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Shalini S YadavView Articles

Volume 19, Number 4Review Articles

The Use of Biomarkers in Prostate Cancer Screening and Treatment

Treatment Update

Joseph Renzulli IIAshley V AlfordJoseph M Brito IIIKamlesh K YadavShalini S YadavAshutosh K Tewari

Prostate cancer screening and diagnosis has been guided by prostate-specific antigen levels for the past 25 years, but with the most recent US Preventive Services Task Force screening recommendations, as well as concerns regarding overdiagnosis and overtreatment, a new wave of prostate cancer biomarkers has recently emerged. These assays allow the testing of urine, serum, or prostate tissue for molecular signs of prostate cancer, and provide information regarding both diagnosis and prognosis. In this review, we discuss 12 commercially available biomarker assays approved for the diagnosis and treatment of prostate cancer. The results of clinical validation studies and clinical decision-making studies are presented. This information is designed to assist urologists in making clinical decisions with respect to ordering and interpreting these tests for different patients. There are numerous fluid and biopsy-based genomic tests available for prostate cancer patients that provide the physician and patient with different information about risk of future disease and treatment outcomes. It is important that providers be able to recommend the appropriate test for each individual patient; this decision is based on tissue availability and prognostic information desired. Future studies will continue to emphasize the important role of genomic biomarkers in making individualized treatment decisions for prostate cancer patients. [Rev Urol. 2017;19(4):221–234 doi: 10.3909/riu0772] © 2018 MedReviews®, LLC

Prostate cancerBiomarkers4KscoreProlarisPCA3Prostate Health IndexApifinyMichigan Prostate ScoreSelectMDxConfirmMDxProMarkPTEN/TMPRSS2:ERGDecipher

Shannon CheroneView Articles

Volume 21, Number 1Original Research

Prostate Biopsy Features: A Comparison Between the Pre– and Post–2012 United States Preventive Services Task Force Prostate Cancer Screening Guidelines With Emphasis on African American and Septuagenarian Men

Navin ShahVladimir IoffeShannon Cherone

We compare prostate biopsy (Pbx) characteristics from 3 years prior to the 2012 United States Preventive Services Task Force (USPSTF) prostate cancer (PCa) screening guidelines with those of 2018, with a focus on African American (AA) men and healthy men aged 70 to 80 years. We completed a retrospective comparative analysis of 1703 sequential patients that had had a Pbx from 2010 to 2012 (3 years) with 383 patients biopsied in 2018. Data was collected on patient age, race, prostate-specific antigen (PSA), digital rectal examination (DRE), total number of biopsies performed, and Gleason sum score (GSS). The data was analyzed to determine whether the 2012 USPSTF screening recommendations affected PCa characteristics. Two study groups were defined as group A and B, Pbx prior to the 2012 USPSTF screening guidelines and that of 2018, respectively. The study population consisted of 71% high-risk AA patients. In Group A (pre-2012 USPSTF guidelines), 567 patients/year underwent a Pbx versus Group B, 383 patients/year, a 32% reduction post-USPSTF. The annual positive Pbx rate for Group A is 134/year versus Group B with 175/year, a 31% increase post-USPSTF. In Group B, there was a 94% relative increase in total positive biopsies. Group A had high-grade PCa (GSS 7-10) in 51.5% versus 60.5% in Group B, a 9% increase post-USPSTF. The proportion of patients with a PSA 10 ng/mL or higher was 25.4% in group A versus 29.3% in group B. The age group of 70 to 80 years demonstrated an increasing trend for patients with PSA 10 ng/mL and higher, 31% in Group A versus 38% in Group B; high-grade tumors (GSS 7-10) occurred in 61% in Group A versus 65% in Group B. After the 2012 USPSTF guidelines against PCa screening, our study shows decreased prostate cancer screening with decreased Pbx, increased PCa diagnosis, and increased high-grade (GSS 7-10) PCa. These trends were especially notable in the 70- to 80-year age group, which showed a larger proportion of total patients (compared with pre-2012 USPSTF guidelines), increased PCa grades, increased PSA levels, and a higher percentage of patients with greater than 50% positive cores. As our patient population consists of 71% AA patients, our results support aggressive PCa screening for high-risk patients, which includes AA men, men with a family history of PCa, and healthy men aged 70 to 80 years. [Rev Urol. 2019;21(1):1–7] © 2019 MedReviews®, LLC

Prostate cancerElderly menUnited States Preventive Services Task ForceScreeningProstate-specific antigen (PSA)African American Men