Screening for prostate cancer – The controversy continues, but can it be resolved?

Bul, Meelan; Schröder, Fritz H.

doi:10.3109/0284186x.2010.522197

Cited by 17 publications

(14 citation statements)

References 23 publications

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“…However, few patients may be saved by these treatments because only a minority of cases will die of the disease if left untreated. The number needed to treat to save one life estimated in two studies was 12–15 [3] and up to 48 [4]. Numerous nomograms and related prediction methods have been created based on clinical variables at the time of diagnosis but, to date, such tools have provided limited advice regarding which patients harbor aggressive disease requiring radical treatment possibly followed by adjuvant therapy and which patients may be suitable for a more conservative active surveillance program [5]–[9].…”

Section: Introductionmentioning

confidence: 99%

Expression Changes in the Stroma of Prostate Cancer Predict Subsequent Relapse

et al. 2012

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Biomarkers are needed to address overtreatment that occurs for the majority of prostate cancer patients that would not die of the disease but receive radical treatment. A possible barrier to biomarker discovery may be the polyclonal/multifocal nature of prostate tumors as well as cell-type heterogeneity between patient samples. Tumor-adjacent stroma (tumor microenvironment) is less affected by genetic alteration and might therefore yield more consistent biomarkers in response to tumor aggressiveness. To this end we compared Affymetrix gene expression profiles in stroma near tumor and identified a set of 115 probe sets for which the expression levels were significantly correlated with time-to-relapse. We also compared patients that chemically relapsed shortly after prostatectomy (<1 year), and patients that did not relapse in the first four years after prostatectomy. We identified 131 differentially expressed microarray probe sets between these two categories. 19 probe sets (15 genes overlapped between the two gene lists with p<0.0001). We developed a PAM-based classifier by training on samples containing stroma near tumor: 9 rapid relapse patient samples and 9 indolent patient samples. We then tested the classifier on 47 different samples, containing 90% or more stroma. The classifier predicted the risk status of patients with an average accuracy of 87%. This is the first general tumor microenvironment-based prognostic classifier. These results indicate that the prostate cancer microenvironment exhibits reproducible changes useful for predicting outcomes for patients.

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Section: Introductionmentioning

confidence: 99%

Expression Changes in the Stroma of Prostate Cancer Predict Subsequent Relapse

et al. 2012

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“…Esta recomendação sobressaiu pelo contraste estabelecido com as suas normas de 2008 (em que não fazia uma recomendação nem a favor nem contra o rastreio do cancro prostático), agitou a comunidade científica e veio motivar uma corrente de outras publicações. [4][5][8][9] A European Association of Urology sugere que, no caso opiniãoedebate de se iniciar o rastreio do cancro prostático através do PSA sérico, uma primeira colheita deverá ser realizada aos 40 anos, enquanto a American Urological Association propõe actualmente um início aos 55 anos. 3 11 Nenhuma das sociedades científicas referidas acima (assim como a American Cancer Society, American Society of Clinical Oncology, , American College of Physicians, American College of Preventive Medicine, entre outras) recomenda, na versão mais recente das suas normas, o rastreio sistemático e universal e sem considerar as suposições e dúvidas em seu torno.…”

Section: Re Su Mounclassified

Rastreio do cancro prostático: o actual paradigma da medicina centrada na pessoa

Agostinho¹

2014

RPMGF

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AS NORMAS E AS SUAS LEITURAS D esde há alguns anos que o rastreio do cancro prostático tem emergido, entre a literatura médica, pela discussão em torno da sua razão efectividade/risco. 1 O Antigénio Específico da Próstata (PSA) começou a ser usado como método de rastreio nos anos 90. Porém, desde que foram publicados na primeira década do século XXI os resultados de ensaios clínicos aleatorizados e controlados (cuja qualidade era superior à dos estudos observacionais), sabe-se que o rastreio deste carcinoma através do PSA não tem o benefício que era anteriormente considerado. 1-5 Esses mesmos ensaios clínicos, que merecerão maior detalhe abaixo, produziram novos resulta-Rev Port Med Geral Fam 2014;30:122-8 ABSTRACT PROSTATE CANCER SCREENING IN THE LIGHT OF PERSON-CENTERED MEDICINEFor several years, there has been debate regarding the cost effectiveness of prostate cancer screening. In 2012 the U.S. Preventive Services Task Force (USPSTF) recommended against screening for prostate cancer, concluding that there is considerable evidence that this is not beneficial. The impact of the recommendations of USPSTF may be noted in the guidelines produced by other scientific societies. Clinicians need to know the evidence.The results of two randomized controlled trials, the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) and the European Randomized Study of Screening for Prostate Cancer (ERSPC), form the largest body of current evidence, although both have limitations. An analysis of the results of these trials shows a small reduction in prostate cancer deaths among men who were screened. The first trial showed no reduction in mortality [RR = 1.09 (0.87 to 1.36)], while the latter trial showed that the number of deaths from prostate cancer was 5 per 1000 men in the group without screening and 4 per 1000 men undergoing screening [RR = 0.79 (0.68 to 0.91)] after 11 years of follow up. There is evidence that 100 to 200 men per 1000 men screened will have a false-positive test. Most of these men will undergo prostate biopsy. A large proportion of patients with prostatic carcinomas detected by screening may be subjected to surgery, radiotherapy or androgen deprivation therapy. This article highlights the evidence against systematic screening. It proposes a holistic approach involving the individual in the discussion of the advantages and disadvantages of prostate cancer screening.

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“…1,7 However, a large increase in the detection of indolent disease with PSA testing, followed by indiscriminate treatment of most men after a diagnosis, has led many to question the overall health benefits of PSA screening. 8 Results from the prostate cancer prevention trial (PCPT) increased awareness of the high prevalence of indolent prostate cancer among men with PSA levels below 4.0 ng ml 21 . 2 These data show that 15% of men at a median age of 69 years, with an average PSA of around 1.5 ng ml 21 , have prostate cancer on a sextant biopsy; and 85% of these would be considered of low grade.…”

Section: Importance Of Differentiating Between Lethal and Non-lethal mentioning

confidence: 99%

Differentiation of lethal and non lethal prostate cancer: PSA and PSA isoforms and kinetics

Carter

2012

Asian J Androl

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Prostate-specific antigen (PSA) testing for the early diagnosis of prostate cancer has led to a decrease in cancer mortality. However, the high prevalence of low-grade prostate cancer and its long natural history, competing causes of death in older men and treatment patterns of prostate cancer, have led to dramatic overtreatment of the disease. Improved markers of prostate cancer lethality are needed to reduce the overtreatment of prostate cancer that leads to a reduced quality of life without extending life for a high proportion of men. The PSA level prior to treatment is routinely used in multivariable models to predict prostate cancer aggressiveness. PSA isoforms and PSA kinetics have been associated with more aggressive phenotypes, but are not routinely employed as part of prediction tools prior to treatment. PSA kinetics is a valuable marker of lethality post treatment and routinely used in determining the need for salvage therapy.

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Screening for prostate cancer – The controversy continues, but can it be resolved?

Cited by 17 publications

References 23 publications

Expression Changes in the Stroma of Prostate Cancer Predict Subsequent Relapse

Expression Changes in the Stroma of Prostate Cancer Predict Subsequent Relapse

Rastreio do cancro prostático: o actual paradigma da medicina centrada na pessoa

Differentiation of lethal and non lethal prostate cancer: PSA and PSA isoforms and kinetics

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