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AGE SPECIFIC PROSTATE SPECIFIC ANTIGEN (PSA)
Zahid Iqbal
The Professional Medical Journal , 2000,
Abstract: OBJECTIVES: To see the specific values of PSA in different ethnic groups of Punjab. PSA is an importantmarker in screening, staging and monitoring the course of prostate cancer. Its levels vary in various agegroups and ethnic groups. DESIGN OF STUDY: Comparative study. PERIOD: November 1998 toFebruary 1999 (04 months). SETTING: Department of urology Mayo Hospital & various localities inLahore, Minare & Hafizabad. PATIENTS & METHODS: 101 healthy male individuals above the age offorty years were evaluated. They were studied in three different groups on the basis of ethinicity. Group Iwas comprising of individuals from an area of mixed ethinicity. Group II and III were comprising ofindividuals belonging to two ethnic groups Gujjars and Bhatti’s . Age specific values in fifty sexually activein the three ethnic groups was also noted. RESULTS: Out of these 101 normal individuals, 91% had normalserum PSA levels. In 50 patients with BPH only 40% of the patients had serum PSA levels within normallimits. Rise in serum PSA level was found with increase in age. Serum PSA levels were found in dangerzone in (7%), (3%) and 0% patients in group I, II and III respectively. While 34% of BPH patients had serumPSA levels in danger zone. Statistically no difference was found in the serum PSA levels in the 3 ethnicgroups. No relationship was found between serum PSA levels and sexual activity.
A study of prescriptions for prostate specific antigen (PSA) testing  [PDF]
Cros L,Germanaud J,Charlon R
Revue Médicale de l'Assurance Maladie , 2005,
Abstract: Aim: To assess prescriptions for prostate specific antigen (PSA) with respect to the guidelines of the National Agency for Accreditation and Evaluation in Health (ANAES). Method: We analyzed the French national healthfund’s reimbursement data for the Centre region of France during 12 consecutive months (from March 1, 2000 to February 28, 2001). Results: In the Centre region, 61,547 PSA determinations were reimbursed during the twelve month study period for 49,836 patients. Among affiliates of the general scheme of the national healthfund, PSA determinations were performed in 21 % of patients older than 75 years, in 17 % of patients aged between 50 and 74 years and in 1 % of patients aged between 40 and 50 years. In 72 % of the PSA determinations, PSA levels had never been determined before. Among these first determinations, seven out of ten exclusively ordered PSA. 27 % of the patients who had their PSA tested were younger than 50 years or older than 75 years. PSA determinations are not recommended for individuals in these age groups. Only 1 % of the patients who had PSA tests were exonerated from co-payments due to the long-term disorder, cancer of the prostate, during the two-year period following the test. 83 % of the tests were prescribed by general practitioners and 10 % by urologists. There were important differences in the frequency with which the tests were prescribed within the same specialty. When prescriptions included a PSA index, the ANAES guidelines were poorly followed: 40 % were prescribed without asking for the total reference PSA and when the index was prescribed, it was appropriately prescribed in only 40 % of the cases. Conclusion: Individual screening with PSA determinations were routinely performed in contradiction to the ANAES guidelines. There is an enormous disparity in how often physicians prescribe PSA tests. In addition, these tests do not target patients very well.
Postoperative monitoring of prostate-specific antigen (PSA) after treatment with high-intensive focused ultrasound (HIFU  [PDF]
Popkov V.M.,Fomkin R.N.,Blyumberg B.I.
