Serum Prostate-specific Antigen Determination Research Articles

Incidental carcinoma of the prostate in cystoprostatectomy specimens - is it always a toothless lion?

Incidental prostate carcinoma (iPC) is a subject of debate concerning its definition, incidence, biology, diagnosis, staging, and treatment. The present study aimed to assess the incidence and main clinical-morphological characteristics of iPC identified in radical cystoprostatectomy (RCP) specimens over a 5-year period. Using the database of the Urology and Pathology Departments, we identified all patients with bladder carcinomas (BCs) who underwent RCP within a 5-year frame time. We selected only those patients with synchronous BC and prostate carcinoma (PC). The following parameters were analyzed for these patients: age, type of bladder and prostate tumor, degree of differentiation, pathological stage, and other prognostic parameters. We identified 91 men with bladder tumors treated by RCP among whom 43, aged between 53 and 84 years (mean age: 69.2 years), presented synchronous PC. iPC was more prevalent in older individuals (>65 years: 30 patients, 69.8%), with only six out of the 43 (12.8%) patients with iPC being aged ≤60 years. All iPC cases were conventional adenocarcinoma. Well-differentiated prostate adenocarcinomas (grade group 1) predominated (65.1%). Among the 43 iPCs, 16 (37.2%) were clinically significant PCs. iPC is frequently identified in patients with BC when inclusion and evaluation of all or most of the prostate tissue are performed. Although more than half of iPCs were well-differentiated tumors confined to the prostate, a significant number of cases met the criteria of clinically significant PC. All men over the age of 50 who are candidates for RCP, should undergo evaluation through serum prostate specific antigen determination.

Label-Free Determination of PSA and Free PSA Using MA-SERS

Prostate cancer is one of the compelling types of cancer diagnosed in men. Development of screening analytical methods, which provide fast and reliable results is, thus, demanding. Currently applied methods are usually based on the determination of serum prostate-specific antigen (PSA), where several limitations were identified. However, scientific reports have shown a direct correlation between the percentage of free PSA and prostate volume, and indirect correlation between the unfavorable course of the disease of prostate cancer and the percentage of free PSA in men with elevated PSA levels. Parallel analysis of PSA and free PSA presents an interesting alternative. Here, we present a new analytical method for a parallel analysis of PSA and free PSA in a whole human blood based on MA-SERS. The method is based on magnetic Fe3O4@Ag nanocomposite functionalized using anti-PSA. The method can distinguish between levels of PSA and free PSA within a single analytical run with limits of detection of 0.62 ng/ml for PSA and 0.49 ng/ml for free PSA, respectively.

Relationship between serum prostate-specific antigen and transrectal prostate sonographic findings in asymptomatic Ugandan males

BackgroundProstate disorders are among the leading causes of morbidity and mortality in men above the age of 40 years globally. Serum prostate-specific antigen (PSA) levels may be used to screen men at risk of prostate cancer and determine choice of medical treatment in benign prostatic hyperplasia (BPH) and evaluation of patients with prostatitis, while prostate sonography determines prostate volume (PV) and detects nodules. BPH may exhibit distinct hypoechoic, isoechoic, or hyperechoic nodules in the transition zone, whereas hypoechoic nodules in the peripheral zone are diagnostic for prostate cancer in over 50% of cases. In this study, we aimed at determining the relationship between serum PSA levels and transrectal prostate sonographic findings among asymptomatic Ugandan males.MethodsUgandan males above 30 years of age or older without lower urinary tract symptoms were cross-sectionally enrolled into the study. Serum PSA determination and transrectal ultrasound were performed. Association between PSA levels and PV was assessed using Spearman’s correlation coefficients (ρ).ResultsA total of 277 men were studied. The median serum PSA level was 1 (95% CI: 1–2). Most (n = 217, 78.3%) participants had serum PSA levels ≤ 4 ng/ml. The median sonographic PV was 26 (95% CI: 26–29) mls. One hundred and fifty-five (56.0%) participants had PV between 25 and 50 mls. Both PSA levels and PV progressively increased with age from 0.9 ng/ml and 22 mls in the 30–39 year age group to 7 ng/ml and 38 mls in the 60–69 year age group, respectively. PSA levels weakly correlated with PV (ρ = 0.27) (p < 0.0001). One hundred and thirty (47%) participants had prostatic nodules. Of these, 100 (77%) had features of benign nodules and 23% had suspicious nodules for prostate cancer. The median (range) serum PSA level in those with nodules was 2.0 (0.1–16.0) ng/ml and for those without nodules was 1.1 (0.1–8.0) ng/ml (p < 0.0001).ConclusionsSerum PSA has a weak direct correlation with PV and not a reliable marker for the prediction of presence or absence of prostatic nodules in asymptomatic adult males.

