Prostate-specific Antigen Ratio Research Articles

Clinical efficacy of transrectal ultrasound-guided prostate biopsy in men younger than 50 years old with an elevated prostate-specific antigen concentration (>4.0 ng/mL)

BackgroundProstate cancer (PCa) is not commonly found in men younger than 50 years of age. However, serum prostate-specific antigen (PSA) concentration has been examined more frequently at a younger age in Asia partially due to an increased awareness of prostate cancer. The purpose of our study was to investigate the efficacy and complication of PSA-triggered transrectal ultrasonography-guided prostate (TRUSP) biopsies. We retrospectively reviewed TRUSP biopsies in young men with elevated PSA concentration in Taipei Veterans General Hospital. MethodsWe reviewed the cases of patients younger than 50 years of age with elevated PSA concentration (>4.0 ng/mL), who received 12 cores TRUSP biopsies at TPEVGH from January 2008–December 2013. The age, family history, digital rectal examination (DRE) results, PSA concentration, free/total PSA ratio, total prostate volume, PSA density, lower urinary tract symptoms and complications after the procedure were reviewed. The pathologic findings of TRUSP biopsy and clinical follow-up were reviewed and analyzed according to the Epstein criteria. ResultsA total of 77 patients were included and were divided into 2 groups: 1) the younger group consisted of 20 patients <40 years of age; and 2) the elder group had 57 patients who were 40–50 years of age. The overall detection rate of PCa was 11.69% (9/77), and all of the PCa cases were diagnosed in the elder group (group detection rate: 15.8%). There was a significant difference in the severity of lower urinary tract symptoms (LUTS) between these 2 groups. All PCa patients were clinically significant according to the Epstein criteria. Two patients experienced fever (2.60%) after TRUSP biopsy. ConclusionFrom our patient cohort, it appears that no benefit was apparent for patients younger than 40 years old who received TRUSP biopsy, even with elevated PSA. However, PCa detected in men between 40 and 50 years of age were all clinically significant. Overall, our results supported current major practice guidelines which recommend an initial PSA checkup at 40 years of age.

Simultaneous Detection of Dual Prostate Specific Antigens Using Surface-Enhanced Raman Scattering-Based Immunoassay for Accurate Diagnosis of Prostate Cancer.

Accurate analysis of specific biomarkers in clinical serum is essential for early diagnosis and treatment of cancer. Here, a surface-enhanced Raman scattering (SERS)-based immunoassay, using magnetic beads and SERS nano tags, was developed for the determination of free to total (f/t) prostate specific antigen (PSA) ratio to improve the diagnostic performance of prostate cancer. To assess the clinical applicability of the proposed method, SERS-based assays for the simultaneous detection of dual PSA markers, free PSA (f-PSA) and complexed PSA (c-PSA), were performed for clinical samples in the gray zone between 4.0 and 10.0 ng/mL. Our assay results for f/t PSA ratio showed a good linear correlation with those measured using the electrochemiluminescence (ECL) system installed in the clinical laboratory of the University Hospital. In addition, the simultaneous assay provided better precision than parallel assays for the detection of f-PSA and c-PSA in 13 clinical serum samples. Therefore, our SERS-based assay for simultaneous detection of dual PSA markers in clinical fluids has strong potential for application in the accurate diagnosis of prostate cancer.

Different free prostate-specific antigen to total prostate-specific antigen ratios using three detecting systems.

Prostate-specific antigen (PSA) is used as an indicative marker of a pathologic condition of the prostate, and the ratio of free PSA (fPSA) to total PSA (tPSA) helps to distinguish benign prostatic hyperplasia (BPH) from prostate cancer (PCa). In this study, we present some reversed ratios of fPSA to tPSA and analyze the possible mechanism. Using the UniCel DxI800 Access Immunoassay System, eight reversed fPSA to tPSA ratios were obtained, and then these samples were retested with an Abbott Architect i2000 Immunoassay Analyser and Cobas e602. Four of the eight reversed ratios kept a ratio >1 using Abbott Architect i2000, and seven of them turned into a ratio <1 using Cobas e602. In consideration of the assay these three detecting systems apply, the possible reason of the reversed ratios can be heterophile antibodies. To get accurate reason, further study is required.

