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PubMed2001

Age, prostate-specific antigen, and digital rectal examination as determinants of the probability of having prostate cancer.

OBJECTIVES: The decision to perform prostate biopsy has traditionally been based on an abnormal prostate-specific antigen (PSA) level or abnormal digital rectal examination (DRE) findings. For example, a 60-year-old man with a benign DRE and PSA level of 4.1 ng/mL would be counseled for biopsy, and the same man with a PSA level of 3.9 ng/mL might be counseled against biopsy. However, the difference in these PSA levels and in the likelihood of these two men having prostate cancer is not significant. We constructed a probability nomogram for the likelihood of detecting prostate cancer, thus aiding in the decision of whether to perform a prostate biopsy. METHODS: Using multivariate logistic regression analysis and data from 2054 men (mean age 64 years) participating in the Tyrol Screening Project between January 9, 1993 and January 9, 1997, patient age, PSA level, and DRE findings were analyzed for their ability to determine the likelihood of finding prostate cancer on transrectal ultrasound-guided biopsy. RESULTS: DRE was suspicious in 278 men (13.5%). Overall, 498 (24.5%) of 2054 men biopsied had prostate cancer. The probability of discovering cancer on biopsy was calculated using patient age, DRE findings, and PSA level. CONCLUSIONS: DRE status had a large influence on the likelihood of positive biopsy across all PSA and age ranges. A combination of PSA, DRE result, and age better defined the probability of a positive biopsy than any factor alone. Using this nomogram, the decision to proceed with or defer prostate biopsy can be based on an actual probability of discovering prostate cancer rather than a single PSA-based cutpoint. These data may aid physicians and patients in decision-making.

Age Factors↗
PubMed2002

Serum pro-gastrin-releasing peptide (31-98) in benign prostatic hyperplasia and prostatic carcinoma.

OBJECTIVES: To clarify whether serum levels of pro-gastrin-releasing peptide (ProGRP) (31-98) could be a useful marker in patients with prostatic carcinoma. GRP is produced and secreted by prostatic neuroendocrine cells. METHODS: Serum levels of ProGRP(31-98) were measured by enzyme-linked immunosorbent assay in 20 patients with benign prostatic hyperplasia and 107 patients with prostatic carcinoma. RESULTS: The mean serum levels of ProGRP(31-98) in patients with distant metastasis and hormone-resistant prostate cancer were significantly elevated compared with those in patients with organ-confined disease. Significantly elevated levels of ProGRP(31-98) were detected in 9 patients with prostatic carcinoma before any treatment. During hormone-resistant prostate cancer progression, ProGRP(31-98) levels were elevated in 9 patients (23%). Of the 9 patients with Stage D3 and elevated serum ProGRP, 4 had a normal serum prostate-specific antigen level. CONCLUSIONS: ProGRP may be a potential tumor marker for prostate cancer. Additional studies in large groups of patients are needed to define the clinical value of ProGRP.

Adenocarcinoma↗
PubMed2003

Benign growth of different prostate zones in aging men with slightly elevated PSA in whom prostate cancer has been excluded: a prospective study of 510 patients.

OBJECTIVES: To study, in a selected series of patients, whether the peripheral/central zone volumes also change with age. The reported normal total prostate volume in the third decade seems not to exceed 25 to 30 cm(3). Benign prostatic hyperplasia is generally accepted to originate in the transition zone and periurethral tissue, which accordingly show substantial growth with age. METHODS: From January 1997 through December 2000, we performed transrectal ultrasound volume measurements of the different prostate zones in patients admitted for suspected prostate cancer. The information was registered according to a prospectively designed protocol. A total of 872 patients were examined, of whom 360 shown to have prostate cancer were excluded. Two more patients were excluded because of missing volume data, leaving 510 patients with noncancerous prostates for inclusion in this study. RESULTS: The mean age was 62.8 years and the mean total prostate-specific antigen level was 9.8 microg/L. It was found that 64.9% (331 of 510) had a peripheral/central zone volume larger than 30 cm(3), indicating that some form of growth had occurred also in this zone. A weak but significant correlation was found between age and the peripheral/central zone volume. CONCLUSIONS: The results of our study indicate that the peripheral/central zone may contribute to the benign growth of the prostate gland in men younger than 70 years old with slightly elevated total prostate-specific antigen levels.

