Looking Back at PCPT: Looking Forward to New Paradigms in Prostate Cancer Screening and Prevention
|
|
- Darrell Morgan
- 5 years ago
- Views:
Transcription
1 european urology 51 (2007) available at journal homepage: Review Prostate Cancer Looking Back at PCPT: Looking Forward to New Paradigms in Prostate Cancer Screening and Prevention Edith Canby-Hagino a, *, Javier Hernandez b, Timothy C. Brand a, Ian Thompson a a Department of Urology, University of Texas Health Science Center at San Antonio, TX, United States b Division of Urology, Brooke Army Medical Center, San Antonio, TX, United States Article info Article history: Accepted September 3, 2006 Published online ahead of print on September 15, 2006 Keywords: Finasteride Prevention Prostate cancer Please visit europeanurology to read and answer questions on-line. The EU-ACME credits will then be attributed automatically. Abstract Objectives: Provide a critical summary of the latest interpretation of findings from the Prostate Cancer Prevention Trial (PCPT). Methods: Findings from PCPT and recently published post-hoc analyses are reviewed. Results: PCPT demonstrated that finasteride can reduce the prevalence of prostate cancer, permitted the first large-scale assessment of the performance characteristics of prostate-specific antigen for prostate cancer screening, and identified new-onset erectile dysfunction as an early predictor of cardiovascular events. Conclusions: PCPT has and will continue to yield valuable information regarding future strategies for prostate cancer prevention and detection, benign prostatic hyperplasia, and other matters of public health importance. # 2006 Published by Elsevier B.V. on behalf of European Association of Urology. *Corresponding author. Department of Urology, UTHSCSA, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States. Tel ; Fax: address: canbyhagino@uthscsa.edu (E. Canby-Hagino). 1. The case for prevention Prostate cancer is the most common noncutaneous malignancy in men [1]. Despite numerous advances in the early detection and treatment of the disease, approximately 27,350 men will die of the disease in 2006 [1]. Although some investigators have demonstrated a recent decrease in mortality rates from prostate cancer, the reason for this trend is not entirely clear [2]. In cases of hormone refractory disease, docetaxel-based chemotherapy improves survival. However, the improvement in survival seen with this approach is modest at best [3,4]. Furthermore, costs associated with the treatment of prostate cancer in the last year of life of patients dying from this malignancy tend to be quite substantial [5]. Therefore, strategies that focus solely on the treatment of advanced prostate cancer /$ see back matter # 2006 Published by Elsevier B.V. on behalf of European Association of Urology. doi: /j.eururo
2 28 european urology 51 (2007) are unlikely to lead to major reductions in cancer deaths. Perhaps of greater impact from a public health perspective is the cumulative cost and morbidity for the treatment of early-stage prostate cancer, a substantial portion of which could be attributed to the over-treatment of clinically insignificant disease. The treatment of patients with biochemical recurrence also contributes significantly to this cost. The aging of the US population in conjunction with the application of lower prostatic-specific antigen (PSA) cut-off levels will in all likelihood lead to increasing prostate cancer detection rates. Although screening for prostate cancer is a widespread practice in the United States, there is a lack of high-level evidence to support a public health benefit for this practice [6]. Given the limited nature of resources available for health care expenditure, the current strategies for detection and treatment of prostate cancer will most likely come under great scrutiny in the future. An important alternative approach to prostate cancer as a public health challenge is the concept of cancer prevention. The efficacy of potential preventive agents against the target disease as well as the potential side-effects are issues that must be carefully elucidated before any potential preventive agent can be widely accepted by the medical community and the public. Understandably, healthy patients may be less willing to accept the risks historically associated with chemopreventive interventions as compared to patients undergoing treatment interventions in which there may be a greater acceptance of side-effects and toxicities. Another potential challenge for prevention initiatives is the current emphasis on funding therapeutic as opposed to preventive clinical trials. This approach may not be entirely cost effective from a public health perspective, as illustrated by the recent analysis by Unger et al. [7]. The authors compared the estimated impact of eight positive phase 3 clinical trials of the Southwest Oncology Group as measured in person-years saved in the first 5 yr to the estimated impact of the Prostate Cancer Prevention Trial (PCPT). Whereas application of the new treatments from the eight therapeutic clinical trials would have saved 114,641 person-years over the first 5 yr, implementation of the findings from PCPT would have saved 99,441 person-years during a similar period of time. Moreover, the potential additional benefits of chemoprevention, such as reduction in surgery related to benign prostatic hyperplasia (BPH) and episodes of acute urinary retention in men taking finasteride, should be taken into consideration [8,9]. A final, often-forgotten aspect of chemoprevention is the effect on the individual; although most individuals will express a desire for early cancer detection and treatment, a preferred alternative is the opportunity to never have to face the diagnosis in the first place (i.e., prevention). 2. What is the status of prostate cancer chemoprevention today? To date, finasteride is the only agent that has been definitively proven in a randomised, placebocontrolled, prospective clinical trial to prevent prostate cancer [9]. However, this agent has not yet received wide use for the prevention of prostate cancer, primarily due to the increased risk of highgrade disease noted among participants in the treatment arm compared to placebo. Basic science and epidemiologic studies suggest that various agents with antioxidant, antiproliferative, anti-inflammatory, or proapoptotic actions may prevent prostate cancer [10]. Paradoxically, many of these, mostly over-the-counter dietary supplements, which have yet to be definitively proven to prevent prostate cancer in the context of a phase 3 clinical trial, are widely used by men with the goal of preventing prostate cancer. The early enthusiasm for these agents may ultimately fade away possibly from contradictory results from clinical trials, as was the case with b-carotene [11] or from adverse effects as seen in the Breast Cancer Prevention Trial or the Vioxx trial [12,13]. Closure of the Vioxx trial is certainly unfortunate given the known overexpression of cyclooxygenase-2 (COX-2) enzyme in proliferative inflammatory atrophy of the prostate, which is felt to be associated with prostatic carcinogenesis [14]. Ongoing clinical trials should better define the role of other agents in the prevention of prostate cancer. The Selenium and Vitamin E Cancer Prevention Trial (SELECT) completed accrual in 2004 and trial results are anticipated in 2013 [10]. The Reduction by Dutasteride of Prostate Cancer Events (REDUCE), which is designed to determine whether or not dutasteride reduces the risk of prostate cancer in men with an elevated PSA level and a prior negative biopsy, should have results available within approximately 4 yr [15]. As the only randomised, prospective clinical trial that has demonstrated an agent to have chemopreventive properties against prostate cancer, we summarise the PCPT study design and
