Prostate-specific Antigen Era Research Articles

Value of digital rectal examination in patients with suspected prostate cancer: a prospective cohort analysis study.

Digital rectal examination (DRE) is a straightforward, cost-effective, practical, and time-honored physical examination method that plays a valuable role in the detection of prostate cancer (PCa). Nevertheless, with the advent of the prostate-specific antigen (PSA) era, the necessity of performing DRE has become a subject of debate. Our aim was to investigate the diagnostic efficacy and adjunctive role of DRE in a population (Prostate Imaging Reporting and Data System (PI-RADS), PI-RADS ≥3 or PSA ≥4 ng/mL) suspected of PCa. Five hundred and ninety-seven patients with suspected PCa requiring referral for biopsy were prospectively enrolled consecutively from February 2020 to May 2021. All patients received DRE and corresponding clinical diagnosis by a urologist before biopsy. According to the collected clinical and pathological information, the diagnostic performance of DRE in different PSA stratifications, and its association with tumor location and Gleason score (GS) were statistically analyzed. Among patients with suspected cancer, the diagnostic accuracy of DRE was 63.45%. Compared with central zone or transition zone tumors, the recall rate of peripheral zone PCa with DRE-positive results was higher (65.50% vs. 34.55%). DRE-positive results were significantly correlated with GS ≥7 PCa (P<0.001), and the average GS of DRE-positive PCa patients was significantly higher than that of DRE-negative (7.92 vs. 7.11, P<0.001). DRE may help physicians further judge the necessity of biopsy in patients with elevated PSA, and preliminarily estimate the location and invasiveness of the tumor. However, it is still necessary to explore the value of DRE in a normal PSA population.

Association of Blood Pressure with Prostate Cancer Risk by Disease Severity and Prostate Cancer Death: A Pooled Cohort Study.

The association of blood pressure (BP) with prostate cancer risk after accounting for asymptomatic prostate-specific antigen (PSA) testing, and with prostate cancer death, is unclear. We investigated BP, measured at a mean age of 38 years among 430,472 men from five Swedish cohorts, in association with incident prostate cancer (n = 32,720) and prostate cancer death (n = 6718). HRs were calculated from multivariable Cox regression models. Increasing systolic and diastolic BP levels combined were associated with a slightly lower prostate cancer risk, with a HR of 0.98 (95% CI, 0.97-0.99) per standard deviation (SD) of mid-BP (average of systolic and diastolic BP). The association was restricted to the PSA era (1997 onwards, HR, 0.96; 95% CI, 0.95-0.98), to diagnoses initiated by a PSA test in asymptomatic men (HR, 0.95; 95% CI, 0.93-0.97), and to low-risk prostate cancer (HR, 0.95; 95% CI, 0.92-0.97). There was no clear association with more advanced disease at diagnosis. In cases, a slightly higher risk of prostate cancer death was observed for higher BP levels (HR, 1.05; 95% CI, 1.01-1.08) per SD of mid-BP; however, the association was restricted to distant metastatic disease (Pheterogeneity between case groups = 0.01), and there was no association for BP measured less than 10 years prior to diagnosis. Prediagnostic BP is unlikely an important risk factor for prostate cancer development and death. Less asymptomatic PSA testing among men with higher BP levels may explain their lower risk of prostate cancer. Elevated BP is unlikely to be an important risk factor for prostate cancer.

