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Journal of Clinical Oncology : Official... Apr 2024
Topics: Male; Humans; Prostate-Specific Antigen; Prostatic Neoplasms; Chronic Disease; Neoplasm Recurrence, Local
PubMed: 38261976
DOI: 10.1200/JCO.23.02410 -
Clinical Nuclear Medicine Jan 2024Diagnosis and treatment of prostate cancer are complex and very challenging, being a major health care burden. The efficacy of radioligand therapy with prostate-specific... (Review)
Review
Diagnosis and treatment of prostate cancer are complex and very challenging, being a major health care burden. The efficacy of radioligand therapy with prostate-specific membrane antigen agents has been proven beneficial in certain clinical indications. In this review, we describe management of prostate cancer patients according to current guidelines, especially focusing on the available clinical evidence for prostate-specific membrane antigen radioligand therapy.
Topics: Male; Humans; Prostate-Specific Antigen; Prostatic Neoplasms; Prostatic Neoplasms, Castration-Resistant
PubMed: 37882758
DOI: 10.1097/RLU.0000000000004919 -
International Journal of Cancer Feb 2024Guidelines for prostate specific antigen (PSA) testing in Australia recommend that men at average risk of prostate cancer who have been informed of the benefits and...
Guidelines for prostate specific antigen (PSA) testing in Australia recommend that men at average risk of prostate cancer who have been informed of the benefits and harms, and who decide to undergo regular testing, should be offered testing every 2 years from 50 to 69 years. This study aimed to estimate the benefits and harms of regular testing in this context. We constructed Policy1-Prostate, a discrete event microsimulation platform of the natural history of prostate cancer and prostate cancer survival, and PSA testing patterns and subsequent management in Australia. The model was calibrated to pre-PSA (before 1985) prostate cancer incidence and mortality and validated against incidence and mortality trends from 1985 to 2011 and international trials. The model predictions were concordant with trials and Australian observed incidence and mortality data from 1985 to 2011. Out of 1000 men who choose to test according to the guidelines, 36 [21-41] men will die from prostate cancer and 126 [119-133] men will be diagnosed with prostate cancer, compared with 50 [47-54] and 94 [90-98] men who do not test, respectively. During the 20 years of active PSA testing, 32.3% [25.6%-38.8%] of all PSA-test detected cancers are overdiagnosed cases that is, 30 [21-42] out of 94 [83-107] PSA-test detected cancers. Australian men choosing to test with PSA every two years from 50 to 69 will reduce their risk of ever dying from prostate cancer and incur a risk of overdiagnosis: for every man who avoids dying from prostate cancer, two will be overdiagnosed with prostate cancer between 50 and 69 years of age. Australian men, with health professionals, can use these results to inform decision-making about PSA testing.
Topics: Male; Humans; Prostate-Specific Antigen; Australia; Early Detection of Cancer; Prostatic Neoplasms; Prostate; Mass Screening
PubMed: 37819139
DOI: 10.1002/ijc.34731 -
Journal of Clinical Oncology : Official... Jun 2024
Topics: Humans; Male; Prostatic Neoplasms; Prostate-Specific Antigen; Prognosis; Predictive Value of Tests
PubMed: 38743913
DOI: 10.1200/JCO.23.02689 -
Journal of Endourology Sep 2023There is a paucity of guidelines for prostate-specific antigen (PSA) monitoring after simple prostatectomy (SP) despite these patients remaining at risk for prostate...
