Prostate cancer screening in a healthy population cohort in eastern Nepal: an explanatory trial study

The Clinical Efficacy of Prostate Cancer Screening in Worldwide and Iran: Narrative Review

Prostate cancer (CaP) imposes a great health burden on men, while its incidence has significantly increased in recent years. The screening program for CaP is still controversial and recent large trials have failed to present a significant reduction in prostate-specific mortality and all-cause mortality. An entire body of data obtained from worldwide studies conducted on CaP screening is required to better evaluate health policy decisions and patient decision-making. In current review, the clinical efficacy of screening programs on CaP was discussed in numerous parts of the world, such as in the US, Europe, and Asia, to provide an updated screening recommendation. Finally, we discuss about CaP screening status in Iran and update the screening recommendation in Iran.

Prostate cancer screening in Europe and Asia

Prostate cancer (PCa) is the second most common cancer among men worldwide and even ranks first in Europe. Although Asia is known as the region with the lowest PCa incidence, it has been rising rapidly over the last 20 years mostly due to the introduction of prostate-specific antigen (PSA) testing. Randomized PCa screening studies in Europe show a mortality reduction in favor of PSA-based screening but coincide with high proportions of unnecessary biopsies, overdiagnosis and subsequent overtreatment. Conclusive data on the value of PSA-based screening and hence the balance between harms and benefits in Asia is still lacking. Because of known racial variations, Asian countries should not directly apply the European screening models. Like in the western world also in Asia, new predictive markers, tools and risk stratification strategies hold great potential to improve the early detection of PCa and to reduce the worldwide existing negative aspects of PSA-based PCa screening.

A model approach to calculate cancer prevalence from 5 years survival data for selected cancer sites in India--part II

OBJECTIVE

Prevalence is a statistic of primary interest in public health. In the absence of good follow-up facilities, it is often difficult to assess the complete prevalence of cancer for a given registry area. An attempt is made to arrive at the complete prevalence including limited duration prevalence with respect of selected sites of cancer for India by fitting appropriate models to 1, 3 and 5 year cancer survival data available for selected registries of India.

METHODOLOGY

Cancer survival data, available for the registries of Bhopal, Chennai, Karunagappally, and Mumbai was pooled to generate survival for the selected cancer sites. With the available data on survival for 1, 3 and 5 years, a model was fitted and the survival curve was extended beyond 5 years (up to 30 years) for each of the selected sites. This helped in generation of survival proportions by single year and thereby survival of cancer cases. With the help of estimated survived cases available year wise and the incidence, the prevalence figures were arrived for selected cancer sites and for selected periods. In our previous paper, we have dealt with the cancer sites of breast, cervix, ovary, lung, stomach and mouth (Takiar and Jayant, 2013).

RESULTS

The prevalence to incidence ratio (PI ratio) was calculated for 30 years duration for all the selected cancer sites using the model approach showing that from the knowledge of incidence and P/I ratio, the prevalence can be calculated. The validity of the approach was shown in our previous paper (Takiar and Jayant, 2013). The P/I ratios for the cancer sites of lip, tongue, oral cavity, hypopharynx, oesophagus, larynx, nhl, colon, prostate, lymphoid leukemia, myeloid leukemia were observed to be 10.26, 4.15, 5.89, 2.81, 1.87, 5.43, 5.48, 5.24, 4.61, 3.42 and 2.65, respectively.

CONCLUSION

Cancer prevalence can be readily estimated with use of survival and incidence data.

Histopathologic characterization of prostate diseases in Madinah, Saudi Arabia

AIMS

To delineate the histopathological pattern of prostate diseases and to highlight age variations in prostate specific antigen (PSA) values and histopathological features.

MATERIALS AND METHODS

A retrospective review was made of all prostate biopsy reports seen between January 2006 and December 2013 at the King Fahad Hospital, Madinah, Saudi Arabia. Prostate lesions were tabulated and classified into benign and malignant groups. Histological scoring of adenocarcinomas was accomplished using the Gleason system. PSA values were correlated with Gleason scores.