Adult↗
PubMed1998

Treatment with finasteride preserves usefulness of prostate-specific antigen in the detection of prostate cancer: results of a randomized, double-blind, placebo-controlled clinical trial. PLESS Study Group. Proscar Long-term Efficacy and Safety Study.

OBJECTIVES: To evaluate prostate cancer detection and prostate-specific antigen (PSA) among men with benign prostatic hyperplasia treated with finasteride. METHODS: Three thousand forty men 45 to 78 years of age with PSA less than 10 ng/mL and no history of prostate cancer were randomized in a double-blind, placebo-controlled trial to finasteride (n = 1524) or placebo (n = 1516) for up to 4 years. A prerandomization biopsy negative for prostate cancer was obtained in 98% of patients with a screening PSA of 4.0 ng/mL or more, and an end-of-study biopsy was requested of all such patients without a recent second negative biopsy or a prostate cancer diagnosis. RESULTS: Overall, 644 patients (21%) underwent biopsy and 201 (6.6%) underwent transurethral resection of the prostate. Prostate cancer was diagnosed in 4.7% of men on finasteride and 5.1% on placebo (P = 0.7). Elevated PSA prompted diagnosis in 35% of cases on finasteride and 34% on placebo. The area under the receiver operating characteristic curve for last PSA was 0.84 on finasteride and 0.79 on placebo (P = 0.07). Use of an upper limit of normal for last PSA of 2.0 ng/mL for finasteride and 4.0 ng/mL for placebo yielded similar sensitivity (66% versus 70%, P = 0.6), higher specificity (82% versus 74%, P < 0.0001), and a higher likelihood ratio (3.6 versus 2.7, P < 0.05) for finasteride than for placebo. CONCLUSIONS: In men treated with finasteride, multiplying PSA by 2 and using normal ranges for untreated men preserves the usefulness of PSA for prostate cancer detection.

Aged↗
PubMed1999

Total and transition zone prostate volume and age: how do they affect the utility of PSA-based diagnostic parameters for early prostate cancer detection?

OBJECTIVES: To define the role of total prostate (TP) volume, transition zone (TZ) volume, and age as determinants of the utility of prostate-specific antigen (PSA)-based diagnostic parameters for early detection of prostate cancer (PCa) in a prospective multicenter study. METHODS: The study participants were 974 consecutive men with serum total PSA (tPSA) levels of 4 to 10 ng/mL who were referred for early PCa detection or lower urinary tract symptoms. All patients underwent prostate ultrasound examination and sextant biopsy with two additional TZ biopsies. In patients with negative initial biopsies, repeated biopsies were performed at 6 weeks. tPSA, the free/total PSA ratio (f/t PSA), PSA density of the TZ (PSA-TZ), PSA density (PSAD), and PSA velocity (PSAV) were determined and compared across TP volume strata of 30 cm3 or less and greater than 30 cm3, TZ volume strata of 20 cm3 or less and greater than 20 cm3, and various age groups to evaluate the need for volume and/or age-specific reference ranges. RESULTS: PCa was found in 345 (35.4%) of 974 patients and benign prostatic tissue was found in 629 (64.6%) of 947 patients. Across TP volume strata, significantly higher values of tPSA (P <0.01), PSA-TZ, PSAD (P <0.001), and PSAV (P <0.05) and lower values of f/t PSA (P <0.001) were observed in patients with PCa than in those without PCa. Similar results were obtained with respect to TZ volume strata, except in the case of PSAV (P <0.05). tPSA, PSA-TZ, and PSAD were significantly higher (P <0.05) in patients with PCa than in those without PCa for all corresponding age ranges. In patients with PCa, f/t PSA was significantly lower (P <0.001) within the same age ranges. Within each group (PCa or benign), f/t PSA, PSAD, PSA-TZ, and PSAV values were unaffected by age strata. However, PSA parameters dependent on prostate volume (PSAD, PSA-TZ) were statistically lower (P <0.001) in prostates with a higher TP volume (greater than 30 cm3) and TZ volume (greater than 20 cm3); f/t PSA values were unaffected by TP and TZ volumes. CONCLUSIONS: f/t PSA and PSA-TZ were the most powerful parameters to differentiate between benign prostatic tissue and PCa. f/t PSA was the sole parameter unaffected by age and prostate volume. We believe new volume-specific cutpoints, as presented in the current study, should be employed when using PSAD and PSA-TZ for the early detection of PCa.

