Epidemiological and Histopathological Profile of Prostate Cancer: A Retrospective Study in the Pathology Department of the University Clinics of Kinshasa

Background: Prostate cancer, the most common male cancer, represents a real public health problem in terms of its frequency and severity in different countries around the world. It disproportionately affects people of African descent wherever they live in the world [1]. To the best of our knowledge, its extent and particularities in the African environment are not well known. Objective: To determine the epidemiological and histopathological profile of prostate cancer in the CUK anatomopathology department. Methodology: This is a retrospective study conducted at the University Clinics of Kinshasa Anapathology Department from January 1, 2015 to December 31, 2022, a period of 8 years. Word processing and tables were entered using the Hp brand computer, with Microsoft Office WORD 2016 software. Data analysis was performed with SPSS version 22.0 software. Results were presented in tables and figures. Results: Prostate was diagnosed in 132 cases, i.e. 1.58% of all CUK laboratory analyses and 8% of cancers diagnosed. The age group most affected was 66-75 years, i.e. 59% of all subjects. Adenocarcinoma was the most frequent histological type, and biopsy dominated in 111 cases (84.1%). Conclusion: Prostate cancer is a real public health problem. Worldwide, and in the Democratic Republic of Congo, it is the most frequently diagnosed cancer in men, and the leading cause of cancer-related death in men. In the DRC, because of the delay in consulting our patients and the weakness of systematic screening, patients are seen at an advanced stage of the disease. Treatment is multidisciplinary, involving surgery, radiotherapy and chemotherapy (including targeted therapies). Patient awareness and screening campaigns will help to considerably reduce the delay in diagnosis and the morbidity and mortality associated with prostate cancer.

Impact of tertiary Gleason pattern 5 on prostate cancer aggressiveness:Lessons from a contemporary single institution radical prostatectomy series

Objective:To better evaluate tertiary Gleason pattern reporting and to evaluate the impact of tertiary Gleason pattern 5(TP5)on prostate cancer pathological features and biochemical recurrence at our large single institution.Methods:We retrospectively reviewed 1962 patients who underwent radical prostatectomy(RP)for prostate cancer;TP5 was reported in 159 cases(8.1%).Men with Gleason score(GS)7 and GS 8 disease were divided into subgroups with and without TP5,and histopathological features were compared.Multivariate analyses were conducted to assess the impact on TP5 on biochemical-free survival(BFS).Results:Tumors possessing GS 3+4 with TP5 were more likely to exhibit extraprostatic extension(EPE)and had a larger tumor diameter(TD)than GS 3+4 alone.GS 3+4 with TP5 was also associated with positive surgical margins(SM),seminal vesicle involvement(SVI),and higher pre-operative prostate-specific antigen(PSA)values,but without statistical significance.GS 4+3 with TP5 more commonly presented with EPE,positive SM,SVI,and greater TD and pre-operative PSA level than GS 4+3 alone.In multivariate analysis,Gleason score,EPE,and TP5 were overall independent risk factors for PSA recurrence in this cohort.Additionally,GS 4+3 with TP5 was associated with shorter time to recurrence versus GS 4+3 alone.Conclusion:Our results emphasize the importance of TP5 and suggest that criteria for tertiary pattern reporting in prostate cancer should be standardized.Further studies are needed to evaluate the role of tertiary patterns in prognostic models.

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios alone or combined with prostate-specific antigen for the diagnosis of prostate cancer and clinically significant prostate cancer

