How to improve prostate biopsy detection of prostate cancer

Abstract

The combination of serum prostate-specific antigen (PSA) testing and transrectal ultrasonography is a highly effective strategy to diagnose prostate cancer at an early curable stage. Even though PSA is the most useful serum biomarker to aid in prostate cancer detection, it has limited specificity: as many as 75% of men who undergo prostate biopsy because of an elevated PSA do not have prostate cancer. Additionally, sextant prostate biopsies miss prostate cancer at least 20% of the time. To reduce the number of false-negative biopsies, many have advocated obtaining 12 or more cores in a single biopsy session. Studies have shown that this practice is safe and can enhance cancer detection modestly. Although it is unlikely that prostate cancer imaging will replace prostate biopsy in the near future, many exciting new imaging technologies should eventually improve targeting of prostate needle biopsy and reduce false-negative biopsies. Some of the most exciting areas include power Doppler sonography, microbubble intravenous ultrasound contrast agents, and magnetic resonance spectroscopy. These functional imaging modalities can assess tumor blood flow and metabolic activity at a cellular level and can detect malignant changes that may not be detected by standard anatomic imaging.

Colonic Tumor CEA, CSAp and MUC-1 Expression following Radioimmunotherapy or Chemotherapy

“…Others are more specific for a particular cancer type, for example, PAP [26] and PSA [27] for prostate cancer, p97 [28] for melanoma, and ferritin and AFP [29,30] for liver cancer. Radiolabeled antibody has had some success in the treatment of cancer, more so with the hematologic cancers (e.g.…”

Detecting prostate cancer by intracellular macrophage prostate‐specific antigen (PSA): a more specific and sensitive marker than conventional serum total PSA

“…The specificity of the conventional serum total PSA test must be considered suboptimal since in nearly 75% of men with PSA levels between 4 and 10 ng mL −1 no tumour tissue is found in biopsy [20,21]. In an attempt to find new diagnostic screening methods, intracellular PSA in circulating and tissue macrophages was studied [17,18].…”

Efficacy and tolerability of the dual 5α-reductase inhibitor, dutasteride, in the treatment of benign prostatic hyperplasia in African-American men

“…The risk of the development and progression of BPH is similar, or possibly higher, in African-Americans compared with Caucasians, 3,4,6,7,9 yet the majority of clinical trials investigating the efficacy and safety of BPH pharmacotherapies have enrolled predominantly Caucasian men, [27][28][29] and the degree to which results of these studies can be generalized to African-Americans is unknown. Possible reasons for the low level of participation of minorities in clinical trials include lack of awareness of study programmes, communication barriers, religious beliefs, economic disadvantages and study inclusion and exclusion criteria.…”

“…2 In clinical studies, African-American men have been shown to have a similar, or greater, risk of BPH compared with Caucasian men. [3][4][5][6][7] In an analysis of community-based studies, the severity of lower urinary tract symptoms (LUTS) was significantly greater among African-Americans compared with Caucasians, although African-American men reported less bother for each unit increase in LUTS severity. 8 In addition, a recent retrospective cohort study showed that African-American men have a significantly higher risk of BPH progression than Caucasian-American men.…”