Smoking and Risk of Prostate Cancer and Prostate Cancer Death: A Pooled Study

BackgroundProspective and detailed investigations of smoking and prostate cancer (PCa) risk and death are lacking. ObjectiveTo investigate prediagnosis smoking habit (status, intensity, duration, and cessation) as a risk factor, on its own and combined with body mass index (BMI), for PCa incidence and death. Design, setting, and participantsWe included 351448 men with smoking information from five Swedish cohorts. Outcome measurements and statistical analysisWe used Cox regression to calculate hazard ratios (HRs) and confidence intervals (CIs) for PCa incidence (n = 24731) and death (n = 4322). Results and limitationsSmoking was associated with a lower risk of any PCa (HR 0.89, 95% CI 0.86–0.92), which was most pronounced for low-risk PCa (HR 0.74, 95% CI 0.69–0.79) and was restricted to PCa cases diagnosed in the prostate-specific antigen (PSA) era. Smoking was associated with a higher risk of PCa death in the full cohort (HR 1.10, 95% CI 1.02–1.18) and in case-only analysis adjusted for clinical characteristics (HR 1.20, 95% CI 1.11–1.31), which was a consistent finding across case groups (p = 0.8 for heterogeneity). Associations by smoking intensity and, to lesser degree, smoking duration and cessation, supported the associations for smoking status. Smoking in combination with obesity (BMI ≥30 kg/m2) further decreased the risk of low-risk PCa incidence (HR 0.40, 95% CI 0.30–0.53 compared to never smokers with BMI <25 kg/m2) and further increased the risk of PCa death (HR 1.49, 95% CI 1.21–1.84). A limitation of the study is that only a subgroup of men had information on smoking habit around the time of their PCa diagnosis. ConclusionsThe lower PCa risk for smokers in the PSA era, particularly for low-risk PCa, can probably be attributed to low uptake of PSA testing by smokers. Poor survival for smokers, particularly obese smokers, requires further study to clarify the underlying causes and the preventive potential of smoking intervention for PCa death. Patient summarySmokers have a higher risk of dying from prostate cancer, which further increases with obesity.

Colonic perforation due to advanced prostate cancer in prostate-specific antigen era

Prostate cancer presentation with perforation peritonitis due to rectal infiltration is quite rare. We report a 53-year-old man who presented with rectal growth resulting in bowel obstruction and transverse colon perforation, for which emergent exploration was performed. Postoperative evaluation with imaging, serum tumor markers, and histopathological examination including immunohistochemistry revealed it to be prostate cancer infiltrating to surrounding structures including the rectum. It is rare to observe such advanced cases in the era of serum prostate-specific antigen screening, but a high index of suspicion is necessary for adequate diagnosis and treatment, eventually benefitting the patient.

Hypoehoic lesions on Transrectal Ultrasound and its correlation to Gleason grade in the diagnosis of Clinically Significant Prostate Cancer: A Prospective Study.

Context The importance of hypoechoic lesions on transrectal ultrasound (TRUS) merits re-assessment in the present era of widespread prostate-specific antigen (PSA) testing. Aims We aimed to investigate the predictive accuracy of hypoechoic lesions on TRUS of prostate in the diagnosis of prostate cancer and to examine the association of hypoechoic lesions with the aggressiveness of prostate cancer. Settings and Design This prospective study was conducted in a tertiary care center in South India from November 2017 to December 2019. Methods and Material We included 151 patients undergoing TRUS-guided 12-core prostate biopsy in view of raised serum PSA with or without suspicious digital rectal examination (DRE) findings in the study. Age, DRE findings, serum PSA level, TRUS findings, and histopathology reports were documented. These were compared between patients with and without hypoechoic lesions on TRUS. Statistical Analysis Used The statistical analysis for this study was performed using SPSS v20.0 software. Results Among 151 men, prostate cancer was diagnosed in 68 (45.03%) with mean age at presentation 69.81 ± 6.49 years. Fifty-eight cases (38.41%) had hypoechoic lesion on TRUS and the cancer detection rate (68.96%) amongst this group was significantly higher than in those without hypoechoic lesion ( p <0.0001). Patients with hypoechoic lesion were more likely to have higher grade cancer. Abnormal DRE findings and hypoechoic lesion on TRUS were independent predictors of a clinically significant cancer ( p <0.05). Conclusion Hypoechoic lesion on TRUS can be considered as an indicator of clinically significant prostate cancer.

PET/CT imaging of prostate cancer in the era of small molecule prostate specific membrane antigen targeted tracers.