An ultrasensitive label-free electrochemical immunosensor based on 3D porous chitosan–graphene–ionic liquid–ferrocene nanocomposite cryogel decorated with gold nanoparticles for prostate-specific antigen

A highly sensitive and selective label-free electrochemical immunosensor was successfully fabricated for measuring prostate-specific antigen (PSA). A composite of chitosan, graphene, ionic liquid and ferrocene (CS-GR–IL–Fc) was drop casted onto a screen-printed carbon electrode (SPCE) and frozen to create a layer of 3D porous cryogel (CS-GR-IL-Fc cry) which was decorated with gold nanoparticles (AuNPs). The biocompatibility and porosity of the cryogel increased the surface area available for AuNPs loading via amino groups and the population of anti-PSA, immobilized on the AuNPs via chemisorption, could be increased. The CS-GR-IL-Fc cry displayed excellent conductivity, enhancing electron transfer and amplifying the current signal. Differential pulse voltammetry was employed to determine PSA by measuring the reduction in the Fc oxidation peak current in response to the formation of PSA/anti-PSA immunocomplex. Under the optimized incubation time and electrolyte pH, the developed immunosensor displayed excellent analytical performances, including a wide linear range at concentrations from 1.0 × 10−7 to 1.0 × 10−1 ng mL−1, with a very low limit of detection of 4.8 × 10−8 ng mL−1 and good reproducibility (relative standard deviation of <4.6%, n = 6), stability (90% sensitivity within 20 days), repeatability (12 cycles of binding–rebinding, the sensitivity > 90%) and selectivity. The results obtained from the device for the determination of PSA in human serum were consistent with results from the enzyme-linked immunosorbent assay (P > 0.05), and indicated the promising potential of the proposed immunosensor in clinical diagnosis.

Self-powered electrochromic sensing for visual determination of PSA in serum using PB as an indicator

Herein, we used Prussian blue (PB) as an indicator for self-powered electrochromic visual sensing driven by photoelectrochemical (PEC) cell to detect prostate specific antigen (PSA). The sensor consists of a photoanode and a PB/ITO cathode. Under the visible light excitation, photoelectrons generated from the photoanode will transmit to PB through an external circuit, making the blue PB reduced to transparent Prussian white (PW). In the presence of PSA, the transfer rates of photoelectrons slow due to steric hindrance, leading to different fading degree of PB. Moreover, the color intensity of PB is proportional to the concentration of PSA, we can quantitatively detect the PSA according to the color intensity. Under the optimal conditions, the linear range of detecting PSA was 0.1–50ng/mL with the detection limit of 0.03ng/mL (S/N=3). Meanwhile, the prepared novel sensing platform exhibited great selectivity and provided a rapid, visual method for PSA detection in human serum, which has great application prospects in point-of-care (POC) diagnostics.

A glassy carbon electrode modified with graphene nanoplatelets, gold nanoparticles and chitosan, and coated with a molecularly imprinted polymer for highly sensitive determination of prostate specific antigen

The authors describe an amperometric assay for the detection of prostate specific antigen (PSA) that combines the advantages of using a molecularly imprinted polymer (MIP) and of a nanocomposite composed of graphene nanoplatelets (graphene sheets; GS), gold nanoparticles (AuNPs) and chitosan (Chit). The GS-AuNP composite was synthesized by a single-step reduction of GS and HAuCl4 solution. The MIP was synthesized by electropolymerization of dopamine and characterized by scanning electron microscopy and differential pulse voltammetry (DPV). Sensitivity is strongly improved by the magnified current obtained by using the GS-AuNP hybrid. Chit was further employed as a film-forming material to prevent the leakage of nanomaterials. Under optimized conditions, the method displays good analytical performance for the detection of PSA by DPV and by using hexacyanoferrate as the electrochemical probe. The peak current (typically measured at 0.16 V vs. SCE) increases linearly in the 1 pg mL−1 to 100 ng mL−1 PSA concentration range, and the detection limit is 0.15 pg mL−1 at a signal to noise ratio of 3. The method was successfully applied to the determination of PSA in serum. The assay is highly selective, sensitive, reproducible and stable. In our perception, it represents an attractive alternative to the commercially available ELISA kits for PSA.

