Prostate‐specific antigen‐based prostate cancer screening: Past and future

Prostate‐specific antigen‐based prostate cancer screening remains a controversial topic. Up to now, there is worldwide consensus on the statement that the harms of population‐based screening, mainly as a result of overdiagnosis (the detection of clinically insignificant tumors that would have never caused any symptoms), outweigh the benefits. However, worldwide opportunistic screening takes place on a wide scale. The European Randomized Study of Screening for Prostate Cancer showed a reduction in prostate cancer mortality through prostate‐specific antigen based‐screening. These population‐based data need to be individualized in order to avoid screening in those who cannot benefit and start screening in those who will. For now, lacking a more optimal screening approach, screening should only be started after the process of shared decision‐making. The focus of future research is the reduction of unnecessary testing and overdiagnosis by further research to better biomarkers and the value of the multiparametric magnetic resonance imaging, potentially combined in already existing prostate‐specific antigen‐based multivariate risk prediction models.     

Three-dimensional computer-simulated prostate models: lateral prostate biopsies increase the detection rate of prostate cancer

OBJECTIVES: Urologists routinely use the systematic sextant needle biopsy technique to detect prostate cancer. However, recent evidence suggests that this technique has a significant sampling error. We developed a novel three-dimensional (3D) computer-assisted prostate biopsy simulator based on whole-mounted step-sectioned radical prostatectomy specimens to compare the diagnostic accuracy of various prostate needle biopsy protocols. METHODS: We obtained digital images of 201 step-sectioned whole-mounted radical prostatectomy specimens. 3D computer simulation software was developed to accurately depict the anatomy of the prostate and all individual tumor foci. Additional peripheral devices were incorporated into the system to perform interactive prostate biopsies. We obtained 18 biopsies of each prostate model to determine the detection rates of various biopsy protocols. RESULTS: The 10- and 12-pattern biopsy protocols had a 99.0% detection rate; the traditional sextant biopsy protocol rate was only 72.6%. The 5-region biopsy protocol had a 90.5% detection rate and the 14-pattern, which includes all the biopsies used in the patterns above, only added 1 additional positive case (99.5%). Transitional zone and seminal vesicle biopsies did not result in a significantly increased detection rate when added to the patterns above. Only one positive model was obtained when the transitional zone biopsies were added. The lateral sextant pattern had a detection rate of 95.5%, and the 4-pattern lateral biopsy protocol had a 93.5% detection rate. CONCLUSIONS: Our results suggest that all the biopsy protocols that use laterally placed biopsies based on the 5-region anatomic model are superior to the routinely used sextant prostate biopsy pattern. Lateral biopsies in the mid and apical zones of the gland are the most important.     

Xanthoma of the prostate: a mimicker of high-grade prostate adenocarcinoma

Prostatic xanthoma may mimic high-grade prostatic adenocarcinoma or prostate cancer treated with hormone therapy. From 1995 to 2006, 40 cases of prostatic xanthoma were diagnosed at The Johns Hopkins Hospital. Thirty-four cases were received in consultation from outside institutions. Hematoxylin and eosin-stained or unstained slides were available in 27 cases (24 consultation cases; 3 in-house cases). Xanthoma was found on needle biopsy in 25 cases, with 2 cases noted on transurethral resection of prostate. Twenty-six cases contained only 1 focus of prostatic xanthoma with 1 case having 3 foci on the same core biopsy specimen. In 21 xanthomas, the lesions were small measuring 1 mm with the largest one measuring 2.5 mm. Xanthoma cells had small uniform, benign-appearing nuclei, small inconspicuous nucleoli, and abundant vacuolated foamy cytoplasm. No mitoses were identified. Focal necrosis was identified in 1 case. Most xanthomas were arranged in circumscribed solid nodular pattern (17 cases). Ten xanthomas consisted of cords and individual cells infiltrating the prostatic stroma, further mimicking high-grade prostate carcinoma. Two xanthomas contained a mixed circumscribed nodular pattern and infiltrating pattern. Of cases with the lesion still present on slides for immunohistochemistry, CD68 was diffusely strongly positive in 18/19 (94.7%) and CAM5.2 was positive in none of the cases 0/14 (0%). One of 15 (6.7%), 2/17 (11.8%), and 1/12 (8.3%) cases were positive for prostate-specific antigen, prostate-specific acid phosphatase, and alpha-methylacyl-CoA racemase, respectively. Careful attention to morphology with adjunctive use of CD68 and CAM5.2 immunohistochemical stains are helpful in the diagnosis of prostatic xanthoma, especially in difficult cases with an infiltrative pattern.     

Causal’ mapping’ of depression and anxiety among prostate cancer patients: a preliminary interview study

Background

Men with prostate cancer experience elevated levels of anxiety and depression, with some previous data suggesting that this is due to loss of previously-available social and personal reinforcing pleasant activities and abilities. Little is currently known about the range of activities/abilities that these patients lose, leaving open the question of how to best target lifestyle changes designed to help them overcome these negative effects on their mental health. This study used personal interviews to gather details of the pattern of lost activities/abilities from a sample of men with prostate cancer so that a self-report questionnaire might be developed for use in large-scale studies of the ‘causal map’ of anxiety and depression among these patients.

Method

Ten men who had received a diagnosis of, and treatment for, prostate cancer during the previous 30 months were voluntary participants in a personal interview that tapped their experiences of the diagnostic and treatment processes and the effects of these upon their lifestyles.

Results

Data confirmed the primary effect of lost activities/abilities (particularly sexual) on these men as being causal vectors for the development of anxiety and depression.

Conclusion

As well as providing an insight into the experiences of these prostate cancer patients, the findings reported here allowed for the development of a 50-item self-report questionnaire for exploration of the causal factors underlying anxiety and depression among prostate cancer patients.