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Raoof S, Lee RJ, Jajoo K, Mancias JD, Rebbeck TR, Skates SJ. Multicancer Early Detection Technologies: A Review Informed by Past Cancer Screening Studies. Cancer Epidemiol Biomarkers Prev 2022; 31:1139-1145. [PMID: 35320352 DOI: 10.1158/1055-9965.epi-21-1443] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 12/14/2022] Open
Abstract
More than 75% of cancer-related deaths occur from cancers for which we do not screen. New screening liquid biopsies may help fill these clinical gaps, although evidence of benefit still needs to be assessed. Which lessons can we learn from previous efforts to guide those of the future? Screening trials for ovarian, prostate, pancreatic, and esophageal cancers are revisited to assess the evidence, which has been limited by small effect sizes, short duration of early-stage disease relative to screening frequency, study design, and confounding factors. Randomized controlled trials (RCT) to show mortality reduction have required millions of screening-years, two-decade durations, and been susceptible to external confounding. Future RCTs with late-stage incidence as a surrogate endpoint could substantially reduce these challenges, and clinical studies demonstrating safety and effectiveness of screening in high-risk populations may enable extrapolation to broader average-risk populations. Multicancer early detection tests provide an opportunity to advance these practical study designs. Conditional approvals based on RCTs with surrogate endpoints, contingent upon real world evidence generation and continuation of trials to definitive endpoints, may lower practical barriers to innovation in cancer screening and enable greater progress.
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Affiliation(s)
- Sana Raoof
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard J Lee
- Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Kunal Jajoo
- Harvard Medical School, Boston, Massachusetts.,Brigham and Women's Hospital, Boston, Massachusetts
| | - Joseph D Mancias
- Harvard Medical School, Boston, Massachusetts.,Brigham and Women's Hospital, Boston, Massachusetts.,Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Timothy R Rebbeck
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Steven J Skates
- Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Daher M, Telvizian T, Dagher C, Abdul-Sater Z, Massih SA, Chediak AE, Charafeddine M, Shahait M, Alameddine R, Temraz S, Geara F, Youssef B, El Hajj A, Nasr R, Wazzan W, Bulbul M, Khauli R, Shamseddine A, Mukherji D. High rates of advanced prostate cancer in the Middle East: Analysis from a tertiary care center. Urol Ann 2021; 13:418-423. [PMID: 34759656 PMCID: PMC8525480 DOI: 10.4103/ua.ua_47_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 01/12/2021] [Indexed: 11/28/2022] Open
Abstract
Objectives: Prostate cancer incidence is increasing in the Middle East (ME); however, the data of stage at the diagnosis and treatment outcomes are lacking. In developed countries, the incidence of de novo metastatic prostate cancer ranges between 4% and 14%. We hypothesized that the rates of presentation with advanced disease are significantly higher in the ME based on clinical observation. This study aims to examine the stage at the presentation of patients with prostate cancer at a large tertiary center in the ME. Methods: After Institutional Review Board approval, we identified the patients diagnosed with prostate adenocarcinoma and presented to a tertiary care center between January 2010 and July 2015. Clinical, demographic, and pathological characteristics were abstracted. Patients with advanced disease were stratified according to tumor volume based on definitions from practice changing clinical trials. Descriptive and Kaplan–Meier survival analysis was used. Results: A total of 559 patients were identified, with a median age at the diagnosis of 65 years and an age range of 39–94 years. Median prostate-specific antigen (PSA) at the presentation was 10 ng/ml, and almost a quarter of the men (23%) presented with metastatic disease. The most common site of metastasis was the bone (34/89, 38%). High-volume metastasis was present in 30.3%, 9%, and 5.2% of the cohort based on STAMPEDE, CHAARTED, and LATITUDE trial criteria, respectively. Conclusion: This is the first report showing the high proportion of men from ME presenting with de novo metastasis. This could be due to many factors, including the highly variable access to specialist multidisciplinary management, lack of awareness, and lack of PSA screening in the region. There is a clear need to raise the awareness about prostate cancer screening and early detection and to address the rising burden of advanced prostate cancer affecting men in the ME region.
