Prostate-specific Antigen Score Research Articles

Outcome of prostate cancer with CNS metastasis: An analysis of SEER database (2010-2020).

e17037 Background: Brain metastasis from prostate cancer is rare, with an estimated incidence of <1%, and its characteristics and outcomes are poorly understood. We report a contemporary analysis of outcomes in patients with CNS metastasis from prostate cancer in association with clinicopathological variables by utilizing the Survival, Epidemiology, and End Result (SEER) database with data from 2010 to 2020. Methods: From the SEER database, we identified histologically confirmed primary prostate cancers with any distant metastasis. Data for survival as well as multiple clinicopathological variables including age, race, prostate-specific antigen (PSA) level, Gleason score, prior radiotherapy, histology, and specific metastatic sites were extracted. Statistical analysis included chi-square. ANOVA, and Kaplan-Meier analysis for overall survival (OS) and disease-specific survival. Results: SEER database (2010-2020) identified 27,501 patients with metastatic prostate cancer, of which 27,118 (98.6%) were adenocarcinoma and 383 (1.4%) were prostate cancer with neuroendocrine features. Brain metastasis was seen in 282 (1.04%) and 15 (5.32%) patients in these histologic groups, respectively. Brain metastases were associated with worse prognosis with median OS of 14 months compared to bone-dominant and non-regional lymph node only diseases that showed median OS of 31 months and not reached, respectively (P < 0.01). Within the population with brain metastases, outcome comparison based on age (<65 vs. ≥65 years), ethnicity (Caucasian vs. African American vs. Hispanic), PSA (<98 vs. ≥98 ng/ml), and Gleason score (<9 vs. ≥9) showed no statistically significant difference (table). Presence of metastasis to other solid organs showed numerically worse outcome without statistical significance (OS: 26 months vs. 13 months, p=0.09). Significant OS difference was observed between the adenocarcinoma and neuroendocrine tumor within the brain metastasis subgroup (OS: 14 months vs. 6 months, p=0.03). Conclusions: CNS metastasis with prostate cancer carries worse prognosis in comparison to metastases to bone or distant lymph-nodes. Neuroendocrine tumor has higher risk of CNS metastasis although most of such cases are from adenocarcinoma due to its higher prevalence. OS analysis confirms worse outcome with neuroendocrine features compared to adenocarcinoma in CNS metastatic settings. [Table: see text]

The correlation between obesity and prostate volume in patients with benign prostatic hyperplasia: A prospective cohort study.

Benign prostatic hyperplasia (BPH) is increasing substantial burden on health care systems. Men with high body mass index (BMI) have bigger prostate volumes (PV) with subsequent increase in lower urinary tract symptoms (LUTS) than men with normal BMI. The purpose of this research was to investigate the correlation between Obesity and PV in patients with BPH. The study included 560 patients (50-80 years) with BPH. Weight and height measured to calculate BMI. TRUS was used to measure PV. Patient demographics such as IPSS score and prostate specific antigen (PSA) were also noted. Patients in the study had a mean age of 65.3 ± 9.45 years and the mean BMI was 23.97 ± 4.89 kg/m2. The mean PV of each BMI group were 37.45 ± 0.81, 57.89 ± 1.52 and 77.94 ± 2.17 (ml) for normal, overweight and obese groups, respectively, and the average PV score was 57.76 ± 1.50 ml. The mean PSA score was 3.26 ± 0.94 (ng/dl) with a range of 0.6-10.4. There was significant correlation between BMI and PV (p = 0.001) as well as between BMI with PSA and IPSS (p = 0.02, 0.001, respectively). The results showing strong correlation between BMI and PV also BMI with PSA and IPSS. Therefore reducing weight may lead to a lower prostate volume in the elderly stage, making LUTS less noticeable and improving quality of life.

MpMRI-targeted biopsy of the prostate in men ≥ 75 years. 7-year report from a high-volume referral center.

Multiparametric magnetic resonance imaging (mpMRI) -Ultrasound- fusion guided biopsy of the prostate (FBx) is the new gold standard for the detection of prostate cancer. Hallmark studies showing superior detection rates of FBx over randomized biopsies routinely excluded patients≥75 years and information on outcome of FBx on this patient cohort is sparse. As a large referral center, we have performed FBx on a substantial number of patients this age. By evaluating outcome of FBx of patients over the age of 75 years we wanted to close the gap of knowledge on this patient cohort. Between 2015 -2022, 1577 patients underwent FBx at our department and were considered for analysis. Clinical and histopathological parameters were recorded. Clinical data comprised age at FBx, serum level of Prostate-specific antigen (PSA), prostate volume, PSA-density, history of previous biopsies of the prostate, result of the digital rectal examination (DRE) and assessment of the indexlesion of mpMRI according to the Prostate Imaging and Reporting Data System (PI-RADS). Univariate analysis and multivariable logistic regression was used to identify age barrier of 75 years as a potential risk factor of detection of clinically significant prostate cancer by FBx. 379/1577 patients (24%) were≥75 years and 1198/1577 (76%) patients were < 75 years, respectively. Preoperative PSA was significantly higher in patients≥75 years compared to patients < 75 years (9.54 vs. 7.8, p < 0.001). Patients≥75 years presented significantly more often with mpMRI target lesions classified as PI-RADS 5 compared to patients < 75 years (45% vs. 29%, p < 0.001). Detection rate of clinically significant prostate cancer was significantly higher in patients≥75 years compared to patients < 75 years (63% vs. 43%, p < 0.001). Aggressive prostate cancer grade ISUP 5 was significantly more often detected in patients≥75 years compared to patients < 75 years (13% vs. 8%, p = 0.03). On multivariable logistic regression model adjusted for PSA and PI-RADS score, age barrier of 75 years was identified as a significant risk factor for the detection of clinically significant prostate cancer by FBx (OR: 1.77, 95% CI: 1.36 -2.31, p < 0.001). After evaluation of a large patient cohort, we show that age≥75 years represents a significant risk factor for the detection of clinically significant prostate cancer. Further studies on mid- and long term outcome are necessary to draw conclusions for clinical decision making in this patient cohort.