Adult↗
PubMed2005

[Isolated intraepithelial prostatic neoplasia and positive prostate adenocarcinoma results at repeated biopsy. Review of our series].

OBJECTIVE: To review the incidence of isolated prostatic intraepithelial neoplasia (PIN) as well as the positive prostate cancer results in repeat biopsy in our series of transrectal biopsy of the prostate. We compare these results with the actual literature. MATERIALS AND METHODS: We review the 2.475 transrectal ultrasound guided biopsies of the prostate made in our department from January 1992 to June 2004 looking for intraepithelial neoplasia and looking in particular for isolated High-grade PIN (HGPIN). We review repeat biopsies made at this patients and the likelihood of detecting prostate cancer in them. RESULTS: The diagnosis of PIN was found in 31 biopsies, 13 of them were isolated HGPIN what means a 0.52% incidence of the total biopsies performed in our department. We performed 7 repeat biopsies of the 13 cases in a period from 3 months to 2 years after the first biopsy, and we found 3 cases of prostate cancer what means that 43% of isolated HGPIN with repeated biopsy showed prostate cancer. The mean age of the patients studied was 67 years (range 53-88). The median PSA value of the studied cases was 9.8 ng/ml. The Gleason score of the positive biopsies was always between 3 and 7. In our series, age and PSA levels did not have correlation with the positive results for prostate cancer in repeated biopsies. CONCLUSIONS: In spite of a lower number of HGPIN cases in our series, the positive for prostate cancer in repeated biopsy (43%) is similar to the incidence reported in literature so it is advisable rigorous controls and repeated biopsies for these patients.

Adenocarcinoma↗
PubMed2001

The clinical utility of the percent of positive prostate biopsies in predicting biochemical outcome following external-beam radiation therapy for patients with clinically localized prostate cancer.

PURPOSE: An investigation was performed of the clinical utility of the percent of positive prostate biopsies in predicting prostate-specific antigen (PSA) outcome following external-beam radiation therapy (RT) for men with PSA-detected or clinically palpable prostate cancer. METHODS AND MATERIALS: A Cox regression multivariable analysis was used to determine whether the percent of positive prostate biopsies provided clinically relevant information about PSA outcome following external beam RT in 473 men while accounting for the previously established risk groups based on the pretreatment PSA level, biopsy Gleason score, and the 1992 American Joint Commission on Cancer (AJCC) clinical T stage. RESULTS: Controlling for the known prognostic factors, the percent of positive prostate biopsies added clinically significant information (p = 0.02) regarding time to PSA failure following RT. Specifically, 76% of the patients in the intermediate risk group (1992 AJCC T(2b) or biopsy Gleason 7 or PSA > 10 ng/mL and < or = 20 ng/mL) could be classified into either an 30% or 85% 5-year PSA control cohort using the preoperative prostate biopsy data. CONCLUSION: The previously validated stratification of PSA outcome following radical prostatectomy (RP) using the percent of positive prostate biopsies in intermediate-risk patients is also clinically significant for men treated with external beam RT. The percent positive prostate biopsies should be considered in conjunction with the PSA level, biopsy Gleason score, and 1992 AJCC clinical T stage when counseling patients with newly diagnosed and clinically localized prostate cancer about PSA outcome following RP or external beam RT.

