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Title: PSA-Based Screening Outcomes, Dietary Heterocyclic Amine Exposure, and Prostate Cancer Risk in African Americans: Annual Report (Year 1 of 3)

Abstract

Prostate cancer (PC) is the second leading cause of male U.S. cancer deaths, with African-Americans having the highest rate of PC mortality worldwide, as well as more abnormal results from screening tests that correlate with current or eventual PC. A 3-year prospective clinic-based study is studying the performance of current (PSA and DRE) vs. (% free PSA) clinical biomarkers of PC risk in 400 African-American men 50 to 70 years of age who undergo PC screening in Oakland, CA (East Bay San Francisco area), as well as possible association of PC screening results for these men with their dietary exposures to the cancer-causing heterocyclic amine, 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) that forms when meat is cooked. This study expands an ongoing NIH-funded study (by the same research team) to add a new %-free-PSA test, results of which will be compared with PSA/DRE results and PhIP exposures estimated by dietary interviews. For 392 men studied under the NIH protocol, an odds ratio (95% CL) of 32 (3.2, 720) for highly elevated PSA ({ge}20 ng/mL) was observed in the highest 15% vs. the lower 50% of estimated daily PhIP intakes. Approximately 100 additional men have completed participation in the expanded NIH/DOD-supported study. This study willmore » help define the potential value of improved screening and dietary/behavioral intervention to reduce PC risk, namely, prevention of PhIP intake by avoiding overcooked meats.« less

Authors:
Publication Date:
Research Org.:
Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)
Sponsoring Org.:
USDOE
OSTI Identifier:
898480
Report Number(s):
UCRL-TR-218258
TRN: US200708%%112
DOE Contract Number:
W-7405-ENG-48
Resource Type:
Technical Report
Country of Publication:
United States
Language:
English
Subject:
59 BASIC BIOLOGICAL SCIENCES; 99 GENERAL AND MISCELLANEOUS//MATHEMATICS, COMPUTING, AND INFORMATION SCIENCE; AMINES; MALES; MEAT; MORTALITY; NEOPLASMS; PERFORMANCE; PROSTATE

Citation Formats

Bogen, K T. PSA-Based Screening Outcomes, Dietary Heterocyclic Amine Exposure, and Prostate Cancer Risk in African Americans: Annual Report (Year 1 of 3). United States: N. p., 2006. Web. doi:10.2172/898480.
Bogen, K T. PSA-Based Screening Outcomes, Dietary Heterocyclic Amine Exposure, and Prostate Cancer Risk in African Americans: Annual Report (Year 1 of 3). United States. doi:10.2172/898480.
Bogen, K T. Wed . "PSA-Based Screening Outcomes, Dietary Heterocyclic Amine Exposure, and Prostate Cancer Risk in African Americans: Annual Report (Year 1 of 3)". United States. doi:10.2172/898480. https://www.osti.gov/servlets/purl/898480.
@article{osti_898480,
title = {PSA-Based Screening Outcomes, Dietary Heterocyclic Amine Exposure, and Prostate Cancer Risk in African Americans: Annual Report (Year 1 of 3)},
author = {Bogen, K T},
abstractNote = {Prostate cancer (PC) is the second leading cause of male U.S. cancer deaths, with African-Americans having the highest rate of PC mortality worldwide, as well as more abnormal results from screening tests that correlate with current or eventual PC. A 3-year prospective clinic-based study is studying the performance of current (PSA and DRE) vs. (% free PSA) clinical biomarkers of PC risk in 400 African-American men 50 to 70 years of age who undergo PC screening in Oakland, CA (East Bay San Francisco area), as well as possible association of PC screening results for these men with their dietary exposures to the cancer-causing heterocyclic amine, 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) that forms when meat is cooked. This study expands an ongoing NIH-funded study (by the same research team) to add a new %-free-PSA test, results of which will be compared with PSA/DRE results and PhIP exposures estimated by dietary interviews. For 392 men studied under the NIH protocol, an odds ratio (95% CL) of 32 (3.2, 720) for highly elevated PSA ({ge}20 ng/mL) was observed in the highest 15% vs. the lower 50% of estimated daily PhIP intakes. Approximately 100 additional men have completed participation in the expanded NIH/DOD-supported study. This study will help define the potential value of improved screening and dietary/behavioral intervention to reduce PC risk, namely, prevention of PhIP intake by avoiding overcooked meats.},
doi = {10.2172/898480},
journal = {},
number = ,
volume = ,
place = {United States},
year = {Wed Jan 18 00:00:00 EST 2006},
month = {Wed Jan 18 00:00:00 EST 2006}
}