MP28-07 AN AUTOMATED-MICROCAPILLARY ELECTROPHORESIS-BASED IMMUNOASSAY SYSTEM MAY IMPROVE DIAGNOSTIC ACCURACY OF PROSTATE CANCER AND BE A GOOD INDICATOR OF GLEASON SCORE

You have accessJournal of UrologyProstate Cancer: Markers I1 Apr 2017MP28-07 AN AUTOMATED-MICROCAPILLARY ELECTROPHORESIS-BASED IMMUNOASSAY SYSTEM MAY IMPROVE DIAGNOSTIC ACCURACY OF PROSTATE CANCER AND BE A GOOD INDICATOR OF GLEASON SCORE Tomokazu Ishikawa, Tohru Yoneyama, Yuki Tobisawa, Shingo Hatakeyama, Tatsuo Kurosawa, Kenji Nakamura, Takuya Koie, Yasuhiro Hashimoto, and Chikara Ohyama Tomokazu IshikawaTomokazu Ishikawa More articles by this author , Tohru YoneyamaTohru Yoneyama More articles by this author , Yuki TobisawaYuki Tobisawa More articles by this author , Shingo HatakeyamaShingo Hatakeyama More articles by this author , Tatsuo KurosawaTatsuo Kurosawa More articles by this author , Kenji NakamuraKenji Nakamura More articles by this author , Takuya KoieTakuya Koie More articles by this author , Yasuhiro HashimotoYasuhiro Hashimoto More articles by this author , and Chikara OhyamaChikara Ohyama More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.820AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Lack of specificity in PSA test for early detection of prostate cancer (PCa) is one of the major issues all over the world. Therefore, the development of novel assay system with improved specificity is urgently needed. We identified PCa-associated aberrant glycosylation of PSA (S2,3PSA) and developed an automated-microcapillary electrophoresis-based immunoassay system (μTAS method). Furthermore, we successfully applied this assay system for clinical setting. METHODS S2,3PSA was clearly differentiated by the lectin reactivity to recognize aberrant glycosylation on free PSA (fPSA) and calculate the ratio (%) in the microfluidic separation channel with fPSA antibody-label conjugates. We measured %S2,3PSA by utilizing μTAS method with extremely shortened assay time (9 min) and evaluated the cutoff values in biopsy proven patient samples (103 with PCa and 50 with non-PCa) including PSA less than 20.0 ng/ml. Receiver operating characteristic (ROC) curves were used to evaluate diagnostic accuracy for %S2,3PSA in comparison with other methods. RESULTS %S2,3PSA of PCa was significantly higher than those of non-PCa (p < 0.0001) and the appropriate cutoff value was determined to be 40% of S2,3PSA ratio in terms of diagnostic accuracy. The area under the curve (AUC) for the detection of PCa with %S2,3PSA ratio was 0.851, which was significantly more effective than that with total PSA (AUC; 0.658). And also, good correlation in this assay with Gleason score after radical prostatectomy (pGS) was suggested for the discrimination of high risk PCa. Especially, high-risk PCa patients with GS≥4+3 could be separated by the S2,3PSA percentage cut off of 50%, achieving a high performance (AUC; 0.921). CONCLUSIONS Although the present study is still preliminary, these results suggest that the newly developed serum %S2,3PSA test may contribute improved diagnostic accuracy having good correlation with prostatectomy Gleason score. Additional validation studies are warranted. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e340 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Tomokazu Ishikawa More articles by this author Tohru Yoneyama More articles by this author Yuki Tobisawa More articles by this author Shingo Hatakeyama More articles by this author Tatsuo Kurosawa More articles by this author Kenji Nakamura More articles by this author Takuya Koie More articles by this author Yasuhiro Hashimoto More articles by this author Chikara Ohyama More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A Dynamic Model for Predicting Prostate Cancer in Iranian Men Based on a Perceptron Neural Network

