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Urology Practice Nov 2023Hormonal therapy is the standard of care in prostate cancer treatment. The approval of the first oral androgen deprivation therapy, relugolix, to treat prostate cancer... (Review)
Review
INTRODUCTION
Hormonal therapy is the standard of care in prostate cancer treatment. The approval of the first oral androgen deprivation therapy, relugolix, to treat prostate cancer patients provides an opportunity to review adherence to oral and injectable/implantable hormonal therapies to aid patients and physicians in making informed decisions.
METHODS
A PubMed search for available literature on adherence to hormonal therapy in prostate cancer was conducted, including published data on relugolix.
RESULTS
Adherence to oral antiandrogen therapy was above 90% by medication possession ratio in several studies worldwide and from 75% to 91% by proportion of days covered. For injectable/implantable androgen deprivation therapy, adherence to treatment ranged from 71% to 95%. In general, 60% and 29% of injections were reported to be delayed by more than 1 week and 2 weeks, respectively, with some patients experiencing testosterone increases (tests above 50 ng/dL). Although real-world data on adherence to relugolix are currently unavailable, pharmacokinetic/pharmacodynamics models demonstrated that, if necessary, treatment interruption up to 7 days would still maintain testosterone suppression levels.
CONCLUSIONS
In general, adherence to hormonal therapy is high in prostate cancer. Studies revealed that adherence to injectable androgen deprivation therapy dosing schedules is important to maintain castrate levels. Pharmacokinetic/pharmacodynamics models showed that relugolix treatment interruption up to 7 days had minimal impact on testosterone suppression levels.
Topics: Male; Humans; Prostatic Neoplasms; Androgen Antagonists; Androgens; Prostate-Specific Antigen; Antineoplastic Agents, Hormonal; Testosterone
PubMed: 37647139
DOI: 10.1097/UPJ.0000000000000445 -
Nature Reviews. Urology Jun 2024Decisions around prostate-specific antigen screening require a patient-centred approach, considering the benefits and risks of potential harm. Using shared... (Review)
Review
Decisions around prostate-specific antigen screening require a patient-centred approach, considering the benefits and risks of potential harm. Using shared decision-making (SDM) can improve men's knowledge and reduce decisional conflict. SDM is supported by evidence, but can be difficult to implement in clinical settings. An inclusive definition of SDM was used in order to determine the prevalence of SDM in prostate cancer screening decisions. Despite consensus among guidelines endorsing SDM practice, the prevalence of SDM occurring before the decision to undergo or forgo prostate-specific antigen testing varied between 11% and 98%, and was higher in studies in which SDM was self-reported by physicians than in patient-reported recollections and observed practices. The influence of trust and continuity in physician-patient relationships were identified as facilitators of SDM, whereas common barriers included limited appointment times and poor health literacy. Decision aids, which can help physicians to convey health information within a limited time frame and give patients increased autonomy over decisions, are underused and were not shown to clearly influence whether SDM occurs. Future studies should focus on methods to facilitate the use of SDM in clinical settings.
Topics: Humans; Prostatic Neoplasms; Male; Decision Making, Shared; Early Detection of Cancer; Physician-Patient Relations; Prostate-Specific Antigen; Patient Participation
PubMed: 38168921
DOI: 10.1038/s41585-023-00840-0 -
Nigerian Journal of Clinical Practice Oct 2023In Nigeria, the diagnostic value of prostate-specific antigen (PSA) is a matter of debate. PSA levels are known to vary with population, environmental factors, and...
BACKGROUND
In Nigeria, the diagnostic value of prostate-specific antigen (PSA) is a matter of debate. PSA levels are known to vary with population, environmental factors, and advancing age. Studies suggest age-specific reference intervals (ASRIs) of PSA value are more accurate than single cut-off PSA value. For ASRIs to be used effectively, reference intervals (RIs) must be fully evaluated.
AIM
We determine ASRIs in a Nigerian population.
MATERIALS AND METHODS
The study was carried out from January 2016 to January 2019 among 660 adult Nigerian men aged 30-86 years old in Enugu State. Participants completed questionnaire demographics and previous screening. Age group was the indicator. Among them, a total 24 (3.6%) were excluded. Data from 636 (96.4%) men were analyzed for ASRIs. Estimation of PSA was done as per the International Federation of Clinical Chemistry Guideline. Spearman correlation was used to identify correlates P values < 0.05 which was considered significant.