RESULTS

Of 417 prostate lesions reviewed, 343 (82.3%) were benign and 74 (17.7%) were malignant, giving a benign to malignant ratio of 4.6:1. Benign prostatic hyperplasia (both with and without inflammation) was the commonest prostatic lesion and accounted for 80.3% of all cases and 97.6% of all benign cases. The age range was 20 to 97 years with a mean of 69.2 years and a peak age group at 70-79 years. Seventy one cases of adenocarcinoma accounted for 95.9% of the total of 74 malignant tumors. It showed an age range of 44 to 95 years, a mean age of 70.9 years and peak prevalence in the 80-89 year age group. Gleason score seven was the most frequent (39.4%) in occurrence. Most adenocarcinomas, 41 cases (57.7%), were moderately differentiated (Gleason score of 5-7). PSA values ranged widely between 16-1,865 ng/ml with a mean of 363.4 ng/ml. Elevated PSA (>100 ng/ml) levels were found in 53 (81.6%) patients. There was a statistically significant positive correlation between serum PSA level and Gleason score (p=0.0304).

CONCLUSIONS

Prostatic lesions constitute a significant source of morbidity among adult males in Madinah. Benign prostatic hyperplasia was the commonest benign prostatic lesion and adenocarcinoma was the commonest histological subtype of prostatic cancer.

Prostate cancer screening in the fit Chilean elderly: a head to head comparison of total serum PSA versus age adjusted PSA versus primary circulating prostate cells to detect prostate cancer at initial biopsy

BACKGROUND

Prostate cancer is predominately a disease of older men, with a median age of diagnosis of 68 years and 71% of cancer deaths occurring in those over 75 years of age. While prostate cancer screening is not recommended for men>70 years, fit elderly men with controlled comorbidities may have a relatively long life expectancy. We compare the use of age related PSA with the detection of primary malignant circulating prostate cells mCPCs to detect clinically significant PC in this population.

MATERIALS AND METHODS

All men undergoing PC screening with a PSA>4.0 ng/ml underwent TRUS 12 core prostate biopsy (PB). Age, PSA, PB results defined as cancer/no-cancer, Gleason, number of positive cores and percentage infiltration were registered. Men had an 8 ml blood sample taken for mCPC detection; mononuclear cells were obtained using differential gel centrifugation and mCPCs were identified using immunocytochemistry with anti-PSA and anti-P504S. A mCPC was defined as a cell expressing PSA and P504S; a positive test as at least one mCPC detected/sample. Diagnostic yields for subgroups were calculated and the number of avoided PBs registered. Esptein criteria were used to define small grade tumours.

RESULTS

A total of 610 men underwent PB, 398 of whom were aged <70 yrs. Men over 70 yrs had: a higher median PSA, 6.24 ng/ml versus 5.59 ng/ml (p=0.04); and a higher frequency of cancer detected 90/212 (43%) versus 134/398 (34%) (p=0.032). Some 34/134 cancers in men<70 yrs versus 22/90 (24%) of men>70 yrs complied with criteria for active surveillance. CPC detection: 154/398 (39%) men<70 yrs were CPC (+), specificity for cancer 86%, sensitivity 88%, 14/16 with a false (-) result had a small low grade PC. In men>70 years, 88/212 (42%) were CPC (+); specificity 92%, sensitivity 87%, 10/12 with a false (-) had small low grade tumours. False (+) results were more common in younger men 36/154 versus 10/88 (p<0.02). With a PSA cutoff of 6.5 ng/ml, in men<70 yrs, 108 PB would be avoided, missing 56 cancers of which 48 were clinically significant. Using CPC detection, 124 biopsies would be avoided, missing only 2 clinically significant cancers. In men>70 yrs using a PSA>6.5 ng/ml would have resulted in 108 PB with 34 PC detected, of which 14(41%) were small low grade tumours.

