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Disease prevention and screening in public health
Published in Ben Y.F. Fong, Martin C.S. Wong, The Routledge Handbook of Public Health and the Community, 2021
Martin C.S. Wong, Junjie Huang, Kevin Law, Hanyue Ding, Yun-yang Deng
Prostate cancer (PCa) is the second most common cancer and the fifth-leading cause of cancer death in males. In 2018, there were nearly 1.28 million new cases of PCa and 359,000 related deaths worldwide. Serum Prostate Specific Antigen (PSA) test and Digital Rectal Examination (DRE) are both commonly used screening methods (Wolf et al., 2010). PSA is a glycoprotein produced by the epithelial cells of the prostate. Normally, the threshold for abnormal PSA levels is 4.0 ng/mL and the Se, Sp, positive predictive value (PPV) and negative predictive value (NPV) of it were 21%, 91%, 30% and 85%, respectively (Wolf et al., 2010). PSA test is associated with the incidence of PCa, but has no effect on the mortality (Bray et al., 2018). DRE is also a common screening method. The Se, Sp, PPV and NPV of it were 33%–58%, 96%–99%, 28%–47% and 99%, respectively (Hong Kong Anti-Cancer Society, 2020).
Tumor Markers
Published in Paloma Tejero, Hernán Pinto, Aesthetic Treatments for the Oncology Patient, 2020
Prostate-specific antigen (PSA) is a glycoprotein produced by the prostate epithelium. Of the total PSA detectable in serum, nearly 15% is present as free PSA, whereas the remaining PSA is bound to α-1-antichymotrypsin [2]. It is the tumor marker of choice in patients with prostate cancer, although it can also be elevated in benign prostate pathologies, such as prostatic hypertrophy, prostatitis, or prostate trauma.
Emergency Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Alastair Brookes, Yiu-Che Chan, Rebecca Fish, Fung Joon Foo, Aisling Hogan, Thomas Konig, Aoife Lowery, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Colin Walsh, John Wang, Ting Hway Wong
The USS showed bilateral hydronephrosis. What next?This would depend on the results of the rectal examination and PSA. If these are normal, then a non-contrast CT is essential to identify the cause and the level of the ureteric obstruction.If these are grossly abnormal (e.g. PSA >100 ng/mL) and pathognomonic of prostate cancer, then commence treatment for prostate cancer and involve the urologist and/or the oncologist.
A multicenter retrospective study on evaluation of predicative factors for positive biopsy of prostate cancer in real-world setting
Published in Current Medical Research and Opinion, 2021
Ben Xu, Gonghui Li, Chuize Kong, Ming Chen, Bin Hu, Qing Jiang, Ningchen Li, Liqun Zhou
Prostate cancer (PCa) is the second most common malignant tumors and one of the leading causes of death in men worldwide1–3. Incidence of PCa and mortality is rapidly increasing in China in recent years, especially in big cities1,4–6. In China, the increased mortality-to-incidence ratio of PCa (∼50%) is probably due to the diagnosis of PCa in the advanced stage2,7,8. The 5-year survival rate in China is less (around 77%)9 compared to the 5-year survival rate in the USA (around 98%)3. Early diagnosis and treatment are very crucial for the prevention of mortality due to PCa and to improve survival outcomes2,10. PCa can be diagnosed at an early stage using prostate specific antigen (PSA) and prostate biopsy11. PSA can be used as a biomarker for clinical diagnosis of prostate cancer. PSA is the primary evaluation index for performing prostate biopsy if the threshold is 4 ng/mL12,13. However, the elevated serum PSA may be due to various factors such as benign hyperplasia of prostate thus resulting in a low predictive value and false-positive rate14,15. This results in unnecessary complications especially in patients with PSA gray zone (4–10 ng/mL) where 65–70% will have a negative biopsy result16.
Prostate cancer specific mortality after 5α-reductase inhibitors medication in benign prostatic hyperplasia patients: systematic review and meta-analysis
Published in The Aging Male, 2021
Jae Joon Park, Hyun Young Lee, Sung Ryul Shim, Sang Wook Lee, Kwang Taek Kim, Jae Heon Kim
However, various biases can arise in defining the effect of 5-ARI on the incidence of prostate cancer. In clinical practice, screening of prostate cancer mainly relies on increased PSA. Since it is clear that PSA decreases in patients treated with 5-ARI, the probability of a prostate biopsy donebecause of high PSA decreases, which may act as a bias in estimating the relationship between 5-ARI and prostate-cancer incidence [9]. In addition, people who need 5-ARI treatment may have higher initial PSA levels than in the general populationbecause of the effect of BPH. Another bias trigger is the prostate volume. Since 5-ARI reduces the volume of the prostate, more prostate tissue is sampled during prostate biopsy;so the probability of a positive biopsy is higher than that of the general population [24,25]. In addition, people who need 5-ARI treatment are likely to have a higher initial prostate volume than is the general population;so this may also act as a bias in estimating the association between 5-ARI and the incidence of prostate cancer.
A Walk with Lu-177 PSMA: How Close we Have Reached from Bench to Bedside?
Published in Cancer Investigation, 2020
Manoj Gupta, G. Karthikeyan, P. S. Choudhury, Venkata Pradeep Babu Koyyala, Manish Sharma, Parveen Jain, Vineet Talwar, Amitabh Singh, Sudhir Rawal
Metastatic castration-resistant prostate cancer (mCRPC) is a known sequela in the disease profile of prostate cancer. Eventually, all advanced prostate cancer patients develop resistance to known standard treatment regimes, and most of them presented with rising PSA, high volume of disease, and progressive symptoms predominantly diffuse bone pains. Therefore, novel efficacious therapies need to be evolved continuously for treatment or palliative care of these patients. The use of the ‘‘Theranostic’’ approach using a prostate-specific membrane antigen (PSMA) as a target is slowly becoming an established modality for the management of these patients. Gallium-68 prostate-specific membrane antigen positron emission tomography-computed tomography (Ga-68 PSMA PET-CT) for imaging and Lutetium 177 prostate-specific membrane antigen 617 (Lu-177 PSMA) for endo-radioligand therapy (RLT) is one such novel theranostic pair. We have discussed here the current status of treatment with Lu177-PSMA for mCRPC patient and future directions.