Objectives: To test a novel neural network prediction model for prostate cancer based on age, rectal examination, prostate specific antigen (PSA) and prostate volume. Methods: 572 men who underwent trans-rectal ultrasound guided prostate biopsy from February, 2013 to September, 2014 participated in the study. Prostate configuration based on digital rectal examination, serum PSA level, and prostate volume were recorded. Pathologic outcomes were categorized in two groups: adenocarcinoma vs. noncancerous reports. A multi-layer perceptron (MLP) neural network was designed in which total PSA, free PSA, age, rectal examination results and prostate volume were vectors. Results: 566 men with the average age of 65.9 ± 8.6 years. Average total and free PSA levels were 19.77 ± 50.03 ng/mL and 2.46 ± 8.36 ng/mL respectively. Average free to total PSA ratio was 14.68 ± 11.24%. Prostate size was 58.58 ± 31.64CC on average. Age, total PSA, prostate volume and abnormal DRE were correlated with prostate cancer at biopsy, and the most powerful of all was abnormal DRE with odds ratio of 0.12. Neural networks were formed on a 3-layer perceptron and finally a network of 6 entry, 9 middle, and 2 output nodes was selected with the learning rate of 0.05. The Correct prediction rate for the model was 85.3%. Conclusions: It seems that our three-layer perceptron neural network model proves better results than the logistic regression model in predicting the presence of prostate cancer based on total and free PSA, DRE result, prostate volume and age.

Elevated insulin and reduced insulin like growth factor binding protein-3/prostate specific antigen ratio with increase in prostate size in Benign Prostatic Hyperplasia

BackgroundInsulin and insulin like growth factor-1 (IGF-1) have growth promoting effects, while insulin like growth factor binding protein-3 (IGFBP-3) has growth inhibitory effects. The present study was designed to assess the concentrations of insulin, IGF-1, IGFBP-3 and their association with prostate size in patients with BPH. MethodsNinety 90 BPH cases and 90 controls were enrolled in the study. Insulin, IGF-1, IGFBP-3, PSA, testosterone and estradiol were estimated in both the groups. ResultsInsulin, IGF-1 and estradiol were increased and IGFBP-3/PSA was decreased in BPH cases when compared with controls. Insulin (r=0.64, p=0.001) and IGF-1 (r=0.22, p=0.03) were positively correlated and IGFBP-3/PSA (r=−0.316, p=0.002) were negatively correlated with prostate size in BPH. Multivariate analysis showed that insulin (p=0.001) and IGFBP-3/PSA (p=0.004) predicts the prostate size in patients with BPH. Insulin was increased and IGFBP-3/PSA was reduced in BPH patients with increased prostate size. At a cutoff concentration of 527.52, IGFBP-3/PSA ratio was found to differentiate benign growth of prostate from normal prostate with 96% sensitivity and 96% specificity. ConclusionInsulin is elevated and IGFBP-3/PSA is reduced with increase prostate size in BPH cases.

An Automated Micro-Total Immunoassay System for Measuring Cancer-Associated α2,3-linked Sialyl N-Glycan-Carrying Prostate-Specific Antigen May Improve the Accuracy of Prostate Cancer Diagnosis.

The low specificity of the prostate-specific antigen (PSA) for early detection of prostate cancer (PCa) is a major issue worldwide. The aim of this study to examine whether the serum PCa-associated α2,3-linked sialyl N-glycan-carrying PSA (S2,3PSA) ratio measured by automated micro-total immunoassay systems (μTAS system) can be applied as a diagnostic marker of PCa. The μTAS system can utilize affinity-based separation involving noncovalent interaction between the immunocomplex of S2,3PSA and Maackia amurensis lectin to simultaneously determine concentrations of free PSA and S2,3PSA. To validate quantitative performance, both recombinant S2,3PSA and benign-associated α2,6-linked sialyl N-glycan-carrying PSA (S2,6PSA) purified from culture supernatant of PSA cDNA transiently-transfected Chinese hamster ovary (CHO)-K1 cells were used as standard protein. Between 2007 and 2016, fifty patients with biopsy-proven PCa were pair-matched for age and PSA levels, with the same number of benign prostatic hyperplasia (BPH) patients used to validate the diagnostic performance of serum S2,3PSA ratio. A recombinant S2,3PSA- and S2,6PSA-spiked sample was clearly discriminated by μTAS system. Limit of detection of S2,3PSA was 0.05 ng/mL and coefficient variation was less than 3.1%. The area under the curve (AUC) for detection of PCa for the S2,3PSA ratio (%S2,3PSA) with cutoff value 43.85% (AUC; 0.8340) was much superior to total PSA (AUC; 0.5062) using validation sample set. Although the present results are preliminary, the newly developed μTAS platform for measuring %S2,3PSA can achieve the required assay performance specifications for use in the practical and clinical setting and may improve the accuracy of PCa diagnosis. Additional validation studies are warranted.

