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1.
Prog Urol ; 30(5): 252-260, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32197936

RESUMEN

INTRODUCTION: European Randomized Study of Screening for Prostate Cancer (ERSPC) mortality results were reported for 7 European countries (excluding France) and showed a significant reduction in Prostate cancer (PCa) mortality. As those results have not been part of the global ERSPC results, it is of interest to report PCa mortality at a median follow-up of 9 years for French section of ERSPC. MATERIAL AND METHODS: Two administrative departments were involved in the study. Only men after randomization in the screening group were invited by mail to be screened by PSA testing with two rounds at 4-6 year intervals. Biopsy was recommended if PSA>=3.0 ng/mL. No information other that the French Association of Urology recommandations on the use of PSA was offered to the control group (own decision of physicians and patients). Follow up was based on cancer registry database. Contamination defined as the receipt of PSA testing in control arm was measured. Poisson regression models were used to estimate the Rate Ratio (RR) of PCa mortality and incidence in the screening vs. control arm. RESULTS: Starting from 2003, 80,696 men aged 55-69 years were included. The percentage of men in the screening arm with at least one PSA test (compliance) was 31%. Compared to the control arm, PCa incidence increased by 10% in the screening arm (RR=1.10; 95% CI=[1.04-1.16], P=0.001), but PCa mortality did not differ (0.222 and 0.215 deaths/1000 person-years; RR=1.03[0.75-1.42], P=0.9). DISCUSSION: Limitations include low participation rate. PSA testing in the control arm was observed in 32% of men (contamination). CONCLUSIONS: Contamination in control group led to no effect of PSA-based screening on prostate cancer mortality at 9 years follow-up. LEVEL OF EVIDENCE: 3.


Asunto(s)
Detección Precoz del Cáncer/métodos , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/mortalidad , Anciano , Detección Precoz del Cáncer/normas , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo
2.
Tijdschr Psychiatr ; 61(10): 725-729, 2019.
Artículo en Holandés | MEDLINE | ID: mdl-31907917

RESUMEN

A 61-year-old woman with a conversion disorder (functional neurological symptom disorder) was referred by her neurologist to the outpatient psychiatric clinic for medically unexplained somatic symptoms. She did not respond well to our treatment, which we initially related to a comorbid mood disorder. Eventually, a progression of both motor and cognitive symptoms were found to be consistent with corticobasal degeneration, a rare neurodegenerative disorder. This case report illustrates the importance of a revised neurological examination when a patient with conversion disorder does not improve.


Asunto(s)
Enfermedades de los Ganglios Basales/diagnóstico , Trastornos de Conversión/diagnóstico , Enfermedades Neurodegenerativas/diagnóstico , Trastornos de Conversión/tratamiento farmacológico , Diagnóstico Diferencial , Femenino , Humanos , Síntomas sin Explicación Médica , Persona de Mediana Edad
3.
Adv Exp Med Biol ; 867: 93-114, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26530362

RESUMEN

In this chapter the use of prostate specific antigen (PSA) as a tumor marker for prostate cancer is discussed. The chapter provides an overview of biological and clinical aspects of PSA. The main drawback of total PSA (tPSA) is its lack of specificity for prostate cancer which leads to unnecessary biopsies. Moreover, PSA-testing poses a risk of overdiagnosis and subsequent overtreatment. Many PSA-based markers have been developed to improve the performance characteristics of tPSA. As well as different molecular subforms of tPSA, such as proPSA (pPSA) and free PSA (fPSA), and PSA derived kinetics as PSA-velocity (PSAV) and PSA-doubling time (PSADT). The prostate health index (phi), PSA-density (PSAD) and the contribution of non PSA-based markers such as the urinary transcripts of PCA3 and TMPRSS-ERG fusion are also discussed. To enable further risk stratification tumor markers are often combined with clinical data (e.g. outcome of DRE) in so-called nomograms. Currently the role of magnetic resonance imaging (MRI) in the detection and staging of prostate cancer is being explored.