Therapeutic effects of finasteride: inhibition of disease progression and serum prostate-specific antigen reduction in patients with prostatic intraepithelial neoplasia.

The objective of this study was to evaluate the impact of finasteride on the progression of prostate intraepithelial neoplasia and levels of prostate-specific antigen (PSA) in patients. A total of 120 patients with high-grade prostatic intraepithelial neoplasia were included in this study from January 2013 to January 2018. All patients underwent prostate biopsies. Among them, 60 patients were assigned to the observation group and received a daily dosage of 5mg finasteride for 60 months, while the remaining 60 patients were assigned to the control group and did not receive finasteride. PSA levels were measured every six months, and imaging scans were conducted throughout the five-year study period. Additional biopsies were performed if PSA levels exceeded 10ng/mL or imaging suggested the presence of prostate cancer. Statistical analysis was applied to the collected data. In total, 25 cases of prostate cancer were identified in this study. Of these cases, 7 patients belonged to the observation group, whereas the remaining 18 patients were from the control group. The observation group exhibited significantly lower levels of total serum PSA (p <0.001) and Gleason scores (p <0.001) compared to the control group. Our study, which involved 120 participants, demonstrated that finasteride effectively reduces serum PSA levels and mitigates the severity of prostate cancer. These findings suggest that finasteride holds potential as a treatment option for patients with -high-grade prostatic intraepithelial neoplasia.

Abstract B122: Association between allostatic load and prostate-specific antigen (PSA) levels in African American men

Abstract Introduction: To further understand cancer health disparities, researchers are utilizing the framework of social determinants of health with a significant factor including physiological factors such as stress. Emerging evidence suggests physiological dysregulation such as high allostatic load to have negative health effects including acting as a driver to cancer risk and development. Understanding the lifetime effects of allostatic load levels within the African American populations is imperative. However, the literature is sparse on allostatic load and prostate cancer in African American men despite high rates of allostatic load and prostate cancer in this population. The goal was to evaluate the association of high allostatic load and prostate cancer within African American men in Chicago. Methods: In 2003-2012, 1200 AA men, over 18 years of age were recruited through yearly community health events in Chicago, Illinois. Allostatic load was defined as the sum of 8 established baseline risk-associated biomarkers, cholesterol, triglyceride, systolic blood pressure, diastolic blood pressure, creatinine, blood urea nitrogen, high-density lipoprotein, low-density lipoprotein, that exceeded specified cut off points adapted from verified scales found in previous literature. Results: The presence of high allostatic load levels was significantly associated with elevated PSA levels in Black men. Participants with high allostatic load scores were 2 times more likely to have elevated PSA levels. [Odds Ratio (OR) 2.129 (95%CI 1.254, 3.614)] Conclusion In conclusion, these results suggest the biological toll of stress in Black men may contribute to higher PSA scores and prostate cancer risks. It is important to understand the complex interplay of the multi-factorial experiences that are unique to Blacks in the United States that may put Black men at higher risk for factors that drive prostate cancer. Further research should be conducted on understanding these socio-biological risk factors to develop effective intervention strategies. Citation Format: Jamirah Y. Chevrin, Rick Kittles. Association between allostatic load and prostate-specific antigen (PSA) levels in African American men [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B122.

