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Kim HH, Moon OJ, Seol YH, Lee J. A simple urine test by
3D‐plus‐3D
immunoassay guides precise
in vitro
cancer diagnosis. Bioeng Transl Med 2023; 8:e10489. [DOI: 10.1002/btm2.10489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/26/2022] [Accepted: 12/29/2022] [Indexed: 01/19/2023] Open
Affiliation(s)
- Hye Hyun Kim
- Department of Chemical and Biological Engineering, College of Engineering Korea University Seoul Republic of Korea
| | - Ok Jeong Moon
- Department of Chemical and Biological Engineering, College of Engineering Korea University Seoul Republic of Korea
| | - Yong Hwan Seol
- Department of Chemical and Biological Engineering, College of Engineering Korea University Seoul Republic of Korea
| | - Jeewon Lee
- Department of Chemical and Biological Engineering, College of Engineering Korea University Seoul Republic of Korea
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Chadha KC, Nair B, Godoy A, Rajnarayanan R, Nabi E, Zhou R, Patel NR, Aalinkeel R, Schwartz SA, Smith GJ. Anti-angiogenic activity of PSA-derived peptides. Prostate 2015; 75:1285-99. [PMID: 25963523 DOI: 10.1002/pros.23010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 04/02/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND PSA is a biomarker for diagnosis and management of prostate cancer. PSA is known to have anti-tumorigenic activities, however, the physiological role of PSA in prostate tumor progression is not well understood. METHODS Five candidate peptides identified based upon computer modeling of the PSA crystal structure and hydrophobicity were synthesized at >95% purity. The peptides in a linear form, and a constrained form forced by a di-sulfide bond joining the two ends of the peptide, were investigated for anti-angiogenic activity in HUVEC. RESULTS None of the five PSA-mimetic peptides exhibited PSA-like serine protease activity. Two of the peptides demonstrated significant anti-angiogenic activity in HUVEC based on (i) inhibition of cell migration and invasion; (ii) inhibition of tube formation in Matrigel; (iii) anti-angiogenic activity in a sprouting assay; and (iv) altered expression of pro- and anti-angiogenic growth factors. Constrained PSA-mimetic peptides had greater anti-angiogenic activity than the corresponding linearized form. Complexing of PSA with ACT eliminated PSA enzymatic activity and reduced anti-angiogenic activity. In contrast, ACT had no effect on the anti-angiogenic effects of the linear or constrained PSA-mimetic peptides. Modeling of the ACT-PSA complex demonstrated ACT sterically blocks the anti-angiogenic activity of the two bioactive peptides. CONCLUSIONS The interaction of a hydrophilic domain on the surface of the PSA molecule with a target on the cell membrane of prostate endothelial and epithelial cells was responsible for the anti-angiogenic or anti-tumorigenic activity of PSA: enzymatic activity was not associated with anti-angiogenic effects. Furthermore, since PSA and ACT are both expressed within the human prostate tissue microenvironment, the balance of their expression may represent a mechanism for endogenous regulation of tissue angiogenesis.