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Affiliation(s)
- Marilyne Daher
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Talar Telvizian
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christelle Dagher
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zahi Abdul-Sater
- Global Health Institute, American University of Beirut, Beirut, Lebanon.,Department of Basic Sciences, Phoenicia University, Mazraat El Daoudiyeh, Amman, Jordan
| | - Sarah Abdel Massih
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Alissar El Chediak
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Charafeddine
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohammed Shahait
- Division of Urology, Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Raafat Alameddine
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sally Temraz
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fady Geara
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bassem Youssef
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Albert El Hajj
- Division of Urology, Department of Surgery, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rami Nasr
- Division of Urology, Department of Surgery, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wassim Wazzan
- Division of Urology, Department of Surgery, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Muhammad Bulbul
- Division of Urology, Department of Surgery, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Raja Khauli
- Division of Urology, Department of Surgery, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Shamseddine
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Deborah Mukherji
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Oey O, Ghaffari M, Li JJ, Hosseini-Beheshti E. Application of extracellular vesicles in the diagnosis and treatment of prostate cancer: Implications for clinical practice. Crit Rev Oncol Hematol 2021; 167:103495. [PMID: 34655743 DOI: 10.1016/j.critrevonc.2021.103495] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/12/2021] [Accepted: 09/08/2021] [Indexed: 12/14/2022] Open
Abstract
Extracellular vesicles (EV) are cell-derived lipid bilayer-delimited structures providing an important means of intercellular communication. Recent studies have shown that EV, particularly exosomes and large-oncosomes contain miRNA and proteins crucial in prostate cancer (PCa) progression, metastasis and treatment resistance. This includes not just EV released from PCa cells, but also from other cells in the tumor microenvironment. PCa patient derived EV have a unique composition compared to healthy and benign prostatic diseases. As such, EV show promise as diagnostic liquid biopsy biomarkers, both as an adjunct and alternative to the invasive current gold-standard. EV could also be utilized to stratify patients' risk and predict response to hormonal, chemo, immune- and targeted therapy, which will direct future treatment decisions in PCa. We present a summary of the current evidence on the role of EV in PCa and the application of EV in PCa diagnosis and treatment to optimize patient outcomes.
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Affiliation(s)
- Oliver Oey
- School of Medicine, The University of Western Australia, Crawley, WA, Australia; Harry Perkins Institute of Medical Research, Murdoch, WA, Australia
| | - Mazyar Ghaffari
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Jiao Jiao Li
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, NSW, Australia
| | - Elham Hosseini-Beheshti
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.
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Kumar S, Burney IA, Satyapal N, Kunju J, Al-Marhoon MS, Siddiqui KM. Clinicopathological features, treatment and outcome of Omani patients with localised prostate cancer. Arab J Urol 2020; 18:219-225. [PMID: 33312732 PMCID: PMC7717606 DOI: 10.1080/2090598x.2020.1781386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives: To report the outcomes of Omani men diagnosed with localised prostate cancer (PCa), as PCa incidence is increasing in developing countries and there are scarce data regarding clinicopathological features and outcomes of PCa from the Arab world. Patients and methods: All men diagnosed with localised PCa between January 2006 and December 2017, and treated at a university hospital in Oman were included in the study. Data included demographic information, clinical, laboratory, pathological and radiological features at presentation, treatment modalities, and survival outcomes. Patients were followed until April 2019 or until death for disease-free survival (DFS) and overall survival (OS) whichever came first. Survival rates were estimated using the method of Kaplan and Meier. Univariate and multivariate analysis and Cox regression analyses were performed to study factors affecting DFS and OS. Results: Out of 239 men diagnosed with PCa over the study period, only 47 had localised disease (19.7%). The median age was 69 years. The majority (53.2%) had a Gleason score of ≥8 and a median (range) PSA level of 23.71 (range 0.6 – 452.9)ng/mL. In all, 16 patients