Asunto(s)
Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/diagnóstico , Detección Precoz del Cáncer , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasias de la Próstata/sangre
4.
Br J Cancer ; 108(10): 1971-7, 2013 May 28.
Artículo en Inglés | MEDLINE | ID: mdl-23674085

RESUMEN

BACKGROUND: Men with screen-detected prostate cancer can choose to undergo immediate curative treatment or enter into an expectant management programme. We quantified how the benefits and harms of immediate treatment vary according to the prognostic factors of clinical T-stage, Gleason score, and patient age. METHODS: A microsimulation model based on European Randomized Study of Screening for Prostate Cancer data was used to predict the benefits and harms of immediate treatment versus delayed treatment of local-regional prostate cancer in men aged 55-74 years. Benefits included life-years gained and reduced probability of death from prostate cancer. Harms included lead time and probability of overdiagnosis. RESULTS: The ratio of mean lead time to mean life-years gained ranged from 1.8 to 31.2, and the additional number of treatments required per prostate cancer death prevented ranged from 0.3 to 11.6 across the different prognostic groups. Both harm-benefit ratios were lowest, most favourable, for men aged 55-59 years and diagnosed with moderate-risk prostate cancer. Ratios were high for men aged 70-74 years regardless of clinical T-stage and Gleason score. CONCLUSION: Men aged 55-59 years with moderate-risk prostate cancer are predicted to derive greatest benefit from immediate curative treatment. Immediate treatment is least favourable for men aged 70-74 years with either low-risk or high-risk prostate cancer.


Asunto(s)
Detección Precoz del Cáncer/métodos , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/terapia , Anciano , Humanos , Longevidad/fisiología , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Pronóstico , Antígeno Prostático Específico/análisis , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/patología , Medición de Riesgo , Factores de Riesgo , Análisis de Supervivencia
5.
Br J Cancer ; 109(3): 633-40, 2013 Aug 06.
Artículo en Inglés | MEDLINE | ID: mdl-23860533

RESUMEN

BACKGROUND: Patients' preferences are important for shared decision making. Therefore, we investigated patients' and urologists' preferences for treatment alternatives for early prostate cancer (PC). METHODS: A discrete choice experiment was conducted among 150 patients who were waiting for their biopsy results, and 150 urologists. Regression analysis was used to determine patients' and urologists' stated preferences using scenarios based on PC treatment modality (radiotherapy, surgery, and active surveillance (AS)), and risks of urinary incontinence and erectile dysfunction. RESULTS: The response rate was 110 out of 150 (73%) for patients and 50 out of 150 (33%) for urologists. Risk of urinary incontinence was an important determinant of both patients' and urologists' stated preferences for PC treatment (P<0.05). Treatment modality also influenced patients' stated preferences (P<0.05), whereas the risk of erectile dysfunction due to radiotherapy was mainly important to urologists (P<0.05). Both patients and urologists preferred AS to radical treatment, with the exception of patients with anxious/depressed feelings who preferred radical treatment to AS. CONCLUSION: Although patients and urologists generally may prefer similar treatments for PC, they showed different trade-offs between various specific treatment aspects. This implies that urologists need to be aware of potential differences compared with the patient's perspective on treatment decisions in shared decision making on PC treatment.


Asunto(s)
Prioridad del Paciente/psicología , Pautas de la Práctica en Medicina , Neoplasias de la Próstata/radioterapia , Neoplasias de la Próstata/cirugía , Anciano , Toma de Decisiones , Disfunción Eréctil/etiología , Disfunción Eréctil/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Estudios Prospectivos , Neoplasias de la Próstata/psicología , Ensayos Clínicos Controlados Aleatorios como Asunto , Incontinencia Urinaria/etiología , Incontinencia Urinaria/prevención & control
7.
Prostate Cancer Prostatic Dis ; 24(4): 1048-1054, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-33833378

RESUMEN

BACKGROUND: The reduction of overtreatment by active surveillance (AS) is limited in patients with low-risk prostate cancer (PCa) due to high rates of patients switching to radical treatment. MRI improves biopsy accuracy and could therewith affect inclusion in or continuation of AS. We aim to assess the effect of MRI with target biopsies on the total rate of patients discontinuing AS, and in particular discontinuation due to Grade Group (GG) reclassification. METHODS: Three subpopulations included in the prospective PRIAS study with GG 1 were studied. Group A consists of patients diagnosed before 2009 without MRI before or during AS. Group B consists of patients diagnosed without MRI, but all patients underwent MRI within 6 months after diagnosis. Group C consists of patients who underwent MRI before diagnosis and during follow-up. We used cumulative incidence curves to estimate the rates of discontinuation. RESULTS: In Group A (n = 500), the cumulative probability of discontinuing AS at 2 years is 27.5%; GG reclassification solely accounted for 6.9% of the discontinuation. In Group B (n = 351) these numbers are 30.9 and 22.8%, and for Group C (n = 435) 24.2 and 13.4%. The three groups were not randomized, however, baseline characteristics are highly comparable. CONCLUSIONS: Performing an MRI before starting AS reduces the cumulative probability of discontinuing AS at 2 years. Performing an MRI after already being on AS increases the cumulative probability of discontinuing AS in comparison to not performing an MRI, especially because of an increase in GG reclassification. These results suggest that the use of MRI could lead to more patients being considered unsuitable for AS. Considering the excellent long-term cancer-specific survival of AS before the MRI era, the increased diagnostic accuracy of MRI could potentially lead to more overtreatment if definitions and treatment options of significant PCa are not adapted.