There is a paucity of guidelines for prostate-specific antigen (PSA) monitoring after simple prostatectomy (SP) despite these patients remaining at risk for prostate cancer (PCa). Our objective was to determine if PSA kinetics can be a potential indicator of PCa after SP. A retrospective review was performed of all simple prostatectomies at our institution from 2014 to 2022. All patients who met criteria were included in the study. Relevant clinical variables were collected preoperatively, including PSA value, prostate size, and voiding symptoms. Surgical and urinary function outcomes were analyzed. A total of 92 patients were divided into two groups based on malignancy status. Sixty-eight patients did not have PCa, while 24 patients had known PCa before surgery (14) or were diagnosed as having incidental PCa from the pathological specimen (10). Patients with benign prostates had an initial postoperative PSA value of 0.76 ng/mL compared with 1.68 ng/mL for those with cancer ( < 0.01). PSA velocity for the first 24 months after surgery was 0.042 ± 1.61 ng/(mL·year) for the benign cohort compared with 1.29 ± 1.02 ng/(mL·year) for the malignant cohort ( = 0.01). Voiding improvements were noted by objective (postvoid residual and flow rate) and subjective (American Urological Association symptom score and quality of life score) measures in both groups. PSA interpretation and monitoring after SP have not been well established. Our study indicates that initial postoperative PSA value and PSA velocity are important indicators of underlying malignancy in patients after SP. Further efforts are needed to establish threshold values and formal guidelines.
Topics: Male; Humans; Prostate-Specific Antigen; Quality of Life; Prostatic Neoplasms; Prostatectomy; Prostate
PubMed: 37376750
DOI: 10.1089/end.2023.0101 -
European Urology Oct 2023Considering the long natural history of prostate cancer (PCa), long-term results of the European Randomised Study of Screening for PCa (ERSPC) are crucial. (Randomized Controlled Trial)
Randomized Controlled Trial
A Detailed Evaluation of the Effect of Prostate-specific Antigen-based Screening on Morbidity and Mortality of Prostate Cancer: 21-year Follow-up Results of the Rotterdam Section of the European Randomised Study of Screening for Prostate Cancer.
BACKGROUND
Considering the long natural history of prostate cancer (PCa), long-term results of the European Randomised Study of Screening for PCa (ERSPC) are crucial.
OBJECTIVE
To provide an update on the effect of prostate-specific antigen (PSA)-based screening on PCa-specific mortality (PCSM), metastatic disease, and overdiagnosis in the Dutch arm of the ERSPC.
DESIGN, SETTING, AND PARTICIPANTS
Between 1993 and 2000, a total of 42376 men, aged 55-74 yr, were randomised to a screening or a control arm. The main analysis was performed with men aged 55-69 yr (n = 34831). Men in the screening arm were offered PSA-based screening with an interval of 4 yr.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Intention-to-screen analyses with Poisson regression were used to calculate rate ratios (RRs) of PCSM and metastatic PCa.
RESULTS AND LIMITATIONS
After a median follow-up of 21 yr, the RR of PCSM was 0.73 (95% confidence interval [CI]: 0.61-0.88) favouring screening. The numbers of men needed to invite (NNI) and needed to diagnose (NND) to prevent one PCa death were 246 and 14, respectively. For metastatic PCa, the RR was 0.67 (95% CI: 0.58-0.78) favouring screening. The NNI and NND to prevent one metastasis were 121 and 7, respectively. No statistical difference in PCSM (RR of 1.18 [95% CI: 0.87-1.62]) was observed in men aged ≥70 yr at the time of randomisation. In the screening arm, higher rates of PCSM and metastatic disease were observed in men who were screened only once and in a selected group of men above the screening age cut-off of 74 yr.
CONCLUSIONS
The current analysis illustrates that with a follow-up of 21 yr, both absolute metastasis and mortality reduction continue to increase, resulting in a more favourable harm-benefit ratio than demonstrated previously. These data do not support starting screening at the age of 70-74 yr and show that repeated screening is essential.
PATIENT SUMMARY
Prostate-specific antigen-based prostate cancer screening reduces metastasis and mortality. Longer follow-up shows fewer invitations and diagnoses needed to prevent one death, a positive note towards the issue of overdiagnosis.