received radical surgery, 17 received hormonal therapy along with definitive radiotherapy, while 15 were treated either with medical or surgical castration only. After a median follow-up of 43 months, the median DFS was 44.0 months. The median OS was not reached for the entire cohort. The 5- and 10-year OS rates were 84% and 57%, respectively Conclusion: Omani patients with localised PCa present with a high PSA level and a high Gleason score. Potentially curative treatments options, e.g. radical surgery and radiotherapy, are underutilised. The survival outcomes are similar to studies reported internationally. Abbreviations: (P)ADT: (primary) androgen-deprivation therapy; CAPRA: Cancer of the Prostate Risk Assessment; 3D: three-dimensional; DFS: disease-free survival; HDI: Human Development Index; Linacs, linear accelerators; NCCN: National Comprehensive Cancer Network; OS: overall survival; (m)(CR)PC: (metastatic) (castrate-resistant) prostate cancer; RP: radical prostatectomy; (IM)RT: (intensity modulated) radiotherapy; SQUH: Sultan Qaboos University Hospital
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Affiliation(s)
- Shiyam Kumar
- Unit of Medical Oncology, Yeovil District Hospital, NHS Foundation Trust, Yeovil, UK
| | - Ikram A Burney
- Unit of Medical Oncology, Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Namrata Satyapal
- Unit of Radiation Oncology, National Oncology Center, Royal Hospital, Muscat, Oman
| | - Joseph Kunju
- Unit of Urology, Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
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Abstract
This review evaluated prostate cancer studies from around the world and investigated the causes of differences among them. Prostate cancer incidence and mortality rates showed significant discrepancies between countries and ethnicities. In North America as well as in other western countries, the most common cancer was found to be prostate cancer; however, it appears to be not as prevalent among men in the Middle East and North Africa. Statistics show that screening of prostate-specific antigen levels should be applied depending on ethnicity and age. Other environmental aspects such as dietary and androgenic factors are believed to have caused these differences.
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Affiliation(s)
- Osman Z Al-Abdin
- Cancer Research Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Shan J, Al-Rumaihi K, Chouchane K, Al-Bozom I, Rabah D, Farhat K, Chouchane L. Prostate cancer small non-coding RNA transcriptome in Arabs. J Transl Med 2017; 15:260. [PMID: 29268752 PMCID: PMC5740966 DOI: 10.1186/s12967-017-1362-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 12/07/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Prostate cancer (PCa) is a complex disorder resulting from the combined effects of multiple environmental and genetic factors. Small non-coding RNAs (sRNAs), particularly microRNAs (miRNAs), regulate several cellular processes and have an important role in many human malignancies including PCa. We assessed the sRNA profiles associated with PCa in Arabs, a population that has rarely been studied. METHODS We used next generation sequencing technology to obtain the entire sRNA transcriptome of primary prostate tumor formalin-fixed paraffin-embedded tissues, and their paired non-tumor tissues, collected from Bedouin patients (Qatari and Saudi). The miRNA and the target gene expression were evaluated by real-time quantitative PCR. miRNA KEGG pathway and miRNA target genes were subsequently analyzed by starBase and TargetScan software. RESULTS Different expression patterns of several sRNA and miRNA editing were revealed between PCa tumor and their paired non-tumor tissues. Our study identified four miRNAs that are strongly associated with prostate cancer, which have not been reported previously. Differentially expressed miRNAs significantly affect various biological pathways, such as cell cycle, endocytosis, adherence junction and pathways involved in cancer. Prediction of potential targets for the identified miRNAs indicates the overexpression of KRAS, BCL2 and down-regulation of PTEN in PCa tumor tissues. CONCLUSION These miRNAs, newly associated with prostate cancer, may represent not only markers for the increased risk of PCa in Arabs, but may also reflect the clinical and pathological diversity as well as the ethno-specific heterogeneity of prostate cancer.
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Affiliation(s)
- Jingxuan Shan
- Laboratory of Genetic Medicine and Immunology, Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha, Qatar
| | | | - Karim Chouchane
- Faculty of Medicine and Surgery, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Issam Al-Bozom
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Danny Rabah
- Department of Surgery, Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Karim Farhat
- Department of Surgery, Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Lotfi Chouchane
- Laboratory of Genetic Medicine and Immunology, Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha, Qatar.
