Skip to main content
SpringerLink
Log in

The Dilemma of Early Diagnosis for a Clinically Relevant Prostate Cancer: The Role of Urologist

  • Chapter
  • First Online:
Multidisciplinary Management of Prostate Cancer

  • 881 Accesses

Abstract

The introduction and widespread adoption of Prostate-Specific Antigen (PSA) has revolutionized the diagnosis and treatment of prostate cancer (PCa). However, the use of PSA has also led to overdiagnosis and overtreatment of PCa resulting in controversy about its use for screening. PSA also has limited predictive accuracy for predicting outcomes after treatment and for making clinical decisions. Hence, there is a need for novel biomarkers or support in medical treatment to supplement PSA for an early detection and management of PCa. For the purpose of this section, we focus not only on PSA-derived forms, precursor forms of PSA, and the biomarker PCA3, but also on the use of 5α reductase inhibitors (5-ARI) therapy like a tool to better discriminate patients with or without aggressive cancer. However, we need in the future more data that permit that a panel of biomarkers will be used to achieve sufficient degree of certainty in order to guide clinical decisions making. In the early diagnosis of PCa, the second step is its histological confirmation at prostate biopsy (PBx). Although the random TRUS-guided biopsy remains the gold standard for PCa detection, it is now clear that we need for a more sensitive and accurate imaging modality to detect early PCa.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Boyle P, Ferlay J (2005) Cancer incidence and mortality in Europe 2004. Ann Oncol 16(3):481–488

    Article  CAS  PubMed  Google Scholar 

  2. Jemal A, Siegel R, Ward E et al (2008) Cancer statistics, 2008. CA Cancer J Clin 58(2):71–96

    Article  PubMed  Google Scholar 

  3. Collin SM, Martin RM, Metcalfe C et al (2008) Prostate-cancer mortality in the USA and UK in 1975–2004: an ecological study. Lancet Oncol 9(5):445–452

    Article  PubMed Central  PubMed  Google Scholar 

  4. Catalona WJ, Richie JP, Ahmann FR et al (1994) Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: results of a multicenter clinical trial of 6,630 men. J Urol 151(5):1283–1290

    CAS  PubMed  Google Scholar 

  5. Thompson IM, Pauler DK, Goodman PJ et al (2004) Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. N Engl J Med 350(22):2239–2246

    Article  CAS  PubMed  Google Scholar 

  6. Schroder FH, Roobol MJ (2009) Defining the optimal prostate-specific antigen threshold for the diagnosis of prostate cancer. Curr Opin Urol 19:227–231

    Article  PubMed  Google Scholar 

  7. Ilic D, O’Connor D, Green S et al (2007) Screening for prostate cancer: a Cochrane systematic review. Cancer Causes Control 18(3):279–285

    Article  PubMed  Google Scholar 

  8. Andriole GL, Crawford ED, Grubb RL et al (2009) Mortality results from a randomized prostate-cancer screening trial. N Engl J Med 360:1310–1319

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Schröder FH, Hugosson J, Roobol MJ et al (2009) Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 360:1320–1328

    Article  PubMed  Google Scholar 

  10. Lee R, Localio AR, Armstrong K, Free PSA Study Group et al (2006) A meta-analysis of the performance characteristics of the free prostate-specific antigen test. Urology 67(4):762–768

    Article  PubMed  Google Scholar 

  11. Roddam AW, Duffy MJ, Hamdy FC et al (2005) Use of prostate-specific antigen (PSA) isoforms for the detection of prostate cancer in men with a PSA level of 2–10 ng/ml: systematic review and meta-analysis. Eur Urol 48:386–399

    Article  CAS  PubMed  Google Scholar 

  12. Maffezzini M, Bossi A, Collette L (2007) Implications of prostate-specific antigen doubling time as indicator of failure after surgery or radiation therapy for prostate cancer. Eur Urol 51(3):605–613, Discussion 613

    Article  CAS  PubMed  Google Scholar 

  13. Chan TY, Mikolajczyk SD, Lecksell K et al (2003) Immunohistochemical staining of prostate cancer with monoclonal antibodies to the precursor of prostate-specific antigen. Urology 62(1):177–181

    Article  PubMed  Google Scholar 

  14. Mikolajczyk SD, Catalona WJ, Evans CL et al (2004) Proenzyme forms of prostate-specific antigen in serum improve the detection of prostate cancer. Clin Chem 50:1017

    Article  CAS  PubMed  Google Scholar 

  15. Catalona WJ, Bartsch G, Rittenhouse HG et al (2004) Serum proprostate specific antigen preferentially detects aggressive prostate cancers in men with 2 to 4 ng/ml prostate specific antigen. J Urol 171:2239