RESULTS
The mean age group was 49.6 ± 10.2 years. ASRIs using 95 percentile, and PSA values in each 10 years groups were 0-1.94 ng/ml (median 0.22), 0-2.52 ng/ml (median 0.42), 0-3.52 ng/ml (median 1.06), 0-4.8 ng/ml (median 2.1), 0-6.95 ng/ml (median 4.1), and 0-5.6 ng/ml (median 2.4), for age groups 30-39, 40-49, 50-59, 60-69, 70-79, and ≥80 years, respectively. There was positive correlation between PSA and age (r = 0.9915, P < 0.0001). Low income and educational background were more prevalent among the study group.
CONCLUSION
Our study provided the ASRIs in our environment but higher than single cut-off value. The data recommended PSA values should be characterized by age and ethnicity.
Topics: Adult; Male; Humans; Middle Aged; Aged; Aged, 80 and over; Prostate-Specific Antigen; Prostatic Neoplasms; Reference Values; Nigeria; Age Factors
PubMed: 37929517
DOI: 10.4103/njcp.njcp_1643_21 -
Radiologie (Heidelberg, Germany) Jun 2024The harm-to-benefit ratio of prostate cancer (PCa) screening remains controversial mainly due to the unfavorable test characteristics of prostate-specific antigen (PSA)... (Review)
Review
BACKGROUND
The harm-to-benefit ratio of prostate cancer (PCa) screening remains controversial mainly due to the unfavorable test characteristics of prostate-specific antigen (PSA) as a screening test.
METHODS
In this nonsystematic review, we present a current overview of the body of evidence on prostate cancer screening with a focus on the role of magnetic resonance imaging (MRI) of the prostate.
RESULTS
Evidence generated in large randomized controlled trials showed that PSA-based screening significantly decreases cancer-specific mortality. The main obstacle in developing and implementing PCa screening strategies is the resulting overdiagnosis and as a consequence overtreatment of indolent cancers. Opportunistic screening is characterized by an adverse benefit-to-harm ratio and should, therefore, not be recommended. The German Statutory Early Detection Program for prostate cancer, which consists of a digital rectal examination (DRE) as a stand-alone screening test, is not evidence-based, neither specific nor sensitive enough and results in unnecessary diagnostics. The European Commission recently urged member states to develop population-based and organized risk-adapted PSA-based screening programs, which are currently tested in the ongoing German PROBASE trial. Finetuning of the diagnostic pathway following PSA-testing seems key to improve its positive and negative predictive value and thereby making PCa screening more accurate. Incorporation of prostatic MRI into screening strategies leads to more accurate diagnosis of clinically significant prostate cancer, while diagnosis of indolent cancers is reduced. In the future, molecular liquid-based biomarkers have the potential to complement or even replace PSA in PCa screening and further personalize screening strategies. Active surveillance as an alternative to immediate radical therapy of demographically increasing PCa diagnoses can potentially further improve the benefit-to-harm ratio of organized screening.
CONCLUSION
Early detection of PCa should be organized on a population level into personalized and evidence-based screening strategies. Multiparametric MRI of the prostate may play a key role in this setting.
Topics: Humans; Male; Early Detection of Cancer; Germany; Magnetic Resonance Imaging; Mass Screening; Prostate-Specific Antigen; Prostatic Neoplasms
PubMed: 38743100
DOI: 10.1007/s00117-024-01312-1 -
Actas Urologicas Espanolas 2024A high prevalence of low testosterone levels has been reported in men with prostate cancer. The use of testosterone therapy in men with a history of prostate cancer is... (Review)
Review
INTRODUCTION
A high prevalence of low testosterone levels has been reported in men with prostate cancer. The use of testosterone therapy in men with a history of prostate cancer is still controversial, and there is uncertainty regarding the management of these patients.
METHODS
We analyzed the European and American guidelines on this topic and presented the clinical experience in the management of patients with low testosterone levels and a history of prostate cancer in one of the world's leading cancer centers.
RESULTS
According to the published evidence to date, testosterone therapy in men with prostate cancer does not increase the risk of prostate cancer recurrence in the short and medium term, but there is a lack of data on the long term. Symptomatic men with low testosterone levels who are candidates for this therapy need a thorough clinical evaluation before commencing testosterone therapy. Evaluation of prostate cancer history including type of treatment administered, pathologic stage of prostate cancer and prostate specific antigen should be requested before and during testosterone treatment to assess its trend.
CONCLUSION
Prostate-specific antigen should remain undetectable after radical prostatectomy or stable after radiotherapy. Otherwise, it would be a sign of uncontrolled prostate cancer, and the patient may require cessation of testosterone therapy and referral to oncology for further evaluation.