Asunto(s)
Imágenes de Resonancia Magnética Multiparamétrica , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/patología , Anciano , Biomarcadores de Tumor/sangre , Biopsia , Humanos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Estudios Prospectivos , Antígeno Prostático Específico/sangre , Sistema de Registros , Espera Vigilante
8.
Br J Cancer ; 103(5): 708-14, 2010 Aug 24.
Artículo en Inglés | MEDLINE | ID: mdl-20664589

RESUMEN

BACKGROUND: Most men with elevated levels of prostate-specific antigen (PSA) do not have prostate cancer, leading to a large number of unnecessary biopsies. A statistical model based on a panel of four kallikreins has been shown to predict the outcome of a first prostate biopsy. In this study, we apply the model to an independent data set of men with previous negative biopsy but persistently elevated PSA. METHODS: The study cohort consisted of 925 men with a previous negative prostate biopsy and elevated PSA (>or=3 ng ml(-1)), with 110 prostate cancers detected (12%). A previously published statistical model was applied, with recalibration to reflect the lower positive biopsy rates on rebiopsy. RESULTS: The full-kallikrein panel had higher discriminative accuracy than PSA and DRE alone, with area under the curve (AUC) improving from 0.58 (95% confidence interval (CI): 0.52, 0.64) to 0.68 (95% CI: 0.62, 0.74), P<0.001, and high-grade cancer (Gleason >or=7) at biopsy with AUC improving from 0.76 (95% CI: 0.64, 0.89) to 0.87 (95% CI: 0.81, 0.94), P=0.003). Application of the panel to 1000 men with persistently elevated PSA after initial negative biopsy, at a 15% risk threshold would reduce the number of biopsies by 712; would miss (or delay) the diagnosis of 53 cancers, of which only 3 would be Gleason 7 and the rest Gleason 6 or less. CONCLUSIONS: Our data constitute an external validation of a previously published model. The four-kallikrein panel predicts the result of repeat prostate biopsy in men with elevated PSA while dramatically decreasing unnecessary biopsies.


Asunto(s)
Biopsia , Calicreínas/análisis , Neoplasias de la Próstata/diagnóstico , Detección Precoz del Cáncer , Humanos , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Países Bajos , Antígeno Prostático Específico/sangre
9.
Br J Cancer ; 101(11): 1833-8, 2009 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-19904272

RESUMEN

BACKGROUND: Prostate cancer screening with prostate-specific antigen (PSA) has shown to reduce prostate cancer mortality in the European Randomised study of Screening for Prostate Cancer (ERSPC) trial. Overdetection and overtreatment are substantial unfavourable side effects with consequent healthcare costs. In this study the effects of introducing widespread PSA screening is evaluated. METHODS: The MISCAN model was used to simulate prostate cancer growth and detection in a simulated cohort of 100,000 men (European standard population) over 25 years. PSA screening from age 55 to 70 or 75, with 1, 2 and 4-year-intervals is simulated. Number of diagnoses, PSA tests, biopsies, treatments, deaths and corresponding costs for 100,000 men and for United Kingdom and United States are compared. RESULTS: Without screening 2378 men per 100,000 were predicted to be diagnosed with prostate cancer compared with 4956 men after screening at 4-year intervals. By introducing screening, the costs would increase with 100% to 60,695,000 euro. Overdetection is related to 39% of total costs (23,669,000 euro). Screening until age 75 is relatively most expensive because of the costs of overtreatment. CONCLUSION: Introduction of PSA screening will increase total healthcare costs for prostate cancer substantially, of which the actual screening costs will be a small part.