The use of five-alpha reductase inhibitors and their association with reclassification and pathologic outcomes in the Canary Prostate Active Surveillance Study (PASS).

22 Background: The outcomes of patients who enroll in active surveillance (AS) programs for prostate cancer (PCa) while currently taking five-alpha reductase inhibitors (5-ARIs) have not been well defined. Previous studies suggest that the initiation of 5-ARIs after enrolling in AS decreases the rate of reclassification and/or treatment for PCa, but there is still an FDA black box warning about the risk of grade risk prostate cancer while on 5-ARI. The objective of this study was to evaluate the safety of remaining on a 5-ARI after initiating AS for PCa. Methods: All men were enrolled in PASS. Inclusion criteria were current or never 5-ARI user, Gleason 3+3 or 3+4 PCa at diagnosis, ≤ 34% core ratio at diagnosis and ≥ 1 surveillance biopsy. Reclassification was defined as an increase in Gleason score and/or ratio of biopsy cores positive for cancer to ≥ 34%. Results: 1045 men were included in this study, 938 who had never used a 5-ARI and 107 5-ARI users. 5-ARI users had larger prostate volume (51 cc vs 40 cc, p &lt; 0.01), a higher rate of BPH (77% vs 29%, p &lt; 0.01) and older age (65 vs 62 years, p &lt; 0.01). All other clinical parameters, including serum PSA, were statistically similar. Kaplan Meier analysis of any reclassification is shown in the figure. There was no significant difference in any reclassification (p = 0.12). The use of 5-ARI at diagnosis was significantly protective for reclassification in a proportional hazards model (HR 0.68, p = 0.03); this difference was not significant after accounting for serum PSA, BMI, prostate size and positive cores ratio at diagnosis (HR 0.78, p = 0.18). There was no significant effect on adjusted analysis when evaluating for disease upgrading. 171 patients underwent radical prostatectomy (RP), 158 never 5-ARI users and 13 5-ARI users. There were no statistically significant differences when evaluating for Gleason grade or adverse pathology. 5-ARI users had a longer median time to RP (3.6 vs 2.1 years, p = 0.045). Conclusions: There is no association between 5-ARI use at diagnosis and reclassification on AS for men in the Canary PASS cohort. 5-ARI users have a longer median time to RP and do not have more severe PCa at RP.

Can PSA Reflex Algorithm be a valid alternative to other PSA-based prostate cancer screening strategies?

The available laboratory tests for the differential diagnosis of prostate cancer, are represented by the total PSA, the free PSA, and the free/total PSA ratio. In Italy most of doctors tend to request both total and free PSA for their patients even in cases where the total PSA doesn't justify the further request of free PSA, with a consequent growth of the costs for the National Health System. The aim of our study was to predict the saving in Euro (due to reagents) and reduction in free PSA tests, applying the "PSA Reflex" algorithm. We calculated the number of total PSA and free PSA exams performed in 2014 in the Hospital of Grosseto and, simulating the application of the "PSA Reflex" algorithm in the same year, we calculated the decrease in the number of free PSA requests and we tried to predict the Euro savings in reagents, obtained from this reduction. In 2014 in the Hospital of Grosseto 25,955 total PSA tests have been performed: 3,631 (14%) resulted greater than 10 ng / ml; 7,686 (29.6%) between 2 and 10 ng / ml; 14,638 (56.4%) lower than 2 ng / ml. The performed free PSA tests were 16904. Simulating the use of "PSA Reflex" algorithm, the free PSA tests would be performed only in cases with total PSA values between 2 and 10 ng / mL with a saving of 54.5% of free PSA exams and of 8,971 euros, only for reagents. Our study showed that the "PSA Reflex" algorithm is a valid alternative leading to a reduction of the costs. The estimated intralaboratory savings, due to the reagents, seem to be modest, however, they are followed by the additional savings due to the other diagnostic processes for prostate cancers.

