Use Of Prostate-specific Antigen Research Articles

Potential use of chymotrypsin-like proteasomal activity as a biomarker for prostate cancer.

Although it is the most widely used biomarker for prostate cancer, the use of prostate specific antigen (PSA) is controversial due to its limitations in specificity and sensitivity. The proteasome is a complex associated with cell proliferation and apoptosis, and the abnormity of these processes may lead to tumor occurrence. Previous studies have reported that proteasomal activity is associated with cancer progression and can be used in risk stratification. The purpose of the present study was thus to investigate the feasibility of proteasome activity as a biomarker for prostate cancer. Proteasome activity in vitro and in vivo was detected, along with the expression of the substrate proteins NF-κB inhibitor-α (IκB-α), Bcl-2-associated X (Bax) and p27. Chymotrypsin-like proteasomal activity was elevated by 70% in vitro and 23% in vivo, and the expression levels of the proteasome substrate proteins IκB-α, Bax and p27 were decreased in prostate cancer cells and prostate tumor xenografts compared with normal mouse prostate tissue. In conclusion, proteasomal chymotrypsin-like activity maybe a potential biomarker for prostate cancer, and may be suitable to supplement PSA in clinical application for prostate cancer diagnosis.

PSA Screening for Prostate Cancer in Men under the Age of 65: A Review of Current Practice

Purpose: To review current practice in the use of Prostate Specific Antigen (PSA) testing and assess the overall risks and benefits of PSA testing for Adenocarcinoma of the Prostate, specifically in men under age 65, and those living with risk factors for the disease. Materials and Methods: An extensive literature review of PSA testing in various age groups was conducted with the goal being to review PSA screening trends and assess current recommendations regarding PSA Screening for Adenocarcinoma of the Prostate in various age groups, focusing on studies directed towards patients under the age of 65 and the long-term risks and benefits of PSA screening in the diagnostic algorithm. In order to reduce bias, we assessed our sources for variables such as reporting, measurement and/or selection bias. Our conclusions were then compared with current recommendations. Relevant studies with data compiled after 2004, centered around PSA screening in men under the age of 65 in general and specifically in men with risk factors for developing Adenocarcinoma of the Prostate were included. Editorials, newspaper articles and other non-scholarly and non-peer reviewed sources were automatically excluded.

Lifestyle Risk Prediction Model for Prostate Cancer in a Korean Population.

PurposeThe use of prostate-specific antigen as a biomarker for prostate cancer (PC) has been controversial and is, therefore, not used by many countries in their national health screening programs. The biological characteristics of PC in East Asians including Koreans and Japanese are different from those in the Western populations. Potential lifestyle risk factors for PC were evaluated with the aim of developing a risk prediction model.Materials and MethodsA total of 1,179,172 Korean men who were cancer free from 1996 to 1997, had taken a physical examination, and completed a lifestyle questionnaire, were enrolled in our study to predict their risk for PC for the next eight years, using the Cox proportional hazards model. The model’s performance was evaluated using the C-statistic and Hosmer‒Lemeshow type chi-square statistics.ResultsThe risk prediction model studied age, height, body mass index, glucose levels, family history of cancer, the frequency of meat consumption, alcohol consumption, smoking status, and physical activity, which were all significant risk factors in a univariate analysis. The model performed very well (C statistic, 0.887; 95% confidence interval, 0.879 to 0.895) and estimated an elevated PC risk in patients who did not consume alcohol or smoke, compared to heavy alcohol consumers (hazard ratio [HR], 0.78) and current smokers (HR, 0.73) (p < 0.001).ConclusionThis model can be used for identifying Korean and other East Asian men who are at a high risk for developing PC, as well as for cancer screening and developing preventive health strategies.

New US Preventive Service Task Force recommendations for prostate cancer screening: a needed update, but not enough

Prostate cancer (PC) screening remains a controversial topic, although it has been studied for more than two decades. Since the 1990s, when the use of Prostate-Specific Antigen (PSA) began in clinical practice, the mortality rate from PC has decreased by around 50%. Prostate cancer screening policies, early diagnosis and treatment are pointed out as responsible to 45%-70% of this reduction.() On the other hand, indiscriminate screening can lead to problems because of unnecessary prostate biopsies, and their possible side effects, [...]

