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Prostate cancer antigen 3 geneView Articles

Volume 10, Number 3Review Articles

Prostate Cancer Specificity of PCA3 Gene Testing: Examples from Clinical Practice

Diagnostic Update

David G BostwickLeonard S Marks

A specific marker for early prostate cancer would fill an important void. In initial evaluations of the prostate cancer antigen 3 (PCA3) gene vis-à-vis serum prostate-specific antigen (PSA) levels, the gene offers great promise. At the cellular level, PCA3 specificity for cancer is nearly perfect because of the gross overexpression of the gene by cancer cells. As a clinical test for early prostate cancer, heightened specificity is also seen in urine containing prostate cells from men with the disease. PCA3 gene testing holds valuable potential in PSA quandary situations: (1) men with elevated PSA levels but no cancer on initial biopsy; (2) men found to have cancer despite normal levels of PSA; (3) men with PSA elevations associated with varying degrees of prostatitis; and (4) men undergoing active surveillance for presumed microfocal disease. [Rev Urol. 2008;10(3):175-181]

Prostate cancerBenign prostatic hyperplasiaProstate-specific antigenProstatitisWatchful waitingProstate cancer antigen 3 geneMicrofocal disease

Prostate cancer markersView Articles
Prostate Cancer Prevention TrialView Articles
Prostate cancer prognosisView Articles

Volume 17, Number 4Original Research

The 4Kscore® Test Reduces Prostate Biopsy Rates in Community and Academic Urology Practices

Jason HafronStephen M ZappalaDipen J ParekhDanielle OsterhoutJeffrey SchockRandy M ChudlerGregory M OldfordKenneth M KernenBadrinath R Konety

There is significant concern regarding prostate cancer screening because of the potential for overdiagnosis and overtreatment of men who are discovered to have abnormal prostate specific antigen (PSA) levels and/or digital rectal examination (DRE) results. The 4Kscore® Test (OPKO Diagnostics, LLC) is a blood test that utilizes four kallikrein levels plus clinical information in an algorithm to calculate an individual’s percentage risk (< 1% to > 95%) for aggressive prostate cancer (Gleason score ≥ 7) on prostate biopsy. The 4Kscore Test, as a follow-up test after abnormal PSA and/or DRE test results, has been shown to improve the specificity for predicting the risk of aggressive prostate cancer and reduce unnecessary prostate biopsies. A clinical utility study was conducted to assess the influence of the 4Kscore Test on the decision to perform prostate biopsies in men referred to urologists for abnormal PSA and/or DRE results. The study population included 611 patients seen by 35 academic and community urologists in the United States. Urologists ordered the 4Kscore Test as part of their assessment of men referred for abnormal PSA and/or DRE test results. Results for the patients were stratified into low risk (< 7.5%), intermediate risk (7.5%-19.9%), and high risk (≥ 20%) for aggressive prostate cancer. The 4Kscore Test results influenced biopsy decisions in 88.7% of the men. Performing the 4Kscore Test resulted in a 64.6% reduction in prostate biopsies in patients; the actual percentage of cases not proceeding to biopsy were 94.0%, 52.9%, and 19.0% for men who had low-, intermediate-, and high-risk 4Kscore Test results, respectively. A higher 4Kscore Test was associated with greater likelihood of having a prostate biopsy (P < 0.001). Among the 171 patients who had a biopsy, the 4Kscore risk category is strongly associated with biopsy pathology. The 4Kscore Test, as a follow-up test for an abnormal PSA and/or DRE results, significantly influenced the physician and patient shared decision in clinical practice, which led to a reduction in prostate biopsies while increasing the probability of detecting aggressive cancer. [Rev Urol. 2015;17(4):231-240 doi: 10.3909/riu0699] © 2016 MedReviews®, LLC

Prostate cancerProstate-specific antigen4KscoreGleason scoreDigital rectal examinationBiopsy rateProstate cancer prognosis

Prostate cancer recurrenceView Articles

Volume 9, Number 2Review Articles

The Impact of Definitions of Failure on the Interpretation of Biochemical Recurrence Following Treatment of Clinically Localized Prostate Cancer