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Affiliation(s)
- Kailash C Chadha
- Department of Molecular and Cellular Biology, Roswell Park Cancer Institute, Buffalo, New York
| | - Bindukumar Nair
- Department of Molecular and Cellular Biology, Roswell Park Cancer Institute, Buffalo, New York
- Division of Allergy/Immunology & Rheumatology, Department of Medicine, State University of New York at Buffalo, Buffalo, New York
| | - Alejandro Godoy
- Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rajendram Rajnarayanan
- Department of Pharmacology & Toxicology, State University of New York at Buffalo, Buffalo, NewYork
| | - Erik Nabi
- Department of Molecular and Cellular Biology, Roswell Park Cancer Institute, Buffalo, New York
| | - Rita Zhou
- Department of Molecular and Cellular Biology, Roswell Park Cancer Institute, Buffalo, New York
| | - Neel R Patel
- Department of Molecular and Cellular Biology, Roswell Park Cancer Institute, Buffalo, New York
| | - Ravikumar Aalinkeel
- Division of Allergy/Immunology & Rheumatology, Department of Medicine, State University of New York at Buffalo, Buffalo, New York
| | - Stanley A Schwartz
- Division of Allergy/Immunology & Rheumatology, Department of Medicine, State University of New York at Buffalo, Buffalo, New York
| | - Gary J Smith
- Department of Urologic Oncology, Roswell Park Cancer Institute, Buffalo, New York
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3
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Stephan C, Ralla B, Jung K. Prostate-specific antigen and other serum and urine markers in prostate cancer. Biochim Biophys Acta Rev Cancer 2014; 1846:99-112. [PMID: 24727384 DOI: 10.1016/j.bbcan.2014.04.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 03/24/2014] [Accepted: 04/01/2014] [Indexed: 11/16/2022]
Abstract
Prostate-specific antigen (PSA) is one of the most widely used tumor markers, and strongly correlates with the risk of harboring from prostate cancer (PCa). This risk is visible already several years in advance but PSA has severe limitations for PCa detection with its low specificity and low negative predictive value. There is an urgent need for new biomarkers especially to detect clinically significant and aggressive PCa. From all PSA-based markers, the FDA-approved Prostate Health Index (phi) shows improved specificity over percent free and total PSA. Other serum kallikreins or sarcosine in serum or urine show more diverging data. In urine, the FDA-approved prostate cancer gene 3 (PCA3) has also proven its utility in the detection and management of early PCa. However, some aspects on its correlation with aggressiveness and the low sensitivity at very high values have to be re-examined. The detection of a fusion of the androgen regulated TMPRSS2 gene with the ERG oncogene (from the ETS family), which acts as transcription factor gene, in tissue of ~50% of all PCa patients was one milestone in PCa research. When combining the urinary assays for TMPRSS2:ERG and PCA3, an improved accuracy for PCa detection is visible. PCA3 and phi as the best available PCa biomarkers show an equal performance in direct comparisons.
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Affiliation(s)
- Carsten Stephan
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute for Urologic Research, Berlin, Germany.
| | - Bernhard Ralla
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Klaus Jung
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute for Urologic Research, Berlin, Germany
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Abstract
BACKGROUND Prostate-specific antigen (PSA) is currently used as a biomarker for diagnosis and management of prostate cancer (CaP). However, PSA typically lacks the sensitivity and specificity desired of a diagnostic marker. OBJECTIVE The goal of this study was to identify an additional biomarker or a panel of biomarkers that is more sensitive and specific than PSA in differentiating benign versus malignant prostate disease and/or localized CaP versus metastatic CaP. METHODS Concurrent measurements of circulating interleukin-8 (IL-8), Tumor necrosis factor-α (TNF-α) and soluble tumor necrosis factor-α receptors 1 (sTNFR1) were obtained from four groups of men: (1) Controls (2) with elevated prostate-specific antigen with a negative prostate biopsy (elPSA_negBx) (3) with clinically localized CaP and (4) with castration resistant prostate cancer. RESULTS TNF-α Area under the receiver operating characteristic curve (AUC = 0.93) and sTNFR1 (AUC = 0.97) were strong predictors of elPSA_negBx (vs. CaP). The best predictor of elPSA_negBx vs CaP was sTNFR1 and IL-8 combined (AUC = 0.997). The strongest single predictors of localized versus metastatic CaP were TNF-α (AUC = 0.992) and PSA (AUC = 0.963) levels. CONCLUSIONS The specificity and sensitivity of a PSA-based CaP diagnosis can be significantly enhanced by concurrent serum measurements of IL-8, TNF-α and sTNFR1. In view of the concerns about the ability of PSA to distinguish clinically relevant CaP from indolent disease, assessment of these biomarkers in the larger cohort is warranted.
