Vaginal Prostate Specific Antigen (PSA) Is a Useful Biomarker of Semen Exposure Among HIV-Infected Ugandan Women

Woolf-King, S.E., Muyindike, W., Hobbs, M.M. et al. AIDS Behav (2016). doi:10.1007/s10461-016-1433-7

Abstract

The practical feasibility of using prostate specific antigen (PSA) as a biomarker of semen exposure was examined among HIV-infected Ugandan women. Vaginal fluids were obtained with self-collected swabs and a qualitative rapid test (ABAcard^®p30) was used to detect PSA. Trained laboratory technicians processed samples on-site and positive PSA tests were compared to self-reported unprotected vaginal sex (UVS) in the last 48 h. A total of 77 women submitted 126 samples for PSA testing at up to three study visits. Of these samples, 31 % (n = 39/126) were PSA positive, and 64 % (n = 25/39) of the positive PSA samples were accompanied by self-report of no UVS at the study visit the PSA was collected. There were no reported difficulties with specimen collection, storage, or processing. These findings provide preliminary data on high levels of misreported UVS among HIV-infected Ugandan women using practically feasible methods for PSA collection and processing.

 

 

How women can help men spot symptoms of prostate cancer

From: Louisa Peacock. from the Telegraph

As male patients are being given false hope on prostate cancer, Louisa Peacock outlines how wives and girlfriends can help their male partners spot the disease.

Prostate cancer is very tricky to spot. In some cases, the symptoms may develop over a number of years. In other patients, by the time symptoms become noticeable, prostate cancer has already spread to their bones.

Most men with early prostate cancer do not have symptoms, the charity points out.

However, there are some warning signs for men,  because men routinely risk their health by failing to go and see the doctor, their partners can often encourage them to go and get symptoms checked before it's too late.

Symptoms to look out for:
- Having to get up in the night several times to empty your bladder, which you wouldn't normally do

- Having trouble starting to urinate
- Feeling as though the bladder isn't emptying properly
- Dribbling after urinating

Fear of the doctor
A recent study  by the National Pharmacy Association showed that nearly nine in 10 men don't like to trouble a doctor unless they have a "serious problem". This reticence has largely been attributed to men’s fear of the doctor, (white coat syndrome) and male machismo.
Partners, wives or girlfriends of men should encourage their loved one to get checked if they notice any unusual bathroom habits.
Historically, women have usually been the custodians of health in the family. Mums, grandmothers, sisters, aunts – have typically been the ones to make their men visit health professionals and sort any kind of ill health out proactively.
Women can help men quell the irrational fear of going to the doctor, so they can seek help before it's too late.
Where prostate cancer has already spread to the bones, the symptoms can include long standing pain in one area, such as the back or pelvic bones.
However, this could be a sign of another illness, such as arthritis.
Blood in semen or in urine could indicate prostate or urine infection, or prostate cancer, he adds. Either way, you're advised to check it out.

Heart disease may be a risk factor for prostate cancer

Published: Wednesday, February 8, 2012 - 15:36 in Health & Medicine
In a large analysis of men participating in a prostate drug trial, researchers at the Duke Cancer Institute found a significant correlation between coronary artery disease and prostate cancer, suggesting the two conditions may have shared causes. If confirmed that heart disease is a risk factor for prostate cancer, the malignancy might be combated in part by lifestyle changes such as weight loss, exercise and a healthy diet, which are known to prevent heart disease.

"What's good for the heart may be good for the prostate," said Jean-Alfred Thomas II, MD, a post-doctoral fellow in the Division of Urology at Duke and lead author of the study, which appears online this month in the journal Cancer Epidemiology, Biomarkers & Prevention.

Coronary artery disease kills more adults in the United States than any other cause, accounting for one in four deaths. Risk factors include inactivity, obesity, high blood pressure and cholesterol, cigarette smoking, and diabetes.

Similarly, prostate cancer is a common killer. It's the second-most lethal cancer for U.S. men, behind lung cancer, with about 240,000 new cases diagnosed a year, and 34,000 deaths. Previous studies exploring the relationship between coronary artery disease and prostate cancer risk have found conflicting results, making it difficult to determine whether the malignancy is fueled by poor lifestyle choices.

In the current study, the Duke team used data from 6,390 men enrolled in a large study called REDUCE, a four-year, randomized trial to test the prostate cancer risk reduction benefits of a drug called dutasteride. All the study participants had a prostate biopsy at the two- and four-year marks, regardless of their PSA levels. They also provided a detailed medical history that included their weight, incidence of heart disease, alcohol intake, medication use, and other factors.

Among the men in the study, 547 reported a pre-enrollment history of coronary artery disease. This group of men tended to be older, heavier and less healthy, with higher baseline PSA levels, plus more diabetes, hypertension, and high cholesterol. The men were also much more likely to develop prostate cancer, even after accounting for all the baseline differences.