3 european urology 51 (2007) Fig. 1 Schema for the Prostate Cancer Prevention Trial. PSA = prostate-specific antigen. findings, as well as the impact of these findings on screening practices for prostate cancer. 3. Summary of PCPT design The PCPT is the first prospective, randomised clinical trial of prostate cancer prevention [9]. The challenges to the design of this trial were substantial and included selection of meaningful end points, recruitment and retention of a study population sufficiently large to yield statistical power, and complete ascertainment of disease status [16]. The study design is depicted in Fig. 1. PCPT, conceived in 1992 and activated in 1993 shortly after US Food and Drug Administration (FDA) approval of finasteride, was the first large-scale population-based trial to test a chemopreventive strategy against prostate cancer. This prospective, randomised, blinded, and placebo-controlled trial tested the hypothesis that finasteride, which selectively inhibits type 2 5a-reductase (5-AR), would lower intraprostatic dihydrotestosterone (DHT) levels and thereby prevent prostate cancer. At the start, 18,882 men aged 55 yr or older with a normal digital rectal examination (DRE) and serum PSA level of 3.0 ng/ml were randomly assigned to treatment with 5 mg finasteride daily or placebo for 7 yr. Prostate biopsies were performed for cause (abnormal prostate examination or PSA >4.0 ng/ml) and at the end of 7 yr. The trial was stopped 15 mo early by an independent data and safety monitoring committee, after achievement of the primary end point of a 25% risk reduction on the finasteride arm, and sensitivity analysis indicated that additional biopsies would not change the outcome. Perhaps the greatest challenge to this study was the fact that finasteride affected serum PSA measurement. At the time the study was initiated, it was generally known that finasteride reduced PSA by approximately 50%. Without controlling for this reduction and using a prostate cancer incidence end point, a reduction in prostate cancers detected would be noted but this would be merely due to the fall in PSA. To control for this detection bias, two unique steps were taken. It was acknowledged that to maintain current standard-of-care in the United States, it would be necessary to provide subjects and their physicians with PSA results on an annual basis; these PSA results would then lead to the diagnosis of prostate cancer based on elevated PSA values. At the time the study was designed, concerns existed regarding the previously reported multiply-by-two conversion factor (based on the 50% PSA fall with finasteride) because the observation period was only 24 mo, and PCPT was a 7-yr study [17]. An incorrect adjustment factor could introduce confounds and differential ascertainment. This problem was corrected by a PSA indexing procedure. On an annual basis, all men in the placebo group of the study with a PSA level >4.0 ng/ml were advised to consider a prostate biopsy. The fraction of the total placebo group >4.0 ng/ml was then calculated. Then, the PSA cut-off point in the finasteride group was adjusted so that the same highest fraction of men in the treatment group received a recommendation for biopsy. Practically, a doubling of PSA was initially used to correct for the first 3 yr, but due to a continued fall in PSA in the finasteride group, the PSA in this group was multiplied by 2.3 in subsequent years to ensure the same number of biopsies in the two study groups for the remainder of each subject s years on study. Despite this correction to the PSA value, study coordinators could not be certain that other biases in disease ascertainment and detection did not exist. For example, we know that finasteride reduces the size of the prostate gland. This may alter the gland texture, reducing or increasing the proportion of abnormal DREs. These and other potential confounds led to a second design characteristic of the study an end-of-study prostate biopsy. This biopsy was planned in all individuals not previously diagnosed with prostate cancer who reached the 7-yr mark on study. It was anticipated that 60% of men randomised
4 30 european urology 51 (2007) in the study would have an end point ascertained (interim cancer or end-of-study biopsy). 4. Summary of PCPT findings The results of the PCPT were reported in 2003 [9]. The study was closed early, based on recommendations of an independent data and safety monitoring committee because there was convincing evidence that the primary study objective had been met. There was a 24.8% reduction in period prevalence of the disease, and sensitivity analysis indicated that additional biopsies would not change the findings. The principal findings of PCPT include the following: 1. Prevalence of prostate cancer was reduced from 24.4% in the placebo group to 18.4% in the group taking finasteride (a 24.8% reduction). 2. Prevalence of Gleason grade 7 10 cancers was 6.4% in the finasteride group compared to 5.1% placebo group. 3. Risk reduction in prostate cancer was apparent both for men undergoing biopsy for cause (abnormal prostate examination or elevated PSA) and for men undergoing end-of-study biopsy. 4. Sexual side-effects were more common with finasteride. 5. Urinary symptoms (e.g., lower urinary tract symptoms and risk of urinary retention) and treatments (e.g., transurethral resection of the prostate) were more common with placebo. 6. Prostate volumes in the group taking finasteride were 24% smaller than volumes in the placebo arm. A surprising finding in this study was the high prevalence of prostate cancer among men without clinical suspicion for prostate cancer. The study design assumed a 6% prevalence based on estimates by Cooner for expected prevalence of prostate cancer in clinical urology practice [18,19]. This estimate was deliberately conservative to reduce the risk of under-powering the study. Of note, the incidence of prostate cancer detected on the basis of an abnormal prostate examination or elevated PSA at 7 yr was 6%, suggesting that a substantial fraction of prostate cancers detected by PCPT might never develop clinical manifestations that are important to patients. This over-detection of prostate cancer may be even more pronounced among men treated with finasteride, due to relative over-sampling of their smaller glands by needle biopsy. 5. High-grade prostate cancer in PCPT A concerning finding of the study was the higher prevalence of Gleason grade 7 10 cancers in the finasteride group. Further study on this subset of patients is underway to address the following issues: 1. Histologic artifact associated with finasteride use may result in incorrect grading of prostate cancers. 2. Finasteride may be more effective at preventing development of cancers with Gleason grade 2 6 than Gleason grade A reduction in gland volume may permit a greater degree of ascertainment in men receiving finasteride, resulting in a proportionally higher rate of detection of high-grade cancers in this group. 4. The performance characteristics of PSA and DRE for prostate cancer detection among men receiving finasteride may have been affected by the intervention and thereby changed the rate of detection of high-grade disease. The final hypothesis arises from observation, made at the time of the initial study publication, that the increase in the rate of high-grade disease was seen after 1 yr of subjects being on-study, but this rate did not increase during the 7 yr that the finasteride recipients received the study drug. Some investigators argue that the Gleason grading system has not been validated in men treated with androgen deprivation or finasteride, and thus, it should not be used as an end point in a trial like PCPT [20]. Others have reported that finasteride therapy does not compromise Gleason grading [21,22]. Ongoing studies by the Core Pathology Laboratory of the PCPT as well as independent pathologists not associated with PCPT should clarify whether histologic artifact was operational. It is uncertain whether it can ever be determined if finasteride induced the development of high-grade disease due to the confounds postulated above. A reduction in gland volume with finasteride was conceived at the time of trial design and was thought to potentially lead to oversampling of the glands in this study group, biasing outcomes against finasteride. (This concept can be found in the initial study design.) It is important to consider that, despite a 24% reduction in gland volume, there was still a 24.8% reduction in prostate cancer prevalence over the course of 7 yr. This observation suggests that the true reduction in prevalence is probably greater. How this volume reduction affected tumour grading at the time of biopsy is uncertain and is the subject of ongoing research.