Objective:We evaluated whether the blood parameters before prostate biopsy can diagnose prostate cancer(PCa)and clinically significant PCa(Gleason score[GS]7)in our hospital.Methods:This study included patients with increased prostate-specific antigen(PSA)up to 20 ng/mL.The associations of neutrophil-to-lymphocyte ratio(NLR)and platelet-tolymphocyte ratio(PLR)alone or with PSA with PCa and clinically significant PCa were analyzed.Results:We included 365 patients,of whom 52.9%(193)had PCa including 66.8%(129)with GS of≥7.PSA density(PSAD)and PSA had better the area under the curve(AUC)of 0.722 and 0.585,respectively with pZ0.001 for detecting PCa compared with other blood parameters.PSA combined with PLR(PsPLR)and PSA with NLR(PsNLR)had better AUC of 0.608 and 0.610,respectively with p<0.05,for diagnosing GS≥7 population,compared with PSA,free/total PSA,NLR,PLR,and PsNPLR(PSA combined with NLR and PLR).NLR and PLR did not predict PCa on multivariate analysis.For GS≥7 cancer detection,in the multivariate analysis,separate models with PSA and NLR(Model 1:PsNLRþbaseline parameters)or PSA and PLR(Moder 2:PsPLRþbaseline parameters)were made.Baseline parameters comprised age,digital rectal exam-positive lesions,PSA density,free/total PSA,and magnetic resonance imaging.Model 2 containing PsPLR was statistically significant(odds ratio:2.862,95% confidence interval:1.174-6.975,p=0.021)in finding aggressive PCa.The predictive accuracy of Model 2 was increased(AUC:0.734,p<0.001)than that when only baseline parameters were used(AUC:0.693,p<0.001).Conclusion:NLR or PLR,either alone or combined with PSA,did not detect PCa.However,the combined use of PSA with PLR could find the differences between clinically significant and insignificant PCa in our retrospective study limited by the small number of samples.

Comparison of Transrectal Prostate Digital and Ultrasound-Guided Core Biopsies in 400 Men in a Low-and-Middle Income Country

Background: The diagnosis of prostate cancer (PCa) relies on clinical assessment with digital rectal examination, serum PSA and histological examination. Limitations in our technical facilities, high financial cost of ultrasound-guided biopsy often prevent us from implementing the guidelines on the practice of prostate biopsy. Methods: We conducted a retrospective and cross-sectional descriptive study comparing digital-guided and ultrasound-guided transrectal prostate biopsy of 400 patients over a period of 12 years in the Yaounde Central Hospital. We reviewed files of patients who underwent digital and ultrasound guided biopsy procedures. Data was analyzed using EPI info 7.0. Parametric variables were reported as means and standard deviations and percentages and counts were used to report categorical variables. Results: Out of the 400 patients, 292 digital-guided transrectal biopsies (73%) and 108 ultrasound-guided transrectal biopsies (27%) were performed in patients who were suspected of having prostate cancer (PCa). Patients were aged between 39 to 90 years. Both procedures were effective in identifying prostate cancer. Gleason score between 2 to 10 detected prostate adenocarcinoma for 301 patients (75.2%). The complications included anal pain, rectal bleeding, hematuria and urinary tract infections, with an occurrence rate similar for both ultrasound-guided (2.25%) and digitally-guided techniques (2.5%). Seven patients (1.75%) required hospitalization for management of complications. The mortality rate was null. Conclusion: Both techniques are effective in detecting PCa with the similar complication rates. Digital-guided trans-rectal prostate biopsy still has its place in a resource-limited setting like ours.

Multiparametric MRI reporting using Prostate Imaging Reporting and Data System version 2.0 (PI-RADSv2) retains clinical efficacy in a predominantly post-biopsy patient population

Objective:To evaluate the efficacy of multiparametric magnetic resonance imaging(mp-MRI)using Prostate Imaging Reporting and Data System version 2.0(PI-RADSv2)definitions in detecting organ-confined prostate cancer.Methods:All patients who underwent radical prostatectomy between January 1,2014 and December 30,2014 were identified.All underwent mp-MRI within 180 days before surgery.Those with prior pelvic irradiation or androgen deprivation therapy were excluded.Fully embedded,whole-mount histopathology was centrally reviewed and correlated with imaging for tumour location,Gleason score(GS)and stage.Results:There were 39 patients included,of which 35(90%)had mp-MRI done post-biopsy.A total of 93 cancer foci were identified on whole-mount pathology,of which mp-MRI detected 63(68%).Of those detected by mp-MRI,14 were PI-RADS 3(n=6 for GS 6,n=8 for GS 7,no GS≥8)and 49 were PI-RADS 4e5(nZ7 for GS 6,nZ33 for GS 7,and nZ9 for GS≥8).There were 30(32%)cancer foci missed by mp-MRI(n=15 for GS 6,n=13 for GS 7 and n=2 for GS≥8).A lesion classified as PI-RADS 4e5 predicted a higher grade cancer on pathology as compared to PI-RADS 3(for GS 7 lesions,odds ratio[OR]=3.53,95%CI:0.93e13.45,p=0.064).The mp-MRI size detection limit was 20 mm2 and 100 mm2 for 50%and 75%probability of cancer,respectively.In associating with radiological and pathologic stage,the weighted Kappa value was 0.69(p<0.0001).The sensitivity and positive predictive values for this study were 68%(95%CI:57%e77%)and 78%(95%CI:67%e86%),respectively.Conclusion:In this predominantly post-biopsy cohort,mp-MRI using PI-RADSv2 reporting has a reasonably high diagnostic accuracy in detecting clinically significant prostate cancer.