Association between Type 2 Diabetes Mellitus and Prostate Cancer Aggressiveness

Background: Type 2 diabetes mellitus (T2DM) and prostate cancer (Pca) are two different disease entities that occur frequently in the elderly populations. Researchers have identified some mechanisms that could link T2DM to the development, progression and prognosis of Pca. Although controversies surround this concept, T2DM has been reported to confer protection to the development of low grade Pca and to a lesser extent high grade Pca. Materials and Methods: One hundred and thirty-six (136) men with Pca were evaluated in this study. Information from their case-notes were retrospectively retrieved during their clinic visits including bio-data, history, physical examination findings, laboratory and radiological investigation results and reports of prostate biopsy. Patients were grouped as diabetic and non-diabetic based on the history and laboratory records. Age and prostate specific antigen (PSA) levels were also categorized. Collated data were analyzed using the Statistical Package for Social Sciences (SPSS) version 20.0 software. Results: One hundred and thirty six (136) men with a mean age of 69.10±8.40 years ranging from 48 to 91 years and diagnosed with Pca were evaluated. Diabetic men were older and had higher mean serum PSA and Gleason score (GS) than non-diabetic men (Table3i – iii). Conclusion: Diabetic men in this study had higher values of variables portraying more aggressive Pca than non-diabetic men. Therefore, in evaluating this group of patients presenting with symptoms suspicious of Pca, concerns of probably dealing with highly aggressive tumours should be held strong.

Yield of second-round MRI targeted ultrasound-guided fusion prostate biopsy after initial first-round targeted biopsy.

We aimed to determine the yield of second-round magnetic resonance imaging-ultrasound (MRI-US) fusion biopsy and factors that may predict eventual clinically significant (CS) prostate cancer (PCa) diagnosis. From 2013 to 2021, 85 men underwent second-round MRI-US fusion biopsy of 92 lesions (47.8% [44/92] peripheral zone and 52.2% [48/92] transition zone). Patient age, prostate-specific antigen (PSA), PSA density (PSAD), size/location of lesions, ADC value, Prostate Imaging-Reporting and Data System (PI-RADS), and PRECISE scores were recorded and compared to histopathological diagnosis (International Society of Urological Pathology [ISUP] grade-group 1 PCa, CS PCa=ISUP grade group ≥2 PCa) using logistic regression. Mean patient age, PSA, and PSAD were 64±7 years, 8.5±7.0 ng/ml, and 0.17±0.11, respectively. Results from first-round targeted biopsy were 63% (58/92) negative and 37% (34/92) clinically insignificant (grade group 1) PCa. Overall, second-round targeted biopsy identified 25% (23/92) CS PCa (grade group 2, n=19; grade group 3, n=4). Considering only lesions with initial negative targeted-biopsy results (n=58), 21% (12/58; grade group 2, n=8; grade group 3, n=4) CS PCa and 13 grade group 1 PCa were diagnosed at second-round biopsy. There was no difference in PSA (p=0.564), size (p=0.595), location (p=0.293), or PI-RADS score (p=0.342) of lesions by eventual CS PCa diagnosis. PSAD (0.2±1.4 vs. 0.16±0.10, p=0.167), ADC (0.748±0.199 vs. 0.833±0.257, p=0.151), and PRECISE score (p<0.01) showed a trend towards association or association with eventual CS PCa diagnosis. Repeat second-round targeted MRI-US fusion biopsy yielded CS PCa diagnosis in the targeted biopsy specimen in approximately 20% of patients in our study. PRECISE score may be a useful marker to help predict which patients require second-round biopsy.

Revolutionizing radical prostatectomy - a comparative study of traditional and modern automated surgical techniques

Introduction and purpose:&#x0D; Prostate cancer is a common malignancy seen worldwide and second most common cancer among Polish men as well as globally. The symptoms of prostate cancer depend on severity of the cancer. Prostate cancer diagnosis is typically established through physical examination- digital rectal examination (DRE), PSA (prostate specific antigen) testing and confirmed by histopathological examination. The choice of treatment method depends on many factors: disease severity, risk assessment (based on PSA, TNM and Gleason score), age of the patient and expected survival time. Treatment include surgery, hormone therapy, radiation therapy or chemotherapy. In some cases, the combination of methods can be used to achieve better outcomes. &#x0D; One of available treatment option is radical prostatectomy which includes open radical prostatectomy (ORP), laparoscopic and laparoscopic robot assisted radical prostatectomy (RARP). We aimed at presenting various outcomes comparing open radical prostatectomy and robot assisted radical prostatectomy.&#x0D; State of knowledge: &#x0D; In order to carry out the review of the topic we began to collect information and comprehensive research in PubMed database. The analysis focused on the treatment of prostate cancer especially radical prostatectomy methods, the course of surgical procedure, postoperative care, oncological results, intraoperative and postoperative complications.&#x0D; Conclusion:&#x0D; ORP and RARP ae two surgical procedures used in prostate cancer treatment. Both of them involve removal of the prostate gland but also have a multiplicity of differences. RARP is safe and less invasive alternative to ORP with shorter postoperative hospitalization. However, ORP is known for no necessity for expensive specialized equipment such as Da Vinci or Versius robot surgery system and shorter operative time.

Measuring cancer burden in prostatic needle core biopsies: simplified assessments outperform complex measurements in assessing outcome: evidence to assist pathologist efficiency and minimize datasets.

