Early prostate-specific antigen changes and the diagnosis and prognosis of prostate cancer

Abstract

Purpose of review-To delineate how recent findings on prostate-specific antigen (PSA) can improve prediction of risk, detection, and prediction of clinical endpoints of prostate cancer (PCa).Recent findings-The widely used PSA cut-point of 4.0 ng/ml increasingly appears arbitrary, but no cut-point achieves both high sensitivity and high specificity. The accuracy of detecting PCa can be increased by additional predictive factors and combinations of markers. Evidence implies that a panel of kallikrein markers improves the specificity and reduces costs by eliminating unnecessary biopsies. Large, population-based studies have provided evidence that PSA can be used to predict PCa risk many years in advance, improve treatment selection and patient care, and predict the risk of complications and disease recurrence. However, definitive evidence is currently lacking as to whether PSA screening lowers PCa -specific mortality.Summary-PSA is still the main tool for early detection, risk stratification, and monitoring of PCa. However, PSA values are affected by many technical and biological factors. Instead of using a fixed PSA cut-point, using statistical prediction models and considering the integration additional markers may be able to improve and individualize PCa diagnostics. A single PSA measurement at early middle age can predict risk of advanced PCa decades in advance and stratify patients for intensity of subsequent screening.

A Prospective Study of Total and Ionized Serum Calcium and Time to Fatal Prostate Cancer

“…This is especially problematic because the prevalence of clinically insignificant prostate cancers among older men is high. Unnecessary biopsies may detect these insignificant lesions and lead to overtreatment of prostate cancer (40,41). Our data indicate that total and ionized serum calcium levels are significantly elevated in men without clinical prostate cancer who die of prostate cancer within 8 years.…”

The Role of Sarcosine, Uracil, and Kynurenic Acid Metabolism in Urine for Diagnosis and Progression Monitoring of Prostate Cancer

“…Data shows that metabolomics may help improving diagnosis and provide information with regards to tumor progression and invasion patterns by providing detailed read-outs of tumor cell physiology and biochemical activity making [3,4,5]. Metabolic profiling of samples from PCa patients is of great interest because it may lead to the detection and identification of statistical significant biomarkers related to prostate cancer and subsequently solve the problem of low specificity and sensitivity of the current PCa screening, diagnosis, staging, and monitoring protocols based on measurements of the serum prostate-specific antigen (PSA) or its derivatives, digital rectal examination (DRE), histopathological studies of core needle biopsies, and Gleason Scores [6,7,8,9,10,11]. …”

N-acetyl-L-aspartyl-L-glutamate peptidase-like 2 is overexpressed in cancer and promotes a pro-migratory and pro-metastatic phenotype

“…14,15 Unlike PCA3, PSA has shown some promise in predicting aggressive disease and relapse following treatment, but this remains an area of prostate research where novel markers could significantly impact on clinical decisions. 16,17 We describe the expression and oncogenic properties of NAALADL2, the least studied of the NAALADases. We demonstrate that NAALADL2 protein is expressed in a number of cancers and highly expressed in prostate cancer where it predicts for relapse following radical prostatectomy.…”