A novel immunosensing platform for highly sensitive prostate specific antigen detection based on dual-quenching of photocurrent from CdSe sensitized TiO2 electrode by gold nanoparticles decorated polydopamine nanospheres

Herein, a novel photoelectrochemical (PEC) immunosensing platform for highly sensitive detection of prostate specific antigen (PSA) was constructed based on dual-quenching of photocurrent from CdSe sensitized TiO2 electrode by gold nanoparticles decorated dopamine–melanin nanospheres (AuNPs-Dpa-melanin CNSs). In this proposal, CdSe sensitized TiO2 was used as photoelectrochemical matrix and the functional AuNPs-Dpa-melanin CNSs were used as signal quenching element. The dual quenching of the gold nanoparticles decorated Dpa-melanin CNSs to the CdSe sensitized TiO2 was achieved as follows: (i) the strong energy transfer between the CdSe quantum dots (QDs) and Au NPs diminishes the photocurrent signal of CdSe QDs; (ii) the steric hindrance of AuNPs-Dpa-melanin CNSs partly obstructs the diffusion of the electron donor, i.e. ascorbic acid, to the surface of photoelectrode, which make the depleting efficiency of the photogenerated holes decrease, leading to a declined photocurrent intensity. On the basis of the dual quenching effect of AuNPs-Dpa-melanin CNSs, a competitive immunosensing platform for PSA was designed upon the specific binding of anti-PSA to PSA and PSA functionalized AuNPs-Dpa-melanin CNSs conjugates. This proposed immunosensor possesses wide linear range from 1.0×10–11gmL−1 to 1.0×10−7gmL−1 with the detection limit of 2.7pgmL−1. Moreover, the applicability of the present method was demonstrated in the determination of PSA in human serum. The strategy creates new paradigms for PSA and other tumor markers detection and demonstrates high sensitivity, good specificity, and satisfied applicability in complex biological samples.

Molecular Diagnostic of Prostate Cancer From Body Fluids Using Methylation-Specific PCR (MS-PCR) Method

Worldwide prostate cancer (PCa) represents the 2nd leading cause of cancer related deaths among men. Currently, the screening for early detection of PCa is based on determination of serum prostate-specific antigen (PSA) levels. But this biomarker presents some disadvantages related to its specificity and sensitivity. In our study, we want to determine if methylation levels of the glutathione S-transferase P1 (GSTP1) gene could be used as a new biomarker for the early detection of PCa and to distinguish between malignant and benign pros-tatic lesions. To determine the methylation levels of the GSTP1 gene, 31 men with histopathological diagnosis of prostate adenocarcinoma and 34 men with the histopathological diagnosis of benign prostatic hyperplasia (BPH) as controls were included in the study group. The genomic DNA was extracted from urine samples. We analyzed the methylation levels of the GSTP1 gene by methylation-specific polymerase chain reaction (MS-PCR) method. In prostate cancer patients 27 of 31 (87%) presented hypermethylated levels of the GSTP1 gene, whereas 4 of 34 (11.8%) BPH patients had hypermethylated levels of the GSTP1 gene. Further, in the case of these four patients a second biopsy was done, which confirmed the diagnosis of prostate adenocarcinoma. Using the receiver operating curve (ROC), we obtained a specificity of 87% and a sensitivity of 98% for the GSTP1 gene. We can conclude that GSTP1 represents a new molecular biomarker which can aid in early detection of PCa and be used to discriminate between benign and malignant prostatic lesions from body fluids by noninvasive methods.

