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1.
Arch Esp Urol ; 75(2): 173-184, 2022 Mar.
Article in English, Spanish | MEDLINE | ID: mdl-35332887

ABSTRACT

INTRODUCTION AND OBJECTIVES: Active surveillance (AS) is currently a therapeuticstrategy recommended by all Clinical Guidelines forthe initial management of very low-risk, low-risk, andsome intermediate-risk prostate cancer (PCa). However,a high percentage of cases will present the need for active treatment and a quarter of them will presentunfavorable anatomopathological characteristics. METHODS: review of the biomarkers' literature oncircumscribed to the inclusion and follow-up of patientsin AS. RESULTS: PSA and its variants remain the most widelyused and most cost-effective biomarker in AS. Inparticular, the use of PSA density based on the prostatevolume detected by mpMRI has gained much weight.Different multipanel biomarkers in blood and urineare commercially available to predict progressionto PCa ≥3 + 4 (GG2), but they have not clearly beenprospectively tested in AS cohorts. Tissue biomarkersanalyze gene panels that offer predictive informationindependent of classical clinicopathological variablesand may play a role in controversial indications for AS.Lastly, risk calculators are cost-effective and validatedfor their care use in AS and are probably underused. CONCLUSIONS: Although there is no specific biomarkerfor the optimization of AS, its rational use togetherwith mpMRI may in the future optimize the inclusionof patients in AS and follow-up differentiatedby risk groups.


INTRODUCCIÓN Y OBJETIVOS: La vigilanciaactiva (VA) es actualmente una estrategia terapéuticarecomendada por todas las Guías Clínicaspara el manejo inicial del cáncer de próstata (CaP) deriesgo muy bajo, bajo riesgo y algún caso de riesgo intermedio.Sin embargo, un alto porcentaje de casospresentarán necesidad de tratamiento activo y de ellosuna cuarta parte presentarán características anatomopatológicasdesfavorables.MÉTODOS: Revisión de la literatura en biomarcadoresutilizables en práctica asistencial circunscritos a lainclusión y seguimiento de pacientes en VA.RESULTADOS: El PSA y sus variantes sigue siendo elbiomarcador más utilizado y más costo-efectivo en VA.En concreto ha ganado mucho peso el uso de la densidadde PSA basándose en el volumen prostático detectado por RMmp. Distintos biomarcadores multipanelen sangre y orina son asequibles comercialmentepara predecir la progresión a CaP ≥ 3+4 (GG2), perono han sido claramente testados prospectivamenteen cohortes de VA. Los biomarcadores tisulares analizanpaneles de genes que ofrecen una informaciónpredictiva independiente de las variables clínico-patológicasclásicas y pueden tener su papel en indicacionescontrovertidas de VA. Por último, las cálculadorasde riesgo sí que son costo-efectivas y validadaspara su uso asistencial en VA y probablemente estáninfrautilizadas.CONCLUSIONES: Si bien no existe un biomarcadorespecífico para la optimización de la VA, su uso racionaljunto a la RMmp puede optimizar en un futuro lainclusión de pacientes en VA y seguimientos diferenciadospor grupos de riesgo.


Subject(s)
Prostate-Specific Antigen , Prostatic Neoplasms , Follow-Up Studies , Humans , Male , Prostatic Neoplasms/pathology , Risk Factors , Watchful Waiting
2.
Arch Esp Urol ; 75(2): 203-214, 2022 Mar.
Article in English, Spanish | MEDLINE | ID: mdl-35332890

ABSTRACT

In the recent years, research in oncologyhas focused on liquid biopsies, which rely on thedetection of cancer-derived components, includingcirculating tumor cells (CTCs), circulating tumor DNA(ctDNA), circulating free RNA (cfRNA), and extracellularvesicles (EVs), in the biofluids of patients, providinggenomic, epigenetic and transcriptomic, informationabout tumors and metastatic sites. In this reviewwe collect current evidence regarding the potentialof liquid biopsies for the diagnosis and follow-up ofuro-oncology patients, as well as the advantages andlimitations of these approaches. Although promising,the way in which this methodology must be incorporatedinto the clinical routine needs to be still definedboth at the pre-analytical and analytical level beforetheir clinical utility is demonstrated.