Asunto(s)
Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/sangre , Anciano , Simulación por Computador , Costos y Análisis de Costo/métodos , Humanos , Masculino , Tamizaje Masivo/economía , Tamizaje Masivo/métodos , Persona de Mediana Edad , Modelos Estadísticos , Estadificación de Neoplasias , Antígeno Prostático Específico/economía , Neoplasias de la Próstata/economía , Neoplasias de la Próstata/patología
10.
Clin Chem ; 54(12): 1999-2006, 2008 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-18927249

RESUMEN

BACKGROUND: Clinicians may be unaware that replacement of the historical total prostate-specific antigen (tPSA) standard with the WHO 96/670 international standard leads to difficulties in interpreting tPSA results. Our aim was to investigate the relationship between the Hybritech and WHO calibrations of the Beckman Coulter tPSA assay, and to assess the impact on prostate cancer (PCa) detection. METHODS: tPSA concentrations were measured in 106 serum samples with both Hybritech and WHO calibrations. The established relationships were used for an in silico experiment with a cohort of 5865 men. Differences in prostate biopsy rates, PCa detection, and characteristics of missed cancers were calculated at biopsy thresholds of 3.0 and 4.0 microg/L. RESULTS: A linear relationship was observed between the 2 calibrations, with a 20.3% decrease in tPSA values with the WHO standard compared with the Hybritech calibration. Applying the WHO calibration to the cohort of 5865 men yielded a 20% or 19% decrease in prostate biopsies and a 19% or 20% decrease in detected cancers compared with the Hybritech calibration, at a cutoff for biopsy of 3.0 or 4.0 microg/L, respectively. The decrease in detected cancers declined to 9% or 11% if an abnormal result in a digital rectal examination or a transrectal ultrasound evaluation was used as trigger for prostate biopsy (cutoff of 3.0 or 4.0 microg/L, respectively). CONCLUSIONS: Application of the WHO standard for tPSA assays with commonly used tPSA thresholds leads to a significant decrease in PCa detection. Careful assessment of the relationship between the WHO standard and the thresholds used for prostate biopsy is hence necessary.


Asunto(s)
Antígeno Prostático Específico/normas , Neoplasias de la Próstata/diagnóstico , Biopsia/estadística & datos numéricos , Calibración , Humanos , Masculino , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/patología , Estándares de Referencia , Organización Mundial de la Salud
11.
Prostate Cancer Prostatic Dis ; 20(1): 99-104, 2017 03.
Artículo en Inglés | MEDLINE | ID: mdl-27897172

RESUMEN

BACKGROUND: To adapt the well-performing European Randomized Study of Screening for Prostate Cancer (ERSPC) risk calculator to the Chinese setting and perform an external validation. METHODS: The original ERSPC risk calculator 3 (RC3) for prostate cancer (PCa) and high-grade PCa (HGPCa) was applied to a development cohort of 3006 previously unscreened Hong Kong Chinese men with initial transrectal biopsies performed from 1997 to 2015, age 50-80 years, PSA 0.4-50 ng ml-1 and prostate volume 10-150 ml. A simple adaptation to RC3 was performed and externally validated in a cohort of 2214 Chinese men from another Hong Kong hospital. The performance of the models were presented in calibration plots, area under curve (AUC) of receiver operating characteristics (ROCs) and decision curve analyses. RESULTS: PCa and HGPCa was diagnosed in 16.7% (503/3006) and 7.8% (234/3006) men in the development cohort, and 20.2% (447/2204) and 9.7% (214/2204) men in the validation cohort, respectively. The AUCs using the original RC3 model in the development cohort were 0.75 and 0.84 for PCa and HGPCa, respectively, but the calibration plots showed considerable overestimation. In the external validation of the recalibrated RC3 model, excellent calibration was observed, and discrimination was good with AUCs of 0.76 and 0.85 for PCa and HGPCa, respectively. Decision curve analyses in the validation cohort showed net clinical benefit of the recalibrated RC3 model over PSA. CONCLUSIONS: A recalibrated ERSPC risk calculator for the Chinese population was developed, and it showed excellent discrimination, calibration and net clinical benefit in an external validation cohort.