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Affiliation(s)
- Kailash C Chadha
- Department of Molecular and Cellular Biology, Roswell Park Cancer Institute, University at Buffalo, Buffalo, NY, USA
| | - Austin Miller
- Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, University at Buffalo, Buffalo, NY, USA
| | - Bindukumar B Nair
- Department of Molecular and Cellular Biology, Roswell Park Cancer Institute, University at Buffalo, Buffalo, NY, USA ; Department of Medicine, Division of Allergy/Immunology and Rheumatology, University at Buffalo, Buffalo, NY, USA
| | - Stanley A Schwartz
- Department of Medicine, Division of Allergy/Immunology and Rheumatology, University at Buffalo, Buffalo, NY, USA
| | - Donald L Trump
- Department of Medicine, Roswell Park Cancer Institute, University at Buffalo, Buffalo, NY, USA
| | - Willie Underwood
- Department of Urologic Oncology, Roswell Park Cancer Institute, University at Buffalo, Buffalo, NY, USA
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Murad AS, Down L, Davey Smith G, Donovan JL, Athene Lane J, Hamdy FC, Neal DE, Martin RM. Associations of aspirin, nonsteroidal anti-inflammatory drug and paracetamol use with PSA-detected prostate cancer: findings from a large, population-based, case-control study (the ProtecT study). Int J Cancer 2011; 128:1442-8. [PMID: 20506261 DOI: 10.1002/ijc.25465] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Evidence from laboratory studies suggests that chronic inflammation plays an important role in prostate cancer aetiology. This has resulted in speculation that nonsteroidal anti-inflammatory drugs may protect against prostate cancer development. We analysed data from a cross-sectional case-control study (n(cases) = 1,016; n(controls) = 5,043), nested within a UK-wide population-based study that used prostate specific antigen (PSA) testing for identification of asymptomatic prostate cancers, to investigate the relationship of aspirin, nonsteroidal anti-inflammatory drug (NSAID) and paracetamol use with prostate cancer. In conditional logistic regression models accounting for stratum matching on age (5-year age bands) and recruitment centre, use of non-aspirin NSAIDs [odds ratio (OR) = 1.32; 95% confidence interval (CI): 1.04-1.67] or all NSAIDs (OR = 1.25; 95% CI = 1.07-1.47) were positively associated with prostate cancer. There were weaker, not conventionally statistically significant, positive associations of aspirin (OR = 1.13; 95% CI = 0.94-1.36) and paracetamol (OR = 1.20; 95% CI = 0.90-1.60) with prostate cancer. Mutual adjustment for aspirin, non-aspirin NSAIDs or paracetamol made little difference to these results. There was no evidence of confounding by age, family history of prostate cancer, body mass index or self-reported diabetes. Aspirin, NSAID and paracetamol use were associated with reduced serum PSA concentrations amongst controls. Our findings do not support the hypothesis that NSAIDs reduce the risk of PSA-detected prostate cancer. Our conclusions are unlikely to be influenced by PSA detection bias because the inverse associations of aspirin, NSAID and paracetamol use with serum PSA would have attenuated (not generated) the observed positive associations.
