scholarly journals Persistent Intraprostatic Androgen Concentrations after Medical Castration in Healthy Men

2006 ◽  
Vol 91 (10) ◽  
pp. 3850-3856 ◽  
Author(s):  
Stephanie T. Page ◽  
Daniel W. Lin ◽  
Elahe A. Mostaghel ◽  
David L. Hess ◽  
Lawrence D. True ◽  
...  
Keyword(s):  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Receptor Expression ◽  
Prostate Cell ◽  
Hormone Levels ◽  
Prostate Biopsies ◽  
Clinical Consequences ◽  
Normal Men ◽  
The Impact

Abstract Context: The impact of serum androgen manipulation on prostate tissue hormone levels in normal men is unknown. Studies of men with prostate cancer have suggested that prostatic androgens are preserved in the setting of castration. Tissue androgens might stimulate prostate growth, producing adverse clinical consequences. Objective: The objective of the study was to determine the effect of serum androgen manipulation on intraprostatic androgens in normal men. Design: Thirteen male volunteers ages 35–55 yr (prostate-specific antigen < 2.0 ng/ml; normal transrectal ultrasound) were randomly assigned to: 1) a long-acting GnRH-antagonist, acyline, every 2 wk; 2) acyline plus testosterone (T) gel (10 mg/d); or 3) placebo for 28 d. Serum hormones were assessed weekly. Prostate biopsies were obtained on d 28. Extracted androgens were measured by RIA, and immunohistochemistry for androgen-regulated proteins was performed. Results: The mean decrease in serum T was 94%, whereas prostatic T and dihydrotestosterone levels were 70 and 80% lower, respectively, in subjects receiving acyline alone compared with controls (P < 0.05). Despite this decrease in prostate androgens, there were no detectable differences in prostate epithelial proliferation, apoptosis, prostate-specific antigen, and androgen receptor expression. Conclusion: In this small study of healthy subjects, despite a 94% decrease in serum T with medical castration, intraprostatic T and dihydrotestosterone levels remained 20–30% of control values, and prostate cell proliferation, apoptosis, and androgen-regulated protein expression were unaffected. Our data highlight the importance of assessing tissue hormone levels. The source of persistent prostate androgens associated with medical castration and their potential role in supporting prostate metabolism deserves further study.

Clinical Impact of New Prostate-Specific Antigen WHO Standardization on Biopsy Rates and Cancer Detection

2008 ◽  
Vol 54 (12) ◽  
pp. 1999-2006 ◽  
Author(s):  
F H Jansen ◽  
M Roobol ◽  
C H Bangma ◽  
R H N van Schaik
Keyword(s):  
Prostate Specific Antigen ◽  
Prostate Biopsy ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Digital Rectal Examination ◽  
Serum Samples ◽  
Prostate Biopsies ◽  
Ultrasound Evaluation ◽  
The Impact ◽  
The Relationship

Abstract 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 μg/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 μg/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 μg/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.

scholarly journals Heritability of Prostate-Specific Antigen and Relationship with Zonal Prostate Volumes in Aging Twins*

2000 ◽  
Vol 85 (3) ◽  
pp. 1272-1276
Author(s):  
Aruna Bansal ◽  
Darrell K. Murray ◽  
James T. Wu ◽  
Robert A. Stephenson ◽  
Richard G. Middleton ◽  
...  
Keyword(s):  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Peripheral Zone ◽  
Monozygotic Twin ◽  
Total Serum ◽  
Free Psa ◽  
Two Factors ◽  
Total Psa ◽  
The Impact