Asunto(s)
Pueblo Asiatico , Neoplasias de la Próstata/epidemiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Anciano , Anciano de 80 o más Años , Biopsia , China/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Pronóstico , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/etiología , Curva ROC , Ensayos Clínicos Controlados Aleatorios como Asunto/normas , Reproducibilidad de los Resultados , Medición de Riesgo
12.
J Natl Cancer Inst ; 93(15): 1153-8, 2001 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-11481387

RESUMEN

BACKGROUND: The currently recommended frequency for prostate-specific antigen (PSA) screening tests for prostate cancer is 1 year, but the optimal screening interval is not known. Our goal was to determine if a longer interval would compromise the detection of curable prostate cancer. METHODS: A cohort of 4491 men aged 55-75 years, all participants in the Rotterdam section of the European Randomized Study of (population-based) Screening for Prostate Cancer, were invited to participate in an initial PSA screening. Men who received that screening were invited for a second screen 4 years later. Pathology findings from needle biopsy cores were compared for men in both rounds. Statistical tests were two-sided. RESULTS: A total of 4133 men were screened in the first round (the prevalence screen), and 2385 were screened in the second round. The median amount of cancer in needle biopsy sets was 7.0 mm (95% confidence interval [CI] = 5.4 mm to 8.6 mm) in the first round and 4.1 mm (95% CI = 2.6 mm to 5.6 mm) in the second round (P =.001). Thirty-six percent of the adenocarcinomas detected in the first round but only 16% of those detected in the second round had a Gleason score of 7 or higher (mean difference = 20% [95% CI = 10% to 30%]; P<.001). Whereas 25% of the adenocarcinomas detected in the first round had adverse prognostic features, only 6% of those detected in the second round did (mean difference = 19% [95% CI = 11% to 26%]; P<.001). Baseline PSA values were predictive for the amount of tumor in biopsies in men with cancer in the first round but not for that in the second round. CONCLUSION: Most large prostate cancers with high serum PSA levels were effectively detected in a prevalence screen. In this population, a screening interval of 4 years appears to be short enough to constrain the development of large tumors, although it is inconclusive whether this will result in a survival benefit.


Asunto(s)
Adenocarcinoma/inmunología , Adenocarcinoma/patología , Tamizaje Masivo/métodos , Vigilancia de la Población , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/inmunología , Neoplasias de la Próstata/patología , Adenocarcinoma/prevención & control , Anciano , Biopsia con Aguja , Europa (Continente) , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Valor Predictivo de las Pruebas , Pronóstico , Neoplasias de la Próstata/prevención & control , Factores de Tiempo
14.
J Natl Cancer Inst ; 107(1): 366, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25505238

RESUMEN

BACKGROUND: The results of the European Randomized Study of Screening for Prostate Cancer (ERSPC) trial showed a statistically significant 29% prostate cancer mortality reduction for the men screened in the intervention arm and a 23% negative impact on the life-years gained because of quality of life. However, alternative prostate-specific antigen (PSA) screening strategies for the population may exist, optimizing the effects on mortality reduction, quality of life, overdiagnosis, and costs. METHODS: Based on data of the ERSPC trial, we predicted the numbers of prostate cancers diagnosed, prostate cancer deaths averted, life-years and quality-adjusted life-years (QALY) gained, and cost-effectiveness of 68 screening strategies starting at age 55 years, with a PSA threshold of 3, using microsimulation modeling. The screening strategies varied by age to stop screening and screening interval (one to 14 years or once in a lifetime screens), and therefore number of tests. RESULTS: Screening at short intervals of three years or less was more cost-effective than using longer intervals. Screening at ages 55 to 59 years with two-year intervals had an incremental cost-effectiveness ratio of $73000 per QALY gained and was considered optimal. With this strategy, lifetime prostate cancer mortality reduction was predicted as 13%, and 33% of the screen-detected cancers were overdiagnosed. When better quality of life for the post-treatment period could be achieved, an older age of 65 to 72 years for ending screening was obtained. CONCLUSION: Prostate cancer screening can be cost-effective when it is limited to two or three screens between ages 55 to 59 years. Screening above age 63 years is less cost-effective because of loss of QALYs because of overdiagnosis.


Asunto(s)
Biomarcadores de Tumor/sangre , Detección Precoz del Cáncer/economía , Detección Precoz del Cáncer/métodos , Tamizaje Masivo/economía , Tamizaje Masivo/métodos , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/economía , Neoplasias de la Próstata/mortalidad , Calidad de Vida , Años de Vida Ajustados por Calidad de Vida , Factores de Edad , Anciano , Simulación por Computador , Análisis Costo-Beneficio , Europa (Continente) , Reacciones Falso Positivas , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/diagnóstico , Factores de Tiempo
15.
J Clin Endocrinol Metab ; 89(9): 4391-6, 2004 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-15356036