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Affiliation(s)
- Ali S Murad
- Department of Social Medicine, University of Bristol, Bristol, United Kingdom
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Bangma CH, van Schaik RH, Blijenberg BG, Roobol MJ, Lilja H, Stenman UH. On the use of prostate-specific antigen for screening of prostate cancer in European Randomised Study for Screening of Prostate Cancer. Eur J Cancer 2010; 46:3109-19. [DOI: 10.1016/j.ejca.2010.09.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 09/16/2010] [Accepted: 09/17/2010] [Indexed: 10/18/2022]
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Kilpeläinen TP, Tammela TLJ, Määttänen L, Kujala P, Stenman UH, Ala-Opas M, Murtola TJ, Auvinen A. False-positive screening results in the Finnish prostate cancer screening trial. Br J Cancer 2010; 102:469-74. [PMID: 20051951 PMCID: PMC2822946 DOI: 10.1038/sj.bjc.6605512] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND There is evidence that prostate cancer (PC) screening with prostate-specific antigen (PSA) serum test decreases PC mortality, but screening has adverse effects, such as a high false-positive (FP) rate. We investigated the proportion of FPs in a population-based randomised screening trial in Finland. METHODS Finland is the largest centre in the European Randomized Study of Screening for Prostate Cancer. We have completed three screening rounds with a 4-year screening interval (mean follow-up time 9.2 years) using a PSA cutoff level of 4.0 ng ml(-1); in addition, men with PSA 3.0-3.9 and a positive auxiliary test were referred. An FP result was defined as a positive screening result without cancer in biopsy within 1 year from the screening test. RESULTS The proportion of FP screening results varied from 3.3 to 12.1% per round. Of the screened men, 12.5% had at least one FP during three rounds. The risk of next-round PC following an FP result was 12.3-19.7 vs 1.4-3.7% following a screen-negative result (depending on the screening round), risk ratio 3.6-9.9. More than half of the men with one FP result had another one at a subsequent screen. Men with an FP result were 1.5 to 2.0 times more likely to not participate in subsequent rounds compared with men with a normal screening result (21.6-29.6 vs 14.0-16.7%). CONCLUSION An FP result is a common adverse effect of PC screening and affects at least every eighth man screened repeatedly, even when using a relatively high cutoff level. False-positive men constitute a special group that receives unnecessary interventions but may harbour missed cancers. New strategies are needed for risk stratification in PC screening to minimise the proportion of FP men.
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Affiliation(s)
- T P Kilpeläinen
- Department of Urology, University of Tampere and Tampere University Hospital, Box 2000, Tampere FIN-33521, Finland.
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Abstract
Prostate cancer is the most prevalent malignancy in men and the third leading cause of cancer deaths worldwide. Although the wide-spread introduction of total prostate-specific antigen (tPSA) testing has revolutionized the approach to the managed care of this disease, there are some biological, analytical, clinical, and economical issues that argue against the cost-effectiveness of tPSA-based population screening for early identification of cancer. The on-going standardization/harmonization efforts, along with the outcomes of recent epidemiological investigations, demonstrate that the current tPSA thresholds might be revised and possibly recalculated according to several demographical variables, such as age, ethnicity, genotype, family history, and body mass index. A major shortcoming of tPSA screening is the lack of reliable evidences of reduction in prostate cancer-associated mortality, due to the large lead-time because of the indolent growth rate, the impossibility to differentiate high-grade from indolent cancers, and the treatment-associated morbidity. Since no single tPSA cut-off was proven able to efficiently identify men at higher risk of death, the jeopardy of over-diagnosis and over-treatment is also tangible. The large expenditure is an additional source of concern. Finally, a wide-spread population screening also carries several ethical, social, and psychological implications, which might overwhelm the potential benefits.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Chemistry, University-Hospital of Verona, Verona, Italy.
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Bindukumar B, Schwartz S, Aalinkeel R, Mahajan S, Lieberman A, Chadha K. Proteomic profiling of the effect of prostate-specific antigen on prostate cancer cells. Prostate 2008; 68:1531-45. [PMID: 18646040 DOI: 10.1002/pros.20811] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Prostate-specific antigen (PSA) is a well-known biomarker for diagnosis and management of prostate cancer. PSA has been shown to have anti-angiogenic activity. We used the emerging proteomic research technology to identify proteins in prostate cancer cells whose expression is regulated by enzymatically active PSA. METHODS Differentially expressed proteins in PC-3M cells treated with PSA were analyzed by 2D-DIGE analysis and identified by HPLC-MS/MS and SEQUEST data mining. Biological network analysis was carried out using MetaCore integrated software designed for functional analysis of experimental data. Gene expression data for several regulated proteins were confirmed by real-time, quantitative PCR. RESULTS A total of 41 proteins were significantly (P < 0.05) changed in abundance in PC-3M cells in response to PSA treatment. Proteins from 26 gel-spots were identified. Many of the down-regulated proteins including N8 gene product long isoform, laminin receptor, vimentin, DJ-1 and Hsp60 are known to be involved in tumor progression. DISCUSSION The relevance of the level of PSA in prostate tissue microenvironment and its relation to tumor progression has not been elucidated. PSA has been shown to down-regulate several proteins that are known to have involvement in tumor progression. This suggests that normal physiological levels of PSA in prostate tissue microenvironment may be promoting non-angiogenic environment and its down-regulation may promote tumor growth.