Clinical and Biochemical Influence of Prostatic Stones

Introduction: The study aimed to explore clinical influence of prostatic stones on lower urinary tract symptoms (LUTS), seminal plasma cytokines, and serum biomarkers. Materials and Methods: A total of 70 men aged ≤50 years with LUTS divided into 2 groups: group with stones (GSt) and group without prostatic stones (GNoSt). All subjects completed the International Prostate Symptom Score (IPSS) questionnaire and National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) scoring questionnaire. Pre- and post-prostate massage test and uroflowmetry were performed. The serum concentration of total prostate specific antigen (PSA), free PSA, and free/total PSA (f/t PSA) ratio, seminal concentration of cytokines interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12p70, and tumor necrosis factor-alpha were measured. Results: GSt subjects had significantly more severe symptoms based on IPSS answers (p = 0.0289). All domains in NIH-CPSI scores were significantly higher in the GSt group: pain (p = 0.001), urinary symptoms (p = 0.023), quality of life (p = 0.008), and with overall (p = 0.003). GSt subjects also had significantly lower maximum urinary flow (Qmax; p = 0.011), lower f/t PSA ratio (p = 0.048), and higher concentration of IL-1β (p = 0.011) and IL-8 (p = 0.001). Conclusions: Prostatic stones may influence the severity of LUTS and the symptoms of chronic prostatitis. They might reduce Qmax rate and lead to reduction of the f/t PSA ratio and produce more severe inflammation causing increased seminal concentration of IL-1β and IL-8.

Clinical Utility of PCA3 Assay in Patients with Suspicious Prostate Cancer

Background: this study evaluated the clinical utility of the PCA3 assay in guiding initial biopsy decisions in prostate cancer. Subjects and Methods: this study was conducted on fifty patients selected from the Urology Department at Ain Shams University Hospitals and scheduled for prostate biopsy after digital rectal examination first catch urine was collected. PCA3 scores were determined using RT-PCR and compared to biopsy outcome. The diagnostic accuracy of PCA3 was compared to total prostate specific antigen and %free prostate specific antigen.Results: the best cutoff for PCA3 was 4.6 folds (RQ). This cutoff had a diagnostic sensitivity of 94.7%, specificity 95% and area under the curve (AUC) was 0.978. Total PSA at the cutoff 10 ng/mL had a diagnostic sensitivity 68%, specificity 70% and AUC was 0.766. At cut off 19%, f/t PSA ratio had a diagnostic sensitivity 38%, diagnostic specificity 90 %, and AUC was 0.529. Conclusions: the PCA3 assay can aid in guiding biopsy decisions. It is superior to total prostate specific antigen and %free prostate specific antigen in predicting initial biopsy outcome, and may be indicative of prostate cancer aggressiveness.

Diagnostic efficacy of free prostate-specific antigen/total prostate-specific antigen ratio for the diagnosis of prostate cancer in low concentration (≤4 ng/ml) and intermediate levels of total prostate-specific antigen (4.01-10.0 ng/ml).

Serum prostate-specific antigen (PSA) is a useful tumor biomarker for prostate cancer (PCa) diagnosis. In this study, I aimed to compare the free/total PSA (fPSA%) with PSA alone for their usefulness in diagnosis for PCa. The patients who underwent prostate biopsy between January 2010 and January 2015 were evaluated retrospectively. Data were expressed as a mean + standard error and P < 0.05 as considered with statistical significance (Med Calc 14.12-2014). The receiver operating characteristic curves were calculated to study the sensitivity and specificity of fPSA and PSA and compared to each other in different PSA levels. There were 1055 patients in the study. The mean age of the patients was 64.2 + 7.5 and 66.3 + 6.4 years in Groups 1 and 2. The mean PSA and free/total PSA of the patients was 2.79 + 1 ng/ml, 0.2 + 0.08 and 6.49 + 1.59 ng/ml and 0.19 + 0.09 in Groups 1 and 2, respectively. I found the optimal cutoff for fPSA% was ≤18 and ≤14 in Groups 1 and 2 with a sensitivity of 62-45% and specificity of 58-79%. There was a statistical significant difference for fPSA when comparing the area under curve in the PSA level of 4.01-10 ng/ml (P = 0.0009). In this study, serum fPSA% has advantages for diagnosis of PCa when comparing PSA alone in different levels of PSA. These advantages are significant in PSA level of 4.01-10 ng/ml.