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7
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Elabbady A, Hashad MM, Kotb AF, Ghanem AE. Studying the effect of type 2 diabetes mellitus on prostate-related parameters: A prospective single institutional study. Prostate Int 2016; 4:156-159. [PMID: 27995116 PMCID: PMC5153428 DOI: 10.1016/j.prnil.2016.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/09/2016] [Accepted: 07/27/2016] [Indexed: 01/23/2023] Open
Abstract
Background To examine the effects of type 2 diabetes mellitus (DM) on the variables associated with prostatic growth including serum prostate-specific antigen (PSA), serum testosterone, and prostate volume, and to correlate these variables with the duration of diabetes treatment. Methods Our study was conducted over 3 months recruiting 501 men aged ≥ 55 years; of whom 207 had type 2 DM. Exclusion criteria were active urinary tract infection, suspicious rectal examination, urologic cancer, end-organ damage, and recent urological manipulations. Serum PSA and serum testosterone were measured. Prostate volume was determined by abdominal ultrasonography using an ellipsoid formula. Results The mean patient age was 60.21 ± 5.95 years. The mean PSA, testosterone, and prostate volume for diabetic men were 2.3 ng/mL, 3 ng/mL, and 56 g, respectively. The corresponding values for nondiabetic men were 3.5 ng/mL, 4 ng/mL, and 51 g, respectively (P = 0.001, P = 0.001, P = 0.03, respectively). The mean PSA density was 0.049 ± 0.043 ng/mL/cm3 in diabetics versus 0.080 ± 0.056 ng/mL/cm3 in non-diabetics (P < 0.001). Conclusion Type 2 DM is significantly associated with lower serum PSA and testosterone, and larger prostate volume.
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Affiliation(s)
- Ahmed Elabbady
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed M Hashad
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed F Kotb
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ali E Ghanem
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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8
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Elabbady A, Eid A, Fahmy A, Kotb AF. Pattern of prostate cancer presentation among the Egyptian population: A study in a single tertiary care center. Cent European J Urol 2014; 67:351-6. [PMID: 25667753 PMCID: PMC4310882 DOI: 10.5173/ceju.2014.04.art7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 05/01/2014] [Accepted: 06/23/2014] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Prostate cancer is a common health problem that in the majority of cases starts to develop at the age of 50 years, reaching its peak at 60-70 years of age. A variation in its incidence and prevalence exists between western, Asian and Arabic populations. The aim of our work was to report the pattern of prostate cancer presentation in Alexandria University that as a tertiary referral center provides care for uro-oncology cases. MATERIAL AND METHODS Data collection for all patients diagnosed with prostate cancer at Alexandria University in Egypt through the year 2012 was done. RESULTS The mean age of the patients was 67. Mean serum total PSA, prostate volume and PSAd were 149 ng/ml, 63 grams and 3.1 ng/ml/gm respectively. 25% of patients were asymptomatic diagnosed accidentally during screening for prostate cancer. The remaining group was presenting with LUTS, including 23 patients who presented initially with back pain. CONCLUSIONS Egyptian men with prostate cancer have a markedly high PSA density and Gleason grade at diagnosis.
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Affiliation(s)
- Ahmed Elabbady
- University of Alexandria, Faculty of Medicine, Department of Urology, Alexandria, Egypt
| | - Ahmed Eid
- University of Alexandria, Faculty of Medicine, Department of Urology, Alexandria, Egypt
| | - Ahmed Fahmy
- University of Alexandria, Faculty of Medicine, Department of Urology, Alexandria, Egypt
| | - Ahmed Fouad Kotb
- University of Alexandria, Faculty of Medicine, Department of Urology, Alexandria, Egypt
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El Ezzi AA, Zaidan WR, El-Saidi MA, Al-Ahmadieh N, Mortenson JB, Kuddus RH. Association of Benign Prostate Hyperplasia with Polymorphisms in VDR, CYP17, and SRD5A2 Genes among Lebanese Men. Asian Pac J Cancer Prev 2014; 15:1255-62. [DOI: 10.7314/apjcp.2014.15.3.1255] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kehinde EO, Al-Maghrebi M, Sheikh M, Anim JT. Combined Ciprofloxacin and Amikacin Prophylaxis in the Prevention of Septicemia After Transrectal Ultrasound Guided Biopsy of the Prostate. J Urol 2013; 189:911-5. [DOI: 10.1016/j.juro.2012.08.237] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 08/28/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Elijah O. Kehinde
- Department of Surgery (Division of Urology), Faculty of Medicine, Kuwait University, Kuwait
| | - May Al-Maghrebi
