Valor diagnóstico y predictivo del estudio en orina del gen PCA3 para el manejo clínico de pacientes con antígeno prostático específico alterado / Diagnostic and Predictive Value of Urine PCA3 Gene Expression for the Clinical Management of Patients with Altered Prostatic Specific Antigen

Objetivo: Analizar el impacto de la introducción del estudio del gen PCA3 en orina posmasaje prostático, en el manejo clínico de pacientes con PSA alterado, valorando su capacidad diagnóstica y predictiva de agresividad tumoral. Métodos: Estudio observacional, prospectivo y multicéntrico de pacientes con sospecha de adenocarcinoma de próstata (AP) candidatos a biopsia. Presentamos una serie de 670 muestras consecutivas de orina posmasaje prostático recogidas durante 3 años en las que se determinó el «score de PCA3» (s-PCA3). Se indicó biopsia únicamente en los casos con s-PCA3 positivo. Resultados: El s-PCA3 fue positivo en el 43,7% de las muestras. En las 124 biopsias realizadas, la incidencia de AP o proliferación microacinar atípica fue del 54%, llegando al 68,6% en s-PCA3 ≥ 100. Demostramos relación estadísticamente significativa entre el s-PCA3 y el grado tumoral. En los casos con s-PCA3 positivo pero inferior a 50, solo el 23% de AP fueron de alto grado (Gleason ≥ 7); en cambio, en los casos con s-PCA3 superior a 50 lo fueron el 76,7%. La relación entre el s-PCA3 y el porcentaje de cilindros afectados en la biopsia fue significativa. Ambas relaciones se confirmaron al aplicar el modelo log-lineal. Conclusiones: La incorporación del PCA3 permite prescindir de la biopsia en un 54% de los pacientes. La positividad del s-PCA3 aumenta la probabilidad de biopsia positiva, especialmente en s-PCA3 superior a 100 (68,6%). El s-PCA3 es también un indicador de agresividad tumoral y aporta información esencial en la toma de decisiones terapéuticas

Objective: Analyze the impact of the introduction of the study of PCA3 gene in post-prostatic massage urine in the clinical management of patients with PSA altered, evaluating its diagnosticability and predictive value of tumor aggressiveness. Methods: Observational, prospective, multicenter study of patients with suspected prostate cancer (PC) candidates for biopsy. We present a series of 670 consecutive samples of urine collected post-prostatic massage for three years in which we determined the «PCA3 score»(s-PCA3). Biopsy was only indicated in cases with s-positive PCA3. Results: The s-PCA3 was positive in 43.7% of samples. In the 124 biopsies performed, the incidence of PC or atypical small acinar proliferation was 54%, reaching 68,6% in s-PCA3≥100. Statistically significant relationship between the s-PCA3 and tumor grade was demonstrated. In cases with s-PCA3 between 35 and 50 only 23% of PC were high grade (Gleason≥7), compared to 76.7% in cases with s-PCA3 over 50. There was a statistically significant correlation betweens-PCA3 and cylinders affected. Both relationships were confirmed by applying a log-linear model. Conclusions: The incorporation of PCA3 can avoid the need for biopsies in 54% of patients.s-PCA3 positivity increases the likelihood of a positive biopsy, especially in higher s-PCA3 100(68.6%). s-PCA3 is also an indicator of tumor aggressiveness and provides essential information nin making treatment decisions

Diagnostic and predictive value of urine PCA3 gene expression for the clinical management of patients with altered prostatic specific antigen.