Abstract 5450: Urinary microRNA as diagnostic and prognostic biomarkers for prostate cancer

Abstract Widespread use of Prostate Specific Antigen (PSA) testing for prostate cancer (PC) detection has led to extensive overdiagnosis and overtreatment. Thus, we aimed to train and validate urine-based microRNA (miRNA) biomarkers that may assist in the diagnosis and prognosis of PC. To this end, we profiled the expression levels of 92 miRNAs by RT-qPCR in exosome-enriched cell-free urine samples from 20 patients with benign prostatic hyperplasia (BPH) and 188 patients with clinically localized PC (cohort 1). The diagnostic potential of individual miRNAs and multi-miRNA ratio models were assessed by receiver operating characteristic (ROC) curve analysis. Prognostic potential was evaluated by Kaplan-Meier, uni- and multivariate Cox regression analyses using biochemical recurrence (BCR) after radical prostatectomy (RP) as endpoint. Our findings were validated in an independent cohort of 20 BPH patients and 197 patients with clinically localized PC (cohort 2). We identified and validated several deregulated miRNAs in urine samples from PC patients. In addition, we trained a novel diagnostic 3-miRNA model that distinguished BPH and PC patients with an area under the curve (AUC) of 0.95 in cohort 1, and which was successfully validated in cohort 2 (AUC=0.89). Furthermore, we trained a novel prognostic 3-miRNA model that predicted time to BCR after RP independently of routine clinicopathological parameters in cohort 1, and was successfully validated in cohort 2. Citation Format: Jacob Fredsøe, Anni K. Rasmussen, Anni R. Thomsen, Peter Mouritzen, Søren Høyer, Michael Borre, Torben F. Ørntoft, Karina D. Sørensen. Urinary microRNA as diagnostic and prognostic biomarkers for prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5450. doi:10.1158/1538-7445.AM2017-5450

THE USE OF MODERN ANALOGUES OF LUTEINIZING HORMONE RELEASING HORMONE IN THE HORMONAL THERAPY IN PATIENTS WITH PROSTATE CANCER

The urgency of the problem of prostate cancer (PC) remains extremely high due to the continued growth of morbidity and mortality from this disease. Despite the introduction of diagnostics with the use of prostate specific antigen (PSA) and the increase in the number of cases of detection of localized forms of the disease, frequency of detection in the primary treatment of patients with advanced and metastatic prostate cancer remains high. Therapy aimed at reducing testosterone levels in the body of the patient with metastatic prostate cancer is the gold standard of treatment, so surgical or pharmacological castration to reduce testosterone levels, are generally accepted methods of therapy. Hormone therapy (HT) using a pharmacological castration is the major and most commonly used method of treatment of patients with metastatic prostate cancer, the effectiveness of which is comparable with surgical castration. The article presents a review of studies that compared the effectiveness and side effects of HT with the use of surgical and medical castration, as well as the results of domestic studies evaluated the effectiveness of the application of the drug buserelin-domestic analogue of LHRH.

Magnetic resonance imaging in prostate cancer.

Prostate cancer screening and detection has historically been performed through the use of prostate-specific antigen (PSA) and systematic transrectal ultrasound guided biopsy among all men with perceived elevation of PSA level.

Diagnostic and Prognostic MicroRNA Biomarkers for Prostate Cancer in Cell-free Urine