Topics: Male; Humans; Prostatic Neoplasms; Testosterone; Practice Guidelines as Topic; Prostate-Specific Antigen
PubMed: 38101513
DOI: 10.1016/j.acuroe.2023.12.001 -
Abdominal Radiology (New York) Dec 2023Prostate cancer is the second leading cause of cancer-related deaths in men in the United States. Imaging techniques such as CT, MRI, and bone scans have traditionally... (Review)
Review
Prostate cancer is the second leading cause of cancer-related deaths in men in the United States. Imaging techniques such as CT, MRI, and bone scans have traditionally been used for diagnosis and staging. Molecular imaging modalities targeting the prostate-specific membrane antigen (PSMA) have recently gained attention due to their high affinity and accuracy. PSMA PET has been combined with other modalities such as multiparametric MRI for better diagnostic and prognostic performance. PSMA imaging has been studied at different clinical settings with a wide range of disease aggressiveness. In this review we will explore the role of PSMA PET in high-risk prostate cancer staging, biochemical recurrence, and castration-resistant prostate cancer. The primary focus of this review article is to examine the latest developments in the use of PSMA imaging and emphasize the clinical situations where its effectiveness has been demonstrated to significantly impact the treatment of prostate cancer. In addition, we will touch upon the potential future advancements of PSMA PET imaging and its evolving significance in the management of prostate cancer.
Topics: Humans; Male; Prostatic Neoplasms; Prostate-Specific Antigen; Positron Emission Tomography Computed Tomography; Choline; Neoplasm Staging; Recurrence; Molecular Targeted Therapy
PubMed: 37493837
DOI: 10.1007/s00261-023-04002-z -
Cancer Causes & Control : CCC Mar 2024Early detection of prostate cancer using prostate-specific antigen (PSA) remains controversial and disparities in the receipt of prostate cancer screening persist in the...
BACKGROUND
Early detection of prostate cancer using prostate-specific antigen (PSA) remains controversial and disparities in the receipt of prostate cancer screening persist in the US. We sought to examine disparities in PSA testing rates among groups with higher prostate cancer risk and differential access to healthcare.
METHODS
We identified a cohort of 37,706 males within the All of Us Research Program without a history of prostate cancer between the ages of 40 and 85 at time of enrollment (2017-2021). Incidence rate ratios (IRR) for the number of PSA tests received during follow-up through December 2021 were estimated using age- and multivariable-adjusted negative binomial regression models. PSA testing frequencies in the cohort were compared with population-based estimates from the 2020 Behavioral Risk Factor Surveillance System (BRFSS).
RESULTS
A total of 6,486 males (17.2%) received at least one PSA test over the course of follow-up. In multivariable-adjusted models, non-Hispanic Black males received PSA tests at a 17% lower rate (IRR = 0.83, 95% CI 0.76, 0.90) than non-Hispanic White males. Higher educational attainment, higher annual income, having self-/employer-purchased insurance, having a spouse or domestic partner, and having a family history of prostate cancer were all associated with higher rates of PSA testing. The proportion of males ages 55 to 69 who received a PSA test within two years was lower in All of Us (12.4%, 95% CI 11.8-13.0%) relative to population-based estimates from the BRFSS (35.2%, 95% CI 34.2-36.3%).
CONCLUSION
Absolute PSA testing rates in All of Us were lower than population-based estimates, but associations with PSA testing in the cohort mirrored previously reported disparities in prostate cancer screening. These findings highlight the importance of addressing barriers to care in order to reduce disparities in cancer screening.
Topics: Male; Humans; Adult; Middle Aged; Aged; Aged, 80 and over; Prostate-Specific Antigen; Prostatic Neoplasms; Early Detection of Cancer; Population Health; Ethnicity; Mass Screening
PubMed: 37878135
DOI: 10.1007/s10552-023-01807-7 -
The Malaysian Journal of Pathology Aug 2023Prostate cancer is the second-most frequently diagnosed cancer in men worldwide. Serum prostatespecific antigen is currently used for the early detection of prostate... (Review)
Review
Prostate cancer is the second-most frequently diagnosed cancer in men worldwide. Serum prostatespecific antigen is currently used for the early detection of prostate cancer. However, new biomarkers are needed to decrease over diagnosis and over treatment of prostate cancer due to limitations of prostate-specific antigen. Recently, molecular biomarkers have shown promising results for diagnosis and prognosis of prostate cancer. Molecular biomarkers have improved the sensitivity and specificity of prostate-specific antigen and studies are ongoing to identify molecular biomarkers as a replacement for prostate-specific antigen. This review aims to give an overview of emerging molecular biomarkers for diagnosis and prognosis of prostate cancer.