The optimal method of measuring cancer extent in prostate cancer (PCa) biopsies is unknown. Nine hundred eighty-one men with clinically localised PCa managed conservatively were reviewed with follow up. The number of positive cores (NPC), the Maximum Cancer Length in a core (MCL), Total Cancer Length (TCL), and percentage of positive cores (%+cores) was calculated and univariate and multivariate analysis performed using prostate-specific antigen (PSA), T-stage, and Gleason score. The presence of stromal gaps (SG) was recorded. Univariate models were run where SG made a difference to the MCL. All variables showed significant association with PCa death in univariate models. In multivariate models, incorporating PSA, T-stage, and Gleason score, only %+cores was a significant predictor of outcome, with a 10% increase in %+cores resulting in a hazard ratio (HR) of 1.07 (likelihood-ratio test P > Χ2 =0.01). There were 120 patients where SG made a difference to the MCL and a total of 20 events in this group. Including SG, on univariate analysis the median MCL was 10 mm and HR was 1.16 (P=0.007), not including SG, the median MCL was 6 mm and HR was 1.23 (P=6.3 × 10-4 ). Inclusion or exclusion of SG made no significant difference to TCL as a predictor of outcome. Cancer extent is a strong predictor of PCa death but only %+cores added to the multivariate model. Expressed as a fraction of NPC/total number of cores, this is the simplest method of assessment, which we favour over more complicated methods in nontargeted biopsies.

Serum prostate specific antigen is a good indicator of prostatic volume in men with benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is the most common cause of bladder outlet obstruction in men over the age of 50 years. An association between the prostate specific antigen (PSA), International Prostate Symptoms Score (IPSS) and prostate volume (PV) may be instrumental in determining patients who may benefit from treatment. Targeted therapy will reduce the cost of care because it is unwise to treat all men with prostate enlargement to prevent complications when the risk of occurrence is negligible. To determine the correlation between the PSA, IPSS and PV in men of African descent. This was a cross sectional analysis involving 92 patients diagnosed as having symptomatic BPH at the Ho Teaching Hospital. The data were collected using standardised questionnaires. The IPSS determined urinary symptom severity. The PV was determined using a transabdominal ultrasound machine. Serum PSA was retrieved from the electronic medical records. The mean PV was 61.04 cm3 ± 21.95 cm3, the mean PSA was 4.21 ng/mL ± 3.85 ng/mL, and mean IPSS of 21.59 ± 3.78. The Pearson's correlation between PV and PSA was 0.283 (p = 0.01), between PV and IPSS was 0.108 (p = 0.30), and finally, between Serum PSA and IPSS Score was -0.086 (p = 0.42). This study showed that serum PSA has a positive correlation with PV. However, IPSS had no significant association with PSA or PV in patients with BPH.Contribution: This study provides insights into the implications of clinical parameters on the management of prostate enlargement.

Bladder neck-sparing retropubic radical prostatectomy: assessing risk factors for detection of positive surgical margins

Background. Bladder neck preservation during retropubic radical prostatectomy (rRP) promotes a protective effect on urinary continence compared to standard rRP.Aim. To assessment of possible predictors for positive surgical margin (PSM) recognition is an important step.Materials and methods. 136 patients with localized prostate cancer (PCa) were studied in the study. Group 1, 90 patients (retrospective assessment), underwent standard rRP, group 2, 46 patients (prospective assessment), underwent rRP modified by bladder neck preservation with a part of the proximal prostatic urethra. The clinical and pathological stages of PCa were assessed; the groups were compared to the parameter PSM. Statistical analysis was performed using nonparametric statistical methods.Results. Both groups were comparable in age and baseline total prostate specific antigen (PSA) but differed in prostate volume and Gleason score. Also, there were differences in clinical and pathological stages of PCa. PSM-patients had more aggressive PCa according to the International Society of Urological Pathology (ISUP) and TNM classifications and had higher progression risk prognosis stages. In PSM-patients, correlations were determined between prostate volume and baseline Gleason index (r = 0.338; p &gt;0.05); baseline total PSA and Gleason score before (r = 0.529; p &gt;0.05) and after (r = 0.310; p &gt;0.05) rRP, respectively. Nevertheless, the incidence of PSM among all subjects was 6.6 % of cases, while in groups 1 and 2 was 7.8 and 4.3 % of cases, respectively. In this way, surgical techniques that maximize bladder neck preservation with a part of proximal prostatic urethra have no significant effect on PSM. Ranges of total PSA, clinical stage of PCa, Gleason score and progression risk stages (prognostic group for PCa) were determined as predictors of PSM. Their use will make it possible to establish patient selection criteria for bladder neck preservation with proximal prostatic urethra during rRP.Conclusion. The identified predictors will allow determining during clinical staging minimal risks of detecting PSM. The rRP modified by bladder neck preservation with part of the proximal prostatic urethra does not increase the incidence of PSM compared to the standard rRP. The feasibility of this technique should be related to total PSA, clinical stage of PCa, Gleason score, and the progression risk stage.

Clinicopathological Features, Treatment, and Outcome of Omani Patients with Metastatic Prostate Cancer.