5 european urology 51 (2007) Validation of PSA as a screening tool Even when the primary findings of PCPT have not been widely applied, secondary findings on the performance characteristics of PSA as a screening tool have reshaped the prostate cancer screening landscape. The prospective nature of the study along with the protocol recommendation for all men in the study to undergo a prostate biopsy at the end of the study have allowed for a tremendous opportunity to assess the operating characteristics of PSA as a screening test. Arguably, this may be the most significant contribution of this trial to date. Discovered in 1970 [23] and eventually purified while a search was ongoing for a marker that could be used in the investigation of rape crimes [24], PSA was introduced into clinical practice in the mid-1980s. Early experience with PSA as a tumour marker led to several important observations [25 27]. A fall in the PSA level following the institution of hormonal therapy correlated with response to treatment. Additionally, a rise in the PSA level following treatment precedes and predicts disease recurrence. Finally, it was also noted that, following radical prostatectomy, PSA levels should be undetectable. Otherwise, a detectable PSA in this setting indicates persistent or recurrent disease. Despite early recognition by some investigators of the limited specificity of PSA differentiating between cancer and other benign processes within the prostate gland, largescale screening studies were conducted in the late 1980s to early 1990s [18,28 30]. In general, these studies were characterised by major limitations in the ascertainment of disease status among the control populations as well as by the limited application of modern prostate biopsy techniques. Within the PCPT placebo arm of the study, there were 2950 men who, throughout the course of the clinical trial, did not have a PSA level >4.0 ng/ml or an abnormal DRE and underwent an end-of-study biopsy [31]. Analysis of this group found that PSA levels between 0 and 4.0 ng/ml were associated with a positive predictive value of %. Additionally, 14.9% of men diagnosed with cancer had high-grade disease, with this rate reaching 25% among men with PSA levels ranging between 3.1 and 4.0 ng/ml. There was no PSA level at which there was no risk of having cancer or high-grade disease. Moreover, analysis of 5587 men in the placebo group who had at least one PSA measurement, a DRE in the same year, and at least one biopsy has allowed careful examination of the performance characteristics of PSA [32]. Areas under the receiver operating characteristic (ROC) curve for PSA to discriminate between the presence or absence of cancer on biopsy as well as the presence of high-grade cancer versus low-grade or no cancer were established. This analysis demonstrated better performance characteristics among men with high-grade disease. Most importantly, the analysis concluded that there is no PSA cut-off level with both a high sensitivity and specificity to screen healthy men for prostate cancer, underscoring the importance of proper validation of any screening test prior to widespread clinical application of such test. 7. Other lessons learned from PCPT Designing a prostate cancer prevention trial that targets individuals felt to be at increased risk for prostate cancer (i.e., African Americans, men with a family history of prostate cancer, men with an elevated PSA) is tempting, because of the smaller sample size and possibly shorter duration required to achieve study end points. Because the etiology of prostate cancer in selected high-risk populations may be different from the general public and because the efficacy of interventions may also be different, there are problems with studying only high-risk populations. First, a preventive effect may be found that may not be seen in the general population. Second, no effect may be seen in the smaller, high-risk population, whereas a true preventive effect exists (but remains unstudied) in the general population. Third, recruitment may be more challenging. It is for these reasons that PCPT was based on the general population and the value of the study is apparent. Additionally, one cannot understate the vast potential for further evaluation of data from the population for other findings of importance to the public health. For example, the 9457 men in the placebo group comprise a prospective cohort of men who can be studied for many different health events, with conclusions that can be generalised to the public. PCPT investigators recently identified a strong association between erectile dysfunction (ED) and subsequent cardiovascular events [33]. In addition to collecting data associated with the primary end point of reduction in prostate cancer prevalence, the study investigators also monitored a host of measures regarding potential treatment toxicities, medications, hospitalisations, and, in particular, cardiovascular disease. Cardiovascular disease included angina, myocardial infarction, cerebrovascular accident, transient ischemic attack, congestive heart failure, and cardiac arrhythmia. Because of the previously reported impact of finasteride on sexual function, this end point was also carefully measured in all men over the course of the study.
6 32 european urology 51 (2007) At study entry of 9457 men randomised to placebo, 8063 (85%) had no cardiovascular disease. Of these 8063 men, 4247 (53%) reported no ED at study entry. This group was then evaluated for incident ED and cardiovascular disease. Incident ED was associated with a hazard ratio of 1.25 (95%CI, ; p = 0.04) for subsequent diagnosis of cardiovascular disease during the course of the study. For men with either incident or prevalent ED, the hazard ratio for subsequent diagnosis of cardiovascular disease was 1.45 (95%CI, ; p < 0.001). In multivariate analysis of ED with other risk factors traditionally associated with cardiovascular disease, the authors found that incident ED carried a similar risk as did family history of myocardial infarction, current smoking, or hyperlipidaemia. In conclusion, they found ED to be a forewarning symptom for subsequent diagnosis of cardiovascular disease and suggested that ED should lead clinicians to consider further evaluation for cardiovascular disease [33]. Other studies are in progress that will characterise the impact of finasteride on sexual function and changes in sexual function over time in older men [34]. In addition, as the largest and longest clinical trial using finasteride, PCPT will illuminate the natural history of BPH and shed more light on clinical outcomes such as voiding symptoms and surgical interventions for BPH. Biopsy data will further elucidate the associations of high-grade prostatic intraepithelial neoplasia (HGPIN) and inflammation with prostate cancer [35,36]. Another precious resource collected in conjunction with prospective, longitudinal data and ascertainment of prostate cancer status is a biorepository of prediagnostic serum, and, for many patients, DNA, as well as prostatic tissues from biopsy and radical prostatectomy. As has been previously reported, PCPT has provided post-hoc validation of PSA as a biomarker for prostate cancer and has tremendous potential for both identification and validation of future biomarkers [31,32]. The biorepository will permit characterisation of the effects of type 2 5-AR inhibition on prostatic stroma and epithelium and prostate cancer, in addition to exploring the relationship between genetic polymorphisms androgen metabolic loci, BPH, and prostate cancer, among others. 8. Questions that remain unanswered Although finasteride therapy resulted in a significant reduction in prostate cancer cases during the treatment period, the long-term impact of finasteride chemoprevention remains unknown. PCPT participants who were diagnosed with prostate cancer are participating in a long-term follow-up study to assess the impact of their treatment arm on survival and other outcomes related to their diagnosis of prostate cancer. However, PCPT is unable to answer several important questions. PCPT was not designed to identify an optimal duration of 5-AR inhibition for the purpose of prostate cancer prevention. Furthermore, it cannot be determined whether or not men might experience a rebound effect after cessation of finasteride chemoprevention, at which point their risk for prostate cancer and those with higher Gleason scores would equal or even exceed that of untreated men. These unanswered questions, along with concerns regarding the higher prevalence of high-grade disease associated with finasteride therapy, and, most importantly, the reluctance to initiate costly treatment with potential side-effects in men who may never develop clinically significant prostate cancer, temper enthusiasm for widespread use of finasteride as a chemopreventive agent. 