Topics: Humans; Male; Early Detection of Cancer; Follow-Up Studies; Mass Screening; Morbidity; Prostate-Specific Antigen; Prostatic Neoplasms
PubMed: 37029074
DOI: 10.1016/j.eururo.2023.03.016 -
JAMA Network Open Feb 2024Magnetic resonance imaging (MRI) has been proposed to enhance the benefit-to-harm ratio of prostate cancer screening, but data on repeated screening outcomes are lacking. (Randomized Controlled Trial)
Randomized Controlled Trial
Repeated Prostate Cancer Screening Using Prostate-Specific Antigen Testing and Magnetic Resonance Imaging: A Secondary Analysis of the STHLM3-MRI Randomized Clinical Trial.
IMPORTANCE
Magnetic resonance imaging (MRI) has been proposed to enhance the benefit-to-harm ratio of prostate cancer screening, but data on repeated screening outcomes are lacking.
OBJECTIVE
To describe outcomes of prostate-specific antigen (PSA)-based screening with MRI and prostate biopsies at repeat screening.
DESIGN, SETTING, AND PARTICIPANTS
This secondary analysis examined the population-based, screen-by-invitation STHLM3-MRI randomized clinical trial, which recruited Swedish men aged 50 to 74 years. Men were eligible for repeat screening at 2 to 3 years if they had PSA levels of 1.5 ng/mL or greater at trial inclusion, were randomized to the MRI-targeted group (including screening using biomarkers and MRI), and were not diagnosed with prostate cancer after the first screening round. Repeat screening was performed between November 10, 2021, and February 20, 2023. Data analysis was performed between May and August 2023.
INTERVENTION
Participants underwent blood sampling, including PSA testing. A biparametric MRI scan was performed if PSA levels were 3 ng/mL or greater, and men with lesions with a Prostate Imaging-Reporting and Data System (PI-RADS) score of 3 or greater were referred for targeted and systematic biopsies.
MAIN OUTCOMES AND MEASURES
The primary outcome was clinically significant prostate cancer (Gleason score of ≥3 + 4). Secondary outcomes included the proportion of men with clinically insignificant cancer (Gleason score of 6), the number of elevated PSA tests, MRI scans, and biopsy procedures.
RESULTS
Of 7609 men from the first screening round, 2078 (27.3%) were eligible for and were invited for rescreening. Among the invitees, 1500 (72.2%) participated. Their median age was 67 (IQR, 61-72) years. Of 1094 men with PSA levels between 1.5 and 2.9 ng/mL in the first screening round, 326 (29.8%) had levels of 3 ng/mL or greater in the second round. Overall, 667 men (44.5%) had PSA levels of 3 ng/mL or greater: 617 underwent MRI (92.5%), revealing 51 (7.6%) with equivocal lesions (PI-RADS score of 3) and 33 (4.9%) with suspicious lesions (PI-RADS score of ≥4). Only 10 of 383 men (2.6%) with a prior negative MRI result had a lesion with a PI-RADS score of 4 or greater. Among the 1500 rescreened men, 48 (3.2%) had a Gleason score of 3 + 4 or greater, including 19 (1.3%) with a score of 4 + 3 or greater and 11 (0.7%) with a score of 6.
CONCLUSIONS AND RELEVANCE
In this secondary analysis of the STHLM3-MRI randomized clinical trial, cancer detection during the second screening round in biennial PSA and MRI-based prostate cancer screening was limited, and the detection of low-grade tumors remained low. A substantial proportion of men exhibited elevated PSA levels during rescreening, and a considerable portion of MRI scans performed lacked lesions suggestive of cancer. Future studies should explore strategies to reduce MRI-related resource use.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03377881.
Topics: Aged; Humans; Male; Early Detection of Cancer; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Prostate-Specific Antigen; Prostatic Neoplasms; Middle Aged
PubMed: 38324313
DOI: 10.1001/jamanetworkopen.2023.54577 -
The Prostate Feb 2024Previous reports have shown a potential causal impact of vasectomy on prostate cancer (PCa). The objective of this study was to investigate the association between...
BACKGROUND
Previous reports have shown a potential causal impact of vasectomy on prostate cancer (PCa). The objective of this study was to investigate the association between vasectomy and PCa, while evaluating the influence of confounding factors such as prostate-specific antigen (PSA) screening and body mass index (BMI).