BackgroundWidespread use of prostate-specific antigen (PSA) testing for prostate cancer (PC) detection has led to extensive overdiagnosis and overtreatment. Urine-based microRNA (miRNA) biomarkers could be useful in PC diagnosis and prognosis. ObjectiveTo train and validate urine-based microRNA (miRNA) biomarkers that may assist in PC diagnosis and prognosis. Design, setting, and participantsWe profiled the expression levels of 92 miRNAs via reverse transcriptase–poymerase chain reaction in cell-free urine samples from 29 patients with benign prostatic hyperplasia (BPH) and 215 patients with clinically localized PC (cohort 1). Our findings were validated in an independent cohort of 29 BPH patients and 220 patients with clinically localized PC (cohort 2). Results and limitationsWe identified and validated several deregulated miRNAs in urine samples from PC patients. In addition, we trained a novel diagnostic three-miRNA model (miR-222-3p*miR-24-3p/miR-30c-5p) that distinguished BPH and PC patients with an area under the curve (AUC) of 0.95 in cohort 1, and was successfully validated in cohort 2 (AUC 0.89). Furthermore, we trained a novel prognostic three-miRNA model (miR-125b-5p*let-7a-5p/miR-151-5p) that predicted time to biochemical recurrence after radical prostatectomy independently of routine clinicopathological parameters in cohort 1, and was successfully validated in cohort 2. ConclusionsFuture clinical implementation of our novel diagnostic and prognostic three-miRNA signatures could help in primary diagnosis of PC and guide treatment decisions. Further validation studies are warranted. Patient summaryUsing two large patient cohorts, we searched for novel prostate cancer biomarkers in urine. We found two new sets of microRNA biomarkers in urine that could accurately predict the presence of prostate cancer and the likelihood of recurrence after prostatectomy. Further studies are needed before an actual clinical test can be developed.

Nationwide analysis: Changes in the natural history of low risk localized prostate cancer.

12 Background: Increased use of prostate-specific antigen (PSA) has introduced an increase in PCa incidence and a lead time and stage migration at diagnosis, altering the natural history of PCa. Contemporary PCa patients are likely younger and have smaller tumor burden at diagnosis. We investigated if changes in the PCa landscape have altered the course of low-risk localized PCa. Methods: In the Danish Prostate Cancer Registry (DaPCaR), patients diagnosed from 1995 to 2011 with localized (T1-2, N0/X, M0) PCa with Gleason score ≤ 6 were identified. Patients were stratified into three periods of diagnosis; 1995-2000 (period 1), 2001-2005 (period 2) and 2006-2011 (period 3). Competing risk analysis treating PCa and other-cause death as competing events was performed. Results: Of the 5,660 patients identified, 35.9% had undergone radical prostatectomy (RP). From period 1 to period 3, the median age at diagnosis decreased from 72.2 to 66.0 years and the median PSA decreased from 16.2 to 8.6 ng/mL. From period 1 to period 3, the 5-year risk of PCa-death decreased from 14.3% (95% CI: 12.1-16.4%) to 1.3% (95% CI: 0.83-1.7%), p &lt; .0.0001 and the risk of other cause death decreased from 18.1% (95% CI: 15.8-20.5%) to 7.2% (95% CI: 6.2-8.2), p = 0.0001. In patients undergoing RP, the 5-year risk of PCa-death decreased from 0.67% (95% CI: 0.67-2.0%) for patients diagnosed in period 1 to 0.45% (95% CI: 0.0055-0.84), for patients diagnosed in period 3, p = 0.92. For patients not undergoing RP, the 5-year risk of PCa death decreased from 16.6% (95% CI: 14.1-19.1) to 2.0% (95% CI: 1.2-2.7%), p &lt; 0.0001. Conclusions: In a nationwide cohort of patients with low risk localized PCa, the 5-year risk of PCa-death significantly decreased when comparing patients diagnosed during 2006-2011 to those diagnosed during 1995-2000. This was mainly driven by patients not undergoing RP. In the most recently diagnosed group, the difference in 5-year PCa-death between patients undergoing RP and not undergoing RP was small (0.45% vs. 2.0%). Our data demonstrate that the impact of PSA induced lead-time and stage migration has diminished the absolute effect of RP on the risk of 5-year PCa-death because contemporary low-risk localized patients have a significantly better prognosis.

