Tag Archive | "prostate biopsy"

Gene Test Effectively Predicts Presence of nearby Prostate Cancer

Data from a large group of tissue samples showed that gene expression in prostate stroma predicted the presence of nearby cancer with 97% overall accuracy.  Stroma adjacent to or near prostate tumors expressed genes significantly differently from normal stroma.

In a recent issue of Cancer Research, it was reported that the correlation between stromal gene expression and cancer increased with proximity to cancer.  The 144-gene panel had 98% sensitivity and 88% specificity for predicting the presence of cancer, whereas, a randomly selected 100-gene panel had no predictive value.  If replicated in additional studies, the gene test has multiple therapeutic implications.

The research team compared gene expression profiles in 13 prostate biopsy specimens containing stroma near tumor and in 15 biopsy specimens from men without prostate cancer and identified 3,800 significant changes in expression.

The authors developed a 114-gene stroma-specific classifier for nearby tumor after filtering for age-related genes and for genes known to be expressed at detectable levels in tumors.  They tested the classifier in 364 prostate specimens, consisting of 243 tumor-bearing samples and 121 normal specimens.  These 364 specimens included samples from normal prostate biopsies, normal prostate tissue obtained from autopsies, stroma remote to tumor, and stroma from within a few millimeters of tumor.  The gene panel correctly identified all but two of the 243 tumor-containing specimens. Analysis of the two misclassifications suggested the tissue might not have come from patients with prostate cancer.

The research team also compared expression patterns in stromal tissue near and far from the tumor and found a gradient of classification frequency values of 98%, 75%, and 36% for stromal samples adjacent to, close to, and remote (>15 mm) from the tumor.

These findings suggest several practical applications of the gene test, such as assessment of suspicious initial biopsies and possibly therapeutic targeting of stromal expression changes indicating the presence of tumor while leaving normal stroma relatively untouched.

Some of the authors of the gene expression study disclosed relationships with Proveri, a company involved in translational research related to the study.

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Radiotherapy And Androgen Deprivation More Beneficial Than Radiotherapy Alone in Some Prostate Cancer Patients

In a recent study funded by grants from the National Cancer Institute and published in the New England Journal of Medicine, it was reported that short-term androgen-deprivation therapy improves survival in men with intermediate-risk, localized prostate cancer.  From 1994 to 2001, one thousand seventy nine men with localized prostate cancer and prostate-specific antigen levels of 20 ng/mL or less were randomized to receive radiotherapy alone (992 patients) or radiotherapy plus four months of androgen-deprivation therapy (987 patients).

The overall ten-year survival rate was significantly higher with combination therapy than with radiation alone, and combination therapy decreased disease-specific deaths.  The median follow-up period was 9.1 years, and the ten-year rate of overall survival was 62% among patients receiving radiotherapy plus short-term ADT (the combined-therapy group), as compared with 57% among patients receiving only radiotherapy.  The addition of short-term ADT was associated with a decrease in the 10-year disease-specific mortality from eight percent to four percent. Biochemical failure, distant metastases, and the rate of positive findings on repeat prostate biopsy at two years were significantly improved with radiotherapy plus short-term ADT.  In the two groups, acute and late radiation-induced toxic effects were similar.

The study was carried out because it had not been known whether short-term androgen-deprivation therapy (ADT) before and during radiotherapy improves cancer control and overall survival among patients with early, localized prostate adenocarcinoma.

It was found in a post-hoc analysis that the benefits of combination therapy were limited to men with intermediate-risk disease rather than men with low-risk cancer.

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Recent Increase in Unnecessary Prostate Biopsy

With an increase in attention given to PSA (prostate specific antigen) levels in men in the United States comes an increase in referrals for prostate biopsy. Oftentimes, these biopsies are recommended even when doctors have no other indications of prostate cancer besides the PSA level. A new study, however, finds that such prostate biopsies are unnecessary if men have a normal clinical exam and their total PSA levels are not yet high.

“If a man’s PSA has risen rapidly in recent years, there is no cause for concern if his total PSA level is still low and his clinical exam is normal,” said Andrew Vickers, PhD, the lead author of the new study from Memorial Sloan-Kettering Cancer Center.

In this most recent study, 5,519 men who participated in the Prostate Cancer Prevention trial were evaluated. All the participants were 55 years or older, had no previous history of prostate cancer, and had normal digital rectal findings and PSA levels of 3.0 ng/mL or less.

The men were randomly assigned to take either finasteride (a medication used to treat BPH) or placebo for seven years. Each year, all the men were screened for PSA levels, and those who had a PSA greater than 4.0 ng/mL were advised to have a prostate biopsy. At the end of the study, men who did not have prostate cancer were asked if they would consent to a biopsy.

The researchers concluded, after reviewing the study’s results, that the main factor that predicted the risk of cancer was a man’s PSA level, not how rapidly the PSA rose. Men with a steady PSA of 5 ng/mL were more likely to have prostate cancer than those whose PSA rose from 2.5 to 3.4 ng/mL. They recommended that a rapidly rising PSA should not be included in screening guidelines for prostate cancer.

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New Tests May Reduce Number of Prostate Biopsies

Researchers at the annual American Urological Association meeting announced Tuesday that two new tests may reduce the number of biopsies needed from men suspected of having prostate cancer. Although the tests are still in the early stages of development, they may also offer more insight about which cancers need immediate treatment and which can be left for so-called “watchful waiting”.

One test looked at blood levels of specific DNA that can be increased by prostate cancer. The study included 252 men referred for prostate biopsies because of abnormal PSA test readings. The research team discovered that high levels of the target DNA were significantly associated with the presence of cancer. The other test was targeted to detect elevated levels of PCA3 “messenger RNA” in urine. Elevated levels of this genetic material are associated with the presence of a tumor.

In the study, nearly 2,000 men with abnormal results on a digital rectal examination (which measures prostate enlargement) or elevated PSA levels additionally underwent PCA3 urine tests, followed by biopsies. The team found that e PCA3 readings were significantly higher in men whose biopsies turned out positive for cancer. Additionally, the test could be used to single out prostate cancers requiring immediate surgery or radiation treatment.

Although more research is still needed, the initial results look promising. According to  Dr. E. David Crawford, a professor of urology at the University of Colorado, approximately one million biopsies are preformed in the United States each year due to suspected prostate cancer. “Anything you can do to cut down the large number of biopsies has innumerable advantages,” he said.

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