METHODS
Mendelian randomization (MR) study using summary statistics from genome-wide associations of vasectomy (462,933 European ancestry), ever had PSA test (200,410 European ancestry), time since last PSA test (46,104 European ancestry), BMI (152,893 European males) and PCa (79,148 cases, 61,106 controls, European ancestry). This study was conducted using summary statistic data from large, previously described cohorts. Data analyses were conducted from November 2022 to June 2023.
RESULTS
Genetic liability to vasectomy was not associated with PCa (OR = 0.07, 95% CI: 2.95 10 , 1.54, p = 0.09). Genetic liability to vasectomy was not associated with ever had PSA test (OR = 1.08, 95% CI: 0.49-2.39, p = 0.83) and time since last PSA test (OR = 2.49, 95% CI: 0.71-8.79, p = 0.16). After controlling for PSA test and BMI, there remains no causal relationship between vasectomy and PCa risk (OR = 5.56 10 , 95% CI: 7.29 10 , 4.24, p = 0.10). The reverse MR results showed a weak association between PCa and vasectomy patients (OR = 1.00, 95% CI: 1.0003-1.0033, p = 0.02).
CONCLUSION
Based on the available evidence from MR analysis, the current findings did not support vasectomy being a risk factor for PCa. Further work is required to provide additional confirmation and validation of the potential link.
Topics: Male; Humans; Prostate-Specific Antigen; Vasectomy; Mendelian Randomization Analysis; Prostatic Neoplasms; Risk Factors; Polymorphism, Single Nucleotide; Genome-Wide Association Study
PubMed: 37905786
DOI: 10.1002/pros.24646 -
Interaction between smoking status and dietary selenium intake affects PSA: A cross-sectional study.Urologic Oncology Dec 2023Conflicting results regarding the impact of selenium on reducing prostate cancer have been reported. The current analysis aimed to understand whether there are potential...
BACKGROUND
Conflicting results regarding the impact of selenium on reducing prostate cancer have been reported. The current analysis aimed to understand whether there are potential factors affecting the relationship between selenium and prostate cancer.
OBJECTIVE
To clarify the relationship between dietary selenium intake and prostate cancer, we evaluated the correlation between dietary selenium intake and prostate-specific antigen (PSA) based on the National Health and Nutrition Examination Survey (NHANES) database.
METHODS
After screening the NHANES survey data from 2005 to 2010, data for 3,614 of 31,034 participants were considered suitable to include in our study. Dietary selenium intake was the independent variable of our study, while PSA was the dependent variable. We stratified participants into current, former, and never smokers and performed an interaction test on the relationship between selenium intake and PSA using multivariable logistic regression for each smoking-status subgroup.
RESULTS
For our subgroup analysis, we grouped participants based on smoking status and investigated the association between dietary selenium intake and PSA levels. Among the 242 participants with a PSA level of 4 or higher, the mean age was 58.5 years (±12.1). After adjusting for covariates, we did not find a significant association between dietary selenium and the odds of having a high PSA level. However, we observed a significant interaction between smoking status and dietary selenium in relation to PSA levels (P = .007). Specifically, smokers had lower odds of having high PSA levels, while nonsmokers had higher odds. This suggests that smoking status may modify the effect of dietary selenium on PSA levels.
CONCLUSION
Our findings suggest that smoking status affects the relationship between dietary selenium intake and PSA and that smokers are at lower odds of having a high PSA level.
Topics: Humans; Male; Middle Aged; Cross-Sectional Studies; Nutrition Surveys; Prostate-Specific Antigen; Prostatic Neoplasms; Selenium; Smoking
PubMed: 37940471
DOI: 10.1016/j.urolonc.2023.07.009 -
BMJ (Clinical Research Ed.) Apr 2024
Topics: Male; Humans; Prostatic Neoplasms; Prostate-Specific Antigen; Early Detection of Cancer; Mass Screening
PubMed: 38604700
DOI: 10.1136/bmj.q817