Saratov Journal of Medical Scientific Research , 2012,
Abstract: Research objective: to estimate efficiency of treatment of prostate cancer using high-intensive focused ultrasound on the basis of laboratory analysis of postoperative level prostate-specific antigen (PSA). Objects of research. Objects of research consisted of 110 patients treated in urological clinic of Hospital n.a. S. R. Mirotvortsev (Saratov State Medical University) during the period February, 2009 — March, 2012. Patients took 110 sessions of primary operative treatment of prostate cancer by HIFU therapy method. Technique and research methods. Concentration of PSA in blood changed in all patients every 1,5 month within 6 months after operation, irrespective of its kind (including after repeated HIFU), further — after every 3 month till one year, and later on after 6 months. We were guided by references of the International Consensus, which considers PSA level more than 0,5 ng/ml in blood after 3 months of treatment to be unsatisfactory result. We also headed for PSA level before treatment and oncological risk degree. Results. Median nadir formed 0,5 ng/ml PSA by 3 months after treatment. Patients demonstrated different indicators of PSA dynamics depending on oncological risk, stage and hormonal therapy management. Patients with low oncological risk had initially lower PSA concentration, further PSA concentration reached nadir level faster. At patients with widespread forms of prostate cancer accurate dependence of PSA concentration according to prevalence of process was traced. Time of PSA nadir amount did not differ and was marked as 12-14 weeks on average. At patients received hormonal therapy, lower value of PSA nadir was marked. The conclusion. Monitoring of PSA concentration (PSA nadir by 3 months, dynamics of PSA concentration change) is of great importance in early revealing of relapse after prostate HIFU therapy. High level of PSA nadir and PSA growth according to time period are important prognostic factors.
Applying strategies from libertarian paternalism to decision making for prostate specific antigen (PSA) screening
David C Wheeler, Konrad M Szymanski, Amanda Black, David E Nelson
BMC Cancer , 2011, DOI: 10.1186/1471-2407-11-148
Abstract: Given the inconclusive results from clinical trials and incongruent PSA screening guidelines, the decision to screen for prostate cancer with PSA testing is an uncertain one for patients and health care providers. Screening guidelines from some health organizations recommend an informed decision making (IDM) or shared decision making (SDM) approach for deciding on PSA screening. These approaches aim to empower patients to choose among the available options by making them active participants in the decision making process. By increasing involvement of patients in the clinical decision-making process, IDM/SDM places more of the responsibility for a complex decision on the patient. Research suggests, however, that patients are not well-informed of the harms and benefits associated with prostate cancer screening and are also subject to an assortment of biases, emotion, fears, and irrational thought that interferes with making an informed decision. In response, the IDM/SDM approaches can be augmented with strategies from the philosophy of libertarian paternalism (LP) to improve decision making. LP uses the insights of behavioural economics to help people better make better choices. Some of the main strategies of LP applicable to PSA decision making are a default decision rule, framing of decision aids, and timing of the decision. In this paper, we propose that applying strategies from libertarian paternalism can help with PSA screening decision-making.Our proposal to augment IDM and SDM approaches with libertarian paternalism strategies is intended to guide patients toward a better decision about testing while maintaining personal freedom of choice. While PSA screening remains controversial and evidence conflicting, a libertarian-paternalism influenced approach to decision making can help prevent the overdiagnosis and overtreatment of prostate cancer.Screening for prostate cancer using prostate specific antigen (PSA) has become widespread despite the controversy surround
Prostate-specific antigen (PSA/hK3): a further player in the field of breast cancer diagnostics?