Having coronary artery disease increased the men's risk of prostate cancer by 35 percent, with the risk rising over time. The group was 24 percent more likely to be diagnosed with prostate cancer within the first two years of the study than men who reported no heart disease, and by four years into the study, this group's prostate cancer risk was 74 percent higher.

"We controlled for a number of risk factors, including hypertension, taking statins, or aspirin," Thomas said. "We don't have a good grasp on what's causing the link, but we are observing this association."

Stephen Freedland, MD, associate professor of surgery and pathology in the Division of Urology at Duke and senior author of the paper, said the study had some shortcomings. Notably, it relied on data from a previous trial that didn't account for factors such as diet, physical activity and severity of heart disease that may have influenced the results.

But Freedland said the study eliminated a screening bias common in previous findings that correlated prostate cancer and heart disease using men with high PSA levels.

"This is giving us a lot of good ideas for what to look at next," Freedland said, noting that the overlap between prostate cancer and other diseases associated with poor health habits is a focus of his research group.

In addition to Thomas and Freedland, study authors from Duke include Leah Gerber; Lionel L. Bañez; and Daniel M. Moreira. The Duke authors also hold positions in the surgery section of the Durham VA Medical Center. Study author Roger S. Rittmaster is from GlaxoSmithKline; Gerald L. Andriole is from Washington University School of Medicine in St. Louis.

Source: Duke University Medical Center

he genomic complexity of primary human prostate cancer

Prostate cancer is the second most common cause of male cancer deaths in the United States. However, the full range of prostate cancer genomic alterations is incompletely characterized. Here we present the complete sequence of seven primary human prostate cancers and their paired normal counterparts. Several tumours contained complex chains of balanced (that is, ‘copy-neutral’) rearrangements that occurred within or adjacent to known cancer genes. Rearrangement breakpoints were enriched near open chromatin, androgen receptor and ERG DNA binding sites in the setting of the ETS gene fusion TMPRSS2–ERG, but inversely correlated with these regions in tumours lacking ETS fusions. This observation suggests a link between chromatin or transcriptional regulation and the genesis of genomic aberrations. Three tumours contained rearrangements that disrupted CADM2, and four harboured events disrupting either PTEN (unbalanced events), a prostate tumour suppressor, or MAGI2 (balanced events), a PTEN interacting protein not previously implicated in prostate tumorigenesis. Thus, genomic rearrangements may arise from transcriptional or chromatin aberrancies and engage prostate tumorigenic mechanisms.
Nature
Volume:
470,
Pages:
214–220
Date published:

Prostate Specific Antigen Mass Ratio Potential as a Prostate Cancer Screening Tool

Purpose
Studies suggest lowering the threshold of the prostate specific antigen test in obese men due to the hemodilution effect but prostate specific antigen may be affected by prostate volume and insulin resistance, which also increase with obesity. Thus, we examined the combined effect of these factors on prostate specific antigen.

Materials and Methods
We analyzed 3,461 Korean men 30 to 80 years old with prostate volume data available who underwent routine evaluation. We examined the effect of plasma volume, homeostatic model assessment index, prostate volume and body mass index on prostate specific antigen, and prostate specific antigen mass and mass ratio (total circulating prostate specific antigen protein per prostate volume) by the trend test and/or ANOVA after adjusting for age and/or prostate volume.

Results
Body mass index had positive associations with plasma volume, the homeostatic model assessment index and prostate volume (p for trend <0.01). Prostate specific antigen had a positive association with prostate volume and a negative association with plasma volume (p for trend <0.01) but not with homeostatic model assessment index. The adjusted R2 of prostate volume vs prostate specific antigen was greater than for plasma volume vs prostate specific antigen while for body mass index vs prostate volume it was less than for body mass index vs plasma volume (0.0892, 0.0235, 0.1346 and 0.3360, respectively). Prostate specific antigen mass was not associated with plasma volume or body mass index but it was still associated with prostate volume after adjusting for plasma volume or body mass index (p for trend <0.01). Mean prostate specific antigen mass ratio did not change significantly across body mass index, plasma volume or prostate volume quartiles in men older than 55 years.

Conclusions
It is not logical to lower the prostate specific antigen threshold based on only the hemodilution effect since body mass index related prostate volume enlargement can increase prostate specific antigen in obese men. Another tool is needed and prostate specific antigen mass ratio may be an option.

Volume 184, Issue 2, Pages 488-493 (August 2010)

prostate Specific Antigen Mass Ratio Potential as a Prostate Cancer Screening Tool

Ho-Chun Choi, Jin-Ho Park, Be-Long Cho, Ki-Young Son, Hyuk-Tae Kwon

Bone-marker levels in patients with prostate cancer: Potential correlations with outcomes

Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.