NEW APPROACHES TO PRECLINICAL DIAGNOSIS OF PROSTATE CANCER

THE AIM : to evaluate the clinical significance of the use of prostate-specific antigen (PSA) and its fractions and indexes for early detection of prostate cancer (PCA) in men with total PSA (tPSA) 2-10 ng/ml with a negative digital rectal examination (DRE). MATERIALS AND METHODS . It were examined 904 men aged 45-80 years with tPSA 2-10 ng/ml (Hybritech calibration) and a negative result DRE. Morphologic study of 628 people were identified benign prostatic hyperplasia (BPH) and 276 – PCA. All patients underwent ultrasound examination of the prostate, with determined total PSA (tPSA) concentration, its fractions and indexes. RESULTS. In PCA, the relative concentrations in the serum free PSA was 19% lower and the absolute content [-2]proPSA at 42% higher, and the prostate health idex (PHI) – at 49% higher. At low values of tPSA for prostate cancer would not be diagnosed in 9%, and at normal values of – 28% of patients. The sensitivity of the method at tPSA of 4.0 to 10.0 ng/ml is 0,630 and specificity of 0,519. tPSA, %fPSA were negative, but [-2]proPSA, %[-2] proPSA and PHI is positively correlated with the Gleason sum. All indicators in stage 2 for PCA are significantly different from the values characteristic of stage 1 of the disease. Though, for commonly used metrics – tPSA, fPSA and %fPSA – differences did not exceed 22-27%. However, [-2] proPSA, %[-2]proPSA and PHY at stage 2a increased by 20-53%, and at stage 2b – by 55-77%. CONCLUSION . The most informative indicators for early diagnosis of PCA was PHY, [-2]propsa. Determinatioms of PHY in the dynamics within the screening can substantially improve early diagnosis of PCA.

A Nationwide Survey of Prostate Specific Antigen Based Screening and Counseling for Prostate Cancer

IntroductionControversy surrounds prostate specific antigen screening following the 2012 U.S. Preventive Services Task Force grade D recommendation. There is limited evidence evaluating patterns of prostate specific antigen counseling and patient perceptions of the prostate specific antigen test since 2012. We evaluated the association between prostate cancer screening counseling and patient sociodemographic factors in a nationally representative sample. MethodsUsing data from the 2013 Health Information National Trends Survey we identified 768 male respondents age 40 to 75 years without a prior prostate cancer diagnosis. Using logistical regression we assessed trends in prostate cancer screening, counseling and prostate specific antigen use. ResultsOverall 54.1% of respondents reported ever having a prostate specific antigen test. Men undergoing prostate specific antigen testing were more likely to have had a prior cancer diagnosis other than prostate cancer (OR 3.93, 95% CI 1.19–12.94) and to have had at least some college education (OR 11.35, 95% CI 3.29–39.04). Men 40 to 49 years old had decreased odds of undergoing prostate specific antigen testing compared to men 50 to 69 years old (OR 0.20, 95% CI 0.10–0.39). History of cancer (OR 2.50, 95% CI 1.19–5.26) was associated with greater odds of being counseled on the potential adverse effects of prostate cancer treatment. Younger men (age 40 to 49 years) had decreased odds of discussing the prostate specific antigen test with a health care professional (OR 0.32, 95% CI 0.16–0.62) and being informed of the controversy surrounding prostate specific antigen screening (OR 0.35, 95% CI 0.13–0.95). ConclusionsWe show that certain men receive substantially different prostate specific antigen screening counseling, which may impact shared patient-provider decision making before prostate specific antigen counseling.

Difference of opinion - Radical prostatectomy in metastatic prostate cancer: is there enough evidence? | Opinion: Yes.