Long-term Outcomes for Clinically Localized Prostate Cancer Treated With Permanent Prostate Brachytherapy With Pd-103

In view of the prolonged natural history of prostate cancer, long-term follow-up is warranted to determine the efficacy of treatment. We evaluated the outcome of our prostate brachytherapy patients that were treated at least 15 years ago. The study included 118 consecutive cases of prostate cancer treated with permanent prostate brachytherapy with Pd-103 by a single radiation oncologist between August 1997 and September 1999. Mean age of patients was 73 years (range 53-86 years). Mean prostate-specific antigen (PSA) was 9.25 ng/mL (range 1.3-73.88 ng/mL). The median Gleason score was 6 (range 3-8). Among T stage, 106 (90%) patients had ≤T2a, 10 (8.4%) had T2b, and 2 (1.6%) had T2c or higher disease. Unilateral disease was present in 81 (70%), and 35 (30%) had bilateral disease. The numbers of low-risk, intermediate-risk, and high-risk prostate cancer cases were 62 (52.5%), 44 (37.2%) and 12 (10.1), respectively. Brachytherapy as monotherapy was done in 100 (85%) patients, while 18 (15%) received supplemental external beam radiation therapy (EBRT) to a dose of 45 Gy delivered in 1.8-Gy fractions. Androgen deprivation therapy was used in 75 (64%) patients, mostly for less than 4 months, before the implant. For monotherapeutic approach with brachytherapy, the minimum peripheral dose with Pd-103 was 125 Gy and 90 Gy with boost brachytherapy. Patients were monitored by physical examination, including digital rectal examination and serum PSA determination at 3-6 month intervals for first 5 years and then on a yearly basis. All patients were assessed for clinical and biochemical recurrence based on the Phoenix definition. Kaplan-Meier analysis and curves were used to determine the cause-specific survival (CSS), biochemical progression-free survival (bPFS), and overall survival (OS). Follow-up ranged from 1 to 17 years with a median overall follow-up of 14 years and biochemical follow-up of 13 years for patients who are still alive. Overall median and biochemical follow-up was 11 years and 8 years respectively. A total of 29 cases had biochemical recurrence, with a biochemical control rate of 75%. Distant metastatic disease was documented in 3 patients. The 15-year bPFS for the entire cohort was 68%. The 15-year bPFS by risk group stratification was 75%, 61%, and 52% for low-, intermediate-, and high-risk patients, respectively. There was significant difference in bPFS between low-, intermediate-, and high-risk groups. The prostate cancer-specific survival rate was 97% at 15 years. The overall survival reached 50% at 15 years. Our long-term experience with Pd-103 based permanent prostate brachytherapy shows excellent efficacy as assessed by the 15-year cancer-specific and biochemical relapse-free survival.

Nano-iniferter based imprinted sensor for ultra trace level detection of prostate-specific antigen in both men and women

In this work, a sensitive and selective electrochemical sensor for detection of prostate specific antigen (PSA) was developed using surface imprinting and nanotechnology. The multiwalled carbon nanotubes (MWCNTs) decorated with manganese nanoparticles was functionalized with thio-group to make a nano-iniferter. This nano-iniferter was used as a platform to synthesize a three-dimensional molecularly imprinted polymer matrix for PSA by controlled radical polymerization technique. The PSA-sensor displayed good analytical performance for the detection of PSA by square wave and differential pulse stripping voltammetric techniques. The limit of detection was calculated as low as 0.25pgL−1 (from SWSV) and 3.04pgL−1 (from DPSV) at signal to noise ratio of 3. The proposed sensor was successfully applied for the determination of PSA in human blood serum, urine, and forensic samples without any cross-reactivity. Thus this sensor offers high selectivity, sensitivity, simplicity and clinical applicability for PSA determination in sera of both the men and women, which have not been reported together in the previously reported systems. The sensor may be used as a better alternative for the commercially available ELISA kits for PSA determination.

Association between obesity, prostate-specific antigen level and prostate-specific antigen density in men with a negative prostate biopsy.

To determine the association between body mass index (BMI), serum prostate-specific antigen (PSA) level and PSA density (PSAD) in patients with an elevated serum PSA level but a negative prostate biopsy. This retrospective study enrolled men with a negative prostate biopsy but a serum PSA level of 3.0-10 ng/ml. All men underwent anthropometric measurements, serum PSA determination and transrectal ultrasound examination. BMI was grouped according to the Asia-Pacific obesity criteria: nonobese (<25 kg/m(2)) versus obese (≥ 25 kg/m(2)). Partial correlation and linear regression models between PSA, PSAD and BMI were conducted after adjusting for age. A total of 907 men were enrolled in this study. On multivariate analyses, PSA showed no significant correlation with age or BMI, whereas PSAD had a negative correlation with age and BMI. Similar results were obtained when patients were categorized as having low (3.0 < PSA ≤ 6.5 ng/ml) or high PSA (6.5 < PSA ≤ 10.0 ng/ml) levels. PSAD, but not PSA, demonstrated a significant negative correlation with BMI. This indicates that a new strategy including PSAD rather than simple PSA levels should be adopted in the study of obesity-adjusted PSA cut-offs.