Role of multi-parametric MRI of the prostate for screening and staging:Experience with over 1500 cases

Objective:Contemporary prostate cancer(PCa)screening modalities such as prostate specific antigen(PSA)and digital rectal examination(DRE)are limited in their ability to predict the detection of clinically significant disease.Multi-parametric magnetic resonance imaging(mpMRI)of the prostate has been explored as a staging modality for PCa.Less is known regarding its utility as a primary screening modality.We examined our experience with mpMRI as both a screening and staging instrument.Methods:mpMRI studies performed between 2012 and 2014 in patients without PCa were cross-referenced with transrectal ultrasonography(TRUS)biopsy findings.Statistical analyses were performed to determine association of mpMRI findings with overall cancer diagnoses and clinically significant(Gleason score≥7)disease.Subgroup analyses were then performed on patients with a history of prior negative biopsy and those without a history of TRUS biopsy.mpMRI studies were also cross-referenced with RP specimens.Statistical analyses determined predictive ability of extracapsular extension(ECE),seminal vesicle involvement(SVI),and pathologic evidence of clinically significant disease(Gleason score
7).Results:Four hundred biopsy naive or prior negative biopsy patients had positive mpMRI studies.Overall sensitivity,specificity,positive and negative predictive values were 94%,37%,58%,and 87%,respectively and 95%,31%,42%,and 93%,respectively for overall cancer detection and Gleason score≥7 disease.In patients with no prior biopsy history,mpMRI sensitivity,specificity,positive and negative predictive values were 94%,36%,65%,and 82%,for all cancers,and 95%,30%,50%,and 89%for Gleason score
7 lesions,respectively.In those with prior negative biopsy sensitivity,specificity,positive and negative predictive values were 94%,37%,52%,and 90% for all cancers,and 96%,32%,36%,and 96% for Gleason score
7 lesions,respectively.Seventy-four patients underwent radical prostatectomy(RP)after mpMRI.Lesion size on mpMRI correlated with the presence of Gleason score
7 cancers(p Z 0.005).mpMRI sensitivity,specificity,positive and negative predictive values were 84%,39%,81%,and 44% respectively,for Gleason
7 cancer.For ECE and SVI,sensitivity and specificity were 58% and 98% and 44% and 97%,respectively.Conclusion:mpMRI is an accurate predictor of TRUS biopsy and RP outcomes.mpMRI has significant potential to change PCa management,particularly in the screening population,in whom a significant proportion may avoid TRUS biopsy.Further studies are necessary to determine how mpMRI should be incorporated into the current PCa screening and staging paradigms.

Prostate chronic inflammation type Ⅳ and prostate cancer risk in patients undergoing first biopsy set:Results of a large cohort study

Objective:In prostate specimens,chronic inflammatory infiltrate(CII)type Ⅳ has been detected,but its association with prostate cancer(PCa)is controversial.The aim of the present study is to investigate on associations of CII with PCa detection in patients undergoing prostate first biopsy set.Methods:Ultrasound transrectal-guided biopsies by the transperineal approach were retrospectively evaluated in 441 consecutive patients.The study excluded patients who were in active surveillance,prostate specific antigen(PSA)
30 ng/mL,re-biopsies,incidental PCa after transurethral resection of the prostate(TURP),less than 14 cores or metastatic.Analysis of population and subpopulations(with or without PCa)was performed by statistical methods which included ManneWhitney(U test),KruskaleWallis test,Chi-squared statistic,logistic regression.Multivariate logistic regression models predicting mean probability of PCa detection were established.Results:PCa detection rate was 46.03%.Age,PSA,prostate volume(PV),prostate intraepithelial neoplasia(PIN)and CII were the significant independent predictors of PCa detection.PV(OR Z 0.934)and CII(OR Z 0.192)were both negative independent predictors.CII was a significant negative independent predictor in multivariate logistic regression models predicting the mean probability of PCa detection by age,PSA and PV.The inverse association of CII with PCa does not necessary mean protection because of PSA confounding.Conclusion:In a population of patients undergoing prostate first biopsy set,CII was a strong negative independent predictor of PCa detection.CII type Ⅳ should be considered as an adjunctive parameter in re-biopsy or active surveillance protocols.

