| 1. |
- Carlsson, Sigrid, 1982, et al.
(författare)
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Who and when should we screen for prostate cancer? Interviews with key opinion leaders.
- 2015
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Ingår i: BMC medicine. - : Springer Science and Business Media LLC. - 1741-7015. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Prostate cancer screening using prostate-specific antigen (PSA) is highly controversial. In this Q & A, Guest Editors for BMC Medicine's 'Spotlight on Prostate Cancer' article collection, Sigrid Carlsson and Andrew Vickers, invite some of the world's key opinion leaders to discuss who, and when, to screen for prostate cancer. In response to the points of view from the invited experts, the Guest Editors summarize the experts' views and give their own personal opinions on PSA screening.
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| 2. |
- Dall'Era, Marc A., et al.
(författare)
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Active surveillance for early-stage prostate cancer : review of the current literature
- 2008
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Ingår i: Cancer. - : Wiley. - 0008-543X .- 1097-0142. ; 112:8, s. 1650-9
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Tidskriftsartikel (refereegranskat)abstract
- The natural history of prostate cancer is remarkably heterogeneous and, at this time, not completely understood. The widespread adoption and application of prostate-specific antigen (PSA) screening has led to a dramatic shift toward the diagnosis of low-volume, nonpalpable, early-stage tumors. Autopsy and early observational studies have shown that approximately 1 in 3 men aged >50 years has histologic evidence of prostate cancer, with a significant portion of tumors being small and possibly clinically insignificant. Utilizing the power of improved contemporary risk stratification schema to better identify patients with a low risk of cancer progression, several centers are gaining considerable experience with active surveillance and delayed, selective, and curative therapy. A literature review was performed to evaluate the rationale behind active surveillance for prostate cancer and to describe the early experiences from surveillance protocols. It appears that a limited number of men on active surveillance have required treatment, with the majority of such men having good outcomes after delayed selective intervention for progressive disease. The best candidates for active surveillance are being defined, as are predictors of active treatment. The psychosocial ramifications of surveillance for prostate cancer can be profound and future needs and unmet goals will be discussed.
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| 3. |
- Donovan, Michael J., et al.
(författare)
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Personalized prediction of tumor response and cancer progression on prostate needle biopsy
- 2009
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Ingår i: Journal of Urology. - : Ovid Technologies (Wolters Kluwer Health). - 0022-5347 .- 1527-3792. ; 182:1, s. 125-132
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To our knowledge in patients with prostate cancer there are no available tests except clinical variables to determine the likelihood of disease progression. We developed a patient specific, biology driven tool to predict outcome at diagnosis. We also investigated whether biopsy androgen receptor levels predict a durable response to therapy after secondary treatment. MATERIALS AND METHODS: We evaluated paraffin embedded prostate needle biopsy tissue from 1,027 patients with cT1c-T3 prostate cancer treated with surgery and followed a median of 8 years. Machine learning was done to integrate clinical data with biopsy quantitative biometric features. Multivariate models were constructed to predict disease progression with the C index to estimate performance. RESULTS: In a training set of 686 patients (total of 87 progression events) 3 clinical and 3 biopsy tissue characteristics were identified to predict clinical progression within 8 years after prostatectomy with 78% sensitivity, 69% specificity, a C index of 0.74 and a HR of 5.12. Validation in an independent cohort of 341 patients (total of 44 progression events) yielded 76% sensitivity, 64% specificity, a C index of 0.73 and a HR of 3.47. Increased androgen receptor in tumor cells in the biopsy highly significantly predicted resistance to therapy, ie androgen ablation with or without salvage radiotherapy, and clinical failure (p <0.0001). CONCLUSIONS: Morphometry reliably classifies Gleason pattern 3 tumors. When combined with biomarker data, it adds to the hematoxylin and eosin analysis, and prostate specific antigen values currently used to assess outcome at diagnosis. Biopsy androgen receptor levels predict the likelihood of a response to therapy after recurrence and may guide future treatment decisions.
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| 4. |
- Bjerner, Johan, et al.
(författare)
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Baseline Serum Prostate-specific Antigen Value Predicts the Risk of Subsequent Prostate Cancer Death-Results from the Norwegian Prostate Cancer Consortium.
- 2023
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Ingår i: European urology. - 1873-7560 .- 0302-2838.