Ferdinando Mannello, Giancarlo Gazzanelli
Breast Cancer Research , 2001, DOI: 10.1186/bcr302
Abstract: Omnia, quae nunc vetustissima creduntur, nova fuere [All, which we consider now as most ancient, was new once]Tacitus, Annals, Book XI, 24As with everything else in science, biological research involves the continuous updating of physiological phenomena, sometimes subverting the certainty 'written in stone'. That is also true of prostate-specific antigen (PSA), an antigen discovered in the 1970s and introduced to urological practice about 15 years ago [1]. Although it is widely used as the most sensitive marker available so far for screening, diagnosis and monitoring human prostate cancer progression as well as response to therapy, discoveries over the past decade have unequivocally indicated that the original antigen PSA is no longer prostate-specific, shedding light on the multifunctional behaviour of this 'novel' serine protease [2]. The main characteristics of this kallikrein, which belongs to the family of serine proteases, have previously been described in detail [3] and are therefore mentioned only briefly here. The glandular kallikrein gene family is composed of three genes, localized on chromosome 19q13.3-q13.4; the KLK-3 gene locus encodes the extracellular serine protease PSA, which has also been named human glandular kallikrein 3 (hK3). In the prostate, PSA expression is localized to the differentiated, secretory columnar cells of the glandular epithelium. Biochemically, it is a 33 kDa single-chain glycoprotein with chymotrypsin-like activity that requires post-translational processing for its full proteolytic activity.Physiologically, PSA has a role in the dissolution of the gel structure of freshly ejaculated semen, through specific proteolysis of both high molecular mass semenogelin and fibronectin. In seminal fluid about two thirds of PSA is enzymically active, whereas the remainder is inactive and does not bind to protease inhibitors. Low levels of PSA are normally released into the blood and its predominant molecular form is that complexed with α1-
Effect of Alpha Linolenic Acid Supplementation on Serum Prostate Specific Antigen (PSA): Results from the Alpha Omega Trial  [PDF]
Ingeborg A. Brouwer, Johanna M. Geleijnse, Veronique M. Klaasen, Liesbeth A. Smit, Erik J. Giltay, Janette de Goede, Annemieke C. Heijboer, Daan Kromhout, Martijn B. Katan
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0081519
Abstract: Background Alpha linolenic acid (ALA) is the major omega-3 fatty acid in the diet. Evidence on health effects of ALA is not conclusive, but some observational studies found an increased risk of prostate cancer with higher intake of ALA. We examined the effect of ALA supplementation on serum concentrations of prostate-specific antigen (PSA), a biomarker for prostate cancer. Methods The Alpha Omega Trial (ClinicalTrials.gov Identifier: NCT00127452) was a double-blind, placebo-controlled trial of ALA and the fish fatty acids eicosapentanoic acid (EPA) and docosahexanoic acid (DHA) on the recurrence of cardiovascular disease, using a 2×2 factorial design. Blood was collected at the start and the end of the intervention period. The present analysis included 1622 patients with a history of a myocardial infarction, aged 60–80 years with an initial PSA concentration <4 ng/mL. They received either 2 g per day of ALA or placebo in margarine spreads for 40 months. T-tests and logistic regression were used to assess the effects of ALA supplementation on changes in serum PSA (both continuously and as a dichotomous outcome, cut-off point: >4 ng/mL). Findings Mean serum PSA increased by 0.42 ng/mL on placebo (n = 815) and by 0.52 ng/mL on ALA (n = 807), a difference of 0.10 (95% confidence interval: ?0.02 to 0.22) ng/mL (P = 0·12). The odds ratio for PSA rising above 4 ng/mL on ALA versus placebo was 1.15 (95% CI: 0.84–1.58). Interpretation An additional amount of 2 g of ALA per day increased PSA by 0.10 ng/mL, but the confidence interval ranged from ?0.02 to 0.22 ng/mL and included no effect. Therefore, more studies are needed to establish whether or not ALA intake has a clinically significant effect on PSA or prostate cancer. Trial registration information ClinicalTrials.gov; Identifier: NCT00127452. URL: http://www.clinicaltrials.gov/ct2/show/N?CT00127452.