Biopsy↗
PubMed1998

Longitudinal evaluation of the complexed-to-total prostate specific antigen ratio in men with prostate disease. Effect of treatment.

The longitudinal changes in the complexed-to-total prostate specific antigen (PSA) ratio were evaluated in 90 men with benign prostatic hyperplasia (BPH) and 50 men with prostate cancer. The influence of treatment on this ratio was studied in 45 BPH patients and 50 patients with prostate cancer. Using a cut-off of 0.80 for the complexed-to-total PSA ratio, the large majority of prostate cancer patients had a ratio above the cut-off before treatment in serial determinations, whereas most BPH patients had a ratio consistently below that value. However, the few prostate cancer patients who had a ratio < or = 0.80 showed this low ratio in serial determinations, as did BPH patients who had a ratio > or = 0.80. During treatment, the ratio significantly decreased in 43 of the 50 patients with prostate cancer in parallel with the decrease in total PSA, and 34 of the 41 patients that had a pretreatment ratio > 0.80 showed a ratio < or = 0.80 during hormonal therapy. Our results show that neither the physiological changes in total and complexed PSA nor the treatment of BPH patients change the diagnostic efficacy of the complexed-to-total PSA ratio, whereas in prostate cancer patients under hormonal therapy, the ratio decreased in parallel with the decrease in total PSA. This suggests that, apart from improving the diagnostic efficacy of total PSA, the complexed-to-total PSA ratio could also be used to monitor BPH patients for newly developed tumours or to monitor therapy in patients with prostate cancer.

Antineoplastic Agents, Hormonal↗
PubMed1999

Ratio of gamma-seminoprotein to prostate-specific antigen for the detection of prostate cancer: its discrimination power could be influenced by the assay methods of PSA and/or gamma-seminoprotein.

BACKGROUND: The ratio of gamma-seminoprotein (gamma-Sm) and prostate-specific antigen (PSA) has been regarded as being superior over PSA alone as a discriminator between prostate cancer and benign prostatic diseases. In previous studies, PSA and gamma-Sm were measured by the Eiken kit and the old-version or revised Chugai kit, respectively. We compared the power of gamma-Sm ratio with that of PSA alone when using Markit-M PSA assay and the revised Chugai gamma-Sm assay. METHODS: Fifty-three patients with prostate cancer having no metastasis and 116 with benign prostatic diseases were enrolled in this study. Prostate-specific antigen was measured by Markit-M kit and gamma-Sm was measured by the revised Chugai kit. The discrimination power of gamma-Sm ratio and PSA alone was evaluated with receiver operating characteristic (ROC) curves. Comparisons between prostate cancer and benign diseases were performed with Mann Whitney U-test and Fisher's exact test. RESULTS: The optimal cut-off value was set at 3.1 ng/mL for PSA and 0.935 for gamma-Sm ratio. Sensitivity, specificity and positive predictive value of PSA alone were 81.1, 81.0 and 66.2%, respectively, while those of gamma-Sm ratio were 73.6, 90.5 and 78.0%, respectively. There was no statistical significance in each value between PSA and gamma-Sm ratio. Areas under the ROC curves of PSA and gamma-Sm ratio were 0.881 and 0.866, respectively (P>0.05). CONCLUSION: Contrary to the previous reports, gamma-Sm ratio and PSA were not different in the discrimination between prostate cancer and benign prostatic diseases, which suggested that the discrimination power of gamma-Sm ratio, and presumably that of the free PSA to total PSA ratio as well, could be considerably influenced by the assay kits for serum PSA and/or gamma-Sm (free PSA) used. Therefore, the clinical significance of gamma-Sm ratio should be evaluated for each PSA assay kit.

Biomarkers, Tumor↗
PubMed2004

Quantification of prostate specific antigen mRNA levels in circulation after prostatic surgery and endocrine treatment by quantitative reverse transcription-polymerase chain reaction.

