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Akt-regulated pathways in prostate cancer.

Prostate cancer remains a major cause of cancer-related mortality. Genetic clues to the molecular pathways driving the most aggressive forms of prostate cancer have been limited. Genetic inactivation of PTEN through either gene deletion or point mutation is reasonably common in metastatic prostate cancer and the resulting activation of phosphoinostide 3-kinase, AKT and mTOR provides a major therapeutic opportunity in this disease as mTOR inhibitors, HSP90 inhibitors and PI3K inhibitors begin to enter clinical development.

Humans↗

The diagnosis and treatment of prostate cancer.

Prostate cancer is the most common cancer among American men and is the third leading cause of cancer death in the United States. Over the past few years, significant advances (e.g. improved prostatic ultrasonography and the discovery of serum prostate-specific antigen) have made it possible to detect prostate cancer at an early stage. In addition, refinements in the treatment both of localized disease (by nerve-sparing radical prostatectomy) and of advanced disease (by novel forms of hormonal therapy) have improved the outlook and quality of life for men with prostate cancer.

Humans↗

Tumour markers in prostatic cancer.

Prostate cancer is now the third commonest cancer in men. Extensive clinical trials comparing acid phosphatase, alkaline phosphatase (ALKP) and prostate specific antigen (PSA) have shown that PSA is the most sensitive and specific of the tumour markers available for prostate cancer. Caution is needed when comparing the results from different assay methods, there is no international standard for PSA. In the management of localised disease, radical treatment can reduce the PSA levels to less than 0.4 ng/ml, similar results can be obtained for a varying duration in patients sensitive to androgen withdrawal. Raised levels greater than 0.4 ng/ml after radical prostatectomy are indicative of residual disease. PSA is valuable in monitoring deferred treatment or the effects of hormone manipulation and give an indication of the prognosis and early warning of recurrence. In extensive metastatic disease the combination of PSA and ALP reflects the tumour activity. Less than 15 hot spots on the scintigram at presentation and a PSA less than 10 ng/ml 3 to 6 months after commencing treatment is associated with prolonged survival. The role of PSA in population screening for early prostatic cancer is uncertain; early results suggest it can be used in combination with digital rectal examination and ultrasonic examination of the prostate. The effect of a PSA decision level at 4 or 10 ng/ml has a considerable influence on the pick up rate.

Alkaline Phosphatase↗

Prostate cancer.

Prostate cancer is the most common malignancy in American men and second only to lung cancer in deaths. The American Cancer Society estimates that there will be about 232,090 new cases of prostate cancer in the United States in 2005, and about 30,350 men will die of this disease. Over the past 15 yr, research has expanded our knowledge of this cancer, its risk factors, treatments, and the potential screening tools. Yet, there is no clear consensus of how to deal with every man who comes in for aeromedical certification, how to screen for it, and how to treat it. No man is the same when it comes to prostate cancer. It is the responsibility of the aviation medical examiner to evaluate the unique aspects of every case for aeromedical implications.

Adenocarcinoma↗

Immunotherapy with autologous antigen presenting cells for the treatment of androgen independent prostate cancer.

Prostate cancer is an excellent target for an active vaccine-based approach based on the fact that prostate cancer cells express unique proteins which serve as highly specific targets. APC8015 (Provenge) is one such investigational therapeutic vaccine that uses autologous antigen presenting cells (APCs) loaded with a recombinant fusion protein of prostatic acid phosphatase linked to a molecule that specifically targets a receptor expressed on the surface of human APCs. Clinical trial outcomes have demonstrated activity in patients with androgen independent prostate cancer.

Acid Phosphatase↗

Screening for prostate cancer.

Prostate cancer is a highly prevalent disease in the Western world. In the United States alone, prostate cancer affects approximately 230,000 men and causes the death of 30,000 American men annually. Several theoretical health care measures may be implemented to decrease the morbidity and mortality of any disease. These measures include prevention, screening, improved curative treatment, and the transformation of an acute lethal disease to a chronic, tolerable one. This summary focuses on the screening aspects of prostate cancer.

Biomarkers, Tumor↗

Managing metastatic prostate cancer.

Prostate cancer is one of the most commonly diagnosed malignancies in the west. Most patients with metastatic or recurrent prostate cancer initially respond to androgen deprivation therapy, but almost all eventually progress. This review will focus on current treatment options for metastatic prostate cancer, with a focus on hormonal therapies, chemotherapy and treatment of bony disease, along with biological and targeted therapy.