ObjectivesProstate cancer (PCa) is the third most common cancer worldwide, with its incidence rising in the Middle East. There is a paucity of data about the clinicopathological features and outcomes of metastatic prostate cancer (mPCa) from the Middle East. We report the outcomes of mPCa from Oman.MethodsWe recruited consecutive men diagnosed with mPCa and treated at Sultan Qaboos University Hospital in Oman between January 2006 and December 2017. Information about demographics, clinical, laboratory, pathological, and radiological features at presentation, treatment, and survival outcomes was collected. Data were gathered until April 2019 or until the patient’s death for progression-free survival (PFS) and overall survival (OS), whichever came first. Survival rates were estimated using the Kaplan-Meier method. Univariate and multivariate analysis and Cox regression analyses were performed to study factors affecting the PFS and the OS.ResultsOf the 239 men diagnosed with PCa over the study period, 62 were diagnosed with mPCa. The median age was 71 (range = 57–92) years. The majority of patients (61.3%) had a Gleason score ≥ 8. Median prostate-specific antigen (PSA) level was 100.0. Bone was the most common site of metastatic disease (90.3%). The majority of patients with the hormone-sensitive disease were treated with testosterone suppression only, while abiraterone, enzalutamide, and docetaxel were added for treating metastatic castration-resistant mPCa (mCRPC). After a median follow-up of 34.5 months, the median PFS was 17 months, while the median OS was 43 months. Median survival post mCRPC was 17 months.ConclusionsOmani patients with mPCa present with high PSA and Gleason score and with widespread metastatic disease burden. Treatments offered are according to internationally accepted standards and have comparable PFS and OS as reported elsewhere.

A Bone Scan Is Valuable for Primary Staging of Newly Diagnosed Prostate Cancer in a Low-Resource Setting (Nigeria).

There is a paucity of information on bone scanning for prostate cancer from low-resource countries. This study evaluated the role of bone scan in the primary staging of newly diagnosed prostate cancer in one such setting. A retrospective analysis of 126 men with newly diagnosed prostate cancer undergoing an initial staging bone scan between January 2017 and December 2020 was carried out at a regional nuclear medicine center in Nigeria. Bone scan results were analyzed according to age, serum level of baseline prostate-specific antigen (PSA), and Gleason score. Equivocal scans and patients with no Gleason score or baseline PSA were excluded from the analysis. p < 0.05 was said to be significant statistically. Of 111 patients (aged 38-84years, median 66years), who met the inclusion criteria, 26 (23%) men had evidence of bony metastases as shown by a positive bone scan. Higher PSA levels and Gleason scores were associated with an increased risk of a positive bone scan, p < 0.001. No patient with a PSA level < 20ng/mL and a Gleason score of < 7 had a positive bone scan. The role of bone scanning in staging newly diagnosed prostate cancer patients in Nigeria is consistent with global reports. Our study confirms that a bone scan finding is well associated with the risk classification using PSA and Gleason score in our population.

Abstract PO-023: Connecting under-resourced populations: A community-based prostate cancer screening intervention

Abstract Prostate Cancer (PCa) is the number one diagnosed cancer among Black men (BM) in the United States. Diagnosed earlier, with more aggressive disease, BM are dying at higher rates than other race/ethnic groups. Family history of PCa and lack of access to annual screenings are known contributors to the development of lethal disease. In addition, over 70% of BM are vitamin D deficient (VDD), which promotes tumor aggressiveness, and generally have little knowledge of their family history of PCa. When detected at an early stage, BM have higher survival rates for PCa than other racial/ethnic group. As a result, the American Cancer Society recommends that men with a higher risk of developing PCa should receive information about the benefits and limitations of screening between 40 and 50 years of. Community-based screening (CBS) interventions have been shown to increase early detection and increase knowledge of PCa risk for BM). The purpose of this study is to better understand the feasibility of CBS interventions in reducing PCa disparities among BM. Methodology: Participants were recruited between 2018-2020 from CBS events in Southern California. The men completed a 48-item questionnaire prior to receiving a Prostate-Specific Antigen (PSA) test. Vitamin-D levels were also measured. The survey included questions on demographics, general health, cancer history, and family history of cancer. Inclusion criteria involved BM over the age of 40, without a family history of PCa, with PSA scores greater than 4 ng/ml (abnormal screening result), and Vitamin-D values less than 20 ng/ml (Vitamin D deficiency level). Survey data was analyzed using SPSS Version 25. Results: Our participants (n=497) included 68.8% (n=342) BM, 10% (n=50) White, 11.9% (n=59) Latino, 6.8% (n=34) Asian, and 2.4% (n=12) other. 62% of participants (n=269) have never been screened for PCa, and 74% (n=313) are between 40 and 88 years old. Of the Black population, 62% (n=163) never received a PSA screening, and 66% (n=175) did not have a family history of PCa. In addition, 36% (n=113) of the BM were VDD. Of the BM with an Abnormal Screening Result (ASR) (n=32), 44% (n=14) have never been screened, and 53% (n=17) did not have a family history of PCa. In addition, 44% (n=14) of the participants with an ASR were VDD. Lastly, of the BM above the age of 40 with an ASR, and VDD, (n=14), 50% have never been screened and 57% did not have a family history of PCa. Discussion: This study aimed to identify the feasibility of a community based PCa screening intervention for BM in Southern California. As a result of our CBS program, we identified high risk men without a family history of PCa and were VDD. This program offers early detection and screening opportunities to further increase awareness of PCa risk factors for BM. Future research should include the impact of CBS interventions for BM at perceived lower risk of developing PCa. Citation Format: Dorothy Galloway, Dede Teteh, Leanne Woods-Burnham, Mya Walker, Rick A. Kittles. Connecting under-resourced populations: A community-based prostate cancer screening intervention [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-023.