Prostate cancer (PCa) is the most frequent and the second ranked cause of cancer deaths among men each year. The vast majority of patients are diagnosed with localized disease, however it is estimated that 35,000 American men were diagnosed with locally advanced or metastatic prostate cancer (mPCa) in 2015 (1). During the last few years we have seen notable advances in the treatment of mPCa with the introduction of several second-line hormonal therapy options, immunotherapy and cytotoxic chemotherapy in hormone sensitive disease (2). With newer therapies that prolong survival in patients re-lapsing with mPCa and the increasingly widespread use of prostate-specific antigen (PSA) testing, men with metastatic disease might have lower disease burden at diagnosis than in the past decades (3). Although recent data suggest a relative improvement in 2-year overall survival in mPCa patients treated with systemic therapy, the long-term survival still remains disappointing. Actually, patients with mPCa and non-metastatic PCa present 5-year cancer-specific survival (CSS) rates of 28% and 99%, respectively (4). Thus, there is clearly room for improvement in the treatment of mPCa patients.The concept of cytoreductive surgery is well established in a number of tumors such as ovarian (5) and kidney cancer (6). Cytoreduction is still a largely unexplored subject in PCa, however recent evidences have shown its importance in the mPCa scena-rio. Possible theoretical advantages of cytoreductive prostatectomy (CP) include primary tumor debulking and improved response to systemic therapies. Kadmon et al. described one of the first studies addressing this issue in 1982. In an animal model, the authors used a PCa cell line that uniformly resulted in metastatic lung colonies. The mice were treated with either single-dose chemotherapy, surgical excision of the primary tumor, or a combination of tumor excision and postoperative single-dose chemotherapy. Tumor excision followed by postoperative chemotherapy resulted in a decrease in the number of metastatic sites in the lungs and prolonged survival. Of the combined group, 42% were long-term survivors (tumor-free >180 days), which was not seen in the non-surgery group (7). One additional potential mechanism of action for CP is based on the concept of tumor self-seeding. It is known that circulating tumor cells (CTCs) have the potential to seed metastases in distant organs in a unidirectional process. CTCs can also seed and then colonize their own tumors of origin, which accelerates tumor growth, angiogenesis and stromal recruitment through seed-derived factors (8). CTCs detected by the CellSearch®

Recent advances in prostate cancer pathology: Gleason grading and beyond.

Since its initial description in 1966 by Dr Donald Gleason, Gleason grading has become the cornerstone in the management of prostate cancer (PCa). With widespread use of Prostate Specific Antigen (PSA) screening and needle core biopsy, the diagnosis and management of PCa have dramatically evolved. In addition, better understanding of the morphological spectrum of prostate cancer and its clinical significance have prompted the refinement of the grading criteria and reporting guidelines commensurate to contemporary practice. The modification of the Gleason grading system implemented by the International Society of Urological Pathology in 2005 and subsequent revision in 2014 has profoundly impacted how PCa is graded and managed. This review aims to provide a concise update on the refinement of the histological criteria for various Gleason patterns and problem areas of Gleason grading, and provide recommendations on how to improve the grading reproducibility. The new proposal to group Gleason scores into clinically meaningful "grade groups" will also be discussed. Finally, we will discuss how magnetic resonance imaging (MRI)-targeted biopsy and emerging genetic markers may help improve the Gleason grading accuracy and risk stratification currently based on clinicopathological parameters.

93 A nationwide survey of prostate specific antigen based screening and counseling for prostate cancer

Abstract Introduction Controversy surrounds prostate specific antigen screening following the 2012 U.S. Preventive Services Task Force grade D recommendation. There is limited evidence evaluating patterns of prostate specific antigen counseling and patient perceptions of the prostate specific antigen test since 2012. We evaluated the association between prostate cancer screening counseling and patient sociodemographic factors in a nationally representative sample. Methods Using data from the 2013 Health Information National Trends Survey we identified 768 male respondents age 40 to 75 years without a prior prostate cancer diagnosis. Using logistical regression we assessed trends in prostate cancer screening, counseling and prostate specific antigen use. Results Overall 54.1% of respondents reported ever having a prostate specific antigen test. Men undergoing prostate specific antigen testing were more likely to have had a prior cancer diagnosis other than prostate cancer (OR 3.93, 95% CI 1.19–12.94) and to have had at least some college education (OR 11.35, 95% CI 3.29–39.04). Men 40 to 49 years old had decreased odds of undergoing prostate specific antigen testing compared to men 50 to 69 years old (OR 0.20, 95% CI 0.10–0.39). History of cancer (OR 2.50, 95% CI 1.19–5.26) was associated with greater odds of being counseled on the potential adverse effects of prostate cancer treatment. Younger men (age 40 to 49 years) had decreased odds of discussing the prostate specific antigen test with a health care professional (OR 0.32, 95% CI 0.16–0.62) and being informed of the controversy surrounding prostate specific antigen screening (OR 0.35, 95% CI 0.13–0.95). Conclusions We show that certain men receive substantially different prostate specific antigen screening counseling, which may impact shared patient-provider decision making before prostate specific antigen counseling.