Prostate cancer volume associates with preoperative plasma levels of testosterone that independently predicts high grade tumours which show low densities(quotient testosterone/tumour volume)

Objective:To investigate potential associations of preoperative total testosterone(TT)with tumor volume(TV)and grade of prostate cancer(PCa).Methods:Patients who were under medications impacting on the hypothalamic-pituitaryadrenal-testis-prostate axis were excluded.TT was measured preoperatively at least 1 month after biopsies and TV was calculated on the removed prostate specimen.Other continuous variables included total prostate specific antigen(PSA),percentage of positive cores(Pt)and weight(W)of the removed prostate.Patients were categorized according to the pathologic Gleason score(pGS)in 3 groups(pGS 6,7 and>7).Invasion of the seminal vesicles was coded as seminal vesicle invasion(SVI).Results:The median levels of TT were significantly and increasingly higher from pGS 6(14.7 nmol/L)to pGS 7(15.0 nmol/L)and pGS>7(18.8 nmol/L).The median values of TV were also detected significantly and increasingly higher from pGS 6(5.6 mL)to pGS 7(8.1 mL)and pGS>7(14.8 mL).The median preoperative levels of PSA were also increasing from pGS 6(5.9 μg/L)to pGS 7(6.2 μg/L)and pGS>7(7.7 μg/L).There was a significant and positive correlation of TV to PSA,TT and Pt.Multiple linear regression analysis showed that TV was significantly and independently predicted by TT,PSA and Pt.High grade PCa(pGS>7)independently associated with TV,TT,Pt and SVI.The median density values of TT relative to TV(quotient TT/TV)significantly decreased from pGS 6(2.6 nmol/L/mL)to pGS 7(1.9 nmol/L/mL)and pGS>7(1.4 nmol/L/mL).The median density values of PSA relative to TV(quotient PSA/TV)also significantly decreased from pGS(1.1 μg/L/mL)to pGS 7(0.7 μg/L/mL)and pGS>7(0.6 μg/L/mL).Conclusion:The investigation shows that TT relates to volume and grade of PCa;moreover,the density of TT relative to TV inversely associates with rate of increase of cancer that depends on the grade of the tumour.

Prostate Cancer Characteristics and Associated Factors in Northern Cameroon

Background: The incidence of prostate cancer in Cameroon has been increasing in an alarming rate. The aim of this study is to characterize the form of prostate cancer and associated factors in patients from Cameroon Northern Regions. Methods: All patients with positive prostate biopsy (cancer+) from June 2018 to November 2019 were studied (n = 177). The followings were retrieved: digital rectal examination, standard clinical examinations, laboratory data such as serum prostate-specific antigen (PSA) level, and the Gleason score. Patients self-administered a questionnaire assessing prostate cancer’s risk factors. Results: Patients were mainly from the Far North region (36.72%), and were either farmers or breeders (48.01%). Only prostate adenocarcinoma was present, with predominance of aggressive forms (Gleason score ≥ 7). Significant relationships were observed between Gleason score and 1) patients’ age (P = 0.006), 2) history of urinary tract infections (P = 0.015) and of exposure to agricultural products (P = 0.049), 3) clinical signs (nycturia, pollakiuria, poor acute urine retention, and dysuria) (P = 0.019), 4) prostate weight, and 5) serum PSA levels (P < 0.0001). Conclusion: Aggressive forms of adenocarcinoma are the main prostate cancer in these regions, underlining the need for strategies aimed at raising prostate cancer awareness and early detection.