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Affiliation(s)
- B Bindukumar
- Department of Molecular & Cellular Biology, Roswell Park Cancer Research Institute, Buffalo, New York 14263, USA
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Stephan C, Xu C, Finne P, Cammann H, Meyer HA, Lein M, Jung K, Stenman UH. Comparison of two different artificial neural networks for prostate biopsy indication in two different patient populations. Urology 2007; 70:596-601. [PMID: 17688922 DOI: 10.1016/j.urology.2007.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Revised: 03/08/2007] [Accepted: 04/13/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Different artificial neural networks (ANNs) using total prostate-specific antigen (PSA) and percentage of free PSA (%fPSA) have been introduced to enhance the specificity of prostate cancer detection. The applicability of independently trained ANN and logistic regression (LR) models to different populations regarding the composition (screening versus referred) and different PSA assays has not yet been tested. METHODS Two ANN and LR models using PSA (range 4 to 10 ng/mL), %fPSA, prostate volume, digital rectal examination findings, and patient age were tested. A multilayer perceptron network (MLP) was trained on 656 screening participants (Prostatus PSA assay) and another ANN (Immulite-based ANN [iANN]) was constructed on 606 multicentric urologically referred men. These and other assay-adapted ANN models, including one new iANN-based ANN, were used. RESULTS The areas under the curve for the iANN (0.736) and MLP (0.745) were equal but showed no differences to %fPSA (0.725) in the Finnish group. Only the new iANN-based ANN reached a significant larger area under the curve (0.77). At 95% sensitivity, the specificities of MLP (33%) and the new iANN-based ANN (34%) were significantly better than the iANN (23%) and %fPSA (19%). Reverse methodology using the MLP model on the referred patients revealed, in contrast, a significant improvement in the areas under the curve for iANN and MLP (each 0.83) compared with %fPSA (0.70). At 90% and 95% sensitivity, the specificities of all LR and ANN models were significantly greater than those for %fPSA. CONCLUSIONS The ANNs based on different PSA assays and populations were mostly comparable, but the clearly different patient composition also allowed with assay adaptation no unbiased ANN application to the other cohort. Thus, the use of ANNs in other populations than originally built is possible, but has limitations.
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Affiliation(s)
- Carsten Stephan
- Department of Urology, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany.
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Stephan C, Jung K, Lein M, Diamandis EP. PSA and other tissue kallikreins for prostate cancer detection. Eur J Cancer 2007; 43:1918-26. [PMID: 17689069 DOI: 10.1016/j.ejca.2007.06.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 06/20/2007] [Indexed: 11/26/2022]
Abstract
Prostate cancer is the most common neoplasia of middle-aged men. Prostate specific antigen (PSA) is the first FDA-approved tumour marker for early detection of cancer and it is now in widespread clinical use. The discovery of different PSA molecular forms in serum (free PSA, PSA complexed with various protease inhibitors) in the early 1990s renewed clinical research to enhance the specificity of PSA. Also, the use of a homologous prostate-localised antigen, human glandular kallikrein 2 (KLK2) may further reduce the number of unnecessary prostate biopsies. More recently, promising data is emerging regarding molecular forms of free PSA (proPSA, BPSA, 'intact' PSA) and other members of the expanded human kallikrein family. These new findings may add substantial clinical information for early detection of prostate cancer.