RESUMEN

Recent studies have reported that serum IGF-I levels in the highest quartile of the normal range and IGF binding protein-3 (IGFBP-3) in the lowest quartile of the normal range are associated with an increased risk of future prostate cancer and/or presence of prostate cancer. It has also been suggested that the measurement of circulating total IGF-I concentrations might be a useful tool for the early detection of prostate cancer in men with moderately increased prostate-specific antigen (PSA) levels. To determine whether circulating free IGF-I, total IGF-I, and IGFBP-3 levels can predict future prostate cancer risk, we prospectively studied prostate cancer characteristics in a cohort of men during two rounds (mean interval, 4 yr) of a population-based screening study for prostate cancer. Two hundred one prostate cancer cases were detected at the second-round screening (aged 55-70 yr), and all these subjects were enrolled in the case group for the present study. Prostate cancer had been confirmed by biopsy in all cases. These 201 subjects were matched with the 201 nonprostate cancer cases by age, serum PSA range at the first-round screening (PSA < 2 ng/ml, n = 67; PSA = 2-3 ng/ml, n = 67; and PSA = 3-4 ng/ml, n = 67), and residence area. At baseline, total IGF-I, free IGF-I, and IGFBP-3 levels and prostate volume of cases with prostate cancer were not different from those of healthy controls. PSA velocity was significantly different between cases and controls (P < 0.001).Stepwise forward logistic regression analysis showed that only PSA levels at baseline and PSA at round 2 after 4 yr are good predictors of prostate cancer, whereas total IGF-I, free IGF-I, and IGFBP-3 did not predict the development of prostate cancer. Only one of the 201 subjects with prostate cancer had metastases. Within the subjects with prostate cancer, there were no differences of IGF-I parameters with different tumor node metastasis categories and/or Gleason scores. Our study suggests that the measurement of serum IGF-I and/or IGFBP-3 concentrations in addition to PSA does not improve the identification of men at high risk to develop early stages of prostate cancer. In addition, our results indicate that the endocrine IGF-I system is not directly involved in the growth of the early stages of prostate cancer.


Asunto(s)
Proteína 3 de Unión a Factor de Crecimiento Similar a la Insulina/sangre , Factor I del Crecimiento Similar a la Insulina/análisis , Neoplasias de la Próstata/etiología , Anciano , Estudios de Casos y Controles , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Neoplasias de la Próstata/sangre , Riesgo
16.
Clin Biochem ; 31(8): 633-9, 1998 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-9876895

RESUMEN

OBJECTIVE: Evaluation of the analytical performance of the Hybritech Tandem-E PSA assay as applied to the Rotterdam part of the European Randomized Study of Screening for Prostate Cancer (ERSPC) during 1994-1997. DESIGN AND METHODS: For assessment of test performance imprecision and accuracy contributing to clinical decision making was examined. Pre-analytical variables (specimen handling), long-term reagents stability and calibration check with the Stanford 90:10 PSA Calibrator were studied. RESULTS: Total prostate-specific antigen proved to be a stable marker. Provided correct storage at 4 degrees C, we were not able to find differences between samples analyzed directly after blood withdrawal and those analyzed the following day, with or without centrifugation. Day-to-day precision, we found during 1997 a coefficient of variation of 4.9% for concentration 1.8 micrograms/L and 4.2% for 4.8 micrograms/L (n = 182). The variation among the 21 Tandem-E reagent batches used during 1994-1997 proved to be small. Application of the Stanford 90:10 PSA Calibrator revealed 3% higher values for Tandem-E. CONCLUSION: The overall, long-term picture of Tandem-E PSA is reliable in our hands. Possible differences from the true PSA values, not specific for Tandem-E, need to be elaborated.


Asunto(s)
Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/diagnóstico , Humanos , Inmunoensayo/métodos , Masculino , Antígeno Prostático Específico/inmunología , Neoplasias de la Próstata/mortalidad
17.
Urol Oncol ; 28(6): 686-90, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-21062653