54P Circulating prostate-specific antigen and telomere length in a nationally representative sample of men without history of prostate cancer

Background We investigated the association of prostate-specific antigen (PSA) with leukocyte telomere length, which may be altered in preclinical prostate malignancies. Methods This study was based on the 2001-2002 USA National Health and Nutrition ExaminationSurvey(NHANES). Asubsampleof1,127 menaged40-85yearswithout prior history of prostate cancer who provided informed consent and blood samples were selected. Leukocyte telomere length (LTL) relative to standard DNA reference (T/S ratio) was quantified by polymerase chain reaction (PCR). Survey-weighted multivariable linear regression was performed to examine T/S ratio across quintiles of total and free PSA and free-to-total PSA ratio (%fPSA). A sensitivityanalysis was performed by excluding men dying from prostate cancer during follow-up through to 31 December 2006. Stratification analyses were carried out to assess any effect modification by age group, race, body mass index (BMI) and levels of C-reactive protein (CRP), a marker of inflammation. Results Higher total PSA levels were associated to longer LTL, with approximately 8% increase in log-transformed T/S ratio (95% confidence interval [CI]: 2-13%) among men in the highest quintile of total PSA compared to the lowest in the fully adjusted model (Ptrend —0.01). No significant association was found for free PSA or %fPSA, although nonlinearity between all PSA measures and T/S ratio was indicated. Similar results were found after excluding men who died from prostate cancer during follow-up. We also found the associations between total PSA and T/S ratio to be strongest among non-Hispanic blacks, non-obese men (BMI <30 kg/m2), and those with low CRP. However, a significant interaction was only found between total PSA and race/ethnicity (P interaction— 0.01). Conclusions Total PSA levels were strongly associated to leukocyte telomere length, particularly among non-Hispanic blacks. Our findings support a potential link between PSA and specific mechanisms contributing to prostate cancer development. Legal entity responsible for the study King's College London Funding PILAR Research and Education Foundation Disclosure All authors have declared no conflicts ofinterest.

Diagnostic value of microRNAs in prostate cancer patients with prostate specific antigen (PSA) levels between 2, and 10 ng/mL.

Prostate specific antigen (PSA), used for the early diagnosis of prostate cancer (PCa), is one of the best tumour markers known so far. However, in situations when PSA is between 2-10 ng/mL, which is named as grey zone, PSA falls short of distinguishing benign prostate diseases from PCa. On the other hand, it was demonstrated in many previous studies that microRNA (miRNA) could be a marker for cancer. Therefore, in this study, it was aimed to enhance the diagnostic power of PSA, especially with grey zone patients, by the use of miRNA. Ninety-four patients included in the study were divided into three groups as "control group" (n=44, PSA=2-10 ng/mL and benign), "PCa 1 group" (n=37, PSA=2-10 ng/mL), and "PCa 2 group" (n=13, PSA >10 ng/mL), according to their pathological results and PSA levels. Free PSA (fPSA) and total PSA (T-PSA) levels were measured with chemiluminometric sandwich immunoassay method. Expressions of miRNAs were analyzed using quantitative reverse transcription-polymerase chain reaction (qRT-PCR) method. The most appropriate specificity, sensitivity and prediction values were found by drawing the receiver operating characteristic (ROC) curves of total PSA, free/total PSA (f/T PSA) ratio, and miRNAs, and the diagnostic powers were compared with each other. Diagnostic powers of the f/T PSA ratio and miRNA were compared in PCa 1 and the control groups to determine the marker with higher area under the curve (AUC). It was shown that the diagnostic power of the combination of miR-16-5p and f/T PSA was higher than that obtained when they were used separately. As a result, while making the the discrimination between benign and malignant prostate in patients with grey zone, it was determined that the combination of miR-16-5p and f/T PSA was more valuable than T-PSA or f/T PSA alone. It was thought that diagnostic role of miRNAs in the early diagnosis of the different stages of PCa needed to be examined in further studies with larger groups.