Staging and restaging of prostate cancer is crucial for treatment planning and prognosis. Accurate localization is of high relevance for a tailor-made therapy and an early detection of unknown metastatic spread can lead to a survival benefit. Evidence based guidelines that are currently in use were established using data from conventional imaging (such as magnetic resonance imaging (MRI), computed tomography (CT) and bone scintigraphy). Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is rapidly evolving with promising results. However, up to now there is little consensus about the usefulness of this method, especially since different guidelines are "biased" depending on the association that shapes them. Firstly, little data exists on the staging of low risk tumors and probably PSMA PET/CT should be avoided in this setup for most patients. On the other hand, it has been recently proven that PSMA PET/CT can replace CT and bone scintigraphy (combined) in staging of advanced prostate cancer. Furthermore, the examination gained general acceptance through its excellent performance in biochemical recurrence, both for castration naïve and castration resistant tumors, and should be implemented where available. It is undisputed that PSMA PET/CT provides a more accurate picture of prostate cancer patients and can lead to both upstaging and downstaging, thus affecting therapeutic management. Though it is not clear yet if the more accurate staging will lead to better therapeutic decisions and improve patient outcomes, PSMA PET/CT appears as the next imaging standard for prostate cancer for the years to come.

Impact of biopsy perineural invasion on younger prostate cancer patients after radical prostatectomy

Objectives To identify the potential indicators for higher-risk disease and poor outcome in younger prostate cancer (PCa) patients (age ≤ 50) who had undergone radical prostatectomy (RP) in the prostate-specific antigen (PSA) era. Materials and Methods A total of 186 PCa cases of age ≤ 50 who underwent RP between 2003 and 2010 at our center were included for study. High-risk disease after RP was defined as cases with pre-PSA ≥ 20 ng/ml and/or Gleason score (GS) ≥ 4 + 3 and/or pT stage ≥ 3. The poor outcome group was defined as cases with biochemical recurrence (BCR) and/or metastasis (Mets) and/or all-cause death. Multivariate logistic regression models were performed to identify independent risk factors for both high-risk disease and poor outcome. Results Among 186 younger PCa patients aged ≤ 50, 36 cases (19.5%) had high-risk disease and 24 cases (12.9%) had poor outcome. The presence of biopsy perineural invasion (BxPNI) was significantly associated with high-risk disease and showed a trend to correlate with worse outcome in univariate analysis. On multivariate logistic regression analysis, BxPNI was shown to be a significant independent risk factor with covariate of D’Amico for poor outcome (p = 0.047) and an independent risk factor with covariate of BxGPC for high-risk PCa excepting the variables to define high-risk disease (p = 0.013). Prognostically, cases with BxPNI showed a poor BCR-free survival in univariate analysis but did not reach significance (p = 0.063). Conclusion Our results show that BxPNI could be considered as a risk classification factor to identify the best candidates among younger PCa patients for further treatment and may also be used for developing active surveillance (AS) selection criteria for younger PCa patients.

Re: Noncoding Mutations Target Cis-Regulatory Elements of the FOXA1 Plexus in Prostate Cancer.

No AccessJournal of UrologyUrological Survey1 Nov 2020Re: Noncoding Mutations Target Cis-Regulatory Elements of the FOXA1 Plexus in Prostate Cancer Anthony AtalaMD Anthony AtalaAnthony Atala More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001263AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Re: Noncoding Mutations Target Cis-Regulatory Elements of the FOXA1 Plexus in Prostate Cancer." The Journal of Urology, 204(5), p. 1100 Suggested Reading : Long-term outcome after radical prostatectomy for patients with lymph node positive prostate cancer in the prostate specific antigen era. J Urol 2007; 178: 864. Link, Google Scholar © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 204Issue 5November 2020Page: 1100-1100 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anthony Atala More articles by this author Expand All Advertisement PDF DownloadLoading ...

Current controversies in the treatment of localized prostate cancer

In the prostate-specific antigen (PSA) era, most prostate cancers (PCa) are diagnosed in alocalized stage and aplethora of therapeutic options are warranted in different clinical settings and disease stages of localized PCa. In the current narrative review, we give an overview of the current controversies in the therapeutic landscape of localized PCa and focus on organ-sparing approaches, percutaneous radiotherapy, brachytherapy as well as retropubic and robot-assisted prostatectomy by summarizing studies that have been published within the last two years.

