostate cancer risk and serum prostate-specific antigen (PSA) concentrations. No clear conclusions can be drawn from the studies found in the literature. Our aim was to assess the relationship between PSA and 25-hydroxyvitamin D [25(OH)D]. We selected 415 individuals without prostate pathologies and subgroups were generated according to age and 25(OH)D. Statistical analyses were performed using Shapiro-Wilk test, Student's t and ANOVA tests, and Pearson's correlation. Besides, the minimum sample size needed to obtain statistically significant results between groups according to 25(OH)D concentration was calculated and a Student's t-test for paired samples was performed to study individuals with two PSA measurements over time, where 25(OH)D concentration increased or decreased more than 25 %. We observed a slight correlation between age and PSA concentration (r=0.379, p<0.001). However, we found no significant differences when we compared PSA concentrations between groups according to 25(OH)D concentrations (p=0.891): 1.25±1.32 μg/L (group with 25(OH)D<50 nmol/L) and 1.17±0.90 (group with 25(OH)D≥50 nmol/L). Pearson's correlation coefficient was close to 0. The minimum samples size to obtain statistically significant results was 815,346 men, and we observed no differences in PSA concentrations in individuals with two measurements. Our findings show no association in men without prostate pathologies, based on 25(OH)D levels.

Two-dimensional vs. three-dimensional vision during the laparoscopic radical prostatectomy: A matched comparison of operative and long-term functional outcomes

Background/Aim: The three-dimensional (3D) display system can solve essential problems in conventional laparoscopic radical prostatectomy (LRP), like depth perception and spatial orientation. Several studies reported initial comparisons of LRP with 2D and 3D vision systems in terms of operative outcomes, with 3D systems coming out on top. However, there are few published comparison studies on the long-term outcomes of LRP with 2D and 3D vision systems. In this regard, we aimed to compare operative and long-term functional results of 3D-High definition (HD) LRP with conventional two-dimensional (2D)-HD display systems. Methods: A total of 115 cases that underwent LRP between October 2010 and December 2016 were prospectively evaluated, and a prospective cohort study was conducted. Inclusion criteria at baseline were as follows: age at surgery &lt;75 yr, prostate-specific antigen (PSA) concentration &lt;20 ng/ml, clinical tumor stage &lt;T4, no diagnosis of metastatic disease, and informed consent to participate in the study. Patients who underwent salvage treatments after LRP and patients with incomplete follow-up were excluded. The patients were divided into groups, Group 1 (n=72) and Group 2 (n=43), according to the display systems used, 2D-HD vs. 3D-HD during LRP. Demographic data, operative and postoperative, and long-term follow-up outcomes were recorded. Additionally, urinary continence rate determined with a patient questionnaire and erectile functions determined with the International Index of Erectile Function (IIEF) questionnaire were recorded. All obtained parameters were compared between the groups using the independent t-test and the chi-square test. Differences were considered significant at two-sided P &lt;0.05 and 95% confidence interval. Results: All patients completed a 24-month follow-up procedure. The groups were similar in age, serum PSA level, prostate volume, preoperative Gleason score, and cancer-positive core number. There were significantly better results in group 2 than in group 1 for operative parameters, catheterization time, and hospital stay (P&lt;0.001, for all parameters). At long-term follow-up, the urinary continence rate was significantly higher in group 2 than in group 1 (P=0.023). Similarly, significantly higher IIEF scores were determined in the group 2 (P&lt;0.001). Conclusion: Our results suggest that using a 3D-HD display system during LRP provides much better long-term functional and operative outcomes and may provide a cheap and equal alternative to the RARP procedure.