CONCLUSIONS

The use of CPC detection in the fit elderly significantly decreases the number of PBs without missing clinically significant cancers, indicating superiority to the use of age-related PSA.

Utility of digital rectal examination, serum prostate specific antigen, and transrectal ultrasound in the detection of prostate cancer: a developing country perspective

PURPOSE

To determine the utility of digital rectal examination (DRE), serum total prostate specific antigen (tPSA) estimation, and transrectal ultrasound (TRUS) for the detection of prostate cancer (PCa) in men with lower urinary tract symptoms (LUTS).

MATERIALS AND METHODS

All patients with abnormal DRE, TRUS, or serum tPSA >4ng/ml, in any combination, underwent TRUS-guided needle biopsy. Eight cores of prostatic tissue were obtained from different areas of the peripheral prostate and examined histopathologically for the nature of the pathology.

RESULTS

PCa was detected in 151 (50.3%) patients, remaining 149 (49.7%) showed benign changes with or without active prostatitis. PCa was detected in 13 (56.5%), 9 (19.1%), 26 (28.3%), and 103 (74.6%) of patients with tPSA <4 ng/ml, 4-10 ng/ml, 10-20 ng/ml and >20 ng/ml respectively. Only 13 patients with PCa had abnormal DRE and TRUS with serum PSA <4 ng/ml. The detection rate was highest in patients with tPSA >20 ng/ml. The association between tPSA level and cancer detection was statistically significant (p<0.01). Among 209 patients with abnormal DRE and raised serum PSA, PCa was detected in 128 (61.2%).

CONCLUSIONS

The incidence of PCa increases with increasing serum level of tPSA. The overall screening and detection rate can be further improved by using DRE, TRUS and TRUS-guided prostate needle biopsies.

Epidemiology, etiology, diagnosis and treatment of prostate cancer

Prostate cancer is more common in men over the age of 65 years. There are 15% cases with positive family history of prostate cancer Worldwide. Prostate cancer is the second leading cause of death among the U.S. men. Prostate cancer incidence is strongly related to age with the highest rates in older man. Globally millions of people are suffering from this disease. This study aims to provide awareness about prostate cancer as well as an updated knowledge about the epidemiology, etiology, diagnosis and treatment of prostate cancer.

Role of hyperinsulinemia in increased risk of prostate cancer: a case control study from Kathmandu Valley

AIM

To investigate the effect of hyperglycemia and hyperinsulinemia on prostate cancer risk.

MATERIALS AND METHODS

This hospital based study was carried out using data retrieved from the register maintained in the Department of Biochemistry of a tertiary care hospital of Kathmandu, Nepal between 31st December, 2011 and 31st October, 2013. The variables collected were age, serum cholesterol, serum calcium, PSA, fasting blood glucose, serum insulin. Analysis was performed by descriptive statistics and testing of hypothesis using Excel 2003, R 2.8.0, Statistical Package for the Social Sciences (SPSS) for Windows Version 16.0 (SPSS Inc; Chicago, IL, USA) and the EPI Info 3.5.1 Windows Version.

RESULTS

Of the total 125 subjects enrolled in our present study, 25 cases were of PCa and 100 were healthy controls. The mean value of fasting plasma glucose was 95.5 mg/dl in cases of prostatic carcinoma and the mean value of fasting plasma insulin was 5.78 μU/ml (p value: 0.0001*). The fasting insulin levels μU/ml were categorized into the different ranges starting from ≤2.75, >2.75 to ≤4.10, >4.10 to ≤6.10, >6.10μU/ml. The maximum number of cases of prostatic carcinoma of fasting insulin levels falls in range of >6.10μU/ml. The highest insulin levels (>6.10μU/ml) were seen to be associated with an 2.55 fold risk of prostatic carcinoma when compared with fasting insulin levels of (<2.75 μU/ml).

CONCLUSIONS

Elevated fasting levels of serum insulin appear to be associated with a higher risk of prostate cancer.