Prostate Cancer Mortality in the Finnish Randomized Screening Trial

Prostate cancer (PC) screening with prostate-specific antigen (PSA) has been shown to decrease PC mortality by the European Randomized Study of Screening for Prostate Cancer (ERSPC). We evaluated mortality results in the Finnish Prostate Cancer Screening Trial, the largest component of ERSPC. The primary endpoint was PC-specific mortality. A total of 80 144 men were identified from the population registry and randomized to either a screening arm (SA) or a control arm (CA). Men in the SA were invited to serum PSA determination up to three times with a 4-year interval between each scan and referred to biopsy if the PSA concentration was greater than or equal to 4.0 ng/mL or 3.0 to 3.99 ng/mL with a free/total PSA ratio less than or equal to 16%. Men in the CA received usual care. The analysis covers follow-up to 12 years from randomization for all men. Hazard ratios (HRs) were estimated for incidence and mortality using Cox proportional hazard model. All statistical tests were two-sided. PC incidence was 8.8 per 1000 person-years in the SA and 6.6 in the CA (HR = 1.34, 95% confidence interval [CI] = 1.27 to 1.40). The incidence of advanced PC was lower in the SA vs CA arm (1.2 vs 1.6, respectively; HR = 0.73, 95% CI = 0.64 to 0.82; P < .001). For PC mortality, no statistically significant difference was observed between the SA and CA (HR = 0.85, 95% CI = 0.69 to 1.04) (with intention-to-screen analysis). To avoid one PC death, we needed to invite 1199 men to screening and to detect 25 PCs. We observed no difference in all-cause mortality between trial arms. At 12 years, a relatively conservative screening protocol produced a small, non-statistically significant PC-specific mortality reduction in the Finnish trial, at the cost of moderate overdiagnosis.

Prostate-specific Antigen Density: A Better Index of Obesity-related PSA Decrease in Ostensibly Healthy Korean Men With a PSA

To determine whether prostate-specific antigen density (PSAD) has a more significant correlation with obesity than prostate-specific antigen (PSA). From October 2007 to March 2012, a total of 2402 Korean men over 40 years old who visited our clinic for prostate examination were enrolled in this study. All men underwent anthropometric measurements, digital rectal examination, serum PSA determination, and transrectal ultrasound examination. Body mass index (BMI) was grouped according to the Asia-Pacific criteria of obesity into the following categories: underweight or normal: less than 23; overweight: 23 to 24.9; obese: 25 kg/m(2) or greater. A partial correlation and linear trend model among PSA, PSAD, and BMI were conducted, after adjusting for age. Finally, data from 2294 men in total were collected. Mean age was 52.3 years and mean PSA was 1.07 ng/mL. Partial correlation revealed a significant negative correlation between BMI and both PSA and PSAD (P = .0017 and <.0001, respectively), and revealed positive correlation between BMI and prostate volume (P <.0001). After adjustment for age, the linear trend model demonstrated that BMI had both a significant trend with PSA and PSAD (P = .0162 and <.0001, respectively), however, PSAD showed a significant linear trend in all BMI groups, whereas PSA showed a significant linear trend only in the group with a BMI ≥ 25 kg/m(2). PSAD demonstrated a more significant negative correlation with obesity than PSA.

Cada vez más evidencia en contra de la realización de rastreo de cáncer prostático en la población general

The U.S. Preventive Services Task Force issued its final recommendation against the implementation of prostate cancer screening through the determination of serum prostate-specific antigen in the general asymptomatic population(type D recommendation), on the grounds that there is moderate to high certainty that this service has no net benefit.This article describes the most important evidence that support this recommendation.