Various methods to detect prostatic cells in circulation have given conflicting results. This is probably because qualitative rather than quantitative methods have been used to detect mRNA from prostatic cells. A quantitative method has been developed based on reverse transcription-polymerase chain reaction (RT-PCR) for detection of prostate specific antigen (PSA) mRNA in peripheral blood. A competitive internal mRNA standard was used for quantification of absolute amounts of PSA mRNA. The detection limit of the assay was 7 copies of mRNA, and the highest level of circulating PSA mRNA in 88 control subjects was 25 copies per milliliter of blood. This method was used to study the influence of prostatic surgery and endocrine treatment on prostatic cells in the circulation of 56 patients undergoing biopsy, radical prostatectomy, transurethral resection of the prostate (TURP), orchiectomy, or androgen blockade. Blood samples were drawn before, during and up to 26 weeks after these procedures had been carried out. The highest level of PSA mRNA in controls was 25 copies per milliliter of blood. After RP, TURP or orchiectomy, PSA mRNA levels increased above this level in 27%, 29%, and 25% of the samples, respectively. After prostate biopsy, two out of 15 patients became positive. PSA mRNA levels that were elevated by surgery became undetectable within 1-3 days. No significant correlation was found between PCR positivity and the clinical characteristics of the patients. It is concluded that the level of PSA mRNA in peripheral blood increases after prostatic surgery, indicating temporary dissemination of prostatic cells. However, preoperative levels do not correlate with serum PSA, stage or grade.

Cell Line↗
PubMedDate not supplied

Complications following combined transrectal ultrasound-guided prostate needle biopsies and transurethral resection of the prostate.

In order to evaluate safety and morbidity aspects of additional systematic prostate biopsies, we have conducted a retrospective review of patients who had undergone transurethral resection of the prostate (TUR-P) combined with additional systemic prostate needle biopsies at the Chang Gung Memorial Hospital. To this end, the records of 80 men presenting consecutively at our institution between February 2001 and January 2004 inclusively were examined. These 80 individuals included patients experiencing obstructive voiding symptoms and those featuring suspicious screening parameters, all of whom were to undergo transurethral resection of the prostate for symptomatic benign prostatic hyperplasia (BPH), all procedures being performed by a single surgeon. A total of 20 (25%) specimens were found to be positive for prostate cancer. Cancer was detected in the transrectal prostate biopsy specimen of 16 of 57 men (28%) who had not undergone a previous prostate biopsy, and for four of 23 (17%) who had undergone at least one previous (benign) biopsy. Mild complications associated with transurethral prostrate resection, such as hematuria and hemospermia, were reported frequently, featuring rates of 10% and 2.5%, respectively; more severe complications being noted far less frequently. Fever, usually of a low grade, was observed post-operatively for six (7.5%) patients, but a prompt return to normal temperature following antibiotic treatment for one day was revealed. Four (5%) patients remained admitted to the hospital for a prolonged period following surgery. A review of the literature concerning transrectal biopsies and TUR-P has shown that surgery-associated complication rates are slightly lower than was the case for our study. Additional systematic prostate biopsies for patients undergoing TUR-P would appear to be a relatively safe treatment procedure. Identification of risk factors for post-surgery complications might further improve the safety of the screening procedure.

Aged↗
PubMed1999

Role of transurethral resection of the prostate in population-based prostate cancer incidence rates.

The extensive pool of asymptomatic prostate disease in the population, which increases substantially with age, suggests that the frequent use of transurethral resection of the prostate (TURP) in recent decades has had a large effect on prostate cancer incidence. The authors identified the effect of TURP-detected prostate cancer on the observed incidence rates between 1973 and 1993 for men aged 65 years and older. They linked population-based cancer registry data from the Surveillance, Epidemiology, and End Results Program to Medicare records between 1986 and 1993 to determine whether a TURP occurred sufficiently close to the time of a prostate cancer diagnosis for them to assume that it led to the diagnosis. TURP-detected cases prior to 1986 were calculated using an indirect method that involved multiplying the TURP procedure rate in the general population (from the National Hospital Discharge Survey) by estimates of the proportion of TURPs resulting in a prostate cancer diagnosis (from Medicare data and the literature). TURP explained much of the observed increase in overall prostate cancer incidence between 1973 and 1986 and possibly all of it in men aged 70 years and older. However, its influence on the trend and overall magnitude of the rates diminished between 1987 and 1993. The changing role of TURP in detecting prostate cancer is attributed to changes in medical technology and screening practices. The declining influence of TURP on prostate cancer incidence is likely to have continued beyond the study period due to the recent introduction and increasing use of medications for treating obstructive uropathy.