RESUMEN

INTRODUCTION: The prognosis of bladder cancer (BC) depends mainly on its histology, grade, and stage. Patients with superficial BC (70% of the urothelial carcinomas) have a relatively good prognosis, but patients diagnosed with invasive, high grade BC, and those who progress to invasive BC, have a poor prognosis and will not survive their disease in many cases due to their metastases, despite the currently available treatment options. Early detection can only be beneficial regarding mortality if the high risk cancers are recognized and treated at a localized stage. MATERIALS AND METHODS: Previous pilot studies on early detection consisted of home-based repeated hematuria testing and, in case of hematuria, a urologic evaluation with cytology and cystoscopy was carried out. This design resulted in too many cystoscopies. The recently initiated [Bladder Cancer Urine Marker Project (BLU-P) study www.blu-project.org] assesses the feasibility of a population-based screening for BC and at the same time evaluates a screening algorithm using next to hematuria testing, sensitive specific urine markers for BC (NMP22, FGFR3, MA analyses and MLPa) in an attempt to circumvent the high number of cystoscopies. RESULTS: So far 1,611 men are included and 23.5% tested positive for hematuria (11.6% had one or more true positive test results). The additional molecular-based screening tests before referring to cystoscopy resulted in a decrease of the number of cystoscopies from 378 to 66 (82.5%). In those men referred for cystoscopy, so far only 1 BC case was detected. CONCLUSIONS: Further research is needed to evaluate whether this extremely low detection rate is caused by, e.g., a healthy screenee bias or that the additional selection step using the molecular urine tests is too strict and diagnoses are missed.


Asunto(s)
Biomarcadores de Tumor/orina , Detección Precoz del Cáncer/métodos , Tamizaje Masivo/métodos , Neoplasias de la Vejiga Urinaria/diagnóstico , Neoplasias de la Vejiga Urinaria/orina , Anciano , Biomarcadores de Tumor/análisis , Metilación de ADN , Estudios de Factibilidad , Hematuria/diagnóstico , Humanos , Masculino , Repeticiones de Microsatélite , Persona de Mediana Edad , Mutación , Proteínas Nucleares/orina , Receptor Tipo 3 de Factor de Crecimiento de Fibroblastos/genética , Receptor Tipo 3 de Factor de Crecimiento de Fibroblastos/orina , Neoplasias de la Vejiga Urinaria/genética
18.
Eur J Cancer ; 46(17): 3068-72, 2010 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-21047588

RESUMEN

THE AIM OF THE STUDY: This article presents the incidence of prostate cancer, isolated high grade prostatic intraepithelial neoplasia (PIN) and atypical lesions suspicious for prostate cancer (LSPC) during subsequent screening rounds in the centres of five of the countries participating in the European Randomized Study of Screening for Prostate Cancer (ERSPC). The incidence and predictive value of high grade PIN and LSPC for prostate cancer in subsequent biopsy following these diagnoses were evaluated. PATIENTS AND METHODS: Study group consisted of 56,653 screened men in the ERSPC centres of Finland, Italy, Netherlands, Sweden and Switzerland, who underwent 3-7 screening rounds at 2-4 year interval. Data for prostate cancer were obtained from the ERSPC central database. Data for high grade PIN and LSPC were gathered from each ERSPC centre. Detection rates of subsequent prostate cancer in the first re-biopsy after these diagnoses were determined. RESULTS: The average cancer detection rate was 3.5%, 3.2% and 3.5% for the completed rounds 1, 2 and 3, respectively, in all five centres. Incidence of high grade PIN increased from 1.5% in the first round to 5.0% in the third round, varying among centres in the first round between 0.8% and 7.6%. The cancer detection rate in the first re-biopsy after the diagnosis of high grade PIN was 12.9%. Incidence of LSPC was 2.4%, 2.7%, 2.2% and 2.6% in the first, second, third and fourth round, respectively. The cancer detection rate at the first re-biopsy after the diagnosis of LSPC was in average 33.8%. CONCLUSIONS: Cancer detection rate was stable during the three screening rounds. The wide variation in frequency in particular of high grade PIN among the ERSPC centres suggests a considerable inter-observer variation. The average comparatively low detection rate of isolated high grade PIN in the first screening round may be screening-related, while its consistent increase during three screening rounds could be the consequence of a.o. previous screening and ageing of the population. The observed low risk of prostate cancer after isolated high grade PIN in this screening setting is in line with the current recommendation to abstain from early repeat biopsies after this diagnosis. The association of LSPC with high incidence of prostate cancer in re-biopsies confirms the need for early repeat biopsies and follow-up of these men. The low percentage of LSPC (<3% of biopsies) throughout all rounds is reassuring as it limits the biopsy burden in a screening setting.