The performance of [-2]proPSA and prostate health index tumor markers in prostate cancer diagnosis

Abstract Background: Prostate-specific antigen (PSA) is an established tumor marker for the diagnosis of patients with prostate cancer. The aim of the study was to evaluate the performance of [-2]proenzyme PSA ([-2]proPSA) and prostate health index (PHI) tumor markers in the differential diagnosis between benign prostatic diseases and prostate cancer. Methods: Total PSA (tPSA), free PSA (fPSA) and [-2]proPSA were measured using antibody-based sandwich enzyme-linked immunosorbent assay with a chemiluminescent detection system in 110 patients, with a tPSA of 1.6–8.0 µg/L. The PHI and %[-2]proPSA were calculated from the PSA values mentioned above. The results were compared with histopathological examination results following a transrectal ultrasound-guided biopsy of the prostate. Results: For the prediction of a malignant histopathological result, the specificity at the 90% sensitivity level was 24.3% for [-2]proPSA, 32.4% for %[-2]proPSA, 28.4% for PHI, 18.9% for tPSA and 28.4% for the free-to-total PSA ratio. The area under the curve for [-2]proPSA, %[-2]proPSA, PHI, tPSA and the free-to-total PSA ratio was 0.663, 0.749, 0.742, 0.616 and 0.625, respectively. Conclusions: Our study found a moderate improvement over tPSA and %fPSA in detecting prostate cancer using the [-2]proPSA assay in patients with a tPSA range of 1.6–8.0 µg/L.

10 - Predictive value of PSA density and free/total PSA ratio in detecting prostate cancer in patients with a total PSA

10 - Predictive value of PSA density and free/total PSA ratio in detecting prostate cancer in patients with a total PSA

Predictive Parameters Identifying Men Eligible for a Sole MRI/Ultrasound Fusion-Guided Targeted Biopsy without an Additional Systematic Biopsy

Objective: Evaluating the predictive factors that enable identifying men in which a sole MRI/ultrasound (MRI/US) fusion-guided targeted biopsy (TB) detects the maximal prostate cancer (PCa) risk group. Patients and Methods: Retrospective analysis of 251 consecutive patients who received a sensor-based, real-time MRI/US TB in combination with a 10-core systematic biopsy (SB) between August 2013 and July 2015. Univariate and multivariate binary regression analyses were performed to evaluate the predictors for equal/superior detection of the PCa risk group by TB compared to SB. Results: TB detected PCa in 63% (157/251); SB detected PCa in 70% (176/251); a combination of TB and SB detected PCa in 77% (193/251) of cancer patients. Fifty percent (291/584) of TB cores and 22% (539/2,486) of SB cores showed PCa. Predictors for equal/superior performance of a sole TB were lesion size (maximal diameter; OR 1.050, 95% CI 1.002-1.101, p = 0.043), suspicious digital rectal examination (DRE; OR 2.448, 95% CI 1.062-5.645, p = 0.036) and free/total prostate-specific antigen (PSA) ratio (f/t PSA ratio) ≤0.15 (OR 0.916, 95% CI 0.867-0.967, p = 0.002) on univariate regression analysis and f/t PSA ratio ≤0.15 (OR 0.916, 95% CI 0.867-0.967, p = 0.002) on multivariate regression analysis. Conclusion: The maximal axial diameter of the Prostate Imaging Reporting and Data System-lesion and f/t PSA ratio and a suspicious DRE are possible selection criteria for men eligible for a sole MRI/US fusion-guided targeted prostate biopsy.

Circulating Prostate-Specific Antigen and Telomere Length in a Nationally Representative Sample of Men Without History of Prostate Cancer.