Prostate cancer in 432 men aged

To evaluate the clinical presentation and treatment outcomes of prostate cancer (PCa) in 432 consecutive patients aged < 50years in the prostate-specific antigen (PSA) era. Retrospective analysis was performed on all patients with PCa (14570) from the years 1994 to 2017. A total of 432 consecutive patients aged < 50 years were identified. The patients were stratified by D'Amico risk groups, and their clinical presentation and treatment outcomes were analysed. The rates of biochemical recurrence after surgery were compared with the D'Amico prediction model as well as with older propensity-score-matched patients. The surgical pathology results in patients undergoing active surveillance (AS) were compared with those of low-risk patients who underwent immediate surgery. A total of 44%, 42% and 13% of patients harboured low-risk, intermediate-risk and high-risk PCa, respectively. Their median age was 47years and a positive family history of PCa was reported in 39.1%. Clinical stage was T1 in 65.5% and T2 in 30.0% of patients, and 2.0% of patients had metastatic disease at presentation. Radical prostatectomy (RP) was performed in 78.4% of patients (n = 339) and the biochemical recurrence rates were 7.8% (low-risk), 15.3% (intermediate-risk) and 23.3% (high-risk) at 5years post-surgery. These rates were lower than expected according to the D'Amico prediction model or when compared with older matched patients. A total of 74 patients with low-risk PCa underwent AS and only 17.6% (n = 13) required radical treatment after a median follow-up of 46months. The surgical pathology results in patients undergoing ASdid not differ significantly from patients with low-risk PCa who underwent immediate surgery (positive surgical margins [P = 0.145], tumour volume [P = 0.257] or seminal vesicle involvement [P = 0.100]). Of the present cohort, only 0.4% died from PCa during a median follow-up of 65months. The clinical presentation and prognosis of young patients has changed dramatically during the PSA era. Patients nowadays present with lower-risk disease that can be treated adequately, with reassuring biochemical recurrence rates at 5years post-surgery. AS appears to be safe in patients with low-risk. PCa.

The future of choline PET in the era of prostate specific membrane antigen.

Radiolabeled choline was the first radiopharmaceutical agent employed in prostate cancer patients. It has been considered a metabolic agent able to detect the presence of prostate cancer cell, both in the initial phase of the disease and in the restaging setting. Three agents are now available in clinical practice: one radiolabeled with 11C (called 11C-Choline) and two with 18F (either as 18F-methylcholine or 18F-ethylcholine). During the years, different studies have been performed with 11C -Choline and 18F-Choline demonstrating their performance for the detection of prostate cancer, in different settings of the disease. However, recently, new radiopharmaceutical agents for prostate cancer have been developed, gaining an important role for the diagnosis of prostate cancer, particularly in the restaging setting. The present review has been conceived in order to discuss the current role of radiolabeled choline PET/CT in the era of new agents for prostate cancer, in particular in the era of radiolabeled PSMA.

Racial disparities in prostate cancer survival in a screened population: Reality versus artifact.

Racial disparities in prostate cancer survival (PCS) narrowed during the prostate-specific antigen (PSA) era, suggesting that screening may induce more equitable outcomes. However, the effects of lead time and overdiagnosis can inflate survival even without real screening benefit. A simulation model of PCS in the early PSA era (1991-2000) was created. The modeled survival started with baseline survival in the pre-PSA era (1975-1990) and added lead times and overdiagnosis using estimates from published studies. The authors quantified 1) discrepancies between modeled and observed PCS in the PSA era and 2) residual period effects on PCS given specified values for screening benefit. Lead time and overdiagnosis explained more of the improvement in PCS for older ages at diagnosis (46% [95% confidence interval (CI), 44%-50%] for blacks and 51% [95% CI, 50%-52%] for all races ages 50-54 years vs 98% [95% CI, 97%-99%] for blacks and 100% for all races ages 75-79 years). They also explained more of the narrowing in PCS disparities for older ages (33% [95% CI, 31%-43%] for men ages 50-54 years vs 74% [95% CI, 71%-81%] for men ages 75-79 years). The period effects amounted to reductions of 27% to 40% among blacks and 26% to 38% among all races in the risk of prostate cancer death, depending on the screening benefit. Real improvements in survival disparities in the PSA era are smaller than those observed and reflect similar reductions in the risk of prostate cancer death among blacks and all races. Understanding screening artifacts is necessary for valid interpretation of observed survival trends. Cancer 2018;124:1752-9. © 2018 American Cancer Society.