- Department of Biochemistry, Faculty of Medicine, Kuwait University, Kuwait
| | - Mehraj Sheikh
- Department of Radiology, Faculty of Medicine, Kuwait University, Kuwait
| | - Jehoram T. Anim
- Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait
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Al-Maghrebi M, Kehinde EO, Al-Mulla F, Anim JT. The effect of prostate tissue inflammation in benign prostatic hyperplasia on enhancer of zeste homolog 2 ribonucleic acid expression. Ann Saudi Med 2012; 32:262-8. [PMID: 22588437 PMCID: PMC6081040 DOI: 10.5144/0256-4947.2012.262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Enhancer of zeste homolog 2 (EZH2) has been recently found to regulate several genes involved in immunoresponse and autocrine inflammation network. The aim of the study was to quantitate EZH2 messenger ribonucleic acid (mRNA) expression, evaluate its relation to conditions of prostatitis associated with benign prostatic hyperplasia (BPH), and correlate it with the levels of the inflammatory marker interlukin 6 (IL-6). DESIGN AND SETTING Cross-sectional study in Middle Eastern men with BPH and prostatitis or BPH only. PATIENTS AND METHODS Transrectal ultrasound-guided prostate biopsies were collected from 106 patients suspected of having prostate cancer; however, the histology revealed BPH. Upon further pathological examination, 56 of these cases were identified as BPH with prostatitis and classified as: acute prostatitis (n=13); active chronic prostatitis (n=32); and, chronic inactive prostatitis (n=12). Serum IL-6 levels and EZH2 mRNA expression were measured and compared between patient groups. RESULTS EZH2 mRNA was overexpressed in BPH with prostatitis patients compared to BPH only patients (P<.0001). BPH with active chronic prostatitis had higher EZH2 expression than BPH with acute or chronic inactive prostatitis compared to BPH only (P=.05 and .73, respectively). EZH2 mRNA expression showed a negative correlation with IL-6 concentrations in BPH with prostatitis patients (rs=-0.31, P=.02). EZH2 overexpression was associated with an increased risk of having BPH with prostatitis (crude odds ratio 0.20, 95% CI 0.06-0.65, P=.0076). CONCLUSIONS EZH2 mRNA expression correlates positively with prostatitis conditions associated with BPH and negatively with serum IL-6 levels. This supports the possible involvement of EZH2 mRNA overexpression in the development of prostate inflammation, and its new regulatory role in suppressing the expression of some inflammatory network genes.
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Affiliation(s)
- May Al-Maghrebi
- Department of Biochemistry, Kuwait University, Safat, Kuwait.
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12
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Tang P, Xie KJ, Wang B, Deng XR, Ou RB. Antibacterial therapy improves the effectiveness of prostate cancer detection using prostate-specific antigen in patients with asymptomatic prostatitis. Int Urol Nephrol 2009; 42:13-8. [DOI: 10.1007/s11255-009-9598-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Accepted: 05/25/2009] [Indexed: 10/20/2022]
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Sheikh M, Sinan T, Kehinde EO, Hussein AY, Anim JT, Al-Hunayan AA. Relative contribution of digital rectal examination and transrectal ultrasonography in interpreting serum prostate-specific antigen values for screening prostate cancer in Arab men. Ann Saudi Med 2007; 27:73-8. [PMID: 17356323 PMCID: PMC6077036 DOI: 10.5144/0256-4947.2007.73] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND This study was conducted to determine the utility of digital rectal examination (DRE), transrectal ultrasonography (TRUS) and serum prostate-specific antigen (PSA) in the diagnosis of prostate cancer in men in Arabia, an are of the world with a relatively low incidence of this disease. PATIENTS AND METHODS 329 patients suspected of having prostate cancer on account of raised serum PSA level (>4 ng/ml), DRE or TRUS findings, underwent TRUS-guided prostate biopsy. Raised PSA individually as well as combined, or a lesion suspicious of carcinoma on DRE or TRUS was recorded as PSA(+), DRE(+) or TRUS(+), respectively. The contribution of DRE, TRUS and serum PSA to the diagnosis of prostate cancer was analysed. RESULTS Of the 329 patients who had prostate biopsies 109 cases (33.1%) had PCa. Of these 109 patients 56 (51%) had DRE(+), 77 (42%) had TRUS(+) and 49 (66%) had both DRE(+) and TRUS(+). Statistical analysis revealed that DRE(+) tripled the probability for cancer. PSA over a range of 10-50 ng/mL demonstrated an increasing cancer probability ranging from 2 to 3 fold. TRUS(+) was only significantly associated with cancer risk if PSA was elevated. The presence of all three factors increased the cancer probability by 6 to 7 fold. CONCLUSION TRUS findings are dependent on PSA for interpretation while DRE(+) with elevated PSA makes PCa more likely.