Diagnostic Update

Alan W PartinMatthew E Nielsen

Widespread early detection with prostate-specific antigen (PSA) has radically transformed the clinical management of prostate cancer. PSA has become valuable in the monitoring and risk stratification of recurrent disease following local therapy. In many ways, biochemical recurrence–free survival, or PSA outcome, has become a surrogate measure of treatment efficacy following primary local therapy. Given the inherent differences in PSA kinetics following these treatment approaches, the definition of biochemical success or failure is not uniform among therapies. An appreciation of the inherent strengths, limitations, and biases of the standard definitions of failure can provide a more meaningful context within which to interpret the reported outcomes of different treatment modalities. [Rev Urol. 2007;9(2):57-62]

Prostate-specific antigenRadiotherapyHormonal therapyProstate cancer recurrenceBiochemical failureBrachytherapy

Prostate cancer screeningView Articles

Volume 11, Number 2Meeting Reviews

Best of the 2009 AUA Annual Meeting

Highlights From the 2009 Annual Meeting of the American Urological Association, April 25-30, 2009, Chicago, IL

Dean G AssimosEllen ShapiroAlan W PartinMichael B ChancellorStacy LoebJ Curtis NickelClaus G RoehrbornMichael K BrawerNaoki YoshimuraArie S BelldegrunB ShuchF Pouliot

Prostate cancer screeningObesityBenign prostatic hyperplasiaLower urinary tract symptomsVesicoureteral refluxNephrolithiasisStress urinary incontinenceInflammationSilodosinHormonal therapyTumor markersTMPRSS2ERG4-Kallikrein panelBotulinum toxin type AMale voiding dysfunctionBenign prostatic specific antigenRoux-en-Y gastric bypass surgeryGenitourinary pain indexUPOINT clinical phenotype systemNephron-sparing surgeryWatchful waitingLaparoscopy for adrenal cortical carcinomaPartial adrenalectomyUrethral traumaPediatric urethral strictureEnteric urologic surgery

Prostate cancer treatmentView Articles
Prostate cancer, castration-resistantView Articles
Prostate cancer, cT3View Articles
Prostate cancer, high riskView Articles
Prostate cancer, localizedView Articles

Volume 10, Number 4Review Articles

Vascular Targeted Photodynamic Therapy for Localized Prostate Cancer

Treatment Update

Herbert Lepor

Survival for men diagnosed with prostate cancer directly depends on the stage and grade of the disease at diagnosis. Prostate cancer screening has greatly increased the ability to diagnose small and low-grade cancers that are amenable to cure. However, widespread prostate-specific antigen screening exposes many men with low-risk cancers to unnecessary complications associated with treatment for localized disease without any survival advantage. One challenge for urological surgeons is to develop effective treatment options for low-risk disease that are associated with fewer complications. Minimally invasive ablative treatments for localized prostate cancer are under development and may represent a preferred option for men with low-risk disease who want to balance the risks and benefits of treatment. Vascular targeted photodynamic therapy (VTP) is a novel technique that is being developed for treating prostate cancer. Recent advances in photodynamic therapy have led to the development of photosynthesizers that are retained by the vascular system, which provides the opportunity to selectively ablate the prostate with minimal collateral damage to other structures. The rapid clearance of these new agents negates the need to avoid exposure to sunlight for long periods. Presented herein are the rationale and preliminary data for VTP for localized prostate cancer. [Rev Urol. 2008;10(4):254-261]

Vascular targeted photodynamic therapyPhotodynamic therapyProstate cancer, localizedMinimally invasive ablative treatment for prostate cancerWST-09WST-11PadoporfinPalladium bacteriopheophorbide

Prostate carcinomaView Articles

Volume 10, Number 1Review Articles

Clinical Utility of Prostate Carcinoma Molecular Diagnostic Tests

Diagnostic Update

Scott B Shappell

Instead of relying on serum prostate-specific antigen (PSA) to identify patients for prostate biopsy, new laboratory tests are needed that have improved specificity for prostate carcinoma (CaP), allow accurate classification of clinically insignificant CaPs, allow for detection of clinically significant CaP in patients without elevated serum PSA, and allow for identification of aggressive forms of CaP, which may warrant adjunctive or even molecularly targeted therapy in the future. Over the last several years, highthroughput gene expression profiling and proteinomics have led to the identification of genes and proteins that are specifically overexpressed in CaP. Molecular diagnostic techniques readily translated to the clinical laboratory have been incorporated into the development of new tests based on these novel molecular alterations in CaP. Some of these tests already have well-documented clinical utility, such as in facilitating prostate biopsy decisions, and are routinely available. The current review focuses on the biological, clinical, and laboratory aspects of the most promising of these current and nearfuture molecular CaP tests. [Rev Urol. 2008;10(1):44-69]

Molecular diagnosticsProstate carcinomaProstate cancer antigen 3Alpha-methylacyl-CoA racemaseEarly prostate cancer antigenTransmembrane protease,serine 2ERGDNARNA

Prostate diagnostic or screening testView Articles

Volume 15, Number 3Review Articles

Prostate-Specific Antigen: Any Successor in Sight?