En los últimos años, la investigación enoncología se ha centrado en las biopsias líquidas, quese basan en la detección de elementos derivados delcáncer, incluyendo las células tumorales circulantes(CTCs), el ADN tumoral circulante (ctDNA), el ARN librecirculante (cfRNA), y las vesículas extracelulares(EVs) en los biofluidos de los pacientes, proporcionandoinformación genómica, epigenética y transcriptómicade los tumores y sus metástasis. En estarevisión recogemos la evidencia actual a cerca delpotencial de las biopsias líquidas para el diagnósticoy el seguimiento de los pacientes uro-oncológicos,sus ventajas y sus limitaciones. Aunque su potenciales prometedor, la forma en que esta metodología hade incorporarse a la clínica asistencial necesita definirsetanto a nivel pre-analítico como analítico antesde que se pueda demostrar su utilidad clínica.


Subject(s)
Circulating Tumor DNA , Neoplastic Cells, Circulating , Biomarkers, Tumor , Circulating Tumor DNA/genetics , Humans , Liquid Biopsy/methods , Neoplastic Cells, Circulating/pathology , Prognosis
3.
Arch. esp. urol. (Ed. impr.) ; 75(2): 173-184, mar. 28, 2022. ilus, tab
Article in Spanish | IBECS | ID: ibc-203679

ABSTRACT

INTRODUCCIÓN Y OBJETIVOS: La vigilancia activa (VA) es actualmente una estrategia terapéutica recomendada por todas las Guías Clínicaspara el manejo inicial del cáncer de próstata (CaP) deriesgo muy bajo, bajo riesgo y algún caso de riesgo intermedio. Sin embargo, un alto porcentaje de casospresentarán necesidad de tratamiento activo y de ellosuna cuarta parte presentarán características anatomopatológicas desfavorables.MÉTODOS: Revisión de la literatura en biomarcadores utilizables en práctica asistencial circunscritos a lainclusión y seguimiento de pacientes en VA.RESULTADOS: El PSA y sus variantes sigue siendo elbiomarcador más utilizado y más costo-efectivo en VA.En concreto ha ganado mucho peso el uso de la densidad de PSA basándose en el volumen prostático detectado por RMmp. Distintos biomarcadores multipanelen sangre y orina son asequibles comercialmentepara predecir la progresión a CaP ≥ 3+4 (GG2), perono han sido claramente testados prospectivamenteen cohortes de VA. Los biomarcadores tisulares analizan paneles de genes que ofrecen una informaciónpredictiva independiente de las variables clínico-patológicas clásicas y pueden tener su papel en indicaciones controvertidas de VA. Por último, las cálculadoras de riesgo sí que son costo-efectivas y validadaspara su uso asistencial en VA y probablemente estáninfrautilizadas. CONCLUSIONES: Si bien no existe un biomarcadorespecífico para la optimización de la VA, su uso racional junto a la RMmp puede optimizar en un futuro lainclusión de pacientes en VA y seguimientos diferenciados por grupos de riesgo. (AU)


INTRODUCTION AND OBJECTIVES:Active surveillance (AS) is currently a therapeuticstrategy recommended by all Clinical Guidelines forthe initial management of very low-risk, low-risk, andsome intermediate-risk prostate cancer (PCa). However, a high percentage of cases will present the need for active treatment and a quarter of them will presentunfavorable anatomopathological characteristics.METHODS: review of the biomarkers’ literature oncircumscribed to the inclusion and follow-up of patients in AS.RESULTS: PSA and its variants remain the most widely used and most cost-effective biomarker in AS. Inparticular, the use of PSA density based on the prostate volume detected by mpMRI has gained much weight. Different multipanel biomarkers in blood and urine are commercially available to predict progressionto PCa ≥3 + 4 (GG2), but they have not clearly beenprospectively tested in AS cohorts. Tissue biomarkersanalyze gene panels that offer predictive informationindependent of classical clinicopathological variablesand may play a role in controversial indications for AS.Lastly, risk calculators are cost-effective and validatedfor their care use in AS and are probably underused.CONCLUSIONS: Although there is no specific biomarker for the optimization of AS, its rational use together with mpMRI may in the future optimize the inclusion of patients in AS and follow-up differentiatedby risk groups. (AU)


Subject(s)
Humans , Male , Prostate-Specific Antigen/blood , Watchful Waiting , Biomarkers, Tumor/blood , Follow-Up Studies , Risk Factors , Process Optimization
4.
Arch. esp. urol. (Ed. impr.) ; 75(2): 203-214, mar. 28, 2022.
Article in Spanish | IBECS | ID: ibc-203682