9. Conclusions Lessons learned from PCPT reach far beyond the significant finding that finasteride reduces the risk of prostate cancer by 25%. The disparity between rates of death attributed to prostate cancer and the surprisingly high prevalence of prostate cancer in PCPT participants with no clinical suspicion for prostate cancer (and, therefore, a risk of overtreatment) highlights the need for clinical parameters that can identify those who would truly benefit from prostate cancer diagnosis, treatment, or prevention. Population evidence of a net positive benefit of this preventive intervention suggests that chemoprevention of prostate cancer with finasteride will increase in attractiveness as one of only a few proven interventions for control of prostate cancer. Until biomarkers or other indicators are developed that can reliably distinguish between indolent and clinically significant prostate cancers, the true benefit of finasteride chemoprevention will be reduction in cost of diagnosis and treatment of cancers that were never likely to produce morbidity or mortality. References [1] Jemal A, Siegel R, Ward E, et al. Cancer statistics, CA Cancer J Clin 2006;56: [2] Damber JE. Decreasing mortality rates for prostate cancer: possible role of hormonal therapy? BJU Int 2004;93:
7 european urology 51 (2007) [3] Petrylak DP, Tangen CM, Hussain MH, et al. Docetaxel and estramustine compared with mitoxantrone and prednisone for advanced refractory prostate cancer [see comment]. N Engl J Med 2004;351: [4] Tannock IF, de Wit R, Berry WR, et al. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer [see comment]. N Engl J Med 2004;351: [5] Piper NY, Kusada L, Lance R, Foley J, Moul J, Seay T. Adenocarcinoma of the prostate: an expensive way to die. Prostate Cancer Prostatic Dis 2002;5: [6] Aus G, Abbou CC, Bolla M, et al. EAU guidelines on prostate cancer. Eur Urol 2005;48: [7] Unger JM, LeBlanc M, Crowley JJ, et al. Estimating the impact of new clinical trial proven cancer therapy and cancer chemoprevention on population mortality: the Karnofsky Memorial lecture. J Clin Oncol 2003;21:246s 52s. [8] McConnell JD, Roehrborn CG, Bautista OM, et al. The longterm effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia [see comment]. N Engl J Med 2003;349: [9] Thompson IM, Goodman PJ, Tangen CM, et al. The influence of finasteride on the development of prostate cancer [see comment]. N Engl J Med 2003;349: [10] Klein EA, Thompson IM, Klein EA, Thompson IM. Update on chemoprevention of prostate cancer. Curr Opin Urol 2004;14: [11] The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group [see comment]. N Engl J Med 1994;330: [12] Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study [see comment]. J Natl Cancer Inst 1998;90: [13] Vanchieri C. Vioxx withdrawal alarms cancer prevention researchers. J Natl Cancer Inst 2004;96: [14] Hussain T, Gupta S, Mukhtar H, Hussain T, Gupta S, Mukhtar H. Cyclooxygenase-2 and prostate carcinogenesis. Cancer Lett 2003;191: [15] Gomella LG. Chemoprevention using dutasteride: the REDUCE trial. Curr Opin Urol 2005;15: [16] Goodman PJ, Tangen CM, Crowley JJ, et al. Implementation of the Prostate Cancer Prevention Trial (PCPT). Control Clin Trials 2004;25: [17] Guess HA, Heyse JF, Gormley GJ. The effect of finasteride on prostate-specific antigen in men with benign prostatic hyperplasia. Prostate 1993;22:31 7. [18] Cooner WH, Mosley BR, Rutherford Jr CL, et al. Prostate cancer detection in a clinical urological practice by ultrasonography, digital rectal examination and prostate specific antigen. J Urol 1990;143: , discussion [19] Feigl P, Blumenstein B, Thompson I, et al. Design of the Prostate Cancer Prevention Trial (PCPT). Control Clin Trials 1995;16: [20] Bostwick DG, Qian J, Civantos F, et al. Does finasteride alter the pathology of the prostate and cancer grading? Clin Prostate Cancer 2004;2: [21] Carver BS, Kattan MW, Scardino PT, et al. Gleason grade remains an important prognostic predictor in men diagnosed with prostate cancer while on finasteride therapy. BJU Int 2005;95: [22] Rubin MA, Allory Y, Molinie V, et al. Effects of long-term finasteride treatment on prostate cancer morphology and clinical outcome. Urology 2005;66: [23] Ablin RJ, Soanes WA, Bronson P, Witebsky E. Precipitating antigens of the normal human prostate. J Reprod Fertil 1970;22: [24] Sensabaugh GF. Isolation and characterization of a semen-specific protein from human seminal plasma: a potential new marker for semen identification. J Forensic Sci 1978;23: [25] Ferro MA, Gillatt D, Symes MO, Smith PJ. High-dose intravenous estrogen therapy in advanced prostatic carcinoma. Use of serum prostate-specific antigen to monitor response. Urology 1989;34: [26] Oesterling JE, Chan DW, Epstein JI, et al. Prostate specific antigen in the preoperative and postoperative evaluation of localized prostatic cancer treated with radical prostatectomy. J Urol 1988;139: [27] Stamey TA, Yang N, Hay AR, McNeal JE, Freiha FS, Redwine E. Prostate-specific antigen as a serum marker for adenocarcinoma of the prostate. N Engl J Med 1987; 317: [28] Brawer MK, Beatie J, Wener MH, Vessella RL, Preston SD, Lange PH. Screening for prostatic carcinoma with prostate specific antigen: results of the second year. J Urol 1993; 150: [29] Catalona WJ, Smith DS, Ratliff TL, et al. Measurement of prostate-specific antigen in serum as a screening test for prostate cancer [see comment] (erratum: N Engl J Med 1991;325:1324). N Engl J Med 1991;324: [30] Chodak GW, Schoenberg HW. Early detection of prostate cancer by routine screening. JAMA 1984;252: [31] Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level < or = 4.0 ng per milliliter [see comment] (erratum: N Engl J Med 2004;351:1470). N Engl J Med 2004;350: [32] Thompson IM, Ankerst DP, Chi C, et al. Operating characteristics of prostate-specific antigen in men with an initial PSA level of 3.0 ng/ml or lower. JAMA 2005;294: [33] Thompson IM, Tangen CM, Goodman PJ, et al. Erectile dysfunction and subsequent cardiovascular disease. JAMA 2005;294: [34] Thompson IM, Tangen CM, Klein EA, et al. Phase III prostate cancer prevention trials: are the costs justified? J Clin Oncol 2005;23: [35] Bostwick DG, Qian J, Bostwick DG, Qian J. High-grade prostatic intraepithelial neoplasia. Mod Pathol 2004;17: [36] De Marzo AM, Meeker AK, Zha S, et al. Human prostate cancer precursors and pathobiology. Urology 2003;62:
Do 5a-Reductase Inhibitors Alter Prostate Cancer Detection and What Are the Implications?
european urology supplements 5 (2006) 752 757 available at www.sciencedirect.com journal homepage: www.europeanurology.com Do 5a-Reductase Inhibitors Alter Prostate Cancer Detection and What Are the Implications?
More informationJ Clin Oncol 25: by American Society of Clinical Oncology INTRODUCTION
VOLUME 25 NUMBER 21 JULY 20 2007 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T Prediction of Prostate Cancer for Patients Receiving Finasteride: Results From the Prostate Cancer Prevention Trial
More informationPREVALENCE OF PROSTATE CANCER AMONG HYPOGONADAL MEN WITH PROSTATE-SPECIFIC ANTIGEN LEVELS OF 4.0 ng/ml OR LESS
ADULT UROLOGY PREVALENCE OF PROSTATE CANCER AMONG HYPOGONADAL MEN WITH PROSTATE-SPECIFIC ANTIGEN LEVELS OF 4.0 ng/ml OR LESS ABRAHAM MORGENTALER AND ERNANI LUIS RHODEN ABSTRACT Objectives. To determine
More informationProstate-Specific Antigen (PSA) Test
Prostate-Specific Antigen (PSA) Test What is the PSA test? Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the
More informationProstate Cancer Incidence
Prostate Cancer: Prevention, Screening and Treatment Philip Kantoff MD Dana-Farber Cancer Institute Professor of fmedicine i Harvard Medical School Prostate Cancer Incidence # of patients 350,000 New Cases
More informationThe Relationship between Prostate Inflammation and Lower Urinary Tract Symptoms: Examination of Baseline Data from the REDUCE Trial
european urology 54 (2008) 1379 1384 available at www.sciencedirect.com journal homepage: www.europeanurology.com Benign Prostatic Hyperplasia The Relationship between Prostate Inflammation and Lower Urinary
More informationNIH Public Access Author Manuscript World J Urol. Author manuscript; available in PMC 2012 February 1.
NIH Public Access Author Manuscript Published in final edited form as: World J Urol. 2011 February ; 29(1): 11 14. doi:10.1007/s00345-010-0625-4. Significance of preoperative PSA velocity in men with low
More informationFinasteride Does Not Increase the Risk of High-grade Prostate Cancer: A Biasadjusted. Mary W. Redman, Ph.D. 1. Catherine M. Tangen, Dr.
Finasteride Does Not Increase the Risk of High-grade Prostate Cancer: A Biasadjusted Modeling Approach Mary W. Redman, Ph.D. 1 Catherine M. Tangen, Dr. PH 1 Phyllis J. Goodman, MS 1 Howard Parnes, M.D.