Asunto(s)
Neoplasia Intraepitelial Prostática/diagnóstico , Neoplasias de la Próstata/diagnóstico , Anciano , Biopsia/normas , Biopsia/estadística & datos numéricos , Instituciones Oncológicas/estadística & datos numéricos , Detección Precoz del Cáncer/métodos , Detección Precoz del Cáncer/normas , Europa (Continente)/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Antígeno Prostático Específico/sangre , Neoplasia Intraepitelial Prostática/epidemiología , Neoplasias de la Próstata/epidemiología , Sensibilidad y Especificidad
19.
Eur J Cancer ; 46(17): 3082-9, 2010 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-21047590

RESUMEN

OBJECTIVE: To evaluate a change in tumour characteristics and applied treatments over time in the control arm of all centres of the European Randomized study of Screening for Prostate Cancer (ERSPC) and to compare this with similar data of the screening arm. METHODS: Between 1993 and 2003, 182,160 men, aged 50-74 years, were randomised to the screening arm (N=82,816) and the control arm (N=99,184). Men in the screening arm were offered Prostate Specific Antigen (PSA) testing every 4 years whilst men in the control arm received usual care. Tumour characteristics and treatment were evaluated in all men diagnosed with prostate cancer up to December 2006 or the third screening round. Data on the control arm were divided into 3 periods: 1994-1998, 1999-2002 and 2003-2006. RESULTS: Tumour characteristics were more favourable over time in both the control and the screening arm, with especially increasing proportions of T1C tumours with 29% in 1994-1998 versus 50% in 2003-2006 and 48% at the initial screening round versus 75% at the third screening round, respectively. Tumour characteristics observed in the last period of the control arm were comparable to tumour characteristics in the initial screening round. In the control arm, treatment changed over time with surgery as the most common treatment in the entire observed period, but almost doubling of expectant management and the combination of hormone therapy and radiotherapy over time. In the initial screening round, surgery was the most common treatment (42%), changing over time to expectant management as the most frequently applied treatment in the third screening round (33%). CONCLUSION: Tumour characteristics in the control arm became more favourable over time and show similarity with prostate cancer cases detected at the initial screening round. The most prominent change in treatment over time was an increase of application of expectant management in both arms of the ERSPC. These observations reflect an increasing rate of opportunistic testing over time in men randomised to the control arm.


Asunto(s)
Neoplasias de la Próstata/patología , Anciano , Antineoplásicos Hormonales/uso terapéutico , Biopsia/estadística & datos numéricos , Detección Precoz del Cáncer/métodos , Humanos , Masculino , Persona de Mediana Edad , Antígeno Prostático Específico/sangre , Prostatectomía/estadística & datos numéricos , Neoplasias de la Próstata/terapia
20.
Eur J Cancer ; 46(17): 3053-60, 2010 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-21047586

RESUMEN

BACKGROUND: To describe the variation in PSA level by age group and screening round in the ERSPC centres and the variation in cancer detection rates in relation to the underlying prostate cancer incidence. METHODS: Individual data on men invited for the first and second screening rounds according to protocol (excluding early recalls and interval cancers) were obtained from the central database of the ERSPC (cut-off date 31st December 2006). Data were compared between and within centres for the core age group (55-69 at entry). The cancer detection rate (CDR) was compared with the expected background prostate cancer incidence rate in the absence of screening adjusted for the incidence rate in non-attenders and the control arm (IRS). RESULTS: Mean PSA values in the age groups 55-59 years and 65-69 years showed little variation by centre, except for the Dutch centre, where an increase from 1.6 to 1.8 ng/ml and a decline from 2.9 to 2.5ng/ml was observed, respectively. Most tumours were detected at the PSA range 4.0-9.9 ng/ml, with a shift to more cancer detection at 3.0-3.9 ng/ml in the second screening round. There was high variability in the CDR between the centres in both the first (16-46 per 1000) and the second screening rounds (14-50 per 1000). Although the ratio CDR/IRS was less variable, it is somewhat lower in Italy and Switzerland (12 and 14,respectively) and higher in the Netherlands (28), than in most other centres and in Belgium the ratio increased markedly, from 20 to 44 between the first and second rounds. CONCLUSION: There was no clear evidence of a relationship between the underlying incidence and mean PSA levels at screening or the cancer detection rate.


Asunto(s)
Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/diagnóstico , Factores de Edad , Anciano , Biopsia/estadística & datos numéricos , Detección Precoz del Cáncer/métodos , Detección Precoz del Cáncer/normas , Europa (Continente) , Humanos , Masculino , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Neoplasias de la Próstata/epidemiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Derivación y Consulta/estadística & datos numéricos , Tamaño de la Muestra , Sensibilidad y Especificidad
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