Abstract Both benign prostatic hyperplasia and prostate-specific antigen (PSA) have been shown to increase with age and with prostate volume in men, but the influence of heredity on these relationships is not completely understood. This study has two aims: 1) to investigate the inter-relationships of age, PSA, and various zonal measurements in the prostate; and 2) to assess the impact of heritable influences on total PSA. Eighty-four monozygotic twin pairs and 83 dizygotic twin pairs were studied, and serum total PSA, free PSA, and PSA-∝1-antichymotrypsin were measured. Their prostate volumes [total (TV), transition zone (TZ), and peripheral zone) were quantitated using transrectal ultrasound. Total PSA is significantly correlated with all zonal prostate measurements (TZ, peripheral zone, TV, and TZ/TV) and with age. When linear regression was applied, only age and TZ were retained in the final model. The proportion of variability in total PSA explained by these two factors, however, is below 24%. In contrast, estimates of heritability show that approximately 45% of the variability in total PSA can be explained by inherited factors. Whereas age and TZ are linearly related to total PSA, their influence is much less than that of familial and genetic factors. It is uncertain whether these factors predispose also to prostate cancer or if they are independent of those, whether they confound the accuracy of using total serum PSA level as a diagnostic tool.

scholarly journals What is the risk of prostate cancer mortality following negative systematic TRUS-guided biopsies? A systematic review

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040965
Author(s):  
Sandra Miriam Kawa ◽  
Signe Benzon Larsen ◽  
John Thomas Helgstrand ◽  
Peter Iversen ◽  
Klaus Brasso ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Data Extraction ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Population Based ◽  
Free Text ◽  
Medical Subject Headings ◽  
Prognostic Information ◽  
Prostate Biopsies

ObjectiveTo investigate the risk of prostate cancer-specific mortality (PCSM) following initial negative systematic transrectal ultrasound-guided (TRUS) prostate biopsies.DesignSystematic review.Data sourcesPubMed and Embase were searched using a string combination with keywords/Medical Subject Headings terms and free text in the search builder. Date of search was 13 April 2020.Study selectionStudies addressing PCSM following initial negative TRUS biopsies. Randomised controlled trials and population-based studies including men with initial negative TRUS biopsies reported in English from 1990 until present were included.Data extractionData extraction was done using a predefined form by two authors independently and compared with confirm data; risk of bias was assessed using the Newcastle–Ottawa Scale for cohort studies when applicable.ResultsFour eligible studies were identified. Outcomes were reported differently in the studies as both cumulative incidence and Kaplan-Meier estimates have been used. Regardless of the study differences, all studies reported low estimated incidence of PCSM of 1.8%–5.2% in men with negative TRUS biopsies during the following 10–20 years. Main limitation in all studies was limited follow-up.ConclusionOnly a few studies have investigated the risk of PCSM following initial negative biopsies and all studies included patients before the era of MRI of the prostate. However, the studies point to the fact that the risk of PCSM is low following initial negative TRUS biopsies, and that the level of prostate-specific antigen before biopsies holds prognostic information. This may be considered when advising patients about the need for further diagnostic evaluation.PROSPERO registration numberCRD42019134548.

scholarly journals Personalized Prostate Specific Antigen Testing Using Genetic Variants May Reduce Unnecessary Prostate Biopsies

2013 ◽  
Vol 189 (5) ◽  
pp. 1697-1701 ◽  
Author(s):  
Brian T. Helfand ◽  
Stacy Loeb ◽  
Qiaoyan Hu ◽  
Phillip R. Cooper ◽  
Kimberly A. Roehl ◽  
...  
Keyword(s):  
Prostate Specific Antigen ◽  
Genetic Variants ◽  
Specific Antigen ◽  
Prostate Biopsies ◽  
Prostate Specific Antigen Testing ◽  
Antigen Testing

Detection of Local Recurrence After Radical Prostatectomy by Prostate Specific Antigen and Transrectal Ultrasound

1992 ◽  
Vol 147 (3 Part 2) ◽  
pp. 952-955 ◽  
Author(s):  
Antoine S. Abi-Aad ◽  
Michael T. Macfarlane ◽  
Avi Stein ◽  
Jean B. Dekernion
Keyword(s):  
Radical Prostatectomy ◽  
Local Recurrence ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Transrectal Ultrasound
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