Technical Report:

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  • Purpose: To investigate the time course response of prostate metabolism to irradiation using magnetic resonance spectroscopy (MRS) at 3-month intervals and its impact on biochemical control. Methods and Materials: Between January 2008 and April 2010, 24 patients with localized prostate cancer were prospectively enrolled in the Evaluation of the Response to Irradiation with MR Spectroscopy (ERIS) trial. All the patients had been treated with intensity-modulated radiation therapy with or without long-term adjuvant hormonal therapy (LTHT) and underwent 3-T MRS and prostate-specific antigen (PSA) assays at baseline and every 3 months thereafter up to 12 months. Results: After radiation, the meanmore » normalized citrate level (citrate/water) decreased significantly over time, both in the peripheral zone (PZ) (p = 0.0034) and in the entire prostate (p = 0.0008), whereas no significant change was observed in mean normalized choline levels (choline/water) in the PZ (p = 0.84) and in the entire prostate (p = 0.95). At 6 months after radiation, the mean choline level was significantly lower in the PZ for patients with a PSA value of {<=}0.5 ng/mL at 12 months (4.9 {+-} 1.7 vs. 7.1 {+-} 1.5, p = 0.0378). Similar results were observed at 12 months in the PZ (6.2 {+-} 2.3 vs. 11.4 {+-} 4.1, p = 0.0117 for choline level and 3.4 {+-} 0.7 vs. 16.1 {+-} 6.1, p = 0.0054 for citrate level) and also in the entire prostate (6.2 {+-} 1.9 vs. 10.4 {+-} 3.2, p = 0.014 for choline level and 3.0 {+-} 0.8 vs. 13.3 {+-} 4.7, p = 0.0054 for citrate level). For patients receiving LTHT, there was no correlation between choline or citrate levels and PSA value, either at baseline or at follow-up. Conclusions: Low normalized choline in the PZ, 6 months after radiation, predicts which patients attained a PSA {<=}0.5 ng/mL at 1 year. Further analyses with longer follow-up times are warranted to determine whether or not these new biomarkers can conclusively predict the early radiation response and the clinical outcome for patients with or without LTHT.« less
  • Purpose: To describe the prostate-specific antigen (PSA) pattern profiles observed after external beam radiotherapy with and without short-term neoadjuvant androgen deprivation therapy (ST-ADT) and to report the association of established posttreatment PSA patterns with long-term disease-free survival outcomes. Methods and Materials: A total of 1,665 patients were treated with conformal external beam radiotherapy for clinically localized prostate cancer. Of 570 patients who had the requisite >10 consecutive PSA measurements for statistical analysis, 194 patients received a median of 3 months of ADT before radiotherapy and 376 were treated with radiotherapy alone. The median follow up was 103 months. Results: Inmore » the group treated with ST-ADT, three distinct postradiotherapy PSA patterns were identified: a stable trend (44%), an increasing trend followed by stabilization of the PSA (25%), and an increasing trend (31%). Among the subgroup that demonstrated a rising and subsequent stabilizing patterns, PSA levels had gradually risen to a median value of 0.9 ng/mL after therapy, stabilized, and remained durably suppressed. The only identified trends among patients treated with external beam radiotherapy without ST-ADT were declining PSA levels followed by stable PSA trends or declining patterns followed by rising levels. Patients whose PSA levels stabilized after an initial rise or those with slowly rising PSA profiles had a lower incidence of distant metastasis compared to those with accelerated rises after therapy. Conclusions: For those treated with external beam radiotherapy in conjunction with ST-ADT, a significant percentage who develop a rising PSA after treatment are expected to manifest subsequent stabilization at plateaued levels of approximately 1.0 ng/mL, which can remain durably suppressed. The likelihood of distant metastasis in these patients is low despite the PSA stabilization at levels 1.0 ng/mL or higher and comparable to outcomes observed for those with lower nonrising PSA values.« less