Aged↗
PubMed1995

Effect of inflammation and benign prostatic hyperplasia on elevated serum prostate specific antigen levels.

PURPOSE: We quantify the causes of elevated serum prostate specific antigen (PSA) concentrations in men whose prostate biopsies repeatedly showed no cancer. MATERIALS AND METHODS: The effects of prostate volume, inflammation, echogenicity on ultrasound and calculi were examined in a large PSA-based screening population of 148 men with serum PSA concentrations greater than 4.0 ng./ml., findings suspicious for cancer on digital rectal examination and multiple negative biopsies. These men were selected and compared to 64 men with suspicious rectal examinations, multiple negative biopsies and serum PSA concentrations of 4.0 ng./ml. or less. RESULTS: The high PSA group had larger prostates (68 versus 33 cc, p = 0.0001) and significantly more subclinical prostatic inflammation. Acute and chronic inflammation was more prevalent in the high PSA group (63% versus 27%, p = 0.0001 and 99% versus 77%, p = 0.0001, respectively). A simultaneous regression analysis showed that prostatic size accounted for 23%, inflammation 7%, prostatic calculi 3% and nonisoechoic ultrasound lesions 1% of the serum PSA variance. CONCLUSIONS: Prostate volume and inflammation are the most important factors contributing to serum PSA elevation in men without clinically detectable prostate cancer.

Aged↗
PubMed1996

A comparison of the free fraction of serum prostate specific antigen in men with benign and cancerous prostates: the best case scenario.

PURPOSE: In most previous studies of free-to-total serum prostate specific antigen (PSA) ratios, the specimens from patients with prostate cancer or those with benign prostatic hyperplasia (BPH) have not been highly characterized. We compared preoperative sera from post-radical prostatectomy patients with clinically significant cancers of at least 2 cm.3 to sera from those with BPH and large, biopsy negative prostates. MATERIALS AND METHODS: We used 2 different time resolved immunofluorometric assays for free and total PSA, and a combination of a chemoluminescent immunoassay for free PSA detection with an immunoradiometric assay for total PSA to measure free and total PSA. The serum ratios of free-to-total PSA in these assays were compared to those obtained previously from gel filtration studies. Sera from 51 men with prostate cancer volumes of 2 to 18 cm.3 were compared to those from 48 men with BPH and a mean prostate volume of 78 +/- 7 cm.3. The respective mean serum PSA levels plus or minus standard deviation were 10.0 +/- 6.3 and 8.9 +/- 7.2 ng./ml. RESULTS: Monoclonal assays for free PSA confirmed the previous study with gel filtration. For PSA 4 to 10 ng./ml., 94 to 95% of the men with prostate cancer were correctly diagnosed, with a cutoff of less than 15% for free-to-total PSA on immunofluorometric assay and less than 14% for chemoluminescent immunoassay with immunoradiometric assay. However, 46% (immunofluorometric assay) and 36% (chemoluminescent immunoassay and immunoradiometric assay) of men with BPH did not have enough free PSA for diagnosis of BPH (that is 36 to 46% false-positive rate). CONCLUSIONS: For total PSA 4 to 10 ng./ml., the sensitivity of approximately 15% free-to-total PSA for prostate cancer is high (94 to 95%) but 36 to 46% of men with BPH and a large gland will not be correctly identified. For PSA 2 to 4 ng./ml., no ratio of percent free-to-total PSA discriminated BPH from prostate cancer.

Antibodies, Monoclonal↗
PubMedDate not supplied

Postprostatectomy salvage radiation therapy for prostate cancer: impact of pathological and biochemical variables and prostate fossa biopsy.