Trends in prostate cancer incidence and mortality in Canada during the era of prostate-specific antigen screening.

Widespread use of prostate-specific antigen (PSA) to screen for prostate cancer began in the early 1990s. Advocates for screening assert that this has caused a decrease in prostate cancer mortality. We sought to describe secular changes in prostate cancer incidence and mortality in Canada in relation to the onset of PSA screening. Age-standardized and age-specific prostate cancer incidence (1969-2007) and mortality (1969-2009) from Public Health Agency of Canada databases were analyzed by joinpoint regression. Changes in incidence and mortality were related to introduction of PSA screening. Prior to PSA screening, prostate cancer incidence increased from 54.2 to 99.8 per 100 000 between 1969 and 1990. Thereafter, incidence increased sharply (12.8% per year) to peak at 140.8/100 000 in 1993. After decreasing in all age groups between 1993 and 1996, incidence continued to increase for men aged less than 70 years, but decreased for older men. Age-standardized mortality was stable from 1969 to 1977, increased 1.4% per year to peak in 1995 and subsequently decreased at 3.3% per year; the decline started from 1987 in younger men (age < 60 yr). Incidence was increasing before PSA screening occurred, but rose further after it was introduced. Reductions in prostate cancer mortality began before PSA screening was widely used and were larger than could be anticipated from screening alone. These findings suggest that screening caused artifactual increase in incidence, but no more than a part of reductions in prostate cancer mortality. The reduction may be due to changing treatment or certification of death.

The True NTH Prostate Cancer Survivorship Care programme: Development and evaluation of a model for delivering follow-up care to men with prostate cancer.

42 Background: Increasing use of prostate specific antigen (PSA), improvements in treatment and aging population have led to the escalating incidence of prostate cancer. 5 year survival rate is relatively high and men who have completed treatment require long-term follow-up to detect recurrence or progression of disease, monitor adverse effects of treatment and identify and address psychosocial needs. Studies demonstrate men have a range of unmet physical and psychosocial needs, and health services are struggling to cope with the growing numbers. Changes is critical for long-term sustainability of the health system in many developed nations Methods: This presentation presents a model of follow up care centered on remote surveillance of PSA combined with promoting patient self-management. This initiative is part of the True NTH programme of developments initiated in the UK with funding from Movember Foundation and Prostate Cancer UK. Traditional face to face clinic follow up consultations are replaced with: patient directed individually tailored care and surveillance programme which involves: a 4 hour preparatory patient workshop, remote assessment of unmet needs and symptoms and surveillance of PSA, patient information resources, survivorship care plan, communication of treatment summary and management plan to primary care, and rapid recall system for assessment in secondary care should the need arise. The care programme is mediated through clinician and patient access to an IT portal enabling communication. Results: The second part of the presentation will describe the evaluation protocol. A historical cohort design is comparing a group of men receiving clinic follow up care (N = 300) with men enrolled on the care programme (N = 300) in 3 centers. Patient-reported outcomes are collected at baseline, 4 months and 8 months. Health economic evaluation will compare costs of clinic based follow up with those of the care programme from both a health service and patient perspective. Conclusions: The evaluation will generate data on impact, acceptability and cost of this model of follow-up care.

Transrektalna ultrazvočna preiskava in igelna biopisja prostate

In the last 25 years widespread use of prostatic specific antigen caused a stage migration of prostate cancer towards localized disease at diagnosis, which resulted in transrectal ultrasound biopsy to become standard in clinical practice. Transrectal ultrasound examination of the prostate is used to diagnose benign prostatic diseases, e.g. benign prostatic enlargement, prostatitis, prostatic and seminal vesicle cysts. It is also important in detection of obstructive causes of male infertility. Transrectal ultrasound examination is performed most often in needle biopsy for prostate cancer diagnosis. Besides guiding systematic tissue core biopsy, characteristic ultrasound changes enables target biopsies of suspect areas. The article describes indications, contraindications, antibiotic prophylaxis, various biopsy templates and complications of the needle biopsy. Experience with transrectal ultrasound guided biopsy at Department of urology at University medical center in Ljubljana is presented.