More informationThe cost of prostate cancer chemoprevention: a decision analysis model Svatek R S, Lee J J, Roehrborn C G, Lippman S M, Lotan Y
The cost of prostate cancer chemoprevention: a decision analysis model Svatek R S, Lee J J, Roehrborn C G, Lippman S M, Lotan Y Record Status This is a critical abstract of an economic evaluation that
More informationProstate Cancer Screening Guidelines in 2017
Prostate Cancer Screening Guidelines in 2017 Pocharapong Jenjitranant, M.D. Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital Prostate Specific Antigen (PSA) Prostate
More informationAvailable for Public Disclosure Without Redaction
PROSCAR (finasteride 5 mg) Supplemental New Drug Application Prostate Cancer Prevention Trial Oncologic Drugs Advisory Committee Briefing Document Presented to ODAC on 01-December 2010 Available for Public
More informationContribution of prostate-specific antigen density in the prediction of prostate cancer: Does prostate volume matter?
ORIGINAL ARTICLE Gulhane Med J 2018;60: 14-18 Gülhane Faculty of Medicine 2018 doi: 10.26657/gulhane.00010 Contribution of prostate-specific antigen density in the prediction of prostate cancer: Does prostate
More informationReview of Clinical Manifestations of Biochemicallyadvanced Prostate Cancer Cases
Original Article Review of Clinical Manifestations of Biochemicallyadvanced Prostate Cancer Cases Edmund Chiong, 1,2 Alvin Fung Wean Wong, 2 Yiong Huak Chan 3 and Chong Min Chin, 1,2 1 Department of Surgery,
More informationIntroduction. Key Words: high-grade prostatic intraepithelial neoplasia, HGPIN, radical prostatectomy, prostate biopsy, insignificant prostate cancer
Prostate cancer after initial high-grade prostatic intraepithelial neoplasia and benign prostate biopsy Premal Patel, MD, 1 Jasmir G. Nayak, MD, 1,2 Zlatica Biljetina, MD, 4 Bryan Donnelly, MD 3, Kiril
More informationOutcomes of Radical Prostatectomy in Thai Men with Prostate Cancer
Original Article Outcomes of Radical Prostatectomy in Thai Men with Prostate Cancer Sunai Leewansangtong, Suchai Soontrapa, Chaiyong Nualyong, Sittiporn Srinualnad, Tawatchai Taweemonkongsap and Teerapon
More informationIncreasing Awareness, Diagnosis, and Treatment of BPH, LUTS, and EP
Introduction to Enlarged Prostate E. David Crawford, MD Professor of Surgery (Urology) and Radiation Oncology Head, Urologic Oncology E. David Crawford Endowed Chair in Urologic Oncology University of
More informationSince the beginning of the prostate-specific antigen (PSA) era in the. Characteristics of Insignificant Clinical T1c Prostate Tumors
2001 Characteristics of Insignificant Clinical T1c Prostate Tumors A Contemporary Analysis Patrick J. Bastian, M.D. 1 Leslie A. Mangold, B.A., M.S. 1 Jonathan I. Epstein, M.D. 2 Alan W. Partin, M.D., Ph.D.
More informationPrognostic value of the Gleason score in prostate cancer
BJU International (22), 89, 538 542 Prognostic value of the Gleason score in prostate cancer L. EGEVAD, T. GRANFORS*, L. KARLBERG*, A. BERGH and P. STATTIN Department of Pathology and Cytology, Karolinska
More informationPCa Commentary. Prostate Cancer? Where's the Meat? - A Collection of Studies Supporting the Safety of Its Use. Seattle Prostate Institute CONTENTS
Volume 70 July - August 2011 PCa Commentary SEATTLE PROSTATE INSTITUTE CONTENTS TESTOSTERONE REPLACEMENT in Hypogonadal Men with Treated and Untreated Prostate Cancer? 1 TESTOSTERONE REPLACEMENT in Hypogonadal
More informationAlthough the test that measures total prostate-specific antigen (PSA) has been
ORIGINAL ARTICLE STEPHEN LIEBERMAN, MD Chief of Urology Kaiser Permanente Northwest Region Clackamas, OR Effective Clinical Practice. 1999;2:266 271 Can Percent Free Prostate-Specific Antigen Reduce the
More informationOutcomes Following Negative Prostate Biopsy for Patients with Persistent Disease after Radiotherapy for Prostate Cancer
Clinical Urology Post-radiotherapy Prostate Biopsy for Recurrent Disease International Braz J Urol Vol. 36 (1): 44-48, January - February, 2010 doi: 10.1590/S1677-55382010000100007 Outcomes Following Negative
More informationHow Do New Data from Clinical Trials Allow Us to Optimise the Assessment and Treatment of Patients with Benign Prostatic Hyperplasia?
available at www.sciencedirect.com journal homepage: www.europeanurology.com How Do New Data from Clinical Trials Allow Us to Optimise the Assessment and Treatment of Patients with Benign Prostatic Hyperplasia?
More informationProstate Cancer Prevention with finasteride/proscar or dutasteride/avodart? Compiled by Charles (Chuck) Maack Prostate Cancer Advocate/Activist
Prostate Cancer Prevention with finasteride/proscar or dutasteride/avodart? Compiled by Charles (Chuck) Maack Prostate Cancer Advocate/Activist Disclaimer: Please recognize that I am not a Medical Doctor.
More informationSerum Prostate-Specific Antigen as a Predictor of Prostate Volume in the Community: The Krimpen Study
european urology 51 (2007) 1645 1653 available at www.sciencedirect.com journal homepage: www.europeanurology.com Benign Prostatic Hyperplasia Serum Prostate-Specific Antigen as a Predictor of Prostate
More informationjournal of medicine The new england The Influence of Finasteride on the Development of Prostate Cancer abstract
The new england journal of medicine established in 1812 july 17, 2003 vol. 349 no. 3 The Influence of Finasteride on the Development of Prostate Cancer Ian M. Thompson, M.D., Phyllis J. Goodman, M.S.,
More informationPost Radical Prostatectomy Radiation in Intermediate and High Risk Group Prostate Cancer Patients - A Historical Series
Post Radical Prostatectomy Radiation in Intermediate and High Risk Group Prostate Cancer Patients - A Historical Series E. Z. Neulander 1, Z. Wajsman 2 1 Department of Urology, Soroka UMC, Ben Gurion University,
More informationElevated PSA. Dr.Nesaretnam Barr Kumarakulasinghe Associate Consultant Medical Oncology National University Cancer Institute, Singapore 9 th July 2017
Elevated PSA Dr.Nesaretnam Barr Kumarakulasinghe Associate Consultant Medical Oncology National University Cancer Institute, Singapore 9 th July 2017 Issues we will cover today.. The measurement of PSA,
More informationINTEROBSERVER VARIATION OF PROSTATIC VOLUME ESTIMATION WITH DIGITAL RECTAL EXAMINATION BY UROLOGICAL STAFFS WITH DIFFERENT EXPERIENCES
Clinical Urology International Braz J Urol Official Journal of the Brazilian Society of Urology DIGITAL RECTAL EXAMINATION BY UROLOGICAL STAFFS Vol. 30 (6): 466-471, November - December, 2004 INTEROBSERVER
More informationBJUI. Study Type Prognosis (individual cohort study) Level of Evidence 2b OBJECTIVES CONCLUSIONS
. JOURNAL COMPILATION 2008 BJU INTERNATIONAL Urological Oncology PREDICTING THE OUTCOME OF PROSTATE BIOPSY HERNANDEZ et al. BJUI BJU INTERNATIONAL Predicting the outcome of prostate biopsy: comparison
More informationWhen PSA fails. Urology Grand Rounds Alexandra Perks. Rising PSA after Radical Prostatectomy
When PSA fails Urology Grand Rounds Alexandra Perks Rising PSA after Radical Prostatectomy Issues Natural History Local vs Metastatic Treatment options 1 10 000 men / year in Canada 4000 RRP 15-year PSA
More informationSome prostatic diseases
Some prostatic diseases Benign Prostatic Hyperplasia (Nodular Hyperplasia) Extremely common Present in a significant number of men by the age of 40 & its frequency rises progressively with age, reaching
More informationA Competing Risk Analysis of Men Age Years at Diagnosis Managed Conservatively for Clinically Localized Prostate Cancer
A Competing Risk Analysis of Men Age 55-74 Years at Diagnosis Managed Conservatively for Clinically Localized Prostate Cancer Peter C. Albertsen, MD 1 James A. Hanley, PhD 2 Donald F.Gleason, MD, PhD 3
More informationSetting The setting was primary care. The economic study was conducted in the USA.