Prostate Health Index(phi)and its derivatives predict Gleason score upgrading after radical prostatectomy among patients with low-risk prostate cancer

To analyze the performance of the Prostate Health Index(phi)and its derivatives for predicting Gleason score(GS)upgrading between prostate biopsy and radical prostatectomy(RP)in the Chinese population,an observational,prospective RP cohort consisting of 351 patients from two medical centers was established from January 2017 to September 2020.Pathological reclassification was determined by the Gleason Grade Group(GG).The area under the receiver operating characteristic curve(AUC)and logistic regression(LR)models were used to evaluate the predictive performance of predictors.In clinically low-risk patients with biopsy GG≤2,phi(odds ratio[OR]=1.80,95%confidence interval[95%CI]:1.14-2.82,P=0.01)and its derivative phi density(PHID;OR=2.34,95%CI:1.30-4.20,P=0.005)were significantly associated with upgrading to GG≥3 after RP,and the results were confirmed by multivariable analysis.Similar results were observed in patients with biopsy GG of 1 for the prediction of upgrading to RP GG≥2.Compared to the base model(AUC=0.59),addition of the phi or PHID could provide additional predictive value for GS upgrading in low-risk patients(AUC=0.69 and 0.71,respectively,both P<0.05).In conclusion,phi and PHID could predict GS upgrading after RP in clinically low-risk patients.

Prognostic value of ECOG performance status and Gleason score in the survival of castration-resistant prostate cancer:a systematic review

Eastern Cooperative Oncology Group(ECOG)performance status and Gleason score are commonly investigated factors for overall survival(OS)in men with castration-resistant prostate cancer(CRPC).However,there is a lack of consistency regarding their prognostic or predictive value for OS.Therefore,we performed this meta-analysis to assess the associations of ECOG performance status and Gleason score with OS in CRPC patients and compare the two markers in patients under different treatment regimens or with different chemotherapy histories.A systematic literature review of monotherapy studies in CRPC patients was conducted in the PubMed database until May 2019.The data from 8247 patients in 34 studies,including clinical trials and real-world data,were included in our meta-analysis.Of these,twenty studies reported multivariate results and were included in our main analysis.CRPC patients with higher ECOG performance statuses(≥2)had a significantly increased mortality risk than those with lower ECOG performance statuses(<2),hazard ratio(HR):2.10,95%confidence interval(CI):1.68-2.62,and P<0.001.The synthesized HR of OS stratified by Gleason score was 1.01,with a 95%CI of 0.62-1.67(Gleason score≥8 vs<8).Subgroup analysis showed that there was no significant difference in pooled HRs for patients administered taxane chemotherapy(docetaxel and cabazitaxel)and androgen-targeting therapy(abiraterone acetate and enzalutamide)or for patients with different chemotherapy histories.ECOG performance status was identified as a significant prognostic factor in CRPC patients,while Gleason score showed a weak prognostic value for OS based on the available data in our meta-analysis.

Gleason score and tumor laterality in radical prostatectomy and transrectal ultrasound-guided biopsy of the prostate： a comparative study

We aimed to compare Gleason score and tumor laterality between transrectal ultrasound-guided biopsy of the prostate （TRUSBX） and radical prostatectomy （RP）. Some factors that could cause a discrepancy in results between these two procedures were also evaluated. Among the 318 cases reviewed, 191 cases were selected for inclusion in this comparative Study, We divided the patients into two groups using the Gleason score： an intermediate/high-grade group （≥7） and a low-grade group （〈6）. Exploratory analyses were conducted for comparisons between groups. We also performed comparisons between TRUSBX and RP for tumor laterality. TRUSBX overestimated 6% and underestimated 24% cases in comparison with RP for Gleason score, and overestimated 2.6% and underestimated 46% cases compared with RP for tumor laterality. Biopsy specimens were slightly smaller in TRUSBX cases with underestimated tumor laterality （P〈 0.05）, and no relationship between the biopsy specimen size and underestimated Gleason score in TRUSBX was found. Prostatic volume showed no statistical correlation with the likelihood of under or overestimation （P 〉 0.05）. Thus, our study showed that TRUSBX has a high likelihood of underestimating both the Gleason score and tumor laterality in prostate cancer （PCa）. The size of the fragment appears to be an important factor influencing the likelihood of laterality underestimation and Gleason score overestimation via TRUSBX. Due to the high likelihood of underestimation of the Gleason score and tumor laterality by 12-core prostate biopsy, we conclude that this type of biopsy should not be used alone to guide therapy in Pca.