Androgen Antagonists↗

Chemoprevention of prostate cancer.

Prostate cancer is an attractive target for chemoprevention because of its ubiquity, treatment-related morbidity, long latency between premalignant lesions and clinically evident cancer, and defined molecular pathogenesis. Prevention of this disease would have a major impact on disease-associated cost, morbidity, and mortality for a large segment of the population. A major advance in prevention of prostate cancer came in 2003 with the publication of the Prostate Cancer Prevention Trial (PCPT). This overview summarizes the results of that trial, the design of other large-scale trials, and advances in understanding of the molecular mechanisms underlying the effect of other promising agents, including dutasteride, selenium, Vitamin E, Vitamin D, COX-2 inhibitors, lycopene, and green tea.

Anticarcinogenic Agents↗

Prevention of prostate cancer.

Prostate cancer is an ideal candidate for chemoprevention because of its high prevalence, long latency time, hormone dependency, precursor lesions, and its unique serum marker, PSA. Chemoprevention is the administration of drugs or other agents which aim to prevent the induction or inhibit/delay cancer progression. Large-scale studies favor environmental rather than genetic factors as key determinants of prostate cancer development. Among these environmental factors, nutrition certainly has a leading role. Numerous basic science studies but also clinical studies indicate that dietary compounds or diet modifications may ultimately play a major role in prostate cancer promotion and inhibition. Definitive proofs are often difficult because of methodological problems and complex triggering cascades. New pharmaceutical drugs with minimal toxicity are also currently evaluated.

Antineoplastic Agents↗

Neoadjuvant therapy for high-risk localized prostate cancer.

Prostate cancer patients with clinical stage T3 disease, biopsy Gleason scores of 8 to 10, or serum prostate-specific antigen levels greater than 20 ng/mL are at high risk of recurrence despite local therapy. Although hormonal therapy has palliative benefit for the majority of patients with metastatic disease, randomized trials have not demonstrated a survival benefit for its administration prior to surgery for locally advanced disease. Historically, chemotherapy has been felt to have little activity in hormone-refractory prostate cancer, but new evidence may refute this belief. Ongoing clinical trials are now investigating the use of chemotherapy in the neoadjuvant setting. We review the recent literature regarding the use of neoadjuvant hormonal manipulation, chemotherapy, and promising new molecular targeted agents in patients with high-risk localized prostate cancer.

Antineoplastic Agents, Hormonal↗

[Prostate-specific membrane antigen. A new sensitive molecular indicator in metastasizing prostatic cancer].

Prostate cancer is the most common malignant disease in men in western societies. Extracapsular spread of carcinoma is found in approximately half of the patients that are treated by radical prostatectomy. Recently, a new prostate-specific membrane glycoprotein was cloned and sequenced. A highly sensitive and specific nested reverse transcriptase polymerase chain reaction has been developed to detect early occult haematogeneous micrometastatic prostate cells. We analysed venous samples from 17 patients with metastatic prostate cancer using a modified reaction assay. This showed presence of micrometastatic prostate cells in 14 patients. Molecular detection of circulating prostatic epithelial cells could improve clinical staging and treatment of early prostate cancer.

Aged↗

[Prostate cancer].

Prostate specific antigen (PSA) has been widely used as a tumor marker for screening, diagnosis and monitoring of prostate cancer. Use of PSA is very important for diagnosis during the primary screening for the early detection of prostate cancer. The presence of various PSA assays and with no uniform serum data have led to confusion among clinicians in the evaluation of serum data. The characteristics of each PSA assay, such as the equimolar or skewed type, must be taken into consideration at the time of use. For the early detection of prostate cancer, PSA density (PSAD), PSA adjusted for the transiton zone volume (PSATZ) and free to total PSA ratio may be useful in the selection of patients with intermediate PSA levels who should undergo prostate needle biopsy.

Adult↗

[New biomarkers for prostate cancer].

Prostate cancer is one of the most common cancers in Western men. In Japan, the incidence of this malignancy is increasing. Recent advances in molecular biology brought new biomarkers to prostate cancer diagnosis. In this article, we describe new biomarkers including serum and genetic and histochemical markers for screening, staging and drug selection for the management of prostate cancer patients.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗

[MR imaging and MR spectroscopy in prostate cancer].