Description of Surgical Technique and Oncologic and Functional Outcomes of the Precision Prostatectomy Procedure (IDEAL Stage 1–2b Study)

BackgroundThe existing treatment options for men with intermediate- or high-volume low-risk prostate cancer (PCa) are associated with a substantial risk of over- or undertreatment. The development of risk-adjusted therapies is an unmet need for these patients. ObjectiveTo describe our novel technique of precision prostatectomy, a form of surgical focal therapy that allows radical excision of the index PCa lesion along with >90% prostatic tissue extirpation while preserving the prostatic capsule and seminal vesicle/vas deferens complex on the side contralateral to the dominant cancer lesion, and to report on medium-term functional and oncologic outcomes in the first 88 consecutive men who underwent this procedure between December 2016 and January 2020. Design, setting, and participantsMen with (1) prostate-specific antigen (PSA) ≤20 ng/ml, (2) clinical T stage ≤cT2, (3) a dominant unilateral lesion with Gleason ≤ 4 + 3 disease with any number or percentage of cores involved ipsilaterally on prostate biopsy, (4) no primary Gleason ≥4 lesion contralaterally, and (5) a preoperative Sexual Health Inventory of Men (SHIM) score of ≥17 (out of 25) with/without phosphodiesterase type-5 inhibitor use who consented to undergo precision prostatectomy were included in this single-arm, single-center, IDEAL stage 2b prospective development study. InterventionRobotic precision prostatectomy. Outcome measurements and statistical analysisThe safety and urinary, sexual, and oncologic outcomes of the precision prostatectomy technique were studied. Descriptive statistics and Kaplan-Meier analyses were used to assess 12-mo urinary continence (0–1 pad), 12-mo sexual potency (SHIM score ≥17), 36-mo freedom from clinically significant PCa (grade group ≥2), secondary treatments, metastatic disease, and mortality. Results and limitationsAt study entry, the median age, PSA, and SHIM score were 60.0 yr (interquartile range [IQR] 54.2–65.9), 5.7 ng/ml (IQR 4.2–7.1), and 22 points (IQR 19–24), respectively. The median follow-up was 25 mo (IQR 14–38). At 12 mo, all patients were continent (0–1 pads), with 90.9% of patients using 0 pads. The median time to urinary continence was 1 mo (IQR 1–4). At 12 mo, 85% of all-comers and 90.2% of the preoperatively potent men were potent. The median time to sexual potency was 4 mo (IQR 4–12). From an oncologic standpoint, at 36 mo an estimated 93.4% of the patients were free from clinically significant residual PCa and 91.7% had not undergone any additional treatment. All patients were alive and free of metastatic disease at 36 mo. ConclusionsPrecision prostatectomy is technically safe and reproducible and offers excellent postoperative functional results. At 36-mo follow-up, the oncologic outcomes and secondary treatment rates appear to be superior to existing ablative focal therapy results. Pending long-term data, a risk-stratified surgical approach to PCa may avoid whole-gland therapy and preserve functional quality of life in men with localized PCa. Patient summaryPrecision prostatectomy is a new form of focal therapy for intermediate-risk prostate cancer in which a 5–10-mm rim of prostate capsule is left on the opposite side of the gland to where the dominant cancer is located. The technique appears to be safe and efficacious and adds to the growing armamentarium of risk-adapted therapies for treatment of localized prostate cancer that avoid the adverse effects on urinary and erectile function of whole-gland treatments.

Artificial Intelligence for PET Image Reconstruction.

1330 Objectives: 18F-fluciclovine and 68Ga-prostate-specific membrane antigen (PSMA) are PET radiotracers recommended for the localization of recurrent prostate cancer post-prostatectomy. We examined the positivity rates (planned secondary endpoint) of 18F-fluciclovine PET/CT and 68Ga-PSMA PET/CT in a randomized trial in patients with biochemical recurrence post-prostatectomy. Methods: The first 55 enrolled patients (accrual goal: 140) with detectable prostate-specific antigen (PSA) post-prostatectomy were randomized to undergo treatment planning based on either 18F-fluciclovine (mean dose: 9.85 ± 0.84 mCi) [Arm A] or 68Ga-PSMA (mean dose: 5.09 ± 0.15 mCi) with 20 mg Lasix given unless contraindicated [Arm B] in an ongoing prospective clinical trial. Two independent nuclear medicine physicians interpreted the PET scans by consensus. Final radiotherapy decisions were based on PET. Within the context of the trial, all lesions with abnormal radiotracer uptake, including equivocals, were treated as positive for recurrence unless proven as false positive. Positivity rates on 18F-fluciclovine and 68Ga-PSMA were compared on a whole body and region basis using chi-square or Fisher9s exact test. Results: Three patients dropped out before 18F-fluciclovine PET scanning; therefore, 52 patients were analyzed (26 patients in each arm). Median PSA was 0.28 ng/mL in the 18F-fluciclovine arm and 0.27 ng/mL in the 68Ga-PSMA arm. There was no significant difference in PSA (p = 0.96) and Gleason score at prostatectomy (p = 0.80) between groups. Nine patients had equivocal uptake in lesions: 3 prostate bed, 1 pelvic node, 1 paraaortic lymph node on 18F-fluciclovine, and 4 prostate bed on 68Ga-PSMA. No visceral lesion was detected with either modality. The overall positivity rate on 18F-fluciclovine was significantly higher than 68Ga-PSMA for whole body (96.2% vs 53.9%; p <0.01) and recurrence in prostate bed (80.8% vs 30.8%; p <0.01). Although the positivity rate on 18F-fluciclovine was higher than 68Ga-PSMA for pelvic lymph nodes, there was no significant difference (38.5% vs 19.2%; p = 0.13). Positivity rates for recurrence in extrapelvic regions (lymph nodes and bone) on 18F-fluciclovine and 68Ga-PSMA were similar (15.4% vs 19.2%; p = 1.00) (Table 1A). After stratification by PSA levels (Table 1B), the whole body positivity rate on 18F-fluciclovine compared to 68Ga-PSMA was 94.4% vs 35.3% for PSA <0.5ng/mL and 100% vs 88.9% for PSA ≥0.5 ng/mL. Conclusions: In this secondary endpoint analysis from a randomized trial for patients with biochemical recurrence post-prostatectomy, the interim positivity rate for 18F-fluciclovine was higher than 68Ga-PSMA in the prostate bed and in the pelvis. Positivity rates for distant disease were comparable. This pattern was present even at low PSA levels (<0.5 ng/mL). Further analysis in a larger cohort is recommended to confirm these findings. Change in management and failure-free survival will be reported after full accrual is reached. Funding: NCT03762759 / NIH R01CA226992; Telix Pharmaceuticals (US) Inc. provided PSMA kits to Emory University

Identification of a novel non-invasive biological marker to overcome the shortcomings of PSA in diagnosis and risk stratification for prostate cancer: Initial prospective study of developmental endothelial locus-1 protein

This prospective study sought to clarify the developmental endothelial locus-1 (Del-1) protein as values of diagnosis and risk stratification of prostate cancer (PCa). From February 2017 to December 2019, a total 458 patients who underwent transrectal ultrasound guided prostate biopsy or surgery of benign prostatic hyperplasia agreed to research of Del-1 protein. We prospectively compared and analyzed the Del-1 protein and prostate specific antigen (PSA) in relation to the patients' demographic and clinicopathological characteristics. Mean age was 68.86±8.55 years. Mean PSA and Del-1 protein was 21.72±89.37, 0.099±0.145, respectively. Two hundred seventy-six (60.3%) patients were diagnosed as PCa. Among them, 181 patients underwent radical prostatectomy (RP). There were significant differences in Del-1 protein between benign and PCa group (0.066±0.131 vs 0.121±0.149, respectively, p<0.001). When we set the cut-off value of del-1 protein as 0.120, in patients with 3≤PSA≤8, positive predictive value and specificity of Del-1 protein (≥0.120) for predicting PCa were 88.9% (56/63) and 93.5% (101/108), respectively. Among 181 patients who underwent RP, there were significant differences in Del-1 protein according to stage (pT2 vs pT3a vs ≥pT3b) (0.113±0.078, 0.171±0.121, 0.227±0.161, respectively, p<0.001) and to Gleason score (6 (3+3) or 7 (3+4) vs 7 (4+3) or 8 (4+4) vs 9 or 10) (0.134±0.103, 0.150±0.109, 0.212±0.178, respectively, P = 0.044). Multivariate analysis showed that PSA, Del-1 protein and high Gleason score (≥9) were the independent prognostic factors for predicting higher pT stage (≥3b). Furthermore, age, PSA and Del-1 protein were independent prognostic factors for predicting significant PCa. Patients with PCa showed higher expression of Del-1 protein than benign patients. Del-1 protein increased with the stage and Gleason score of PCa. Collaboration with PSA, Del-1 protein can be a non-invasive useful marker for diagnosis and risk stratification of PCa.