Fluorescence Resonance Energy Transfer Between Quantum Dots of CdSe and CdTe and Its Application for Determination of Serum Prostate-Specific Antigen

Abstract Fluorescence resonance energy transfer (FRET) from CdSe quantum dots to CdTe quantum dots was studied and used to determine the serum prostate-specific antigen (PSA). The effective energy transfer occurred between CdSe and CdTe in Tris-HCl buffer solution at pH 8.0, at which the CdTe fluorescence intensity increased greatly. When prostate-specific antigen (PSA) was added, the fluorescence intensity of CdSe-CdTe system decreased and the fluorescence was finally quenched because of the specific immunological reaction between the PSA antigen and the CdTe-labelled PSA antibody. There was a linear relationship between the concentrations of the PSA antigen and the fluorescence-quenching intensities. Then a new determination strategy of PSA was built by using the CdSe-CdTe system. Under optimum conditions, the linear range of PSA antigen was 2.8–10 μg L−1, with a correlation coefficient of r = 0.9992 and a detected limit of 1.5×10−2μg L−1 (n = 11).

Relationship between Prostate-Specific Antigen and Body Mass Index according to Age: Lower Prostate-Specific Antigen in Middle-Aged Overweight and Obese Korean Men

Objective: To analyze the relationship between serum prostate-specific antigen (PSA) and body mass index (BMI) according to age in a population of ostensibly healthy Korean men. Patients and Methods: Between 2002 and 2006, data from 13,025 men who visited health promotion centers were evaluated. All men underwent anthropometric measurements and serum PSA determination. The relationship between serum PSA and BMI according to age was analyzed. Results: The median age was 50.0 years and the median serum PSA level was 0.69 ng/ml. There was no relationship between serum PSA and BMI in the group whose BMI was <23 kg/m². The serum PSA showed a significant inverse relationship in those with BMI of ≧23 kg/m². However, this finding was only true among 40- to 59-year-old middle aged men and no such relationship between serum PSA and BMI was seen in the older groups (60–79 years of age). Conclusion: Our study revealed serum PSA had a significant inverse relationship with BMI in overweight and obese men aged between 40 and 59 years; however, there was no relationship between serum PSA and BMI in men whose age was older than 60 years.

Serum prostate‐specific antigen is better correlated to body surface area than body mass index in a population of healthy Korean men

It has been suggested that the larger vascular volume among obese men causes a dilution effect, decreasing the concentration of serum prostate-specific antigen (PSA). However, plasma volume is proportional to body surface area (BSA) rather than to body mass index (BMI). We determined whether serum PSA level is better correlated to BSA than BMI in a population of ostensibly healthy Korean men. Data from 2604 men who visited our health promotion center were evaluated. All men underwent anthropometric measurements, digital rectal examination, serum PSA determination, and transrectal ultrasound examination. The correlation between serum PSA and other parameters was statistically analyzed. The mean age was 49.9 years and the mean serum PSA level was 1.14 ng/mL. The multivariate analysis revealed that the serum PSA was positively correlated with age, prostate volume, and negatively correlated with BSA only and not with BMI. In addition, BSA, rather than BMI, was the significant factor in predicting the prostate volume. Our results suggest that men with larger BSA (rather than BMI), have larger prostate volumes, and lower serum PSA.

Prostate Cancer Death of Men Treated With Initial Active Surveillance: Clinical and Biochemical Characteristics

Active surveillance for favorable risk prostate cancer is an approach that may reduce the risk of overtreatment of clinically insignificant prostate cancer. In fact, some patients with favorable risk disease at diagnosis harbor more aggressive disease and may be at risk for prostate cancer mortality despite close monitoring. This is a detailed report of 5 of 453 patients on surveillance who died of prostate cancer. A large phase 2 prospective trial of active surveillance in patients with favorable risk prostate cancer was initiated in 1995. Eligible patients had favorable risk prostate cancer (prostate specific antigen 10 ng/ml or less, Gleason 6 or less, T1c/T2a). Epstein criteria for clinically insignificant prostate cancer (a third or less of cores positive, 50% or less involvement of any 1 core, and prostate specific antigen density less than 0.15) were used for men younger than 55 years. Patients were followed with serial prostate specific antigen determinations every 3 months for 2 years and then every 6 months if stable. Biopsies were performed at 1 year and then every 3 to 4 years. Radical intervention was offered if prostate specific antigen doubling time was less than 3 years or Gleason 3 + 4 pattern disease was identified on repeat biopsy. For the first 5 years of the study patients older than 70 years were eligible if they had Gleason 3 + 4 or less, or prostate specific antigen less than 15 ng/ml. The rate of intervention with radiation or surgery was 38% at 10 years (actuarial). All 5 patients had a prostate specific antigen doubling time of 1.6 years or less triggering a recommendation of radical therapy. Radical intervention was performed in 3 of the 5 patients. Patients 1 and 4 received radiation and patient 3 underwent radical prostatectomy. Of the 2 patients who did not receive definitive treatment 1 was lost to followup (patient 2) and was treated conservatively by his family doctor. Patient 5 elected androgen deprivation therapy rather than radical treatment. The low prostate cancer mortality in our surveillance cohort provides support for an active surveillance approach to favorable risk prostate cancer. Only 1 of the 5 patients presented with favorable disease and experienced a theoretically preventable death. The absence of preventable deaths suggests that the basic approach is sound. Two patients had a trigger for intervention but did not receive it. This reinforces the importance of close monitoring and of definitive treatment for those in whom disease is reclassified as higher risk over time.

