EXPRESSED PROSTATIC SECRETIONS BIOMARKERS IMPROVE STRATIFICATION OF NATIONAL COMPREHENSIVE CANCER NETWORK ACTIVE SURVEILLANCE CANDIDATES

You have accessJournal of UrologyProstate Cancer: Staging (II)1 Apr 2013370 EXPRESSED PROSTATIC SECRETIONS BIOMARKERS IMPROVE STRATIFICATION OF NATIONAL COMPREHENSIVE CANCER NETWORK ACTIVE SURVEILLANCE CANDIDATES Christopher Whelan, M.D., Mark Kawachi, M.D., David Smith, Ph.D., Jennifer Linehan, M.D., Gail Babilonia, B.S., Timothy Wilson, M.D., and Steven Smith, Ph.D. Christopher Whelan, M.D.Christopher Whelan, M.D. Duarte, CA More articles by this author , Mark Kawachi, M.D.Mark Kawachi, M.D. Duarte, CA More articles by this author , David Smith, Ph.D.David Smith, Ph.D. Duarte, CA More articles by this author , Jennifer Linehan, M.D.Jennifer Linehan, M.D. Duarte, CA More articles by this author , Gail Babilonia, B.S.Gail Babilonia, B.S. Duarte, CA More articles by this author , Timothy Wilson, M.D.Timothy Wilson, M.D. Duarte, CA More articles by this author , and Steven Smith, Ph.D.Steven Smith, Ph.D. Duarte, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1758AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance is an option for prostate cancer where a clinical determination of low-risk and presumably organ-confined disease can be made. Various classification schemes (e.g. those of D'Amico, Klotz and Epstein) have proven successful in multiple studies with significnt numbers of patients. In an effort to standardize these classification schemes the National Comprehensive Cancer Network (NCCN) has recently provided guidelines for active surveillance. Our purpose was to determine the effectiveness of Expressed Prostatic Secretions (EPS) biomarkers in detecting these occult risk factors in NCCN active surveillance candidates. METHODS EPS specimens were obtained from patients prior to robot-assisted radical prostatectomy (RARP). Secretion capacity biomarkers: total RNA, EPS specimen and sediment volume were measured by standard techniques. RNA expression biomarkers: TXNRD1-mRNA PSA-mRNA, TMPRSS2:ERG fusion mRNA and PCA3-mRNAs were measured by quantitative reverse-transcription PCR (qRT-PCR). RESULTS Of the 536 patients from whom EPS was collected prior to surgery, 224 were eligible for active surveillance under NCCN guidelines. Patients were classified as low risk or very low risk regardless of age, or they were classified as intermediate risk with a life expectancy of less than 10 y. Within this group, 41% were upgraded, 6% were upstaged and 5% were both upgraded and upstaged after surgery. Receiver Operating Characteristic analysis demonstrated that two secretion capacity biomarkers coupled with serum PSA were effective in detecting patients within this group that were upstaged or both upstaged and upgraded. This reduced the risk of upstaging in patients with a negative test by nearly 8 fold, while doubling the prevalence of upstaging in the positive test group. Moreover, the test reduced the risk of being both upstaged and upgraded to by nearly 6 fold among patients with a negative test. CONCLUSIONS Secondary screening by non-invasive EPS testing may improve patient acceptance of Active Surveillance by dramatically reducing the presence of occult risk factors in patients eligible for Active Surveillance under NCCN guidelines. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e150 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Whelan, M.D. Duarte, CA More articles by this author Mark Kawachi, M.D. Duarte, CA More articles by this author David Smith, Ph.D. Duarte, CA More articles by this author Jennifer Linehan, M.D. Duarte, CA More articles by this author Gail Babilonia, B.S. Duarte, CA More articles by this author Timothy Wilson, M.D. Duarte, CA More articles by this author Steven Smith, Ph.D. Duarte, CA More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...