Lifetime implications and cost-effectiveness of using finasteride to prevent prostate cancer Zeliadt S B, Etzioni R D, Penson D F, Thompson I M, Ramsey S D Record Status This is a critical abstract of
More informationSession 4 Chemotherapy for castration refractory prostate cancer First and second- line chemotherapy
Session 4 Chemotherapy for castration refractory prostate cancer First and second- line chemotherapy October- 2015 ESMO 2004 October- 2015 Fyraftensmøde 2 2010 October- 2015 Fyraftensmøde 3 SWOG 9916 OS
More informationISSN X (Print) Pradesh. *Corresponding author Dr. Ashish
Scholars Journal of Applied Medical Sciences (SJAMS) Sch. J. App. Med. Sci., 2015; 3(8B):2886-2890 Scholars Academic and Scientific Publisher (An International Publisher for Academic and Scientific Resources)
More informationHormone Therapy for Prostate Cancer: Guidelines versus Clinical Practice
european urology supplements 5 (2006) 362 368 available at www.sciencedirect.com journal homepage: www.europeanurology.com Hormone Therapy for Prostate Cancer: Guidelines versus Clinical Practice Antonio
More informationKathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30,
Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 158-163 Original Research Article Correlation of serum free prostate-specific antigen level with histological findings in patients
More informationPSA and the Future. Axel Heidenreich, Department of Urology
PSA and the Future Axel Heidenreich, Department of Urology PSA and Prostate Cancer EAU Guideline 2011 PSA is a continuous variable PSA value (ng/ml) risk of PCa, % 0 0.5 6.6 0.6 1 10.1 1.1 2 17.0 2.1 3
More informationAlpha antagonists from initial concept to routine clinical practice
european urology 50 (2006) 635 642 available at www.sciencedirect.com journal homepage: www.europeanurology.com Editorial 50th Anniversary Alpha antagonists from initial concept to routine clinical practice
More informationUse of early PSA velocity to predict eventual abnormal PSA values in men at risk for prostate cancer {
Use of early PSA velocity to predict eventual abnormal PSA values in men at risk for prostate cancer { (2003) 6, 39 44 ß 2003 Nature Publishing Group All rights reserved 1365 7852/03 $25.00 www.nature.com/pcan
More information10/2/2018 OBJECTIVES PROSTATE HEALTH BACKGROUND THE PROSTATE HEALTH INDEX PHI*: BETTER PROSTATE CANCER DETECTION
THE PROSTATE HEALTH INDEX PHI*: BETTER PROSTATE CANCER DETECTION Lenette Walters, MS, MT(ASCP) Medical Affairs Manager Beckman Coulter, Inc. *phi is a calculation using the values from PSA, fpsa and p2psa
More informationKEY WORDS : Total Prostate Specific Antigen, Prostatic Acid Phosphatase, Benign Prostatic Hyperplasia, Prostate Cancer, and Sudanese.
International Journal of Pharmaceutical Science Invention ISSN (Online): 2319 6718, ISSN (Print): 2319 670X Volume 3 Issue 1 January 2014 PP.36-40 Serum Total Prostatic Specific Antigen and Prostatic Acid
More informationThe Prostate Specific-Antigen (PSA):
The Prostate Specific-Antigen (PSA): Why it could not detect prostate cancer reliably in the past and How it became a sensitive and specific tumor marker Hans H. Glaettli, dipl. Phys. ETH 0. Summary PSA
More informationCancer. Description. Section: Surgery Effective Date: October 15, 2016 Subsection: Original Policy Date: September 9, 2011 Subject:
Subject: Saturation Biopsy for Diagnosis, Last Review Status/Date: September 2016 Page: 1 of 9 Saturation Biopsy for Diagnosis, Description Saturation biopsy of the prostate, in which more cores are obtained
More informationInformation Content of Five Nomograms for Outcomes in Prostate Cancer
Anatomic Pathology / NOMOGRAMS IN PROSTATE CANCER Information Content of Five Nomograms for Outcomes in Prostate Cancer Tarek A. Bismar, MD, 1 Peter Humphrey, MD, 2 and Robin T. Vollmer, MD 3 Key Words:
More informationUrological Society of Australia and New Zealand PSA Testing Policy 2009
Executive summary Urological Society of Australia and New Zealand PSA Testing Policy 2009 1. Prostate cancer is a major health problem and is the second leading cause of male cancer deaths in Australia
More informationOutcomes Associated With the Use of Finasteride: An Evaluation of this Medication as a Chemoprotective Agent and its Efficacy
Pacific University CommonKnowledge School of Physician Assistant Studies Theses, Dissertations and Capstone Projects 8-14-2010 Outcomes Associated With the Use of Finasteride: An Evaluation of this Medication
More informationACCME/Disclosures. Cribriform Lesions of the Prostate. Case
Cribriform Lesions of the Prostate Ming Zhou, MD, PhD Departments of Pathology and Urology New York University Langone Medical Center New York, NY Ming.Zhou@NYUMC.ORG ACCME/Disclosures The USCAP requires
More informationSpecial Articles. Key Words: prostatic neoplasms, radiotherapy, prostate-specific antigen, neoplasm metastasis
Special Articles Adjuvant Radiotherapy for Pathological T3N0M0 Prostate Cancer Significantly Reduces Risk of Metastases and Improves Survival: Long-Term Followup of a Randomized Clinical Trial Ian M. Thompson,*,
More informationPROSTATE CANCER SCREENING: AN UPDATE
PROSTATE CANCER SCREENING: AN UPDATE William G. Nelson, M.D., Ph.D. Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins American Association for Cancer Research William G. Nelson, M.D., Ph.D. Disclosures
More informationCorrelation of Gleason Scores Between Needle-Core Biopsy and Radical Prostatectomy Specimens in Patients with Prostate Cancer
ORIGINAL ARTICLE Correlation of Gleason Scores Between Needle-Core Biopsy and Radical Prostatectomy Specimens in Patients with Prostate Cancer Teng-Fu Hsieh, Chao-Hsian Chang, Wen-Chi Chen, Chien-Lung
More informationIndex. urologic.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Ablative therapies, transurethral needle ablation, Adverse events, sexual side effects of BPH Aging, and incidence of BPH associated with
More informationProstate volume predicts high grade prostate cancer both in digital rectal examination negative (ct1c) and positive ( ct2) patients
ORIGINAL ARTICLE Vol. 40 (5): 613-619, September - October, 2014 doi: 10.1590/S1677-5538.IBJU.2014.05.05 Prostate volume predicts high grade prostate cancer both in digital rectal examination negative
More informationThe Clinical Potential of Pretreatment Serum Testosterone Level to Improve the Efficiency of Prostate Cancer Screening
european urology 51 (2007) 375 380 available at www.sciencedirect.com journal homepage: www.europeanurology.com Prostate Cancer The Clinical Potential of Pretreatment Serum Testosterone Level to Improve
More informationPreoperative Gleason score, percent of positive prostate biopsies and PSA in predicting biochemical recurrence after radical prostatectomy
JBUON 2013; 18(4): 954-960 ISSN: 1107-0625, online ISSN: 2241-6293 www.jbuon.com E-mail: editorial_office@jbuon.com ORIGINAL ARTICLE Gleason score, percent of positive prostate and PSA in predicting biochemical
More informationMini-Invasive Treatment in Urological Diseases Dott. Alberto Saita Responsabile Endourologia Istituto Clinico Humanitas - Rozzano
Dipartimento di Urologia Direttore Prof. Giorgio Guazzoni Mini-Invasive Treatment in Urological Diseases Dott. Alberto Saita Responsabile Endourologia Istituto Clinico Humanitas - Rozzano alberto.saita@humanitas.it
More informationPolicy. not covered Sipuleucel-T. Considerations Sipuleucel-T. Description Sipuleucel-T. be medically. Sipuleucel-T. covered Q2043.