Age specific reference levels of serum prostate-specific antigen, prostate volume and prostate specific antigen density in healthy Iranian men.

It is relevant to highlight that there is not a precise and perfect report on either 95 percentile value (upper limit of normal range) or on appropriate reference intervals for serum PSA in Iranian population. To determine age-specific reference ranges for serum prostate-specific antigen (PSA) concentration and PSA density (PSAD) and prostate volumes in a population of healthy Iranian men. Nine-hundred and thirteen healthy Iranian men, aged 50-79 years, underwent a detailed clinical evaluation including a digital rectal examination, a serum PSA determination (DRE) and transrectal ultrasound (TRUS). PSA test was performed on 666 of the subjects and TRUS was done on 633 of them. None of the subjects had any evidence of prostate cancer by any one of the three diagnostic tests and had no history of Lower Urinary Tract Symptoms (LUTS). Age specific ranges for PSA levels, PSA density and prostate volume were determined. The serum PSA concentration correlated directly with the subjects' age (r=0.280; p<0.001) and prostatic volume (r=0.327; p<0.001). Also prostatic volume was directly proportional to age (r=0.197; p<0.001).The serum PSA ranges (95th percentile) for each age range in Iranian men were: 0.00-2.61 ng/ml for 50-59 years; 0.00-3.59 ng/ml for 60-69 years; and 0.00-4.83 ng/ml for 70-79 years. The respective prostate volumes were: 14-59, 16-66 and 18-73ml. Also respective PSA densities were: 0.00-0.076, 0.00-0.10 and 0.00-0.14 ng/ml/ml. The present study confirms earlier reports that serum PSA levels and prostate volume and PSAD are age- and race- dependent, so it is appropriate to have age- specific reference ranges for these variables in various communities around the world. This will increase the positive predictive value of PSA estimation in the diagnosis of prostate cancer in different communities.

Time to prostate‐specific antigen nadir independently predicts overall survival in patients who have metastatic hormone‐sensitive prostate cancer treated with androgen‐deprivation therapy

The objective of this study was to evaluate the relation between the kinetics of prostate-specific antigen (PSA) decline after the initiation of androgen-deprivation therapy (ADT) and overall survival (OS) in men with metastatic, hormone-sensitive prostate cancer (HSPC). The authors' institutional database was used to identify a cohort of men with metastatic HSPC who were treated with ADT. Patients were included if they had at least 2 serum PSA determinations before PSA nadir and at least 1 serum PSA value available within 1 month of ADT initiation. Patient characteristics, PSA at ADT initiation, nadir PSA, time to PSA nadir (TTN), and PSA decline (PSAD) in relation to OS were analyzed. One hundred seventy-nine patients were identified, and they had a median follow-up after ADT initiation of 4 years. The median OS after ADT initiation was 7 years. The median PSA level at ADT initiation and PSA nadir were 47 ng/mL and 0.28 ng/mL, respectively. On univariate analysis: TTN <6 months, PSAD >52 ng/mL per year, PSA nadir >or=0.2 ng/mL, PSA >or=47.2 ng/mL at ADT initiation, and Gleason score >7 were associated with shorter OS. On multivariate analysis, TTN <6 months, Gleason score >7, and PSA nadir >or=0.2 ng/mL independently predicted shorter OS. To the authors' knowledge, this was the first report to demonstrate that a faster time to reach a PSA nadir after the initiation of ADT was associated with shorter survival duration in men with metastatic HSPC. These results need confirmation but may indicate that a rapid initial response to ADT indicates more aggressive disease.