Milton S. Hershey Medical Center, Pennsylvania State University Cancer Institute, Hershey, Pennsylvania, USA.

The skeleton is typically the first site of metastasis in patients with prostate cancer, and bone metastases can result in severe bone pain and potentially debilitating fractures. Although bone scans are a reliable means of assessing osteoblastic lesions, tools for monitoring early changes in bone health are lacking. Biochemical markers of bone turnover might fulfill this unmet need.

Correlative studies have suggested that bone-marker levels may have utility in assessing disease progression and response to bone-directed therapy. Elevated levels of the markers, N-telopeptide of type I collagen and bone-specific alkaline phosphatase, are associated with higher rates of death and skeletal-related events in the bone metastasis setting. Marker levels also correlate with response to zoledronic acid treatment, and similar data with the investigational agent, denosumab, are emerging.

Changes in bone-marker levels reflect alterations in skeletal homeostasis and can provide important insights into bone disease progression and response to bone-directed therapy in patients with prostate cancer. More mature data from currently ongoing clinical trials will provide further insight on the utility of marker assessments as an adjunct to established monitoring methods in prostate cancer.

Written by:
Saad F, Lipton A

Prostate Cancer Treatments

Different types of treatment are available for prostate cancer. You and your doctor will decide which treatment is right for you. Some common treatments are—

•Active surveillance (watchful waiting): This consists of closely monitoring the patient's prostate cancer by performing the PSA and DRE tests regularly, and treating it only if and when the prostate cancer causes symptoms or shows signs of growing.
•Surgery (radical prostatectomy): Prostatectomy is surgery to remove the prostate completely. Radical prostatectomy removes the prostate as well as the surrounding tissue.
•Radiation therapy: Radiation destroys cancer cells, or prevents them from growing, by directing high-energy X-rays (radiation) at the prostate. There are two types of radiation therapy—
◦External radiation therapy: A machine outside the body directs radiation at the cancer cells.
◦Internal radiation therapy (brachytherapy): Radioactive seeds or pellets are surgically placed into or near the cancer to destroy the cancer cells.
•Hormone therapy: This treatment uses drugs, surgery, or other hormones to remove male sex hormones or block them from working, which prevents cancer cells from growing.
Other therapies used in the treatment of prostate cancer that are still under investigation include—

•Cryotherapy: Placing a special probe inside or near the prostate cancer to freeze and kill the cancer cells.
•Chemotherapy: Using special drugs to shrink or kill the cancer. The drugs can be pills you take or medicines given through an intravenous (IV) tube, or, sometimes, both.
•Biological therapy: This treatment works with your body's immune system to help it fight cancer or to control side effects from other cancer treatments. Side effects are how your body reacts to drugs or other treatments. Biological therapy is different from chemotherapy, which attacks cancer cells directly.
•High-intensity focused ultrasound: This therapy directs high-energy sound waves (ultrasound) at the cancer to kill cancer cells.
For more information, visit the National Cancer Institute's (NCI) Prostate Cancer Treatment Option Overview. This site can also help you find a doctor or treatment facility that works in cancer care. Visit Facing Forward: Life After Cancer Treatment for more information about treatment and links that can help with treatment choices.

Clinical Trials
If you have prostate cancer, you may want to take part in a clinical trial. Clinical trials are research studies that help find new treatment options. Visit the NCI and National Institutes of Health (NIH) sites listed below for more information about finding clinical trials.

•Introduction to Clinical Trials (NCI)
•Search for Clinical Trials (NCI)
•ClinicalTrials.gov (NIH)
Complementary and Alternative Medicine
Complementary medicine is a group of medicines and practices that may be used in addition to the standard treatments for cancer. Alternative medicine means practices or medicines that are used instead of the usual, or standard, ways of treating cancer. Examples of complementary and alternative medicine are meditation, yoga, and dietary supplements like vitamins and herbs.

Complementary and alternative medicine does not treat prostate cancer, but may help lessen the side effects of the cancer treatments or of the cancer symptoms. It is important to note that many forms of complementary and alternative medicines have not been scientifically tested and may not be safe. Talk to your doctor before you start any kind of complementary or alternative medicine.

For more information about complementary and alternative medicine, visit NCI's Complementary and Alternative Medicine.

Which Treatment Is Right for Me?
Choosing which kind of treatment is right for you may be hard. If you have prostate cancer, be sure to talk to your doctor about the treatment options available for your type and stage of cancer. Doctors can explain the risks and benefits of each treatment and their side effects.

Sometimes people get an opinion from more than one doctor. This is called a "second opinion." Getting a second opinion may help you choose the treatment option that is right for you.