Immunohistochemical expression of androgen receptor and prostate-specific antigen in breast cancer.  [cached]
Diana Narita,Marius Raica,Cristian Suciu,Anca C??mpean
Folia Histochemica et Cytobiologica , 2006, DOI: 10.5603/4563
Abstract: AR (androgen receptor) and PSA (prostate-specific antigen) are involved in the pathogenesis of breast cancer, but their role is not clearly defined. The purpose of this study was to analyze by immunohistochemistry the AR and PSA (prostate-specific antigen) expression in 156 female breast carcinomas and to correlate the results with some histopathological parameters, like ER (estrogen receptor), PR (progesterone receptor), HER2/neu, nodal and metastasis status, histological type and grade. ARs and PSA were expressed in 112/156 (72%) and respectively in 61/156 (39%) of cases and we found a positive correlation between AR and PSA expression in breast carcinomas (p<0.0002). We also found an association between the histological type of the tumor and AR (p<0.001), respectively PSA (p=0.01) and between AR and the grade of differentiation (p=0.007) and the nodal status (p=0.02). No correlations were found between the metastasis status and AR or PSA. 47.3% (53/112) of AR-positive cases and 46% (28/61) of PSA-positive cases were ER-negative. High frequency of AR (87.5%) and PSA (75%) expression was found in medullary carcinomas and 53% of lobular invasive carcinomas co-expressed AR and PSA. We found an inverse correlation between HER2/neu and PSA (p=0.05). Although most of the PSA-positive carcinomas were lymph node-negative, well and moderately differentiated, we did not find any statistically significant correlations between these parameters and PSA expression. Our study confirms that ARs are commonly expressed in breast cancer and the expression of PSA and AR are highly correlated. Moreover, all the lobular carcinomas and the majority of medullary carcinomas co-expressed AR and PSA, the majority of AR-positive carcinomas were lymph node-negative, well and moderately differentiated, and large number of ER-negative carcinomas expressed AR and PSA.
Effect of finasteride on serum prostate-specific antigen (PSA) and on prostate of hamster Mesocricetus auratus (hMa)
Vidigal, Dimas José Araújo;Silva, Alcino Lázaro da;Vasconcelos, Anilton César;Fazito, Dilermando Resende;Ver?osa, Bárbara Lanice Araújo;Santana, Nathália Gonsalves;Vidigal, Felipe Eduardo Costa;
Acta Cirurgica Brasileira , 2010, DOI: 10.1590/S0102-86502010000100012
Abstract: purpose: evaluate the effects of finasteride on the serum psa and on the prostate of hamster-mesocricetus auratus(hma). methods: twenty hma male adults were split in groups control and experimental (n=10). animals of the experimental group received 7.14ng/ml of finasteride, subcutaneously (sc) on the back three times per week, during 90 days. the finasteride dose was equivalent to 5.0mg administered to a 70kg man. at the end of the experiment the mean age for the animals in the control group was 15.2±1.13months and for the experimental group was 17.7±0.67 months. there was a statistically significant difference between mean ages of both groups (t value=5.98; p=0.001). the animals of the control group weighted 129.0±18.8g and the experimental group weighted 145.0±15.5g, t=1.88 e p=0.0514. the serum psa was assessed through elisa method. prostates of those animals were collected and processed to histology and morphometry: the diameter of the acinous glands and the acinous epithelium, apoptosis, agnors and cellularity were assessed in both groups. results: serum psa decreased in the experimental group, 0.003ng/ml versus 0.763ng/ml, h= 7.982 e p= 0.0047. decrease in the acinous area occurred in animals that received finasteride, 238.000±24.600 μm2 versus 398.600±55.320 μm2; t= 2.653; p= 0.0122. a remarkable decrease in the area of the acinous epithelium occurred in the animals that received finasteride, 111.900±12.820 μm2 versus 160.400±18.430 μm2 t= 2.162; p= 0.0361. agnors were less expressed in finasteride treated animals, 2.846±0.877 versus 3.68 ±1.07 argyrophilic clusters for μm2, p= < 0.0001. apoptosis was more intense in the experimental group, 53.62±1.389 than in controls, 14.76 ± 2.137, p= 0.0408. however, there was no statistical difference in the cellularity between both groups, 74.75±5.5 cells, in controls versus 65.07±13.24, in treated animals, p=0.5105. conclusions: use of finasteride decreased serum psa and several histological parameters of the hamster's
Permanent 125I-seed prostate brachytherapy: early prostate specific antigen value as a predictor of PSA bounce occurrence