  • Purpose: Radiation oncologists rely on available clinical information (biopsy Gleason score and prostate-specific antigen [PSA]) to determine the optimal treatment regimen for each prostate cancer patient. Existing published nomograms correlating clinical to pathologic extent of disease were based on patients treated in the 1980s and 1990s at select academic institutions. We used the Surveillance, Epidemiology, and End Results (SEER) database to examine pathologic outcomes (Gleason score and cancer stage) in early prostate cancer patients based on biopsy Gleason score and PSA concentration. Methods and Materials: This analysis included 25,858 patients whose cancer was diagnosed between 2010 and 2011, with biopsymore » Gleason scores of 6 to 7 and clinical stage T1 to T2 disease, who underwent radical prostatectomy. In subgroups based on biopsy Gleason score and PSA level, we report the proportion of patients with pathologically advanced disease (positive surgical margin or pT3-T4 disease) or whose Gleason score was upgraded. Logistic regression was used to examine factors associated with pathologic outcomes. Results: For patients with biopsy Gleason score 6 cancers, 84% of those with PSA <10 ng/mL had surgical T2 disease with negative margins; this decreased to 61% in patients with PSA of 20 to 29.9 ng/mL. Gleason score upgrading was seen in 43% (PSA: <10 ng/mL) to 61% (PSA: 20-29.9 ng/mL) of biopsy Gleason 6 patients. Patients with biopsy Gleason 7 cancers had a one-third (Gleason 3 + 4; PSA: <10 ng/mL) to two-thirds (Gleason 4 + 3; PSA: 20-29.9 ng/mL) probability of having pathologically advanced disease. Gleason score upgrading was seen in 11% to 19% of patients with biopsy Gleason 4 + 3 cancers. Multivariable analysis showed that higher PSA and older age were associated with Gleason score upgrading and pathologically advanced disease. Conclusions: This is the first population-based study to examine pathologic extent of disease and pathologic Gleason score upgrading based on clinically available information in modern patients. These data inform the selection of radiation therapy strategies and an understanding of whether prostatectomy alone is likely to be curative for patients with early prostate cancers.« less
  • A request was made by the Mine Safety and Health Administration to assess quantitatively the risk of lung cancer among those occupationally exposed to diesel exhaust. The Armitage-Doll multistage model was adapted to fit both the cases of all tumors and malignant neoplasms alone. A number of assumptions were made to extend the risk estimates derived from the models of tumor response in rats to the risks for humans. These assumptions fell into three categories: those concerning the development of biologically equivalent doses for rats and humans, those relating external exposure to internal dose, and those concerning the scaling ofmore » age between rats and humans to account for the temporal aspects of exposure. Uncertainties in the study included the effects of exposure on lung clearance mechanisms, the deposition rates in humans, and the relevance of the exposure index limit. Based on the findings of the study the excess risk to miners of lung cancer at the upper range of the diesel particulate exposure reported, 1.5mg/cu m, was approximately 1.5 to 3 in 100. According to the authors, the results are consistent with previous recommendations by NIOSH that diesel exhaust should be regarded as a potential human carcinogen, and that efforts should be made to reduce exposures to the lowest feasible concentration.« less
  • Purpose: To report long-term outcomes of low- and intermediate-risk prostate cancer patients treated with high-dose hypofractionated radiation therapy (HypoRT). Methods and Materials: Patients with low- and intermediate-risk prostate cancer were treated using 3-dimensional conformal radiation therapy to a dose of 66 Gy in 22 daily fractions of 3 Gy without hormonal therapy. A uniform 7-mm margin was created around the prostate for the planning target volume, and treatment was prescribed to the isocenter. Treatment was delivered using daily ultrasound image-guided radiation therapy. Common Terminology Criteria for Adverse Events, version 3.0, was used to prospectively score toxicity. Biochemical failure was definedmore » as the nadir prostate-specific antigen level plus 2 ng/mL. Results: A total of 129 patients were treated between November 2002 and December 2005. With a median follow-up of 90 months, the 5- and 8-year actuarial biochemical control rates were 97% and 92%, respectively. The 5- and 8-year actuarial overall survival rates were 92% and 88%, respectively. Only 1 patient died from prostate cancer at 92 months after treatment, giving an 8-year actuarial cancer-specific survival of 98%. Radiation therapy was well tolerated, with 57% of patients not experiencing any acute gastrointestinal (GI) or genitourinary (GU) toxicity. For late toxicity, the worst grade ≥2 rate for GI and GU toxicity was 27% and 33%, respectively. There was no grade >3 toxicity. At last follow-up, the rate of grade ≥2 for both GI and GU toxicity was only 1.5%. Conclusions: Hypofractionation with 66 Gy in 22 fractions prescribed to the isocenter using 3-dimensional conformal radiation therapy produces excellent biochemical control rates, with moderate toxicity. However, this regimen cannot be extrapolated to the intensity modulated radiation therapy technique.« less