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Affiliation(s)
- Carsten Stephan
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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12
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Zhigang Z, Jieming L, Su L, Wenlu S. Serum insulin-like growth factor I/free prostate specific antigen (IGF-I/fPSA) ratio enhances prostate cancer detection in men with total PSA 4.0-10.0 ng/ml. J Surg Oncol 2007; 96:54-61. [PMID: 17345593 DOI: 10.1002/jso.20784] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Recent studies have suggested that IGF-I and IGFBP-3, in combination with PSA, may enhance PCa detection. This study was to investigate the use of serum IGF-I and IGFBP-3, and their combinations with prostate volume and fPSA in enhancing the discriminatory diagnosis of PCa in men with tPSA of 4.0-10.0 ng/ml. METHODS Serum IGF-I and IGFBP-3 were determined by ELISA from 586 men with tPSA between 4.0 and 10.0 ng/ml. Of them, 281 were diagnosed with PCa and 305 without. ROC, univariate and multivariate logistic regression analyses were performed to evaluate the predictive performance of those parameters. RESULTS IGF-I, IGFD, IGF-I/fPSA, and IGFBP-3/fPSA were significantly higher in PCa cases than benign controls, whereas the differences of IGFBP-3 and IGFBPD were statistically insignificant between the two groups, respectively. The AUC values indicated enhanced performance of IGF-I/fPSA ratio (AUC = 0.753) in PCa detection compared with the currently used f/tPSA (AUC = 0.689). Multivariate logistic regression confirmed the observed relationships and identified IGF-I/fPSA as independent factor in PCa presence. CONCLUSION Our data show that IGF-I/fPSA as a promising marker can enhance PCa detection in ambiguous cases often found in the tPSA between 4.0 and 10.0 ng/ml.
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Affiliation(s)
- Zhao Zhigang
- Department of Urology, The Second Affiliated Hospital, Shantou University Medical, College, Shantou, Guangdong Province, China.
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13
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Määttänen L, Hakama M, Tammela TLJ, Ruutu M, Ala-Opas M, Juusela H, Martikainen P, Stenman UH, Auvinen A. Specificity of serum prostate-specific antigen determination in the Finnish prostate cancer screening trial. Br J Cancer 2007; 96:56-60. [PMID: 17213825 PMCID: PMC2360217 DOI: 10.1038/sj.bjc.6603522] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Specificity constitutes a component of validity for a screening test. The number of false-positive (FP) results has been regarded as one of major shortcomings in prostate cancer screening. We estimated the specificity of serum prostate-specific antigen (PSA) determination in prostate cancer screening using data from a randomised, controlled screening trial conducted in Finland with 32 000 men in the screening arm. We calculated the specificity as the proportion of men with negative findings (screen negatives, SN) relative to those with negative and FP results (SN/(SN+FP)). A SN finding was defined as either PSA</=4 ng ml(-1) or PSA 3.0-3.9 ng ml(-1) combined with a negative ancillary test (digital rectal examination, DRE or free/total, F/T PSA ratio). False positives were those with positive screening test followed by a negative diagnostic examination. Of the 30 194 eligible men, 20 794 (69%) attended the first screening round and 1968 (9.5%) had a screen-positive finding. A total of 508 prostate cancers were detected at screening (2.4%). Hence, the number of SN findings was 18 825 and the number of FP results 1358. Specificity was estimated as 0.933 (18 825 out of 20 183) with 95% confidence interval (CI) 0.929-0.936. Specificity decreased with age. Digital rectal examination as ancillary examination had similar or higher specificity than F/T PSA. In the second screening round, specificity was slightly lower (0.912, 95% CI 0.908-0.916). The specificity of PSA screening in the Finnish screening trial is acceptable. Further improvement in specificity could, however, improve acceptability of screening and decrease screening costs.