Prostate cancer is the most common cancer in western men. The morbidity in Japanese men is also increasing. This article reviews MR imaging and MR spectroscopy used for the diagnosis and management of prostatic cancer. Discussion emphasizes techniques for routine MR imaging, imaging findings, and the value of MR imaging in patients with prostatic cancer. The new and promising technique of MR spectroscopy and 3T MR imaging also will be introduce.

Humans↗

Application of genomic technologies to human prostate cancer.

Prostate cancer is the most commonly diagnosed non-cutaneous malignancy in U.S. males and has a broad spectrum of clinical behavior ranging from indolent to lethal. Microarray technology has provided unprecedented opportunity to explore the genetic processes underlying prostate cancer by providing a comprehensive survey of a cell's transcriptional landscape. Prostate cancer, however, has posed significant challenges that have contributed to inconsistent results between studies and difficulty replicating findings. Despite these challenges, several important insights have been gained along with new clinical biomarkers of diagnosis and prognosis. Continued improvements in methods of tissue preparation, microarray technology and data analysis will overcome existing challenges and fuel future discoveries.

Gene Expression Profiling↗

Current management modalities for prostate cancer.

Prostate cancer remains one of the leading causes of morbidity and mortality in elderly men. It is the second most common form of malignancy and the third leading cause of cancer deaths. The cause remains unknown, and only with early detection can this illness be cured. Unfortunately, early warning signs are rare, but any change in urinary pattern should be considered due to prostate cancer until proven otherwise. This discussion will focus on pathophysiology, diagnosis, early detection, evaluation, staging, and treatment modalities for prostate cancer.

Aged↗

Concentration of enzymatically active prostate-specific antigen (PSA) in the extracellular fluid of primary human prostate cancers and human prostate cancer xenograft models.

BACKGROUND: Prostate-specific antigen (PSA) targeted prodrugs are under development in our laboratory. Concentrations of total PSA and enzymatically active PSA produced by various human prostate cancer xenograft models have not been well characterized. METHODS: The concentration of PSA secreted into the extracellular fluid (ECF) in normal human prostate tissue, primary prostate cancers obtained directly from patients, and serially passageable human prostate cancer xenografts (PC-82, LNCaP, LAPC-4) were determined using Tandem assays. Percent enzymatically active PSA in the ECF and in conditioned media was also determined using a previously validated assay employing a monoclonal antibody to the PSA catalytic site. In addition, the concentration and activity of PSA within sera from men with and without prostate cancer, as well as from tumor-bearing animals, was likewise assayed. RESULTS: Normal human prostate tissue and primary human prostate cancers have high concentrations of PSA in the ECF (i.e., 1600-2100 nM). The majority of this PSA is enzymatically active (i.e., 80-90%). Human PC-82 prostate cancer xenografts also have high concentrations of PSA in the ECF (624 +/- 360 nM), and the majority of this PSA is also enzymatically active (i.e., 66 +/- 4%). In contrast, much lower concentrations of PSA are found in the ECF from LNCaP (45 +/- 9 nM) and LAPC-4 (7.3 +/- 0.6 nM). Only a small portion of the total PSA isolated from DHT-containing, serum-free, conditioned media from these cell lines is enzymatically active (i.e., approximately 18%). While PSA was detected in all serum samples regardless of the type of host, no enzymatically active PSA was detected in any of these serum samples. CONCLUSIONS: Prostate cancers obtained directly from patients produce and secrete large amounts of PSA, the majority of which is highly enzymatically active. In contrast, while PSA was detected in the sera, none of this PSA was enzymatically active. This is also the case for the human PC-82 prostate cancer xenografts. In contrast, LNCaP and LAPC-4 human prostate cancer xenograft models secrete approximately 70-300-fold less PSA in the ECF than prostate cancers from patients and the majority of this PSA is enzymatically inactive. Also, the serum from these animals had detectable PSA, but none of this PSA was enzymatically active. Thus, these latter two prostate cancer models define the least and the PC-82, the most, optimized xenograft model for screening PSA targeted prodrugs.

Amino Acid Sequence↗

How to use PSA to screen for prostate cancer.

Prostate cancer screening of asymptomatic men is not recommended by the National Screening Council at present and is not encouraged in the NHS. A number of randomised controlled trials are under way to establish the place of routine screening of asymptomatic men. We report the possible practice of prostate cancer screening with reference to the appropriate age range for screening, how to screen for prostate cancer and how often, and what constitutes an abnormal result that would merit referral to a urologist for a prostate biopsy.

Aged↗