Topics: Male; Humans; Prostate-Specific Antigen; Prognosis; Prostatic Neoplasms; Mutation; Neoplasms, Second Primary
PubMed: 37658525
DOI: No ID Found -
Human Immunology Nov 2023The Cancer Epitope Database and Analysis Resource (CEDAR) is a newly developed repository of cancer epitope data from peer-reviewed publications, which includes... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The Cancer Epitope Database and Analysis Resource (CEDAR) is a newly developed repository of cancer epitope data from peer-reviewed publications, which includes epitope-specific T cell, antibody, and MHC ligand assays. Here we focus on prostate cancer as our first cancer category to demonstrate the capabilities of CEDAR, and to shed light on the advances of epitope-related prostate cancer research.
RESULTS
The meta-analysis focused on a subset of data describing epitopes from 8 prostate-specific (PS) antigens. A total of 460 epitopes were associated with these proteins, 187 T cell, 109B cell, and 271 MHC ligand epitopes. The number of epitopes was not correlated with the length of the protein; however, we found a significant positive correlation between the number of references per specific PS antigen and the number of reported epitopes. Forty-four different class I and 27 class II restrictions were found, with the most epitopes described for HLA-A*02:01 and HLA-DRB1*01:01. Cytokine assays were mostly limited to IFNg assays and a very limited number of tetramer assays were performed. Monoclonal and polyclonal B cell responses were balanced, with the highest number of epitopes studied in ELISA/Western blot assays. Additionally, epitopes were generically described as associated with prostate cancer, with little granularity specifying diseases state. We found that in vivo and tumor recognition assays were sparse, and the number of epitopes with annotated B/T cell receptor information were limited. Potential immunodominant regions were identified by the use of the ImmunomeBrowser tool.
CONCLUSION
CEDAR provides a comprehensive repository of epitopes related to prostate-specific antigens. This inventory of epitope data with its wealth of searchable T cell, B cell and MHC ligand information provides a useful tool for the scientific community. At the same time, we identify significant knowledge gaps that could be addressed by experimental analysis.
Topics: Male; Humans; Prostate-Specific Antigen; Prostate; Ligands; Epitopes, T-Lymphocyte; Prostatic Neoplasms
PubMed: 37679223
DOI: 10.1016/j.humimm.2023.08.145 -
Minerva Urology and Nephrology Oct 2023The aim of this study was to evaluate genomic risk of patients with persistent prostate specific antigen (PSA) using mRNA expression analysis and a validated prognostic...
BACKGROUND
The aim of this study was to evaluate genomic risk of patients with persistent prostate specific antigen (PSA) using mRNA expression analysis and a validated prognostic genomic-risk classifier.
METHODS
Monocentric retrospective study including all patients who underwent radical prostatectomy (RP) by one surgeon and Decipher Test from October 2013 to December 2018. PSA persistent population was defined as all patients with two consecutive PSA>0.1 ng/mL at follow-up after the surgery. Neurovascular Structure-adjacent Frozen-section Examination (NeuroSAFE) was performed intraoperatively for research of positive surgical margins. Multivariate analysis was performed for persistent PSA (pPSA) predictors. A specific localized, organ-confined, and negative margins sub-population with PSA persistence was compared to a similar sub-population without PSA persistence for genomic differential expression analyses.
RESULTS
A total of 564 patients were included and 61 of them had pPSA. Preoperative PSA was higher in the PSA persistent group (11.6 [6.4, 21.2] vs. 6.2 [4.7, 9.2] P=0.00010), as well as PSA density (PSAd) (0.3 [0.2, 0.5] vs. 0.2 [0.1, 0.3] P=0.0001). Postoperative characteristics, Gleason Score, and positive surgical margins were significantly higher in the PSA persistent population. 31 patients had pPSA in our specific subpopulation and were compared to 217 patients with no pPSA. On multivariate analysis, only Decipher Score (OR=5.64 [1.28; 24.89], P=0.022) and preoperative PSA (OR=1.06, [1.02; 1.09], P=0.001) were significant predictors for PSA persistence. We found two genes to be significantly upregulated with a 2.5-fold change in our specific subpopulation (SERPINB11 and PDE11A).
CONCLUSIONS
We found unique genomic features of patients with pPSA, whilst confirming previous clinical findings that this condition behaves to a worse prognosis. Given this high genomic risk, further imaging studies should be performed to select patients for early treatment intensification.
Topics: Male; Humans; Prostate-Specific Antigen; Margins of Excision; Retrospective Studies; Prostatectomy; Frozen Sections; Serpins
PubMed: 37728494
DOI: 10.23736/S2724-6051.23.05395-8