OBJECTIVE: Analyze the impact of the introduction of the study of PCA3 gene in post-prostatic massage urine in the clinical management of patients with PSA altered, evaluating its diagnostic ability and predictive value of tumor aggressiveness. METHODS: Observational, prospective, multicenter study of patients with suspected prostate cancer (PC) candidates for biopsy. We present a series of 670 consecutive samples of urine collected post-prostatic massage for three years in which we determined the "PCA3 score" (s-PCA3). Biopsy was only indicated in cases with s-positive PCA3. RESULTS: The s-PCA3 was positive in 43.7% of samples. In the 124 biopsies performed, the incidence of PC or atypical small acinar proliferation was 54%, reaching 68,6% in s-PCA3≥100. Statistically significant relationship between the s-PCA3 and tumor grade was demonstrated. In cases with s-PCA3 between 35 and 50 only 23% of PC were high grade (Gleason≥7), compared to 76.7% in cases with s-PCA3 over 50. There was a statistically significant correlation between s-PCA3 and cylinders affected. Both relationships were confirmed by applying a log-linear model. CONCLUSIONS: The incorporation of PCA3 can avoid the need for biopsies in 54% of patients. s-PCA3 positivity increases the likelihood of a positive biopsy, especially in higher s-PCA3 100 (68.6%). s-PCA3 is also an indicator of tumor aggressiveness and provides essential information in making treatment decisions.

Trends in the profile of smokers registered in a national database from 2001 to 2006: changes in smoking habits.

OBJECTIVE: In 2001, an electronic medical record system was designed to collect data from smoking cessation services in France. By comparing two periods (2001-2003 and 2004-2006), this study assessed trends in the profile of smokers registered in the database. STUDY DESIGN: A cross-sectional analysis on the 33,219 smokers registered in the database in 2001. METHODS: Sociodemographic details, psychological and medical history, and characteristics of tobacco consumption at baseline were examined. RESULTS: The proportion of young smokers increased from 5.1% to 6.9%, and the proportion of underprivileged smokers increased from 9.3% to 10.9% between 2001-2003 and 2004-2006 (P<0.0001). The medical profile was unchanged, with about 37% of cases with tobacco-related diseases and 31% of cases with past depressive episodes in 2001-2003 and 2004-2006. The main finding was an increase in the mean concentration of carbon monoxide (CO) in expired air [from 18.8 parts per million (ppm) (SD 14.4) to 23.5 ppm (SD 14.1)], despite a decrease in the number of cigarettes smoked per day. The concentration of CO per cigarette also increased from 0.9 (SD 0.9) to 1.3 (SD 1.4). CONCLUSION: As the number of cigarettes smoked per day decreased, the increase in mean concentration of CO per cigarette implies that increases in cigarette prices may have led to new smoking habits and/or compensatory smoking.

[Characteristics of smoker adolescents seeking smoking cessation services]. / Caractéristiques des adolescents fumeurs s'adressant aux consultations de tabacologie.

UNLABELLED: In France, the prevalence of tobacco consumption is 31% for teenagers between 15 and 19 years old. Nevertheless, few French studies have been published on the characteristics of young smokers seeking smoking cessation services. The development of smoking cessation centres in France since 1999 was associated to the setting up of a e-transfer system in order to evaluate the adequacy between these services and the needs of smokers. OBJECTIVE: To analyse the characteristics of smokers aged less than 19 years registered in the smoking cessation services national database. METHODS: A cross-sectional population-based study has been conducted in the smoking cessation services participating in the national database. The study population included 321 young smokers attending the smoking cessation centres during the period 2001-2005. RESULTS: The 321 smokers (mean age 16.6 years) were mostly girls (56.4%). A background of depression was declared by 19% of young smokers and an abnormal result was found for the hospital anxiety depression-screening test among 34% of the population for the anxiety scale and 6% for the depression scale. Mean daily tobacco consumption was 15.3 cigarettes per day and heavy nicotine dependence was found for 24.1% of the population. A nicotine replacement therapy was prescribed for every smoker. CONCLUSION: Nicotine dependence was heavy for 24.1% of the 321 young smokers seeking smoking cessation services. More than 1/3 had an abnormal result for the hospital anxiety depression-screening test. Tailored interventions for smoking cessation should be available for adolescent's smokers, especially school-based services.