The association between metabolic syndrome and advanced prostate cancer in Chinese patients receiving radical prostatectomy

The global incidence of metabolic syndrome （MetS） is dramatically increasing. Considerable interest has been devoted to the relationship between MetS and prostate cancer （PCa） risk. However, few studies have examined the association between MetS and PCa progression. This retrospective study consisted of 1016 patients with PCa who received radical prostatectomy. The association between MetS and pathological features was evaluated using logistic regression analysis. Compared with patients without MetS, those with MetS indicated an increased risk of prostatectomy Gleason score （GS）≥8 （odds ratio [OR] =1.670, 95% confidence interval （CI） 1.096-2.545, P = 0.017）, and a 1.5-fold increased risk of pT3-4 disease （OR = 1.583, 95% CI 1.106-2.266, P = 0.012）. The presence of MetS was an independent predictor of lymph node involvement （OR = 1.751, 95% CI 1.038-2.955, P = 0.036）. Furthermore, as the number of MetS components accumulated, the risk of a GS ≥ 8 increased. The present study indicates a significant association between MetS and advanced PCa. The results need to be evaluated in large-scale prospective cohorts.

Prognostic value of Her-2/neu and clinicopathologic factors for evaluating progression and disease-specific death in Chinese men with prostate cancer

Background Her-2/neu gene overexpression has been found in several malignancies, and is associated with poor prognosis; while its role in the tumorigenesis and progression of prostate cancer （PCa） is still controversial. This study aimed to evaluate the prognostic value of Her-2/neu protein expression and clinicopathologic factors in antiandrogen-treated Chinese men with PCa for disease progression and PCa-specific death. Methods Her-2/neu protein expression was determined using immunohistochemistry （IHC） in specimens collected from 124 prostate biopsies and transurethral resection of prostate （TURP） from seven prostate cancer patients. Results Her-2/neu protein expression was 0, 1＋, 2＋, and 3＋ in 40 （30.5%）, 8 （6.1%）, 67 （51.1%）, and 16 （12.2%） cases respectively. Her-2/neu protein expression showed significant correlation as judged by Gleason score （P=0.049）, clinical tumor-node-metastases （cTNM） stage （P=0.018） and disease progression （P=0.001）, but did not correlate with prostate-specific antigen （PSA） （P=0.126） or PCa-specific death （P=0.585）. PSA （P=0.001）, Gleason score （P=0.017）, cTNM （P=-0.000） and Her-2/neu protein expression （P=0.001） had prognostic value for evaluating the progression of PCa in univariate analysis. In Kaplan-Meier plots, both Gleason score （P=0.035） and cTNM （P=0.013） correlated with PCa-specific death. In multivariate analysis, only cTNM was significant for both disease progression （P=0.001） and PCa-specific death （P=0.031）. Conclusions Her-2/neu protein expression is significantly correlated with Gleason score, cTNM and disease progression, although it is not an independent predictor of disease progression and PCa-specific death, cTNM staging serves as an independent prognostic factor for disease progression and PCa-specific death.

A novel screening strategy for clinically significant prostate cancer in elderly men over 75 years of age

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.

ARHGEF38 as a novel biomarker to predict aggressive prostate cancer

Prostate cancer(PCa)metastasis is considered the leading cause of cancer death in males.Therapeutic strategies and diagnosis for stage-specific PCa have not been well understood.Rho guanine nucleotide exchange factor 38(ARHGEF38)is related to tumor cell polarization and is frequently expressed in PCa.Microarray data of PCa were downloaded from GEO and TCGA databases.A total of 243 DEGs were screened,of which,32 genes were upregulated.The results of enrichment analysis showed the participation of these DEGs in the tumor cell metastasis pathway.ARHGEF38 was significantly up-regulated in the four most prevalent cancers worldwide(p<0.05),and its expression was higher in the tumor samples with higher Gleason score(GS).IHC,qRT-PCR,and western-blot analyses showed the higher expression of ARHGEF38 in PCa than benign prostatic hyperplasia(BPH).In addition,IHC results demonstrated a higher expression of ARHGEF38 in high-grade PCa than the low-grade PCa.