We investigated the association of prostate-specific antigen (PSA) with leukocyte telomere length, which may be altered in preclinical prostate malignancies. This study was based on the 2001-2002 U.S. National Health and Nutrition Examination Survey (NHANES). A subsample of 1,127 men aged 40-85 years without prior history of prostate cancer who provided informed consent and blood samples were selected. Leukocyte telomere length (LTL) relative to standard DNA reference (T/S ratio) was quantified by polymerase chain reaction (PCR). Survey-weighted multivariable linear regression was performed to examine T/S ratio across quintiles of total and free PSA and free-to-total PSA ratio (%fPSA). A sensitivity analysis was performed by excluding men dying from prostate cancer during follow-up through to December 31, 2006. Stratification analyses were carried out to assess any effect modification by age group, race, body mass index (BMI), and levels of C-reactive protein (CRP), a marker of inflammation. Higher total PSA levels were associated to longer LTL, with approximately 8% increase in log-transformed T/S ratio (95% confidence interval [CI]: 2-13%) among men in the highest quintile of total PSA compared to the lowest in the fully adjusted model (Ptrend = 0.01). No significant association was found for free PSA or %fPSA, although nonlinearity between all PSA measures and T/S ratio was indicated. Similar results were found after excluding men who died from prostate cancer during follow-up. We also found the associations between total PSA and T/S ratio to be strongest among non-Hispanic blacks, non-obese men (BMI <30 kg/m2 ), and those with low CRP. However, a significant interaction was only found between total PSA and race/ethnicity (Pinteraction = 0.01). Total PSA levels were strongly associated to LTL, particularly among non-Hispanic blacks. Our findings support a potential link between PSA and specific mechanisms contributing to prostate cancer development. Prostate 77:22-32, 2017. © 2016 Wiley Periodicals, Inc.

Prostate-specific Antigen Density Variation Rate as a Potential Guideline Parameter for Second Prostate Cancer Detection Biopsy.

Background:The diagnostic value of current prostate-specific antigen (PSA) tests is challenged by the poor detection rate of prostate cancer (PCa) in repeat prostate biopsy. In this study, we proposed a novel PSA-related parameter named PSA density variation rate (PSADVR) and designed a clinical trial to evaluate its potential diagnostic value for detecting PCa on a second prostate biopsy.Methods:Data from 184 males who underwent second ultrasound-guided prostate biopsy 6 months after the first biopsy were included in the study. The subjects were divided into PCa and non-PCa groups according to the second biopsy pathological results. Prostate volume, PSA density (PSAD), free-total PSA ratio, and PSADVR were calculated according to corresponding formulas at the second biopsy. These parameters were compared using t-test or Mann-Whitney U-test between PCa and non-PCa groups, and receiver operating characteristic analysis were used to evaluate their predictability on PCa detection.Results:PCa was detected in 24 patients on the second biopsy. Mean values of PSA, PSAD, and PSADVR were greater in the PCa group than in the non-PCa group (8.39 μg/L vs. 7.16 μg/L, 0.20 vs. 0.16, 14.15% vs. −1.36%, respectively). PSADVR had the largest area under the curve, with 0.667 sensitivity and 0.824 specificity when the cutoff was 10%. The PCa detection rate was significantly greater in subjects with PSADVR >10% than PSADVR ≤10% (28.6% vs. 6.5%, P < 0.001). In addition, PSADVR was the only parameter in this study that showed a significant correlation with mid-to-high-risk PCa (r = 0.63, P = 0.03).Conclusions:Our results demonstrated that PSADVR improved the PCa detection rate on second biopsies, especially for mid-to-high-risk cancers requiring prompt treatment.

Free/Total Serum Prostate-Specific Antigen Ratio in Women with Colorectal Cancer Has Prognostic Significance.

The presence of prostate-specific antigen (PSA) in colon cancer tissues has been shown, but its clinical significance has not been known yet in colorectal cancer patients. We investigated the prognostic significance of percent free PSA value (free PSA/total PSA×100) in female patients with colorectal cancer. The serum concentrations of total and free PSA were measured by solid-phase two-site immunoradiometric assay in 184 patients. The cancer-specific survival (CSS) of patients with percent free PSA value ≥35 was significantly better compared to that of patients with percent free PSA value <35 (CSS rate was 82.9 and 55.5%, respectively; log-rank x2=8135, p=0.004). In multivariate Cox analysis, this percent free PSA threshold value had independent prognostic significance (relative risk 0.27, 95% confidence interval 0.11-0.64, p=0.003). Percent free PSA value, calculated by serum total and free PSA levels, has prognostic significance in women with colorectal cancer. The studies with larger patient series, utilizing ultrasensitive PSA assays whose lowest detection limit is lower, are required for a clearer understanding of this issue.