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Affiliation(s)
- Mehraj Sheikh
- Department of Radiology, Faculty of Medicine, Kuwait University P.O. Box 24923, Safat, 13110 Kuwait.
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14
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Anim JT, Kehinde EO, Sheikh MA, Prasad A, Mojiminiyi OA, Ali Y, Al-Awadi KA. Serum prostate-specific antigen levels in Middle Eastern men with subclinical prostatitis. Med Princ Pract 2007; 16:53-8. [PMID: 17159365 DOI: 10.1159/000096141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Accepted: 04/04/2006] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the influence of subclinical or histologically diagnosed prostatitis on serum prostate-specific antigen (PSA) in patients investigated for prostatic disease in Kuwait. MATERIALS AND METHODS Serum PSA was assayed in patients investigated for prostatic disease in Mubarak Al-Kabeer Hospital, Kuwait, between December 2002 and December 2004. These included patients undergoing transrectal ultrasound with needle biopsy of the prostate gland and those who were treated with transurethral resection of the prostate or retropubic prostatectomy. The tissue was evaluated for prostatitis as well as the underlying disease, and the type and severity of prostatitis were compared with levels of serum PSA. RESULTS Of the 331 tissue specimens, 18 (5.4%) did not show prostatitis, while 233 (70.4%) with benign prostate and 80 (24.2%) with malignant prostate disease showed prostatitis. Of 270 men with known serum PSA levels, 198 and 72 had benign and malignant prostate disease, respectively. Of the 198, 77 (41%) with benign prostate disease and prostatitis and of the 72, 52 (76%) with malignant prostate disease and prostatitis had serum PSA levels >10 ng/ml. CONCLUSION The data showed that although raised serum PSA is more commonly associated with prostate cancer, subclinical prostatitis is a significant source of high serum PSA in over 40% of men in Kuwait. That local factors may obscure the usefulness of serum PSA as a screening tool suggests the need for a locally applicable paradigm to identify prostate cancer.
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Affiliation(s)
- J T Anim
- Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait.
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15
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Sheikh M, Al-Saeed O, Kehinde EO, Sinan T, Anim JT, Ali Y. Utility of volume adjusted prostate specific antigen density in the diagnosis of prostate cancer in Arab men. Int Urol Nephrol 2006; 37:721-6. [PMID: 16362587 DOI: 10.1007/s11255-005-4683-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study was undertaken to assess the utility of prostate specific antigen (PSA) and PSA density (PSAD) in discriminating between benign and malignant prostate disease in the Kuwaiti Arab population. METHODS A total of 100 consecutive patients suspected of having prostate cancer because of serum PSA > 4 ng/ml, or detection of a prostatic nodule on rectal examination were further investigated by determination of PSAD, TRUS of prostate, sexant prostatic biopsy and histological analysis to establish the correct diagnosis. Other diagnostic measures included the determination of the area under the receiver operating characteristic (ROC) curve, sensitivity and specificity. RESULTS Of the 100 prostate biopsies that were performed, 33 cases were confirmed to be prostate cancer and 67 were described as benign lesions comprising benign prostatic hyperplasia (BPH) with or without prostatitis. The age range for patients with prostate cancer was 42-90 years, and 52-90 years for those without prostate cancer. The mean prostate volume was 58.82 cc (range 9-177 cc) and 62.60 cc (range 15-140 cc), the mean PSA value was 36.65 ng/ml (range 5.8-200 ng/ml) and 16.49 ng/ml (range 1.4-46.0 ng/ml), while the mean PSAD was 0.92 (range 0.046-5.714) and 0.452 (range 0.034-2.294) for patients with prostate cancer and patients without prostate cancer respectively. Patients with PSA less than 4 ng/ml (3 cases) all had benign prostate lesions, and 7 cases with PSA more than 50 ng/ml all had prostate cancer and were excluded because values above 50 ng/ml have close to 100% specificity for prostate cancer. Further analysis was done on the remaining 90 cases which were patients with a PSA between 4 and 50 ng/ml. The discriminating power of serum PSA for detecting prostate cancer as estimated by the area under ROC was 0.686 while that for PSAD was 0.732. The maximum likelihood for a positive PSA was at a PSAD cut-off point of 0.32. For the PSA cut-off point of l0 ng/ml, the sensitivity was 80%, and specificity was 42.2%. For the PSAD cut-off point of 0.32, the sensitivity was 58% and the specificity 76.6%. CONCLUSIONS Determination of PSAD is not a useful adjunct to serum PSA values in the range of 10-50 ng/ ml in our population. PSAD value less than 0.32 with PSA less than l0 ng/ml strongly suggests benign disease.
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Affiliation(s)
- M Sheikh
- Department of Radiology, Faculty of Medicine, Kuwait University, P.O. Box 24923, 13110, Safat, Kuwait.
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16
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Kobayashi T, Kawahara T, Nishizawa K, Ogura K, Mitsumori K, Ide Y. Value of prostate volume measurement using transabdominal ultrasonography for the improvement of prostate-speci fi c antigen-based cancer detection. Int J Urol 2006; 12:881-5. [PMID: 16323981 DOI: 10.1111/j.1442-2042.2005.01162.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine value of prostate-speci fi c antigen (PSA) adjusted by prostate volume measured using transabdominal ultrasonography in prostate cancer detection among men with elevated PSA. METHODS 238 men aged 79 years or younger with serum PSA levels of 2.0-20.0 ng/mL and normal digital rectal examination fi ndings were studied in terms of total and free PSA, prostate volumes with transrectal (TRUS) and transabdominal (TAUS) ultrasonography and transition zone volumes with TRUS prior to transrectal 10-core biopsy. In addition to sole PSA values and the free-to-total PSA ratio, volume-adjusted PSA values, PSA densities determined by TRUS (PSAD(TRUS)), and TAUS (PSAD(TAUS)), and PSA transition zone densities (PSATzD) were compared using receiver operating characteristic (ROC) analysis. RESULTS Prostate cancer was diagnosed in 58 (24.4%) of the 238 men who underwent prostate biopsies. Of the areas under ROC curves (AUC) of studied parameters, PSATzD (AUC 0.751) was the best and signi fi cantly superior to PSAD(TAUS) (AUC 0.664, P = 0.007). However, PSAD(TAUS) exceeded PSA (AUC 0.559, P = 0.004) and showed potential capability of a one-fourth reduction in unnecessary biopsies without spoiling sensitivity (90%). Cancer detection rate was only 4.2% in the 48 patients whose prostate volume in TAUS was > 50 mL and PSAD(TAUS) was < 0.075. CONCLUSIONS Since PSAD(TRUS) and PSATzD were signi fi cantly superior to PSAD(TAUS), TRUS is feasible as the standard fashion to determine prostate volume in the diagnosis of prostate cancers. However, TAUS is also worthwhile as it can improve the prostate cancer detection using sole PSA, and primary use of TAUS has the potential to reduce the substantial number of unnecessary biopsy safely.
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17
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Anim JT, Kehinde EO, Prasad A, Sheikh M, Mojiminiyi OA, Ali Y, Al-Awadi K. Relationship between Serum Prostate Specific Antigen and the Pattern of Inflammation in Both Benign and Malignant Prostatic Disease in Middle Eastern Men. Int Urol Nephrol 2006; 38:27-32. [PMID: 16502049 DOI: 10.1007/s11255-005-3618-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To determine the effect of prostatitis on serum prostate specific antigen in the diagnosis of prostate cancer in Middle Eastern men, H&E-stained sections of all consecutive prostate specimens were reviewed for diagnosis (malignant or benign) and pattern of inflammation. Inflammation was categorized into acute, active chronic and chronic inactive and graded semi-quantitatively according to previously published criteria. Results were correlated with serum PSA obtained from patients' records. Of 513 prostate specimens reviewed; 435 (84.8%) were benign and 78 (15.2%) were malignant. Chronic inactive prostatitis was present in 259 (204 benign, 55 malignant) and active chronic prostatitis in 221 (204 benign, 17 malignant). Acute prostatitis alone was not observed and prostatitis was absent in 33 (27 benign, 6 malignant). There was no significant difference in the prevalence of inactive chronic prostatitis between benign and malignant specimens (p < 0.071), but active chronic prostatitis was more prevalent in benign specimens (p < 0.001). Increasing serum PSA was observed for increasing grades of both inactive and active chronic prostatitis in both benign and malignant disease. Prostate cancer showed higher serum PSA levels than benign, at different cut-off points (4 ng/ml = p < 0.0001; 8 ng/ml = p < 0.0001; 12 ng/ml = p < 0.0001). However, significant numbers of patients with benign prostate biopsies presented with PSA above 12 ng/ml (82/260 = 32%). We conclude that active chronic prostatitis is common in Middle Eastern men with benign prostatic disease and a significant number of these present with very high PSA levels, some over 300 ng/ml.