    Article  PubMed  Google Scholar 

  16. Guazzoni G, Nava L, Lazzeri M et al (2011) Prostate-specific antigen (PSA) isoform p2PSA significantly improves the prediction of prostate cancer at initial extended prostate biopsies in patients with total PSA between 2.0 and 10 ng/ml: results of a prospective study in a clinical setting. Eur Urol 60(2):214–222

    Article  CAS  PubMed  Google Scholar 

  17. Sokoll LJ, Wang Y, Feng Z et al (2008) [-2]proenzyme prostate specific antigen for prostate cancer detection: a national cancer institute early detection research network validation study. J Urol 180(2):539–543

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Sokoll LJ, Sanda MG, Feng Z et al (2010) A prospective, multicenter, national cancer institute early detection research network study of [-2]proPSA: improving prostate cancer detection and correlating with cancer aggressiveness. Cancer Epidemiol Biomarkers Prev 19:1193–1200

    Article  PubMed Central  PubMed  Google Scholar 

  19. Epstein J, Walsh P, Carmichael M et al (1994) Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. JAMA 27:368–374

    Article  Google Scholar 

  20. Guazzoni G, Lazzeri M, Nava L et al (2012) Preoperative prostate-specific antigen isoform p2PSA and its derivatives, %p2PSA and prostate health index, predict pathologic outcomes in patients undergoing radical prostatectomy for prostate cancer. Eur Urol 61(3):455–466

    Article  CAS  PubMed  Google Scholar 

  21. Lazzeri M, Haese A, Abrate A et al (2013) Clinical performance of serum prostate-specific antigen isoform [-2]proPSA (p2PSA) and its derivatives, %p2PSA and the prostate health index (PHI), in men with a family history of prostate cancer: results from a multicentre European study, the PROMEtheuS project. BJU Int 112(3):313–321

    Article  CAS  PubMed  Google Scholar 

  22. de Kok JB, Verhaegh GW, Roelofs RW et al (2002) DD3(PCA3), a very sensitive and specific marker to detect prostate tumors. Cancer Res 62:2695–2698

    PubMed  Google Scholar 

  23. Hessels D, Klein Gunnewiek JM, van Oort I et al (2003) DD3(PCA3)-based molecular urine analysis for the diagnosis of prostate cancer. Eur Urol 44:8–15

    Article  CAS  PubMed  Google Scholar 

  24. Roobol MJ, Schröder FH, van Leeuwen P et al (2010) Performance of the prostate cancer antigen 3 (PCA3) gene and prostate-specific antigen in prescreened men: exploring the value of PCA3 for a first-line diagnostic test. Eur Urol 58(4):475–481

    Article  CAS  PubMed  Google Scholar 

  25. Haese A, de la Taille A, van Poppel H et al (2008) Clinical utility of the PCA3 urine assay in European men scheduled for repeat biopsy. Eur Urol 54(5):1081–1088

    Article  PubMed  Google Scholar 

  26. Auprich M, Chun FK, Ward JF et al (2011) Critical assessment of preoperative urinary prostate cancer antigen 3 on the accuracy of prostate cancer staging. Eur Urol 59(1):96–105

    Article  PubMed  Google Scholar 

  27. Ploussard G, Durand X, Xylinas E et al (2011) Prostate cancer antigen 3 score accurately predicts tumour volume and might help in selecting prostate cancer patients for active surveillance. Eur Urol 59(3):422–429

    Article  PubMed  Google Scholar 

  28. Ankerst DP, Groskopf J, Day JR et al (2008) Predicting prostate cancer risk through incorporation of prostate cancer gene 3. J Urol 180:1303–1308

    Article  PubMed  Google Scholar 

  29. Andriole GL, Bostwick DG, Brawley OW et al (2010) Effect of dutasteride on the risk of prostate cancer. N Engl J Med 362(13):1192–1202

    Article  CAS  PubMed  Google Scholar 

  30. Thompson IM, Goodman PJ, Tangen CM et al (2003) The influence of finasteride on the development of prostate cancer. N Engl J Med 349:215–224

    Article  CAS  PubMed  Google Scholar 

  31. Thompson IM, Chi C, Ankerst DP et al (2006) Effect of finasteride on the sensitivity of PSA for detecting prostate cancer. J Natl Cancer Inst 98(16):1128–33

    Article  CAS  PubMed  Google Scholar 

  32. Andriole GL, Bostwick D, Brawley OW et al (2011) The effect of dutasteride on the usefulness of prostate specific antigen for the diagnosis of high grade and clinically relevant prostate cancer in men with a previous negative biopsy: results from the REDUCE study. J Urol 185(1):126–131