Utility of Prostate Cancer Screening in Kidney Transplant Candidates.

Screening recommendations for prostate cancer remain controversial, and no specific guidelines exist for screening in renal transplant candidates. To examine whether the use of prostate-specific antigen (PSA)-based screening in patients with ESRD affects time to transplantation and transplant outcomes, we retrospectively analyzed 3782 male patients ≥18 years of age undergoing primary renal transplant evaluation during a 10-year period. Patients were grouped by age per American Urological Association screening guidelines: group 1, patients <55 years; group 2, patients 55-69 years; and group 3, patients >69 years. A positive screening test result was defined as a PSA level >4 ng/ml. We used univariate analysis and Cox proportional hazards models to identify the independent effect of screening on transplant waiting times, patient survival, and graft survival. Screening was performed in 63.6% of candidates, and 1198 candidates (31.7%) received kidney transplants. PSA screening was not associated with improved patient survival after transplantation (P=0.24). However, it did increase the time to listing and transplantation for candidates in groups 1 and 2 who had a positive screening result (P<0.05). Furthermore, compared with candidates who were not screened, PSA-screened candidates had a reduced likelihood of receiving a transplant regardless of the screening outcome (P<0.001). These data strongly suggest that PSA screening for prostate cancer may be more harmful than protective in renal transplant candidates because it does not appear to confer a survival benefit to these candidates and may delay listing and decrease transplantation rates.

Multiparametric prostate magnetic resonance imaging in the evaluation of prostate cancer.

Imaging has traditionally played a minor role in the diagnosis and staging of prostate cancer. However, recent controversies generated by the use of prostate-specific antigen (PSA) screening followed by random biopsy have encouraged the development of new imaging methods for prostate cancer. Multiparametric magnetic resonance imaging (mpMRI) has emerged as the imaging method best able to detect clinically significant prostate cancers and to guide biopsies. Here, the authors explain what mpMRI is and how it is used clinically, especially with regard to high-risk populations, and we discuss the impact of mpMRI on treatment decisions for men with prostate cancer. CA Cancer J Clin 2016;66:326-336. © 2015 American Cancer Society.

Prostate cancer screening practices and diagnoses in patients age 50 and older, Southeastern Michigan, pre/post 2012

IntroductionStudies investigating the regional impact of the 2012 U.S. Preventive Services Task Force (USPSTF) recommendation against the use of prostate specific antigen (PSA) screening for prostate cancer have been limited. MethodsA retrospective cohort study was conducted on men age 50years and older in Southeastern Michigan pre (n=3647) and post (n=3618) USPSTF recommendation. PSA screening, transrectal ultrasound, and prostate biopsy rates were evaluated pre/post using a generalized piecewise linear model with a Poisson distribution, and log link. A knot was placed at year 2011 to estimate pre/post slope coefficients. Generalized estimating equations were used to estimate the marginal probability of a prostate diagnosis as a logistic function of pre and post-period, and comorbidities. ResultsPSA utilization significantly increased (β=0.28; 95% CI: 0.25, 0.31) during the pre-period, but significantly decreased in the post-period (β=−0.29; 95% CI: −0.34, −0.25). Prostate biopsies decreased pre (β=−0.16; 95% CI: −0.25, −0.08) and did not change post (β=0.01; 95% CI: −0.09, 0.12). Transrectal ultrasounds were stable pre (β=0.16; 95% CI: −0.03, 0.35) and significantly decreased post (β=−0.27; 95% CI: −0.50, −0.04). Patients in the post-period had a decreased probability of having a diagnosis of prostate cancer (OR: 0.81; 95% CI: 0.74–0.89) compared to the pre-period. ConclusionOur study demonstrates how PSA tests are still being frequently used in Southeastern Michigan. Further research is needed to better understand regional variation in prostate cancer screening practices in the U.S.