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Affiliation(s)
- L Määttänen
- Finnish Cancer Registry, Liisankatu 21 B, FIN-00170 Helsinki, Finland
- Tampere School of Public Health, FIN-33014 University of Tampere, Tampere, Finland
| | - M Hakama
- Finnish Cancer Registry, Liisankatu 21 B, FIN-00170 Helsinki, Finland
- Tampere School of Public Health, FIN-33014 University of Tampere, Tampere, Finland
| | - T L J Tammela
- Department of Urology, Tampere University Hospital and University of Tampere, Box 2000, FIN-33521 Tampere, Finland
| | - M Ruutu
- Department of Urology, Helsinki University Hospital, Box 580 FIN-00029, Helsinki, Finland
| | - M Ala-Opas
- Department of Urology, Helsinki University Hospital, Box 580 FIN-00029, Helsinki, Finland
| | - H Juusela
- Department of Surgery, Jorvi Hospital, Turuntie 150, FIN-02740 Espoo, Finland
| | - P Martikainen
- Department of Pathology, Tampere University Hospital, University of Tampere, Box 2000, FIN-33521 Tampere, Finland
| | - U-H Stenman
- Department of Clinical Chemistry, Helsinki University Hospital, Box 700, FIN-00029 Helsinki, Finland
| | - A Auvinen
- Tampere School of Public Health, FIN-33014 University of Tampere, Tampere, Finland
- Finnish Cancer Institute, Liisankatu 21 B, FIN-00170 Helsinki, Finland
- Finnish Cancer Institute, Liisankatu 21 B, FIN-00170, Helsinki, Finland. E-mail:
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Abstract
BACKGROUND Prostate-specific antigen (PSA/KLK3) and human kallikrein 2 (hK2/KLK2) belong to the human kallikrein gene family. These two highly homologous genes are specifically expressed in the prostate under androgen control. Expression of these is regulated by similar mechanisms but changes in their relative expression have been observed in prostate cancer. METHODS We determined the relative levels of PSA and hK2 mRNA in benign and malignant prostate tissue using a quantitative reverse transcription-polymerase chain reaction (RT-PCR) method. The mRNA of PSA and hK2 are reverse transcribed and amplified in one reaction with the same primers. RESULTS The variation in the ratio of hK2/PSA mRNA was remarkably small, the difference between the highest and lowest values being three-fold. The ratio was significantly higher in WHO grade 2 compared to normal or benign prostatic hyperplasia tissue (P = 0.032 and P = 0.035, respectively) and in grade 3 compared to normal or benign prostatic hyperplasia tissue (P = 0.006 in both). CONCLUSIONS The new quantitative RT-PCR technique facilitates very accurate quantitation of the relative mRNA levels of homologous genes. Using this method we have shown that the ratio of hK2/PSA mRNA is higher in cancerous than in benign prostatic tissue.
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Affiliation(s)
- Susanna Lintula
- Department of Clinical Chemistry, Helsinki University Central Hospital, Helsinki, Finland.
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15
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Le L, Chi K, Tyldesley S, Flibotte S, Diamond DL, Kuzyk MA, Sadar MD. Identification of serum amyloid A as a biomarker to distinguish prostate cancer patients with bone lesions. Clin Chem 2005; 51:695-707. [PMID: 15695329 DOI: 10.1373/clinchem.2004.041087] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Prostate cancer has a propensity to metastasize to the bone. Currently, there are no curative treatments for this stage of the disease. Sensitive biomarkers that can be monitored in the blood to indicate the presence or development of bone metastases and/or response to therapies are lacking. Surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS) is an affinity-based approach that allows sensitive and high-throughput protein profiling and screening of biological samples. METHODS We used SELDI-TOF MS for protein profiling of sera from prostate cancer patients (n = 38) with and without bone metastases in our effort to identify individual or multiple serum markers that may be of added benefit to those in current use. Serum was applied to ProteinChip surfaces (H4 and IMAC) to quickly screen samples and detect peaks predominating in the samples obtained from patients with bone metastases. Unique proteins in the bone metastasis cohort observed by SELDI-TOF MS were identified by two-dimensional gel electrophoresis, in-gel trypsin digestion, and tandem MS. The identities of the proteins were confirmed by ELISA and immunodepletion assays. RESULTS The cluster of unique proteins in the sera of patients with bone metastases was identified as isoforms of serum amyloid A. Machine-learning algorithms were also used to identify patients with bone metastases with a sensitivity and specificity of 89.5%. CONCLUSIONS SELDI-TOF MS protein profiling in combination with other proteomic approaches may provide diagnostic tools with potential clinical applications and serve as tools to aid in the discovery of biomarkers associated with various diseases.