PURPOSE: A subgroup of prostate cancer patients who have experienced biochemical relapse after radical retropubic prostatectomy (RRP) can benefit from radiation therapy to the prostate fossa. These patients demonstrate biochemical relapse secondary to local failure in the absence of distant failure. In order to define this subgroup, we investigated the impact of pathological and biochemical variables and pre-radiation therapy biopsy of the prostate fossa on biochemical disease-free survival (bNED) and initial prostate-specific antigen response. METHODS: Sixty-two patients with localized prostate cancer who had biochemical relapse after RRP were treated with post-RRP radiation therapy localized to the prostate fossa (median dose, 6120 cGy) and were subsequently followed up for a median time of 47 months. Cox regression analyses and Kaplan-Meier estimates for bNED were used to identify prognostic variables. The Fisher's exact test was used to test the interaction of initial prostate-specific antigen response with identified prognostic variables. RESULTS: Cox regression analysis of bNED as a function of pathological and biochemical parameters showed that only Gleason's score was a significant predictor of bNED. On univariate analysis, seminal vesicle involvement was also found to be a significant predictor. Prostate fossa biopsy result was not significantly related to bNED. Because of the overall high rates of biochemical failure, we wished to identify a high-risk subgroup that did not have local relapse as a component of biochemical relapse after RRP. We assessed initial biochemical response following radiation therapy as a surrogate for local relapse. A complete biochemical response was observed in 50% of patients, and a partial biochemical response was observed in an additional 34%, yielding an overall biochemical response rate of 84%. When stratified by Gleason's score, seminal vesicle, pre-radiation therapy prostate-specific antigen, and biopsy result, response rates greater than 50% were seen for all subgroups. CONCLUSIONS: Gleason's score and seminal vesicle involvement predicted bNED after post-RRP radiation therapy in our cohort. Overall biochemical response rates were high in all subgroups, suggesting that all subgroups demonstrated a high likelihood of residual local disease as a component of failure. Pre-radiation therapy biopsy was predictive of neither bNED nor overall biochemical response.

Adenocarcinoma↗
PubMedDate not supplied

Prognostic significance of percent positive biopsies in clinically organ-confined prostate cancer treated with permanent prostate brachytherapy with or without supplemental external-beam radiation.

PURPOSE: The purpose of this paper was to evaluate the relationship between the percentage of positive biopsies and the biochemical outcome in hormone-naive patients undergoing permanent prostate brachytherapy with or without supplemental external-beam radiation therapy. MATERIALS AND METHODS: Four hundred thirteen hormone-naive patients underwent prostate brachytherapy for clinical T1c-T2b NxM0 (1997 American Joint Committee on Cancer classification) adenocarcinoma of the prostate gland from April 1995 through June 2001. The median patient age was 66.9 years, and the median pretreatment prostate-specific antigen value was 6.8 ng/mL. The median follow-up was 52 months. Patients were stratified by percentage of positive biopsy results into the following cohorts: < 34%, 34%-50%, and > 50%. The influences of percentage of positive biopsy results, patient age, clinical T stage, Gleason score, pretreatment prostate-specific antigen value, risk group, prostate volume, supplemental external-beam radiation therapy, isotope, percentage of prescribed dose covering 90% of the target volume (D90), and volume receiving 100%, 150%, and 200% of the prescribed dose (V100/150/200) were evaluated. Biochemical disease-free survival was defined by the American Society of Therapeutic Radiology and Oncology consensus definition. RESULTS: For all 413 patients, the 7-year actuarial freedom from biochemical progression rate was 99.4%, 94.3%, and 89.2% when stratified by percentage of positive biopsy results in the < 34%, 34%-50%, and > 50% groups, respectively. When low-, intermediate-, and high-risk patients were stratified by percentage of positive biopsy results, a nonsignificant trend for increased biochemical progression was noted with increasing positive biopsy results. In multivariate analysis, percentage of positive biopsy results and pretreatment prostate-specific antigen value were the only significant predictors of biochemical outcome. The median postimplantation prostate-specific antigen value for all biochemically disease-free patients was < 0.1 ng/mL, regardless of risk group or percentage of positive biopsy results cohort. DISCUSSION: Multivariate analysis demonstrated that percentage of positive biopsy results and pretreatment prostate-specific antigen value were statistically significant predictors of 7-year biochemical progression-free survival. However, the relatively small absolute differences in biochemical outcome based on percentage of positive biopsy results may be a result of radiation dose escalation with the utilization of generous periprostatic treatment margins.