Diagnostic Review

Aniebietabasi S ObortMary B AjadiOluyemi Akinloye

Prostate cancer (PCa) is the most frequently diagnosed malignancy and the second leading cause of cancer death in men in the United States and other parts of the world. The lifetime risk of being diagnosed with PCa is approximately 16%. At present, the only widely accepted screening tools for PCa are prostate-specific antigen (PSA) and digital rectal examination. PSA is known to be prostate specific, but not PCa specific, and hence lacks the sensitivity to detect a large number of tumors, especially during the early stages. The PSA level is also known to be affected by many factors, such as medication, inflammation (benign prostatic hyperplasia and prostatitis), and urologic manipulation; hence, the controversy regarding the appropriate level of serum PSA that should trigger a biopsy or have clinical relevance to prostate metastases. Attempts to determine the level of prostate cells in peripheral blood by reverse transcriptase polymerase chain reaction did not significantly improve cancer diagnosis or predict postoperative failure. Therefore, the search continues for a novel biomarker or a panel of markers as well as other possible interventions to improve the use of PSA. This article reviews several possibilities. [Rev Urol. 2013;15(3):97-107 doi 10.3909/riu0567] © 2013 MedReviews®, LLC

Prostate-specific antigenProstate carcinomaProstate diagnostic or screening test

Prostate Health IndexView 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

Prostate markersView Articles
prostate neoplasmView Articles

Volume 23, Number 4Case Review

Exceptional Response to Radiation Therapy to the Primary Tumor in a Patient With de Novo Metastatic Prostate Cancer With High Tumor Mutation Burden

Benjamin MercierAndrew TamDaniela V. CastroSalvador Jaime-CasasAbhishek TripathiYun Rose LiRegina Barragan-Carrillo

We present the case of a patient diagnosed with de novo, low-volume metastatic prostate cancer who received first-line treatment with androgen-deprivation therapy in combination with darolutamide. The patient presented with symptoms derived from local growth from the primary tumor and received pelvic radiation therapy to the primary tumor and pelvic nodes. He experienced complete tumor regression, with high serum prostate-specific antigen declining to nondetectable levels. Next-generation genomic analysis indicated high tumor mutation burden and high microsatellite status instability. Here, we contextualize this patient’s case regarding the importance of precision genomics in radiation oncology and its potential importance for optimizing treatment.

Prostatic neoplasmsRadiation therapyNeoplasm metastasisAndrogen antagonistsprostate neoplasmcastration resistant

Prostate tumor markersView Articles

Volume 5, Number 3Meeting Reviews

Best of the 2003 AUA Annual Meeting

Highlights from the 2003 Annual Meeting of the American Urological Association, April 26-May 1, 2003

Dean G AssimosEllen ShapiroAlan W PartinMichael B ChancellorJ Curtis NickelJacob RajferClaus G RoehrbornMichael K BrawerRandall B MeachamBob DjavanArie S BelldegrunAllan J PantuckMesut RemziMichael DobrovitsMatthew B GretzerKazumasa Torimoto

Prostate cancerRenal cell carcinomaBenign prostatic hyperplasiaDepressionBladder cancerLower urinary tract symptomsUrinary tract infectionProstate-specific antigenNephrolithiasisOveractive bladderRadical prostatectomyPeyronie’s diseaseGleason scoreTransrectal ultrasoundErectile dysfunctionChronic prostatitis/chronic pelvic pain syndromeAcute urinary retentionInternational Prostate Symptom ScoreBacille Calmette-Guérin therapyChronic Prostatitis Symptom IndexMTOPS trialPLESS studyProstate tumor markersSELDI-TOF

Prostate volumeView Articles
Prostate-specific antigenView Articles

Volume 23, Number 3Prostate Cancer

Incorporation of IsoPSA Into Clinical Practice in the Management of Elevated Prostate-Specific Antigen Based on Current Guidelines