Editorial Comment

No AccessJournal of UrologyAdult Urology1 Sep 2017Editorial Comment Daniel J.A. Margolis Daniel J.A. MargolisDaniel J.A. Margolis More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.03.149AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 198(3), p. 590 References 1 : Changing face and different countenances of prostate cancer: racial and geographic differences in prostate-specific antigen (PSA), stage, and grade trends in the PSA era. Int J Cancer2001; 96: 363. Google Scholar 2 : Assessment of PI-RADS v2 for the detection of prostate cancer. Eur J Radiol2016; 85: 726. Google Scholar 3 : The breast imaging reporting and data system: positive predictive value of mammographic features and final assessment categories. AJR Am J Roentgenol1998; 171: 35. Google Scholar © 2017 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 198Issue 3September 2017Page: 590 Advertisement Copyright & Permissions© 2017 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel J.A. Margolis More articles by this author Expand All Advertisement PDF downloadLoading ...

Post Prostatectomy Bladder Dysfunction: Where Are We Now?

During the prostate-specific antigen (PSA) era, the prevalence of male stress urinary incontinence (SUI) continues to rise as more prostatectomies are performed. Treatment of male SUI is a multifactorial decision depending not only on bladder and sphincteric function, but also patient choice. Due to the economic burden and strain on quality of life, procedures and devices have been developed to help patients alleviate their symptoms. Mainstays of treatment include conservative management with biofeedback and Kegel exercises, periurethral bulking agents, or surgical procedures such as the male urethral sling or the artificial urinary sphincter. A proper evaluation is important as bladder dysfunction in the form of detrusor overactivity, detrusor underactivity, and poor bladder compliance can occur independently or coexist with intrinsic sphincter deficiency. Thus, it is important to clearly define patient symptomatology to optimize outcomes.

Prostate-specific antigen testing for prostate cancer: Depleting a limited pool of susceptible individuals?

After the introduction of the prostate specific antigen (PSA) test in the 1980s, a sharp increase in the incidence rate of prostate cancer was seen in the United States. The age-specific incidence patterns exhibited remarkable shifts to younger ages, and declining rates were observed at old ages. Similar trends were seen in Norway. We investigate whether these features could, in combination with PSA testing, be explained by a varying degree of susceptibility to prostate cancer in the populations. We analyzed incidence data from the United States' Surveillance, Epidemiology, and End Results program for 1973-2010, comprising 511,027 prostate cancers in men ≥40years old, and Norwegian national incidence data for 1953-2011, comprising 113,837 prostate cancers in men ≥50years old. We developed a frailty model where only a proportion of the population could develop prostate cancer, and where the increased risk of diagnosis due to the massive use of PSA testing was modelled by encompassing this heterogeneity in risk. The frailty model fits the observed data well, and captures the changing age-specific incidence patterns across birth cohorts. The susceptible proportion of men is [Formula: see text] in the United States and [Formula: see text] in Norway. Cumulative incidence rates at old age are unchanged across birth cohort exposed to PSA testing at younger and younger ages. The peaking cohort-specific age-incidence curves of prostate cancer may be explained by the underlying heterogeneity in prostate cancer risk. The introduction of the PSA test has led to a larger number of diagnosed men. However, no more cases are being diagnosed in total in birth cohorts exposed to the PSA era at younger and younger ages, even though they are diagnosed at younger ages. Together with the earlier peak in the age-incidence curves for younger cohorts, and the strong familial association of the cancer, this constitutes convincing evidence that the PSA test has led to a higher proportion, and an earlier timing, of diagnoses in a limited pool of susceptible individuals.

Incidentally Detected Adenocarcinoma Prostate in Transurethral Resection of Prostate Specimens: a Hospital Based Study from India.