Renaud Mazeron, Agathe Bajard, Xavier Montbarbon, Frédéric Gassa, Claude Malet, Fran?ois Rocher, Sébastien Clippe, Gabriel Bringeon, Olivier Desmettre, Pascal Pommier
Radiation Oncology , 2012, DOI: 10.1186/1748-717x-7-46
Abstract: Men treated with exclusive permanent 125I seed brachytherapy from November 1999, with at least a 36 months follow-up were included. Bounce was defined as an increase ≥ 0.2 ng/ml above the nadir, followed by a spontaneous return to the nadir. Biochemical failure (BF) was defined using the criteria of the Phoenix conference: nadir +2 ng/ml.198 men were included. After a median follow-up of 63.9 months, 21 patients experienced a BF, and 35.9% had at least one bounce which occurred after a median period of 17 months after implantation (4-50). Bounce amplitude was 0.6 ng/ml (0.2-5.1), and duration was 13.6 months (4.0-44.9). In 12.5%, bounce magnitude exceeded the threshold defining BF. Age at the time of treatment and high PSA level assessed at 6 weeks were significantly correlated with bounce but not with BF. Bounce patients had a higher BF free survival than the others (100% versus 92%, p = 0,007). In case of PSA increase, PSA doubling time and velocity were not significantly different between bounce and BF patients. Bounces occurred significantly earlier than relapses and than nadir + 0.2 ng/ml in BF patients (17 vs 27.8 months, p < 0.0001).High PSA value assessed 6 weeks after brachytherapy and young age were significantly associated to a higher risk of bounces but not to BF. Long delays between brachytherapy and PSA increase are more indicative of BF.Permanent seed prostate brachytherapy has become a standard treatment for localized prostate cancer [1,2]. The follow up of patients treated with this technique is mainly based on PSA screening, with PSA levels decreasing slowly over years to a nadir. The value of the nadir has been correlated with patient clinical outcome, which has led some authors to propose a threshold for defining biochemical complete response (i.e. 0.5 ng/ml for patients with at least 6 years follow-up), but no consensus has been reached on this issue for a long time [3-5]. The American Society for Therapeutic Radiology and Oncology (ASTRO) conse
Diagnostic utility of p501s (prostein) in comparison to prostate specific antigen (PSA) for the detection of metastatic prostatic adenocarcinoma
Ming Yin, Rajiv Dhir, Anil V Parwani
Diagnostic Pathology , 2007, DOI: 10.1186/1746-1596-2-41
Abstract: Immunohistochemical stains with anti-P501s antibodies were performed on 5-micron sections of tissue microarray (TMA) specimens. The TMA is constructed with normal donor prostates (NDP), prostatic adenocarcinoma (PRCA), non-neoplastic prostatic tissues adjacent to malignant glands (NAT), benign prostatic hyperplasia (BPH), high-grade prostatic neoplasia (PIN), metastatic adenocarcinoma to lymph nodes (MLN), metastatic adenocarcinoma to other sites (MC), and samples of benign testis, colon, adrenal and kidney. The two groups of metastatic lesions were also subjected to stains with antibodies to PSA. A composite score (ranging from 0 to 3) was assigned to score intensity of staining.Granular staining pattern of p501s was seen in all benign glands (score = 1.77 – 2.1) and malignant acini (score = 1.52) at the apical aspect of cytoplasm, predominantly adjacent to the nuclei. No staining was observed in controls including testis, colon, adrenal and kidney. The MLN group received a score of 1.0, with 10% of cases negative for p501s. The MC cases had a score of 0.64, with 16.7% of case showing loss of p501s expression. Although the metastatic lesions demonstrated similar rate of negative expression with PSA antibody, only 2 MC cases (3.3%) showed simultaneous negative stains for both P501S and PSA.P501s is an organ specific marker for benign and malignant prostatic epithelial cells. Its characteristic cytoplasmic stain pattern provides an additional valuable immunomarker for detection of metastatic prostatic malignancy, even though the intensity of its expression is reduced, as in the case with PSA. Simultaneous stains with P501S and PSA will greatly improve the detection rate and identify a significant majority of the metastases.Prostatic adenocarcinoma is the most prevalent form of cancer in men and the second leading cause of cancer death in the United States [1,2]. The patient's death is often due to local or distal lymph node involvement and distant metastasis [3]. The
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