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Affiliation(s)
- Lyly Le
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
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Wu P, Stenman UH, Pakkala M, Närvänen A, Leinonen J. Separation of enzymatically active and inactive prostate-specific antigen (PSA) by peptide affinity chromatography. Prostate 2004; 58:345-53. [PMID: 14968435 DOI: 10.1002/pros.10337] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Prostate-specific antigen (PSA) is a serine protease with highly prostate-specific expression and an important marker for prostate cancer. We have previously identified novel PSA-binding peptides that enhance the enzymatic activity of PSA when produced as fusion proteins. METHOD PSA-binding peptides and derivatives with a spacer were chemically synthesized and used to prepare an affinity column, which was used to fractionate PSA in seminal plasma, serum, and LNCap cell culture medium. RESULTS Approximately 67% of seminal plasma PSA bound to the peptide affinity column and was eluted under mild conditions. Eluted PSA was intact and enzymatically active while the unbound fraction mainly contained various nicked forms. ProPSA from LNCap cells bound to the peptide column only after activation by trypsin. CONCLUSIONS PSA-binding peptides can be used to separate enzymatically active and inactive forms of PSA. Thus the peptides are potentially useful as ligands for development of methods for specific detection of active free PSA.
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Affiliation(s)
- Ping Wu
- Department of Clinical Chemistry, Helsinki University Central Hospital, Helsinki, Finland
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Zhu H, Roehl KA, Antenor JAV, Catalona WJ. Clinical Value of Longitudinal Free-to-Total Prostate Specific Antigen Ratio Slope to Diagnosis of Prostate Cancer. J Urol 2004; 171:661-3. [PMID: 14713781 DOI: 10.1097/01.ju.0000103644.24520.b7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Free and total serum prostate specific antigen (PSA) levels are frequently used for early prostate cancer detection in men with a total PSA in the 2.6 to 10 ng/ml range. Results from a longitudinal study suggested that the free-to-total PSA ratio (F/T PSA), declining the decade before prostate cancer diagnosis, is the earliest serum marker predicting a subsequent diagnosis of prostate cancer. Other than this study, there are limited data on the predictive value of longitudinal F/T PSA measurements for subsequent cancer. To evaluate the clinical importance of a decreasing F/T PSA, we compared longitudinal F/T PSA in volunteers in a prostate cancer screening study. MATERIALS AND METHODS We evaluated 657 volunteers in a screening study with a total PSA of 2.6 to 10 ng/ml but whose initial biopsies were either negative for cancer or were waived. To obtain meaningful F/T PSA slopes, the patients have been followed with at least 3 F/T PSA levels measured for 3 or greater years (mean 3.5, median 3.5, range 3 to 5.3). Of these men 22 subsequently were diagnosed with prostate cancer. We calculated the F/T PSA slope as the last F/T PSA minus the first F/T PSA divided by the interval between the measurements. The F/T PSA slopes of the patients with and without cancer were compared using chi-square analysis. RESULTS Mean F/T PSA slope for the patients with cancer was -0.06 (median -0.03, range -0.63 to 0.22) compared to mean slope of -0.02 (median -0.01, range -0.57 to 0.69) for patients without cancer (p = 0.21). Of the patients with cancer 61% had a negative slope compared with 54% of patients without cancer (p = 0.59). The positive predictive value of a negative F/T PSA slope for subsequent cancer detection to date is only 4%. CONCLUSIONS A decreasing F/T PSA during a 3 to 5-year interval has little value in predicting subsequent diagnosis of prostate cancer. Further followup of a larger number of patients will be required to determine the value of longitudinal F/T PSA measurements in early prostate cancer detection.
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Affiliation(s)
- Hui Zhu
- Division of Urology, Washington University School of Medicine, St. Louis, Missouri, USA
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