Awareness about prostate cancer has increased in the community, and prostate cancer screening examinations, including prostate specific antigen (PSA) assays, are now widely available. Prior to the PSA era, up to 27% of prostate cancers were detected incidentally at the time of transurethral resection of prostate (TURP). After PSA testing became widely available, the incidence of incidentally detected carcinoma prostate in TURP specimens without prior diagnosis reduced to 5-13%. However, the incidence of incidentally detected carcinoma prostate has been reported to vary across the globe since various factors can influence the identification of this malignancy in TURP specimens. In this paper, we focus on rates of incidentally detected prostate cancer in TURP specimens in our hospital and correlate it with various parameters. This retrospective study of histopathological findings of biopsy specimens was conducted for patients undergoing TURP during a period of 5 years from April 2010. The inclusion criteria were patients diagnosed with benign prostatic hyperplasia (BPH) (digital rectal examination (DRE) not showing any abnormally hard areas and normal age adjusted PSA values). Patients with elevated PSA, abnormal DRE, documented urinary tract infection and proved adenocarcinoma prostate (CaP) were excluded from the study. The total weight of prostatectomy specimen, occurrence of carcinoma prostate in the chips, percentage of total tissue resected showing malignancy and Gleason's scores were recorded. A total of 597 patients belonging to the inclusion criteria were studied. The incidence of occult CaP in the study group was 5.2 % (31/597). Out of these, 8 belonged to T1a and 23 belonged to T1b stages. The age group 70 - 79 years had the maximum incidence of occult CaP. It was observed that the clinical grading of prostate did not have a bearing on the incidence of occult CaP whereas the weight of resected specimen correlated with the incidence of CaP. The incidence of occult CaP was greater with low volume prostates (<20 g). (P=0.15). The rate of incidentally detected adenocarcinoma prostate in patients undergoing TURP for clinically diagnosed BPH was found to be only 5.2 % in our study which is low when compared with similar studies done elsewhere. The age of the patient and weight of the resected specimen correlated with incidence of occult prostate cancer. The clinical grading of prostate by DRE however, demonstrated no correlation.

PD42-08 IS PROSTATE CANCER STAGE MIGRATION CONTINUING FOR BLACK MEN IN THE PSA ERA?

You have accessJournal of UrologyProstate Cancer: Staging I1 Apr 2016PD42-08 IS PROSTATE CANCER STAGE MIGRATION CONTINUING FOR BLACK MEN IN THE PSA ERA? Ryan Dobbs, David Greenwald, Harpreet Wadhwa, Vincent Freeman, and Michael Abern Ryan DobbsRyan Dobbs More articles by this author , David GreenwaldDavid Greenwald More articles by this author , Harpreet WadhwaHarpreet Wadhwa More articles by this author , Vincent FreemanVincent Freeman More articles by this author , and Michael AbernMichael Abern More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1760AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In the U.S., disease specific mortality from prostate cancer is highest among black men. The introduction of widespread prostate specific antigen (PSA) testing has been associated with a reduction in men presenting with metastatic disease and a significant shift towards a lower stage of disease on radical prostatectomy specimens. The objective of our study was to evaluate current prostate cancer stage migration patterns in the U.S. by race. METHODS The Surveillance, Epidemiology and End Results (SEER) registry was queried to obtain all cases of prostate cancer in adult males reported between 2000 and 2011. Stage at diagnosis and race were categorized using SEER definitions. For incidence trend analyses, data were reported as age-adjusted incidence per 100,000 U.S. population. Temporal trends in prostate cancer incidence rates by stage at diagnosis were performed using Poisson regression stratified by race. Predictors of distant stage prostate cancer at diagnosis were determined using logistic regression adjusted for year of diagnosis, age at diagnosis, SEER region, and race. RESULTS A total of 656,662 cases were identified. The median age was 67 years, and the race distribution was 79.1% white, 13.7% black, 4.6% other, and 2.5% unknown. The majority of the cases were diagnosed with localized prostate cancer (83.7%), however 11.9% were diagnosed with regional disease and 4.4% with distant disease. Black race (OR 1.95 [1.89-2.02], p<0.01), and older age (OR 1.07/year [1.06-1.07], p<0.01) were associated with distant prostate cancer at diagnosis. Age at diagnosis <55 years was associated with a reduced likelihood of distant stage at diagnosis (OR 0.63 [0.60-0.66], p<0.01). The incidence rate of distant prostate cancer tended to decline over the study period for black men (OR 0.97/year [0.93-1.00], p=0.05), but not for white men (OR 0.99/year [0.95-1.03], p=0.56). CONCLUSIONS In the contemporary PSA era prostate cancer stage migration towards a lower stage of disease is still occurring among black men but appears to have stabilized among white men. Discontinuation of PSA-based screening for prostate cancer could disproportionately affect black men, whom, as a group, remain most likely to be diagnosed with metastatic and potentially fatal disease. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e990 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ryan Dobbs More articles by this author David Greenwald More articles by this author Harpreet Wadhwa More articles by this author Vincent Freeman More articles by this author Michael Abern More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The Long-term Disease-specific Mortality of Low-risk Localized Prostate Cancer: A Prospective Population-based Register Study Over Two Decades

