Availability of novel hormonal therapies as well as docetaxel and cabazitaxel treatment for metastatic castration-resistant prostate cancer （CRPC） has changed the outlook for this group of patients with improvements...Availability of novel hormonal therapies as well as docetaxel and cabazitaxel treatment for metastatic castration-resistant prostate cancer （CRPC） has changed the outlook for this group of patients with improvements in progression-free survival and overall survival. Physicians often diagnose the progression of prostate cancer using serum prostate-specific antigen （PSA）. However, serum PSA is not always correlated with the clinical status in CRPC. To evaluate the PSA dynamics with greater precision, understanding of the control of PSA and of the mechanisms of development of CRPC is needed. Moreover, it is necessary to use new hormonal therapies with an appropriate timing to optimally improve the prognosis and the QOL of the patients. In the present review, we ascertain the PSA dynamics and the mechanisms of the development of CRPC to assist in optimal utilization of the new treatments for mCRPC.展开更多
A standard modality for prostate cancer detection in men 75 years and older has not been established.A simple screening method for elderly patients is needed to avoid unnecessary biopsies and to effectively diagnose p...A standard modality for prostate cancer detection in men 75 years and older has not been established.A simple screening method for elderly patients is needed to avoid unnecessary biopsies and to effectively diagnose prostate cancer.A retrospective study was conducted on elderly patients who had prostate biopsy at Kanazawa University Hospital(Kanazawa,Japan)between 2000 and 2017.Of the 2251 patients who underwent prostate biopsy,254 had clinically significant prostate cancer(CSPC)with a Gleason score(GS)of≥7 and 273 had a GS of<7 or no malignancy.In this study,patients aged 75 years or older were classified as elderly patients.GS≥7 was characterized by a prostate-specific antigen(PSA)of the maximum area under the curve of 12 ng ml^(-1)with a sensitivity of 76.2%and a specificity of 73.2%.For PSA levels between 4 ng m^(-1)and 12 ng m^(-1)based on the maximum area under the curve,patients with three or four of the following factors may present a GS of≥7:percent free PSA>24,PSA density≥0.24 ng ml^(-2),positive findings on digital rectal examination,and transrectal with 90.0%sensitivity and 67.4%specificity.In this study,we found that raising the PSA cutoff to 12 ng ml^(-1)for CSPC in elderly individuals can significantly reduce unnecessary prostate biopsies.Furthermore,CSPC could be efficiently discovered by combining the four supplementary markers in patients with a PSA level of 4-12 ng ml^(-1).By performing this screening for elderly men over 75 years of age,unnecessary biopsies may be reduced and CSPC may be detected efficiently.展开更多
文摘Availability of novel hormonal therapies as well as docetaxel and cabazitaxel treatment for metastatic castration-resistant prostate cancer （CRPC） has changed the outlook for this group of patients with improvements in progression-free survival and overall survival. Physicians often diagnose the progression of prostate cancer using serum prostate-specific antigen （PSA）. However, serum PSA is not always correlated with the clinical status in CRPC. To evaluate the PSA dynamics with greater precision, understanding of the control of PSA and of the mechanisms of development of CRPC is needed. Moreover, it is necessary to use new hormonal therapies with an appropriate timing to optimally improve the prognosis and the QOL of the patients. In the present review, we ascertain the PSA dynamics and the mechanisms of the development of CRPC to assist in optimal utilization of the new treatments for mCRPC.
文摘A standard modality for prostate cancer detection in men 75 years and older has not been established.A simple screening method for elderly patients is needed to avoid unnecessary biopsies and to effectively diagnose prostate cancer.A retrospective study was conducted on elderly patients who had prostate biopsy at Kanazawa University Hospital(Kanazawa,Japan)between 2000 and 2017.Of the 2251 patients who underwent prostate biopsy,254 had clinically significant prostate cancer(CSPC)with a Gleason score(GS)of≥7 and 273 had a GS of<7 or no malignancy.In this study,patients aged 75 years or older were classified as elderly patients.GS≥7 was characterized by a prostate-specific antigen(PSA)of the maximum area under the curve of 12 ng ml^(-1)with a sensitivity of 76.2%and a specificity of 73.2%.For PSA levels between 4 ng m^(-1)and 12 ng m^(-1)based on the maximum area under the curve,patients with three or four of the following factors may present a GS of≥7:percent free PSA>24,PSA density≥0.24 ng ml^(-2),positive findings on digital rectal examination,and transrectal with 90.0%sensitivity and 67.4%specificity.In this study,we found that raising the PSA cutoff to 12 ng ml^(-1)for CSPC in elderly individuals can significantly reduce unnecessary prostate biopsies.Furthermore,CSPC could be efficiently discovered by combining the four supplementary markers in patients with a PSA level of 4-12 ng ml^(-1).By performing this screening for elderly men over 75 years of age,unnecessary biopsies may be reduced and CSPC may be detected efficiently.