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Affiliation(s)
- J T Anim
- Department of Pathology, Faculty of Medicine, Kuwait University and Mubarak Al-Kabeer Hospital, Kuwait
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18
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Sheikh M, Hussein AYT, Kehinde EO, Al-Saeed O, Rad AB, Ali YM, Anim JT. Patients' tolerance and early complications of transrectal sonographically guided prostate biopsy: prospective study of 300 patients. JOURNAL OF CLINICAL ULTRASOUND : JCU 2005; 33:452-6. [PMID: 16281270 DOI: 10.1002/jcu.20168] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE To determine the degree of pain and discomfort associated with transrectal sonography (TRS)-guided biopsy of the prostate and to analyze the complications associated with this procedure. METHODS Three hundred men referred as part of an investigation to exclude prostate cancer were studied. The reasons for referral were suspected prostate cancer due to increased serum prostate-specific antigen level (>4 ng/ml), the finding of a palpable nodule or greater firmness of one prostatic lobe than the other on digital rectal examination, or the finding of a suspicious area of neoplasm of the prostate on TRS biopsy. All TRS-guided biopsies were performed as outpatient procedures without anesthesia. Ciprofloxacin prophylaxis was used in all patients before biopsy. Tolerance of the procedure was recorded immediately after the examination and graded on a scale of 0-4 as follows: 0, no pain; 1, very mild pain; 2, moderate pain; 3, severe pain; 4, intolerable pain. Complications recorded in the first week after the procedure were analyzed. They included mild pain, self-limiting hematuria, hematospermia, rectal bleeding, severe hematuria, septicemia, severe hemorrhage of the anus, and vasovagal attack. RESULTS Out of 300 TRS-guided biopsies, 10 early complications were recorded. The most frequent was septicemia, which was seen in 5 cases (1.7%). Hematuria occurred in 29 patients, 3 of which were severe. Rectal bleeding and vasovagal attack occurred in 1 patient each. All patients made a full recovery with appropriate conservative management. Ten cases (3.33%) of severe pain (grade 3) and intolerable pain (grade 4) were observed. Three out of these 10 patients completed the procedure. The procedure was terminated in 1 patient, and 6 patients required local anesthetic due to perianal disease. CONCLUSIONS TRS-guided prostate biopsy can be performed without local anesthesia in 90% of patients. Prophylactic antibiotics are mandatory to minimize approximately infectious complications.
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Affiliation(s)
- Mehraj Sheikh
- Department of Radiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
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19
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Abstract
OBJECTIVES To determine the clinical outcome of middle-aged men with acute prostatitis, the optimum time for re-assessing their prostate-specific antigen (PSA) levels, and to detect any possible echotextural and vascular changes that remain as a consequence of acute inflammation. PATIENTS AND METHODS Persistent fever prompted a re-evaluation for prostatic abscess formation in 28 middle-aged men, using transrectal ultrasonography (TRUS) colour Doppler imaging, undertaken at the 3-, 6- and 12-month visits. The results of TRUS were compared with laboratory data and clinical outcome. RESULTS Two abscesses were detected; 19 (68%) of the patients remained infection-free at the 3-month visit. Serum PSA levels were elevated in 11 (39%) of the patients at this visit; three prostate carcinomas were diagnosed. Increased intraprostatic colour flow was detected in 68% and there were hypoechoic areas in 46% of the patients. CONCLUSION The re-evaluation for abscess formation should not be postponed for > 48 h. Patients with acute prostatitis tend to have persistent infection. PSA levels could be high even up to 3 months after an acute episode. Middle-aged men with carcinoma could be missed during the acute phase of inflammation. PSA and TRUS monitoring are strongly recommended.
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Affiliation(s)
- S Kravchick
- Department of Urology, Barzilai Medical Centre, Ashkelon, Israel.
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