Aidan KennedyJason Hafron

Prostate cancer is a highly prevalent malignancy among men worldwide. Optimal management depends on early detection and accurate surveillance. Several screening and surveillance tools are available to men with prostate cancer, including prostate-specific antigen (PSA) testing, digital rectal examination, prostate biopsy, imaging modalities, and a plethora of biomarkers. Prostate-specific antigen, though widespread in its use, is limited in its specificity. Many adjunctive tests to PSA have been developed. One such test is IsoPSA (Cleveland Diagnostics), a novel PSA assay that focuses on structural differences among PSA isoforms to aid in detecting clinically significant prostate cancer. With an improved understanding of the capability and uses of IsoPSA, physicians can enhance patient outcomes through more accurate risk assessment and save costs by reducing the number of unnecessary prostate biopsies and imaging generated resulting from a nonspecific elevation in serum PSA. This review describes the performance and use of IsoPSA.

Prostatic neoplasmsBiomarkerProstate-specific antigen (PSA)Prostate-specific antigenBiomarkers

Prostate-specific antigen (PSA)View Articles

Volume 23, Number 3Prostate Cancer

Incorporation of IsoPSA Into Clinical Practice in the Management of Elevated Prostate-Specific Antigen Based on Current Guidelines

Aidan KennedyJason Hafron

Prostate cancer is a highly prevalent malignancy among men worldwide. Optimal management depends on early detection and accurate surveillance. Several screening and surveillance tools are available to men with prostate cancer, including prostate-specific antigen (PSA) testing, digital rectal examination, prostate biopsy, imaging modalities, and a plethora of biomarkers. Prostate-specific antigen, though widespread in its use, is limited in its specificity. Many adjunctive tests to PSA have been developed. One such test is IsoPSA (Cleveland Diagnostics), a novel PSA assay that focuses on structural differences among PSA isoforms to aid in detecting clinically significant prostate cancer. With an improved understanding of the capability and uses of IsoPSA, physicians can enhance patient outcomes through more accurate risk assessment and save costs by reducing the number of unnecessary prostate biopsies and imaging generated resulting from a nonspecific elevation in serum PSA. This review describes the performance and use of IsoPSA.

Prostatic neoplasmsBiomarkerProstate-specific antigen (PSA)Prostate-specific antigenBiomarkers

Prostate-specific antigen doubling timeView Articles

Volume 8, Supplement 2Review Articles

Prostate Cancer: Epidemiology, Screening, and Biomarkers

16th International Prostate Cancer Update

Gerald W Chodak

Carcinoma of the prostate continues to be a major health problem in the United States. Beginning in 1988, a marked increase in detection of prostate cancer occurred due to the development of a test for prostate-specific antigen (PSA). Controversy exists, however, about the value of PSA as a tumor marker. Although it has prognostic significance both before and after definitive therapy for prostate cancer, it is unclear whether routine PSA screening will translate into a survival advantage for patients. Because of its limitations, PSA may not ultimately be a good enough marker to be used as a screening tool. However, molecular biology has led to a rapid rise in the number of potential new prostate tumor markers, which may eventually overcome the weaknesses of PSA. Considerable progress has occurred in the diagnosis and management of prostate cancer: more is understood about the risk factors for the disease, possible ways to prevent it, and new ways to diagnose and monitor it. These developments have already translated into better patient care, while also identifying where further improvements are needed. [Rev Urol. 2006;8(suppl 2):S3-S8]

Prostate cancerProstate-specific antigenBiomarkersProstate-specific membrane antigenProstate-specific antigen doubling time

Prostate-specific antigen recurrenceView Articles
Prostate-specific antigen screeningView Articles