Adenocarcinoma↗
PubMed1998

Clinical evaluation of serum prostate-specific antigen-alpha1-antichymotrypsin complex values in diagnosis of prostate cancer: a cooperative study.

BACKGROUND: We studied the clinical significance of serum prostate-specific antigen bound to alpha1-antichymotrypsin (PSA-ACT) values determined with a newly developed enzyme immunoassay. METHODS: Serum PSA-ACT values were determined in a total of 652 sera. Clinical utility for the diagnosis of prostate cancer was compared to that of Tandem-R PSA and gamma-seminoprotein (gamma-Sm). The new enzyme immunoassay is based on the use of the Stanford reference as an international standard for PSA assays. RESULTS: Serum PSA-ACT values ranged from less than 0.10 to 1.4 ng/mL in healthy males (n = 100) while values in patients with benign prostatic hyperplasia (n = 155) averaged 3.4 +/- 3.8 ng/mL (mean +/- SD). In patients with prostate cancer, serum PSA-ACT values increased significantly with progression of the clinical stage and there were statistically significant differences between benign prostatic hyperplasia and each stage of prostate cancer except for stage A. Using BPH levels as controls (4.8 ng/mL for PSA-ACT, 7.2 ng/mL for PSA, 3.8 ng/mL for gamma-Sm, and 2.4 ng/mL for the complexed/free PSA ratio of PSA-ACT/gamma-Sm), specificity was 80%. The sensitivity of prostate cancer detection was 79% for PSA-ACT, 77% for PSA, 57% for gamma-Sm, and 46% for the ratio between PSA-ACT/gamma-Sm. CONCLUSION: Although the determination of serum PSA-ACT showed essentially the same utility as that of PSA for the diagnosis of prostate cancer, PSA-ACT may allow prediction of the clinical stage. The PSA-ACT assay may therefore replace PSA in the detection of prostate cancer.

Disease Progression↗
PubMed2005

Serum insulin-like growth factor-I levels and prostatic intraepithelial neoplasia: a clue to the relationship between IGF-I physiology and prostate cancer risk.

Serum insulin-like growth factor-I (IGF-I) levels at the higher end of the reference range have been associated with increased risk for the future development of prostate cancer. We determined whether high serum IGF-I levels are associated with precancerous lesions of the prostate. We conducted a case-control study to determine whether high serum IGF-I levels were associated with the presence of high-grade prostatic intraepithelial neoplasia (HGPIN) among patients who presented for prostate biopsy because of an abnormal serum prostate-specific antigen level or digital rectal exam. We measured serum IGF-I and insulin-like growth factor binding protein-3 (IGFBP-3) prior to prostate biopsy and compared them between 103 men with HGPIN (cases) and 205 men with normal prostate histology (controls). The mean IGF-I level in patients with HGPIN (130.2 ng/mL) was significantly higher compared with controls (118.8 ng/mL, P = 0.01). The mean IGFBP-3 level in patients with HGPIN (2,393.9 ng/mL) was also higher compared with controls (2,276.0 ng/mL, P = 0.06). After adjusting for age, prostate-specific antigen, digital rectal examination, and ethnic background, the odds ratio for a HGPIN diagnosis among men in the highest relative to the lowest quartile of serum IGF-I level was 1.94 (95% confidence interval, 1.0-3.7; P = 0.04). The potential association between a high serum IGF-I level and the presence of HGPIN may represent an important clue to understanding the basis for the relationship between IGF-I physiology and prostate cancer risk. Larger studies will be required to confirm this relationship.

Aged↗