To identify prognostic factors, and to estimate the long-term disease-specific and annual disease-specific mortality rates of low-risk prostate cancer patients from the early prostate-specific antigen (PSA) era. We studied data extracted from the Southeast Region Prostate Cancer Register in Sweden, on1300 patients with clinically localized low-risk tumors, T1-2, PSA level ≤10 µg/L and Gleason scores 2-6 or World Health Organization Grade 1, diagnosed 1992-2003. The Cox multivariate regression model was used to evaluate factors predicting survival. Prostate cancer death rates per 1000 person-years were estimated for 4 consecutive follow-up time periods: 0-5, 5-10, 10-15, and 15+ years after diagnosis. During the follow-up of overall survivors (mean 10.6 years; maximum 21.8 years), 93 patients (7%) died of prostate cancer. Cancer-specific survival was 0.98 (95% confidence interval [CI] 0.97-0.99), 0.95 (95% CI 0.93-0.96), 0.89 (95% CI 0.86-0.91), and 0.84 (95% CI 0.80-0.88), 5, 10, 15, and 20 years after diagnosis. The 5-year increases in cancer-specific mortality were statistically significant (P < .001). Patients with PSA ≥ 4 µg/L managed initially with watchful waiting and those aged 70 years or older had a significantly higher risk of dying from their prostate cancer. The long-term disease-specific mortality of low-risk localized prostate cancer is low, but the annual mortality rate from prostate cancer gradually increases. This indicates that some tumors slowly develop into lethal cancer, particularly in patients 70 years or older with a PSA level ≥ 4 µg/L.

External beam radiation therapy or high intensity focused ultrasound for localized prostate cancer: a matched pair analysis in the prostate-specific antigen era

Background: In the absence of randomised study data institutional series have shown High Intensity Focused Ultrasound (HIFU) to produce excellent overall and cancer specific survival rates in patients with localized prostate cancer (LPCa) compared with alternative curative treatments. Objectives: To evaluate the oncologic outcome of patients treated with HIFU versus conformal external beam radiation therapy (C-EBRT) without previous or associated androgen deprivation (AD). This study is designed to overcome limitations of case series studies by using a matched pair design in patients treated contemporaneously with HIFU and C-EBRT in two institutions in the same town.

Discovery and characterization of long intergenic non-coding RNAs (lincRNA) module biomarkers in prostate cancer: an integrative analysis of RNA-Seq data.

BackgroundProstate cancer (PCa) is a leading cause of cancer-related death of men worldwide. There is an urgent need to develop novel biomarkers for PCa prognosis and diagnosis in the post prostate-specific antigen era. Long intergenic noncoding RNAs (lincRNAs) play essential roles in many physiological processes and can serve as alternative biomarkers for prostate cancer, but there has been no systematic investigation of lincRNAs in PCa yet.ResultsNine lincRNA co-expression modules were identified from PCa RNA-Seq data. The association between the principle component of each module and the PCa phenotype was examined by calculating the Pearson's correlation coefficients. Three modules (M1, M3, and M5) were found associated with PCa. Two modules (M3 and M5) were significantly enriched with lincRNAs, and one of them, M3, may be used as a lincRNA module-biomarker for PCa diagnosis. This module includes seven essential lincRNAs: TCONS_l2_00001418, TCONS_l2_00008237, TCONS_l2_00011130, TCONS_l2_00013175, TCONS_l2_00022611, TCONS_l2_00022670 and linc-PXN-1. The clustering analysis and microRNA enrichment analysis further confirmed our findings.ConclusionThe correlation between lincRNAs and protein-coding genes is helpful for further exploration of functional mechanisms of lincRNAs in PCa. This study provides some important insights into the roles of lincRNAs in PCa and suggests a few lincRNAs as candidate biomarkers for PCa diagnosis and prognosis.