    Article  CAS  PubMed  Google Scholar 

  33. Marberger M, Freedland SJ, Andriole GL et al (2012) Usefulness of prostate-specific antigen (PSA) rise as a marker of prostate cancer in men treated with dutasteride: lessons from the REDUCE study. BJU Int 109(8):1162–1169

    Article  CAS  PubMed  Google Scholar 

  34. Marks LS, Andriole GL, Fitzpatrick JM et al (2006) The interpretation of serum prostate specific antigen in men receiving 5alpha-reductase inhibitors: a review and clinical recommendations. J Urol 176(3):868–874

    Article  CAS  PubMed  Google Scholar 

  35. Gormley GJ, Stoner E, Bruskewitz RC et al (1992) The effect of finasteride in men with benign prostatic hyperplasia. The Finasteride Study Group. N Engl J Med 327:1185–1191

    Article  CAS  PubMed  Google Scholar 

  36. Freedland SJ, Andriole GL (2011) Making an imperfect marker better. Eur Urol 59(2):194–196

    Article  PubMed  Google Scholar 

  37. Hodge KK, McNeal JE, Terris MK et al (1989) Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol 142(1):71–74

    CAS  PubMed  Google Scholar 

  38. Meng MV, Franks JH, Presti JC Jr et al (2003) The utility of apical anterior horn biopsies in prostate cancer detection. Urol Oncol 21:361–365

    Article  PubMed  Google Scholar 

  39. De la Taille A, Antiphon P, Salomon L et al (2003) Prospective evaluation of a 21-sample needle biopsy procedure designed to improve the prostate cancer detection rate. Urology 61:1181–1186

    Article  PubMed  Google Scholar 

  40. Eskew LA, Bare RL, McCullough DL (1997) Systematic 5 region prostate biopsy is superior to sextant method for diagnosing carcinoma of the prostate. J Urol 157:199–202

    Article  CAS  PubMed  Google Scholar 

  41. Zackrisson B, Aus G, Bergdahl S et al (2004) The risk of findings focal cancer (less than 3 mm) remains high on re-biopsy of patients with persistently increased prostate specific antigen but the clinical significance is questionable. J Urol 171:1500–1503

    Article  PubMed  Google Scholar 

  42. Djavan B (2006) Prostate biopsies and Vienna nomograms. Eur Urol Suppl 5:500–510

    Article  Google Scholar 

  43. Inahara M, Suzuki H, Kojima S et al (2006) Improved prostate cancer detection using systematic 14-core biopsy for large prostate glands with normal digital rectal examination findings. Urology 68:815–819

    Article  PubMed  Google Scholar 

  44. San Francisco IF, DeWolf WC, Rosen S, Upton M, Olumi AF (2003) Extended prostate needle biopsy improves concordance of Gleason grading between prostate needle biopsy and radical prostatectomy. J Urol 169:136–140

    Article  PubMed  Google Scholar 

  45. King CR, McNeal JE, Gill H et al (2004) Extended prostate biopsy scheme improves reliability of Gleason grading: implications for radiotherapy patients. Int J Radiat Oncol Biol Phys 59:386–391

    Article  PubMed  Google Scholar 

  46. King CR, Patel DA, Terris MK (2005) Prostate biopsy volume indices do not predict for significant Gleason upgrading. Am J Clin Oncol 28:125–129

    Article  PubMed  Google Scholar 

  47. Freedland SJ, Kane CJ, Amling CL, SEARCH Database Study Group et al (2007) Upgrading and downgrading of prostate needle biopsy specimens: risk factors and clinical implications. Urology 69:495–499

    Article  PubMed Central  PubMed  Google Scholar 

  48. Chun FK, Briganti A, Shariat SF et al (2006) Significant upgrading affects a third of men diagnosed with prostate cancer: predictive nomogram and internal validation. BJU Int 98:329–334

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, University Sapienza Rome, Viale del Policninico 155, Rome, 00161, Italy

    Susanna Cattarino & Mauro Ciccariello

Authors
  1. Susanna Cattarino
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mauro Ciccariello
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Susanna Cattarino .

Editor information

Editors and Affiliations

  1. Dept. of Urology, Sapienza University, Rome, Italy

    Vincenzo Gentile

  2. Department of Radiological Sciences, Oncology & Pathology, Sapienza University, Policlinico Umberto I, Latina, Italy

    Valeria Panebianco

  3. Dept. of Urology, Sapienza University, Rome, Italy

    Alessandro Sciarra

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Cattarino, S., Ciccariello, M. (2014). The Dilemma of Early Diagnosis for a Clinically Relevant Prostate Cancer: The Role of Urologist. In: Gentile, V., Panebianco, V., Sciarra, A. (eds) Multidisciplinary Management of Prostate Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-04385-2_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-04385-2_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-04384-5

  • Online ISBN: 978-3-319-04385-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation