Correlation of Initial PSA Level and Biopsy Features with PSA-Doubling Time in Early Stage Prostate Cancers in Japanese Men

Kakehi, Yoshiyuki; Shiraishi, Taizo; Kato, Takumi; Tobisu, Ken Ichi; Akakura, Koichiro; Egawa, Shin; Maeda, Osamu; Sumiyoshi, Yoshiteru; Arai, Yoichi; Ogawa, Osamu

doi:10.1016/s0302-2838(01)00020-3

Cited by 14 publications

(15 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some of these variations may have been caused by differences in the definition of microfocal carcinoma, because, for instance, the frequency of PSA recurrence was highest (range, 22%-26%) when there were no restrictions on the Gleason score 32,34 and lowest (range, 2%-7%) when the cancer length was restricted and the Gleason score was 6. 11,17,25,31 Some of the variations in the frequency of EPE also may have been attributable to patient selection, because EPE was reported less commonly in studies of screened populations 11,21 and in studies that included a high proportion 20,25 (rather than a low proportion 19 ) of patients with PSA-detected (T1c) prostate cancer (Figs. 1, 3).…”

Section: Discussionmentioning

confidence: 99%

“…4). Only 3 articles reported on symptomatic recurrences or death, with no patients, 11,47 1 of 48 patients (2%), 31 and 2 of 136 patients (1.5%) 47 experiencing recurrence and with 1 reported death. 47 .…”

Section: Clinical Outcomes Patients Treated By Radical Prostatectomymentioning

confidence: 99%

“…By using PSA doubling times as the only outcome measure, favorable biopsy features (1 or 2 positive biopsy cores with 50% involvement by cancer; 38 patients) were only prognostic when combined with World Health Organization grade (grade 1 vs grade 2 or 3) and initial PSA level (P 5 .0034). 31 Conversion to definitive therapy affected 19 of 64 patients (30%; follow-up length and reasons for conversion not given) with 1 or 2 positive cores. 47 …”

Section: Patients Undergoing Watchful Waitingmentioning

confidence: 99%

“…Only 1 article compared the outcomes of patients who had undergone 6 biopsies versus !7 biopsies and reported no significant differences in the frequency of EPE or positive margins. 31 Finally, there were large variations in the reported outcomes of patients undergoing radical treatment, but how much of this was attributable to treatment rather than to biologic tumor characteristics was unclear, because no details were provided about surgical expertise or the specifics of the radiotherapy treatment, although radiation dose was altered according to clinical stage in 1 study. 28 …”

Section: Limitations On Interpretationmentioning

confidence: 99%

See 3 more Smart Citations

The clinical management of patients with a small volume of prostatic cancer on biopsy: What are the risks of progression?

Harnden

Naylor

Shelley

et al. 2008

Cancer

View full text Add to dashboard Cite

Clinically localized prostate cancer is associated with a wide variation in biologic behavior, and men with the less aggressive form of the disease may never develop symptoms. There has been a rise in prostate cancer incidence in countries in which the blood test for prostatic-specific antigen (PSA) is common, and concerns have been expressed that this may be because of the increased detection of indolent disease, subjecting these men to unnecessary treatment and associated side effects. For the current review, the authors conducted a systematic evaluation of the literature regarding the outcomes of men who were diagnosed on the basis of a small volume of cancer in prostatic biopsies. The results indicated that, despite differences in study design and reporting, a significant proportion of patients with microfocal cancer, regardless of how it was defined, had adverse pathologic findings and a significant risk of PSA recurrence after undergoing radical prostatectomy. Biochemical and clinical recurrences also were observed after radiotherapy or watchful waiting. The authors concluded that patients with microfocal carcinoma on biopsy should be advised that their disease is not necessarily ''insignificant'' and should be counseled accordingly. Cancer 2008; 112:971-81.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Clinical Outcomes Patients Treated By Radical Prostatectomymentioning

confidence: 99%

Section: Patients Undergoing Watchful Waitingmentioning

confidence: 99%

Section: Limitations On Interpretationmentioning

confidence: 99%

See 2 more Smart Citations

The clinical management of patients with a small volume of prostatic cancer on biopsy: What are the risks of progression?

Harnden

Naylor

Shelley

et al. 2008

Cancer

View full text Add to dashboard Cite

show abstract

“…A derivative called "PSA doubling time" (PSADt) expresses the increase of PSA in time (t) more precisely; it is calculated using the formula: PSADt = log 2t / log final PSA -log initial PSA. Prostate cancer has shorter PSADt than BPH; in addition, the more aggressive the tumor is, PSADt is shorter 48,49 . Free/total PSA ratio (f/t PSA) is frequently used to distinguish the persons with BPH and PCa having PSA in the gray zone and normal digital rectal examination (DRE).…”

Section: Determination Of Psa In Serum In the Diagnosis Of Bphmentioning

confidence: 98%

Benign prostatic hyperplasia and prostate-specific antigen

et al. 2015

View full text Add to dashboard Cite

Androgens and prostate functionTestosterone (T) and 5α-dihidrotestosterone (DHT) play a crucial role in the fetal prostate development. These androgens stimulate mesenchyme, while mesenchyme induces the proliferation of the epithelial buds from the urogenital sinus. This process, called "mesenchyme-epithelial interaction", starts in the 10th gestational week and continues in the adult age 1, 2 . Testosterone induces the development of the seminal vesicles and Wolffian ducts, while DHT induces the development of the prostate, penis and scrotum.Prostatic tissue is composed of stroma and epithelium. Prostatic stroma is composed of stromal cells (fibroblasts, endothelial capillary cells, lymph vessels and smooth muscle cells), neuroendocrine (NE) cells, neural cell axons, intercellular liquid and collagen fibers 3 . Prostatic epithelium is composed of secretory, basal, intermediary and NE cells. Secretory cells synthesize and secrete various proteins, like prostate specific antigen (PSA), prostatic acid phosphatase (PAP), androgen receptor (AR) and make the greatest part of the prostatic epithelium. It is believed that NE cells induce growth, differentiation, and secretory functions of the prostatic epithelium 4 .Numerous factors regulate prostatic growth: endocrine, neuroendocrine, paracrine, or growth factors (GF), autocrine and intracrine factors. However, the action of the endocrine factors is the best known. Testosterone is the most important serum androgen in the male, with the average serum concentration of 611 ± 186 ng/dL, while the average DHT serum concentration is 56 ± 20 ng/dL. However, the average concentration of active, free T is only 12.1 ± 3.7 ng/dL, while the rest is bound to the globulins and albumins. The major androgen in the prostatic tissue is DHT, with the average tissue concentration of 2.4-5.1 ng/g. The average tissue concentration of T is 3-5 times lower and measures 0.9 ng/g 5-7 .Only free T molecules can enter the prostatic cell, by diffusion. In the cytosol, one part of T molecules transforms into DHT. Both T and DHT bind to AR and form androgen-AR complexes. Subsequently, those complexes make pairs, entering the nucleus and bind to androgen-responsive elements (ARE) on DNA. After the information was transcripted from DNA to mRNA, mRNA leaves the nucleus and comes on ribosomes, where the information is translated into protein. Enzyme 5-alpha reductase (5αR) performs the conversion of T to DHT. There are two isoforms of 5αR: type 5αR-2 is dominant in the prostatic stroma and accessory genital tissues. Type 5αR-1 is present in the skin and prostate epithelium. Benign prostate hyperplasiaBenign prostate hyperplasia (BPH) denotes progressive prostatic enlargement, associated with the symptoms of impaired emptying of the urinary bladder and followed with gradual progression of the symptoms and complications. The most common BPH-related complications are chronic urinary infection, urinary bladder stones, chronic and acute urinary retention. The prevalence of BPH is very high: BPH is the fourth...

show abstract

Continuing Controversy Over Monitoring Men With Localized Prostate Cancer: A Systematic Review of Programs in the Prostate Specific Antigen Era

et al. 2006

View full text Add to dashboard Cite

Purpose-There is continuing controversy over the most appropriate treatment for screendetected and clinically localised prostate cancer and increasing interest in monitoring such men initially, with radical treatment targeted at cancers showing signs of progressive potential but while still curable. Current evidence on monitoring protocols and biomarkers used to predict disease progression was systematically reviewed.Methods-MEDLINE and Excerpta Medica (EMBASE) bibliographic databases were searched from 1988 to October 2004, supplemented by manual searches of reference lists, focusing on studies reporting monitoring of men with localised prostate cancer.Results-48 potentially eligible papers were found, but only five studies (451 men) restricted entry criteria to men with clinically localised (T1-2) prostate cancer. Monitoring protocols varied with little consensus, although the majority used PSA levels and digital rectal examination, with some adding re-biopsy to assess progression. Actuarial probabilities of freedom from disease progression at 4-5 years of follow-up were 67%-72%. However, up to 50% of men abandoned monitoring within 2 years, largely because of anxiety related to rising PSA levels rather than objective evidence of disease progression. There was no robust evidence to support the use of PSA doubling times or velocity to identify men in whom disease may progress. Studies were characterised by small sample size, short-term follow-up, observer bias, and uncertain validity around variable definitions of progression.Conclusions-Current evidence suggests that some form of monitoring would be a suitable treatment option for men with localised prostate cancer, but there is little consensus over what markers should be used in such a programme, or how 'progression' should be properly defined. The search for a method that safely identifies men with prostate cancer who could avoid radical intervention must continue.

show abstract

Correlation of Initial PSA Level and Biopsy Features with PSA-Doubling Time in Early Stage Prostate Cancers in Japanese Men

Cited by 14 publications

References 27 publications

The clinical management of patients with a small volume of prostatic cancer on biopsy: What are the risks of progression?

The clinical management of patients with a small volume of prostatic cancer on biopsy: What are the risks of progression?

Benign prostatic hyperplasia and prostate-specific antigen

Continuing Controversy Over Monitoring Men With Localized Prostate Cancer: A Systematic Review of Programs in the Prostate Specific Antigen Era

Contact Info

Product

Resources

About