Volume 22, Number 3Review Articles

A Trend Toward Aggressive Prostate Cancer

Original Research

Navin ShahVladimir Ioffe

To compare prostate biopsy (Pbx) characteristics before and after the 2012 United States Preventive Services Task Force (USPSTF) prostate cancer (PCa) screening guidelines, we completed a retrospective comparative analysis of 1703 sequential patients that had a Pbx in 2010 to 2012 (3 years) with 383 patients biopsied in 2018 and 310 patients biopsied in 2019. Data was collected on patient age, race, serum prostate specific antigen (PSA) level, digital rectal examination (DRE) results, total number of biopsies performed, and Gleason sum score (GSS). Data were analyzed to determine whether the 2012 USPSTF screening recommendations against PCa screening may have affected PCa characteristics. Three study groups were defined as Group A, Group B, and Group C. Group A represents Pbx prior to the 2012 USPSTF screening guidelines (2010-2012), Group B represents Pbx in 2018, and Group C represents Pbx in 2019. The patient population consisted of 73% Black men, 16% White men, and 11% men of other races. The number of patients that had a biopsy in Groups A through C, respectively, were 567 patients/year, 383 patients/year, and 310 patients/year. The annual positive Pbx rate for Group A through C was 134/year, 175/year, and 201/year, respectively. High-grade PCa (GSS 7-10) in Groups A through C was 51.5%, 60.5%, and 60.0%. The proportion of patients with a serum PSA level 10 ng/mL or greater in Groups A through C was 25.4%, 29.3%, and 33%. For patients age 70 to 80 years, there was an increasing trend for serum PSA levels 10 ng/mL and higher: 31%, 38%, and 39%, respectively. In this age group, high-grade tumors (GSS 7-10) occurred in 61%, 65%, and 68%, respectively. In 2019, Grade Group 3, 4, and 5 was present in 37.7% of 70- to 80-year-old men and 34.6% of Black men. More than 50% positive biopsy cores were present in 46.3% of 70- to 80-year-old men and 36.6% of Black men. Our data through 2019 continued to show that after the 2012 USPSTF recommendations against PCa screening, PCa screening has decreased. We found decreased Pbx, increased PCa diagnosis, and increased high-grade PCa (GSS 7-10). As our patient population consisted of 73% Black patients and 33% of men age 70 to 80 years, our results support aggressive PCa screening for high-risk patients, which include Black men, men with a family history of PCa, and healthy men age 70 to 80 years. [Rev Urol. 2020;22(3):102-109] © 2020 MedReviews®, LLC

Prostate cancerElderly menUnited States Preventive Services Task ForceProstate-specific antigen screeningBlack men

Prostate-specific antigensView Articles

Volume 23, Number 2Prostate Cancer

Real-World Comparison of Deep Prostate-Specific Antigen Response in Patients With Metastatic Castration-Sensitive Prostate Cancer Treated With Apalutamide or Enzalutamide

Benjamin H. LowentrittIbrahim KhilfehDominic PilonShawn DuCarmine RossiFrederic KinkeadLilian DiazJill KorsiakPatrick LefebvreGordon A Brown

Deep prostate-specific antigen reduction of at least 90% (PSA90 response) after androgen receptor pathway inhibitor initiation to treat metastatic castration-sensitive prostate cancer (mCSPC) is associated with longer survival. This real-world study evaluated the proportion of androgen receptor pathway inhibitor–naive patients with mCSPC who achieved PSA90 response 6 months after initiating apalutamide or enzalutamide.

Prostatic neoplasmsProstate-specific antigen (PSA)Prostate-specific antigenProstate-specific antigensCastrationAndrogen receptorAndrogen receptor antagoniststreatment effectiveness

Prostate-specific membrane antigenView Articles
Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening TrialView Articles

Volume 11, Number 3Review Articles

Screening for Prostate Cancer: A Review of the ERSPC and PLCO Trials

Management Update

Herbert LeporSamir S TanejaBob DjavanElisabeth EckersbergerJulia FinkelsteinHelen SadriMarkus Margreiter

The advent of prostate-specific antigen (PSA) testing in the early 1980srevolutionized the diagnosis of prostate cancer. As a result of PSA testing,there has been a surge in the number of prostate cancer diagnoses. Thisreview examines the results of 2 recent landmark trials that studied the effectof screening on prostate cancer mortality: the European Randomized Study ofScreening for Prostate Cancer (ERSPC) and the US-based Prostate, Lung,Colorectal, and Ovarian (PLCO) Cancer Screening Trial.[Rev Urol. 2009;11(3):127-133 doi: 10.3909/riu0474]

PSA screeningEuropean Randomized Study of Screening for Prostate Cancer(ERSPC)Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial

ProstatecancerView Articles
ProstatectomyView Articles

Volume 23, Number 3Prostate Cancer

Advances in Radical Prostatectomy: A Narrative Review

Austin DryschKathryn E. FinkChalairat Suk-OuichaiMitchell M. HuangKent T. PerryHiten D. PatelAshley E. Ross

Radical prostatectomy (RP) is the mainstay surgical treatment for men with localized prostate cancer. The use of robot-assisted RP (RARP) has specifically allowed for the development of novel techniques to improve postoperative quality of life for patients.

Prostatic neoplasmsProstatectomyRobotic-assisted surgeryrobotic surgical procedures

Prostatectomy, radicalView Articles
ProstaticView Articles