The correlation between obesity and prostate volume in patients with benign prostatic hyperplasia at Charlotte Maxeke Johannesburg Academic Hospital

BackgroundBenign prostatic hyperplasia (BPH) is on the increase placing a substantial burden on health care systems. Recent studies have shown that men with high body mass index (BMI) and central obesity, as denoted by waist circumference (WC) have bigger prostate volumes (PV) with subsequent increase in lower urinary tract symptoms (LUTS) than men with normal BMI. The purpose of this research was to investigate the correlation between Obesity and PV in patients with BPH.MethodsThe study included 178 men aged between 50 and 75 years with BPH seen at Charlotte Maxeke Johannesburg academic hospital (CMJAH) Urology Outpatient Department between September 2018 and February 2019. Weight and height measurements were obtained to calculate BMI. Furthermore, WC was measured using a measuring tape, while a transrectal ultrasound (TRUS) was used to measure PV. Patient demographics, clinical characteristics such as hypertension, diabetes, smoking and prostate specific antigen (PSA) were also noted.ResultsPatients in the study had a mean age of 64.87 ± 6.526 years and the mean BMI was 27.31 ± 3.933 kg/m2. The mean PV of each BMI group were 52.92 ± 38.49, 61.00 ± 33.10 and 64.86 ± 37.46 cm3 for normal, overweight and obese groups, respectively, and the average PV score was 59.36 ± 36.507 cm3. The mean PSA score was 4.30 ± 3.126 with a range of 1.3–6.4, while the mean WC was 98.67 cm. There was no correlation between BMI and PV (p value = 0.195) as well as between PV and WC, hypertension, diabetes or smoking. The results revealed that the relationship between PV with PSA level as well as age was significant (p value = 0.001, p value = 0.009, respectively).ConclusionThe results showed no correlation between BMI and PV. Diabetes and hypertension as well had no positive correlation with PV. A follow-up study may be indicated to look at the correlation between obesity, LUTS and urinary flow rates to establish whether aggressive management of obesity would have significant impact on the management of BPH.

Moguća povezanost parodontopatije i prostatitisa - pilot studija

Introduction: Prostatitis is one of the most chronic diseases which is often associated with periodontitis. The serum Prostate Specific Antigen (PSA) levels can be elevated in a non-malignant condition such as symptomatic and asymptomatic prostatitis. Similarity in the inflammatory etiopathogenesis of these diseases is evident through the presence of Gram negative bacteremia, which in turn may be the possible link between these two conditions. Aim: To estimate the possible association between chronic periodontitis and prostatitis, evaluating the PSA levels in patients with moderate and severe periodontitis. Material and methods: 40 patients with prostatitis and elevated Prostate Specific Antigen (PSA) levels (≥ 4ng/ml) that participated in the study were hospitalized at the University Urology Clinic at the Faculty of Medicine in Skopje. Patients were divided into two groups on the basis of the levels of periodontal clinical attachment. First group of 20 patients with Clinical attachment level (CAL) ≥ 3mm, moderate periodontitis and other group of 20 patients with CAL ≥ 5mm, severe periodontitis. Dental plaque index (DPI), Index of gingival inflammation (IGI), Gingival bleeding index (GBI) and Clinical attachment level (CAL) were recorded and an assessment of PSA values was done and correlation to periodontal parameters, respectively. Differences in means, as statistically significant, were analyzed using Student's ttest. The relationship between PSA scores with all clinical parameters was done using Pearson's correlation coefficient technique. Results: Statistically significant differences were noted, (p&lt;0.05) between periodontal index values (DPI, IGI, GBI, CAL) and PSA levels within the two examined groupsHigher PSA levels were recordedin patients with severe periodontitis than inthose with moderate periodontitis. Pearson coefficient test among these periodontal indices (DPI, IGI, GBI and CAL) and PSA levels in two examined groups showed no statistically significant correlation. Conclusion: Patients with severe periodontitis were found to have higher PSA levels than those with moderate periodontitis. The clinical parameters of periodontitis and elevated PSA levels indicated a probable link between the two diseases.

Impedimetric aptamer-based glycan PSA score for discrimination of prostate cancer from other prostate diseases

Prostate specific antigen (PSA) is the common biomarker for prostate cancer (PCa). However, its lack of specificity to differentiate PCa from benign prostate disorders stimulates the search for alternative cancer biomarkers to improve the clinical management of the patients. Different studies have described changes in the core-fucosylation level of PSA between PCa patients and healthy controls. To exploit these findings, we have adapted an impedimetric aptamer-based sensor to the dual recognition of PSA. Two different aptamers, PSAG-1 and anti-PSA, are immobilized onto two adjacent nanostructured gold electrodes. The direct binding from diluted serum samples of specific glycosylated-PSA to the first sensor and total PSA to the second one leads to changes in the charge transfer resistance, which correlate to the amount of glycosylated and total PSA in the sample. The sensors are able to measure PSA in serum with a dynamic range between 0.26 and 62.5 ng/mL (PSAG-1) and from 0.64 to 62.5 ng/mL (anti-PSA), with a reproducibility of 5.4 %. The final output of the proposed platform is the ratio between PSAG-1 reactive PSA and total PSA, defined as the glycan score. The glycan score was tested in serum samples from patients with different pathologies, showing excellent correlation between the measured score and the known diagnosis of the patients. Hence this dual aptamer-based impedimetric biosensor could be used as a minimally invasive method for the diagnosis of prostate cancer.