Cellular Immunotherapy forr Prostate Cancer Policy Number: 8.01.53 Origination: 11/2010 Last Review: 11/2014 Next Review: 11/2015 Policy BCBSKC will provide coverage for cellular immunotherapy for prostate
More informationRepeating an abnormal prostate-specific antigen (PSA) level: how relevant is a decrease in PSA?
Repeating an abnormal prostate-specific antigen (PSA) level: how relevant is a decrease in PSA? Connolly, D., Black, A., Murray, L., Nambirajan, T., Keane, P. F., & Gavin, A. (2009). Repeating an abnormal
More informationWhat Is Prostate Cancer? Prostate cancer is the development of cancer cells in the prostate gland (a gland that produces fluid for semen).
What Is Prostate Cancer? Prostate cancer is the development of cancer cells in the prostate gland (a gland that produces fluid for semen). It is a very common cancer in men; some cancers grow very slowly,
More informationThe Selenium and Vitamin E Prevention Trial
The largest-ever-prostate cancer prevention trial is now underway. The study will include a total of 32,400 men and is sponsored by the National Cancer Institute and a network of researchers known as the
More informationTestosterone Therapy and the Prostate. Frans M.J. Debruyne Professor of Urology The Netherlands
Testosterone Therapy and the Prostate Frans M.J. Debruyne Professor of Urology The Netherlands TRT- Risks Prostate ( Cancer, BPH )? Cardiac? Lipids? Polycythemia Sleep apnea Gynecomastia Edema Testosterone
More informationSupplemental Information
Supplemental Information Prediction of Prostate Cancer Recurrence using Quantitative Phase Imaging Shamira Sridharan 1, Virgilia Macias 2, Krishnarao Tangella 3, André Kajdacsy-Balla 2 and Gabriel Popescu
More informationBIOCHEMICAL RECURRENCE POST RADICAL PROSTATECTOMY
BIOCHEMICAL RECURRENCE POST RADICAL PROSTATECTOMY AZHAN BIN YUSOFF AZHAN BIN YUSOFF 2013 SCENARIO A 66 year old man underwent Robotic Radical Prostatectomy for a T1c Gleason 4+4, PSA 15 ng/ml prostate
More informationIndex. Note: Page numbers of article titles are in boldface type.
Urol Clin N Am 31 (2004) 379 387 Index Note: Page numbers of article titles are in boldface type. A Acinar proliferation, atypical small, as markers for risk of development of prostate cancer, 229 Acupuncture,
More informationOutcomes With "Watchful Waiting" in Prostate Cancer in US Now So Good, Active Treatment May Not Be Better
1 sur 5 19/09/2009 07:02 www.medscape.com From Medscape Medical News Outcomes With "Watchful Waiting" in Prostate Cancer in US Now So Good, Active Treatment May Not Be Better Zosia Chustecka September
More informationSystems Pathology in Prostate Cancer. Description
Section: Medicine Effective Date: July 15, 2015 Subject: Systems Pathology in Prostate Cancer Page: 1 of 8 Last Review Status/Date: June 2015 Systems Pathology in Prostate Cancer Description Systems pathology,
More informationClinical Utility of the PCA3 Urine Assay in European Men Scheduled for Repeat Biopsy
european urology 54 (2008) 1081 1088 available at www.sciencedirect.com journal homepage: www.europeanurology.com Prostate Cancer Clinical Utility of the PCA3 Urine Assay in European Men Scheduled for
More informationeuropean urology 55 (2009)
european urology 55 (2009) 385 393 available at www.sciencedirect.com journal homepage: www.europeanurology.com Prostate Cancer Is Prostate-Specific Antigen Velocity Selective for Clinically Significant
More informationor more transrectal ultrasonography (TRUS)-guided ng/ml and 39% if it was 20.0 ng/ml. of >10 ng/ml have prostate cancer [3], many other
BJU International (1999), 83, 34 38 Elevated serum prostate specific antigen levels in conjunction with an initial prostatic biopsy negative for carcinoma: who should undergo a repeat biopsy? G.C. DURKAN
More informationBPH with persistently elevated PSA 아주대학교김선일
BPH with persistently elevated PSA 아주대학교김선일 PSA in BPH: present status AUA & EAU BPH guideline: PSA: recommended test AUA practice guideline committee. J Urol 2003;170:530 Madersbacher. Eur Urol 2004;46:547
More informationα-blocker Monotherapy and α-blocker Plus 5-Alpha-Reductase Inhibitor Combination Treatment in Benign Prostatic Hyperplasia; 10 Years Long-Term Results
www.kjurology.org http://dx.doi.org/10.4111/kju.2012.53.4.248 Voiding Dysfunction α-blocker Monotherapy and α-blocker Plus 5-Alpha-Reductase Inhibitor Combination Treatment in Benign Prostatic Hyperplasia;
More informationEarly detection the key to prostate cancer
Early detection the key to prostate cancer Kirby R. Early detection the key to prostate cancer. The Practitioner 2009;253 (1715):17 22 Professor Roger Kirby MA MD FRCS Director, The Prostate Centre, London
More informationAlthough current American Cancer Society guidelines
ORIGINAL ARTICLE Diffuse Adenosis of the Peripheral Zone in Prostate Needle Biopsy and Prostatectomy Specimens Tamara L. Lotan, MD* and Jonathan I. Epstein, MD*w z Abstract: We have observed a group of
More informationProstate Cancer: 2010 Guidelines Update
Prostate Cancer: 2010 Guidelines Update James L. Mohler, MD Chair, NCCN Prostate Cancer Panel Associate Director for Translational Research, Professor and Chair, Department of Urology, Roswell Park Cancer
More informationDiagnosis, pathology and prognosis including variant pathology
PROSTATE CANCER Diagnosis, pathology and prognosis including variant pathology No Conflict of Interest Universitat Autónoma de Barcelona F.Algaba Section of Pathology PROSTATE CANCER Diagnosis, pathology
More informationPercentage of Gleason Pattern 4 and 5 Predicts Survival After Radical Prostatectomy
1967 Percentage of Gleason Pattern 4 and 5 Predicts Survival After Radical Prostatectomy Liang Cheng, MD 1,2 Darrell D. Davidson, MD, PhD 1 Haiqun Lin, MD, PhD 3 Michael O. Koch, MD 2 1 Department of Pathology
More informationName of Policy: Cellular Immunotherapy for Prostate Cancer
Name of Policy: Cellular Immunotherapy for Prostate Cancer Policy #: 432 Latest Review Date: July 2014 Category: Medical Policy Grade: A Background/Definitions: As a general rule, benefits are payable
More informationAnatomic distribution and pathologic characterization of small-volume prostate cancer (o0.5 ml) in whole-mount prostatectomy specimens
& 2005 USCAP, Inc All rights reserved 0893-3952/05 $30.00 www.modernpathology.org Anatomic distribution and pathologic characterization of small-volume prostate cancer (o0.5 ml) in whole-mount prostatectomy
