Orchiectomy or LHRH agonist therapy was performed in 14 and 32 patients, respectively. At an interval of at least 3 months following ADT, all men had T < 50 ng/dL. The median level was 3.9 ng/dL in men on LHRH agonist and 8.4 ng/dL in men surgically treated. All but one patient on LHRH therapy had T < 20 ng/dL. There were many presentations based on the

prostate cancer antigen-3 (PCA3) gene. Shikanov and colleagues6 evaluated its utility in monitoring men on active surveillance. Confirmatory repeat biopsy Inhibitors,research,lifescience,medical demonstrating Gleason score > 6, more than 3 positive cores, or more then 50% involvement of a single core was considered unfavorable. The PCA3 urinary median level was 30 and 54 in those Inhibitors,research,lifescience,medical men with favorable and unfavorable pathology, respectively. Goode and coworkers7 compared the utility of PCA3 gene expression in initial and repeat biopsies in 289 men with an initial biopsy and 167 of those with a repeat biopsy.

Although PCA3 was a better predictor of cancer on the initial biopsy, area under the curve (AUC) analysis demonstrated that there was no significant difference between PSA and PCA3’s ability to predict cancer in men undergoing repeat biopsy. Whereas other studies have shown that PCA3 is a better predictor in this setting, this report raises Inhibitors,research,lifescience,medical concerns about relying on PCA3 results to predict missed cancer. Auprich and associates8 also looked at the PCA3 gene to assess prostate cancer aggressiveness on biopsy; 1606 men undergoing biopsy were evaluated, including 834 men undergoing repeat biopsies. Inhibitors,research,lifescience,medical Results Selleckchem ROCK inhibitor indicated that 39.2% of the biopsies

revealed prostate cancer (45.9% initial, 33% repeat). Age, serum PSA level, abnormal digital rectal examination Inhibitors,research,lifescience,medical (DRE) results, and PCA3 correlated with Gleason score > 6 on initial biopsy. On multivariate analysis, only PSA and DRE results were predictive. For repeat biopsies, only PSA was predictive on multivariate analysis. The effort to identify more specific markers for prostate cancer than PSA continues. Catalona and colleagues9 reported on the Prostate Health Index Cell press (PHI), which is an arithmetic manipulation of the level of pro-PSA, free PSA, and total PSA. The researchers evaluated 658 men undergoing prostate biopsy. The AUC for predicting cancer for PHI was 0.703, significantly higher than PSA or percentage of free PSA (0.516 and 0.648, respectively). The economic implications of adding a third analyte (pro-PSA) to afford a 5.5% improvement in test accuracy needs to be considered. The power of the Gleason grading system is seemingly unassailable. It remains the method to beat when considering novel markers for prognostic purposes—an enduring tribute to Dr. Donald Gleason. One problem in assessing molecular markers is preservation of the tissue characteristics that allow assurance that the marker under investigation has precise histologic control.