ABSTRACT

En los últimos años, la investigación enoncología se ha centrado en las biopsias líquidas, quese basan en la detección de elementos derivados delcáncer, incluyendo las células tumorales circulantes(CTCs), el ADN tumoral circulante (ctDNA), el ARN librecirculante (cfRNA), y las vesículas extracelulares(EVs) en los biofluidos de los pacientes, proporcionandoinformación genómica, epigenética y transcriptómicade los tumores y sus metástasis. En estarevisión recogemos la evidencia actual a cerca delpotencial de las biopsias líquidas para el diagnósticoy el seguimiento de los pacientes uro-oncológicos,sus ventajas y sus limitaciones. Aunque su potenciales prometedor, la forma en que esta metodología hade incorporarse a la clínica asistencial necesita definirsetanto a nivel pre-analítico como analítico antesde que se pueda demostrar su utilidad clínica. (AU)


In the recent years, research in oncologyhas focused on liquid biopsies, which rely on thedetection of cancer-derived components, includingcirculating tumor cells (CTCs), circulating tumor DNA(ctDNA), circulating free RNA (cfRNA), and extracellularvesicles (EVs), in the biofluids of patients, providinggenomic, epigenetic and transcriptomic, informationabout tumors and metastatic sites. In this reviewwe collect current evidence regarding the potentialof liquid biopsies for the diagnosis and follow-up ofuro-oncology patients, as well as the advantages andlimitations of these approaches. Although promising,the way in which this methodology must be incorporatedinto the clinical routine needs to be still definedboth at the pre-analytical and analytical level beforetheir clinical utility is demonstrated. (AU)


Subject(s)
Humans , Circulating Tumor DNA/genetics , Neoplastic Cells, Circulating , Biomarkers, Tumor , Liquid Biopsy/methods , Prognosis
5.
Int J Mol Sci ; 22(12)2021 Jun 10.
Article in English | MEDLINE | ID: mdl-34200878

ABSTRACT

Prostate cancer (PCa) is the most commonly diagnosed cancer in men. The diagnosis is currently based on PSA levels, which are associated with overdiagnosis and overtreatment. Moreover, most PCas are localized tumours; hence, many patients with low-/very low-risk PCa could benefit from active surveillance (AS) programs instead of more aggressive, active treatments. Heterogeneity within inclusion criteria and follow-up strategies are the main controversial issues that AS presently faces. Many biomarkers are currently under investigation in this setting; however, none has yet demonstrated enough diagnostic ability as an independent predictor of pathological or clinical progression. This work aims to review the currently available literature on tissue, blood and urine biomarkers validated in clinical practice for the management of AS patients.


Subject(s)
Biomarkers/analysis , Prostatic Neoplasms/diagnosis , Watchful Waiting/statistics & numerical data , Disease Progression , Humans , Male , Prostatic Neoplasms/prevention & control , Watchful Waiting/methods
6.
Int J Mol Sci ; 21(8)2020 Apr 16.
Article in English | MEDLINE | ID: mdl-32316350

ABSTRACT

The purpose of this study is to clinically validate a series of circulating miRNAs that distinguish between the 4 most prevalent tumor types (lung cancer (LC); breast cancer (BC); colorectal cancer (CRC); and prostate cancer (PCa)) and healthy donors (HDs). A total of 18 miRNAs and 3 housekeeping miRNA genes were evaluated by qRT-PCR on RNA extracted from serum of cancer patients, 44 LC, 45 BC, 27 CRC, and 40 PCa, and on 45 HDs. The cancer detection performance of the miRNA expression levels was evaluated by studying the area under the curve (AUC) of receiver operating characteristic (ROC) curves at univariate and multivariate levels. miR-21 was significantly overexpressed in all cancer types compared with HDs, with accuracy of 67.5% (p = 0.001) for all 4 tumor types and of 80.8% (p < 0.0001) when PCa cases were removed from the analysis. For each tumor type, a panel of miRNAs was defined that provided cancer-detection accuracies of 91%, 94%, 89%, and 77%, respectively. In conclusion, we have described a series of circulating miRNAs that define different tumor types with a very high diagnostic performance. These panels of miRNAs would constitute the basis of different approaches of cancer-detection systems for which clinical utility should be validated in prospective cohorts.


Subject(s)
Breast Neoplasms/genetics , Circulating MicroRNA/blood , Colorectal Neoplasms/genetics , Lung Neoplasms/genetics , Prostatic Neoplasms/genetics , Adult , Aged , Aged, 80 and over , Area Under Curve , Breast Neoplasms/diagnosis , Breast Neoplasms/pathology , Case-Control Studies , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/pathology , Early Detection of Cancer , Female , Humans , Lung Neoplasms/diagnosis , Lung Neoplasms/pathology , Male , Middle Aged , Multivariate Analysis , Neoplasm Staging , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/pathology , ROC Curve
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