More informationEUROPEAN UROLOGY 58 (2010)
EUROPEAN UROLOGY 58 (2010) 551 558 available at www.sciencedirect.com journal homepage: www.europeanurology.com Prostate Cancer Prostate Cancer Prevention Trial and European Randomized Study of Screening
More informationA NEURAL NETWORK PREDICTS PROGRESSION FOR MEN WITH GLEASON SCORE 3 4 VERSUS 4 3 TUMORS AFTER RADICAL PROSTATECTOMY
ADULT UROLOGY CME ARTICLE A NEURAL NETWORK PREDICTS PROGRESSION FOR MEN WITH GLEASON SCORE 3 4 VERSUS 4 3 TUMORS AFTER RADICAL PROSTATECTOMY MISOP HAN, PETER B. SNOW, JONATHAN I. EPSTEIN, THERESA Y. CHAN,
More informationThe Actual Value of the Surgical Margin Status as a Predictor of Disease Progression in Men with Early Prostate Cancer
european urology 50 (2006) 258 265 available at www.sciencedirect.com journal homepage: www.europeanurology.com Prostate Cancer The Actual Value of the Surgical Margin Status as a Predictor of Disease
More informationMedical Policy Manual. Topic: Systems Pathology in Prostate Cancer Date of Origin: December 30, 2010
Medical Policy Manual Topic: Systems Pathology in Prostate Cancer Date of Origin: December 30, 2010 Section: Laboratory Last Reviewed Date: April 2014 Policy No: 61 Effective Date: July 1, 2014 IMPORTANT
More informationPSA screening. To screen or not to screen, that s the question Walid Shahrour FRCSC, MDCM, BSc Assistant professor Northern Ontario School of Medicine
PSA screening To screen or not to screen, that s the question Walid Shahrour FRCSC, MDCM, BSc Assistant professor Northern Ontario School of Medicine Conflict of Interest Declaration: Nothing to Disclose
More informationGUIDELINES ON PROSTATE CANCER
10 G. Aus (chairman), C. Abbou, M. Bolla, A. Heidenreich, H-P. Schmid, H. van Poppel, J. Wolff, F. Zattoni Eur Urol 2001;40:97-101 Introduction Cancer of the prostate is now recognized as one of the principal
More informationBPH: a present and future perspective on health impact
BPH: a present and future perspective on health impact Burden of disease in men with moderate LUTS Dalibor Pacík This presentation is financially supported by GlaxoSmithKline. CZ/DUTT/0019/12 Men with
More informationUniversity of Zagreb Medical School Repository
Središnja medicinska knjižnica Tomas, D., Krušlin, B., Rogatsch, H., Schäfer, G., Belicza, M., Mikuz, G. (00) Different Types of Atrophy in the Prostate With and Without Adenocarcinoma. European Urology,
More informationHistopathological Study of Transrectal Ultrasound Guided Biopsies of Prostate
ORIGINAL ARTICLE Histopathological Study of Transrectal Ultrasound Guided Biopsies of Prostate in Patients With Raised Serum Prostate Specific Antigen Prabha Rathour 1, Hetal Jani 2, Urvi Parikh 3, Hansa
More informationElsevier Editorial System(tm) for European Urology Manuscript Draft
Elsevier Editorial System(tm) for European Urology Manuscript Draft Manuscript Number: EURUROL-D-13-00306 Title: Post-Prostatectomy Incontinence and Pelvic Floor Muscle Training: A Defining Problem Article
More informationProstate Health PHARMACIST VIEW
Prostate Health PHARMACIST VIEW Prostate Definition Prostate is a gland made of fibromuscular tissue. It is about 4 cm and surrounds the neck of the bladder and the urethra. It produces seminal fluid.
More informationDavid Gillatt Bristol Urological Institute. David Gillatt Bristol UK
David Gillatt Bristol Urological Institute David Gillatt Bristol UK Prostate Problems The prostate grows with age - >80% men over 60 have benign enlargement As it grows it can obstruct the flow of urine
More informationInsignificant Prostate Cancer in Radical Prostatectomy Specimen: TimeTrends and Preoperative Prediction
European Urology European Urology 43 (2003) 455 460 Insignificant Prostate Cancer in Radical Prostatectomy Specimen: TimeTrends and Preoperative Prediction Herbert Augustin a,b, Peter G. Hammerer a,c,*,
More informationProstate Overview Quiz
Prostate Overview Quiz 1. The path report reads: Gleason 3 + 4 = 7. The Gleason s score is a. 3 b. 4 c. 7 d. None of the above 2. The path report reads: Moderately differentiated adenocarcinoma of the
More informationControversies in Prostate Cancer Screening
Controversies in Prostate Cancer Screening William J Catalona, MD Northwestern University Chicago Disclosure: Beckman Coulter, a manufacturer of PSA assays, provides research support PSA Screening Recommendations
More informationPSA To screen or not to screen? Darrel Drachenberg, MD, FRCSC
PSA To screen or not to screen? Darrel Drachenberg, MD, FRCSC Disclosures Faculty / Speaker s name: Darrel Drachenberg Relationships with commercial interests: Grants/Research Support: None Speakers Bureau/Honoraria:
More informationThe Natural History of Noncastrate Metastatic Prostate Cancer after Radical Prostatectomy
european urology 51 (2007) 940 948 available at www.sciencedirect.com journal homepage: www.europeanurology.com Prostate Cancer The Natural History of Noncastrate Metastatic Prostate Cancer after Radical
More informationSystems Pathology in Prostate Cancer
Systems Pathology in Prostate Cancer Policy Number: 2.04.64 Last Review: 8/2014 Origination: 8/2010 Next Review: 8/2015 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will not provide coverage
More informationOriginal Article - Urological Oncology. Ho Gyun Park 1, Oh Seok Ko 1, Young Gon Kim 1, Jong Kwan Park 1-4
www.kjurology.org http://dx.doi.org/10.4111/kju.2014.55.4.249 Original Article - Urological Oncology http://crossmark.crossref.org/dialog/?doi=10.4111/kju.2014.55.4.249&domain=pdf&date_stamp=2014-04-17
More informationScreening for Prostate Cancer
Screening for Prostate Cancer Review against programme appraisal criteria for the UK National Screening Committee (UK NSC) Version 1: This document summarises the work of ScHARR 1 2 and places it against
More informationProstate Cancer. Biomedical Engineering for Global Health. Lecture Fourteen. Early Detection. Prostate Cancer: Statistics
Biomedical Engineering for Global Health Lecture Fourteen Prostate Cancer Early Detection Prostate Cancer: Statistics Prostate gland contributes enzymes, nutrients and other secretions to semen. United
More informationAre extended biopsies really necessary to improve prostate cancer detection?
(2003) 6, 250 255 & 2003 Nature Publishing Group All rights reserved 1365-7852/03 $25.00 www.nature.com/pcan Are extended biopsies really necessary to improve prostate cancer detection? R Damiano*,1, R
More information