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Tidskriftsartikel (refereegranskat)abstract
- Prostate-specific antigen (PSA) levels in midlife are strongly associated with the long-term risk of lethal prostate cancer in cohorts not subject to screening. This is the first study evaluating the association between PSA levels drawn as part of routine medical care in the Norwegian population and prostate cancer incidence and mortality.To determine the association between midlife PSA levels <4.0 ng/ml, drawn as part of routine medical care, and long-term risk of prostate cancer death.The Norwegian Prostate Cancer Consortium collected >8 million PSA results from >1 million Norwegian males ≥40 yr of age. We studied 176099 men (predefined age strata: 40-54 and 55-69 yr) without a prior prostate cancer diagnosis who had a nonelevated baseline PSA level (<4.0 ng/ml) between January 1, 1995 and December 31, 2005.Baseline PSA.We assessed the 16-yr risk of prostate cancer mortality. We calculated the discrimination (C-index) between predefined PSA strata (<0.5, 0.5-0.9, 1.0-1.9, 2.0-2.9, and 3.0-3.9 ng/ml) and subsequent prostate cancer death. Survival curves were plotted using the Kaplan-Meier method.The median follow-up time of men who did not get prostate cancer was 17.9 yr. Overall, 84% of men had a baseline PSA level of <2.0 ng/ml and 1346 men died from prostate cancer, with 712 deaths (53%) occurring in the 16% of men with the highest baseline PSA of 2.0-3.9 ng/ml. Baseline PSA levels were associated with prostate cancer mortality (C-index 0.72 for both age groups, 40-54 and 55-69 yr). The fact that the reason for any given PSA measurement remains unknown represents a limitation.We replicated prior studies that baseline PSA at age 40-69 yr can be used to stratify a man's risk of dying from prostate cancer within the next 15-20 yr.A prostate-specific antigen level obtained as part of routine medical care is strongly associated with a man's risk of dying from prostate cancer in the next two decades.
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| 5. |
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| 6. |
- Carter, H Ballentine, et al.
(författare)
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Early detection of prostate cancer : AUA Guideline
- 2013
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Ingår i: Journal of Urology. - : Ovid Technologies (Wolters Kluwer Health). - 0022-5347 .- 1527-3792. ; 190:2, s. 419-426
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE:The guideline purpose is to provide the urologist with a framework for the early detection of prostate cancer in asymptomatic average risk men.MATERIALS AND METHODS:A systematic review was conducted and summarized evidence derived from over 300 studies that addressed the predefined outcomes of interest (prostate cancer incidence/mortality, quality of life, diagnostic accuracy and harms of testing). In addition to the quality of evidence, the panel considered values and preferences expressed in a clinical setting (patient-physician dyad) rather than having a public health perspective. Guideline statements were organized by age group in years (age <40; 40 to 54; 55 to 69; ≥ 70).RESULTS:Except prostate specific antigen-based prostate cancer screening, there was minimal evidence to assess the outcomes of interest for other tests. The quality of evidence for the benefits of screening was moderate, and evidence for harm was high for men age 55 to 69 years. For men outside this age range, evidence was lacking for benefit, but the harms of screening, including over diagnosis and overtreatment, remained. Modeled data suggested that a screening interval of two years or more may be preferred to reduce the harms of screening.CONCLUSIONS:The Panel recommended shared decision-making for men age 55 to 69 years considering PSA-based screening, a target age group for whom benefits may outweigh harms. Outside this age range, PSA-based screening as a routine could not be recommended based on the available evidence.
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| 7. |
- Mattisson, Tobias, 1970, et al.
(författare)
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Testing of innovative Fe- and Ca-Mn-based oxygen carriers with natural gas in continuous operation
- 2017
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Ingår i: 9th Trondheim Conference on CO2 Capture, Transport and Storage, Trondheim, Norway, June 12-14, 2017.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Chemical-looping combustion (CLC) of gaseous fuels, such as natural or refinery gas, could be a viable option in a variety of industries for production of heat and electricity with CCS. Further, CLC can be combined with conventional steam–methane reforming for efficientcarbon-neutral hydrogen production. A series of collaborate European projects have been carried out since 2002, which focused on oxygen-carrier development and upscaling of both the CLC process and oxygen-carrier production with natural gas and refinery gas as fuel. Inthe latest project, SUCCESS (2013-2017), a series of oxygen carriers based on Fe and Ca-Mn materials were developed using commercial and low-cost raw materials. Two commercial methods for particle production were used: impregnation of Fe2O3 on Al2O3 and spray-drying of CaMnO3. In this paper, selected results are presented from investigation of these two promising oxygen carriers using a laboratory-scale unit with continuous operation and a nominal fuel input of 10 kWth. In this unit, the gas velocities in the riser and in the grid jet zone of the gas distributor come close to gas velocities of industrial-scale units and the material is exposed to a large number of redox cycles. Therefore, this unit is highly applicable for judging particle lifetime. Both materials functioned well during operation with natural gas, with little or no agglomeration. The total time with fuel was 30 h and >100 h for the impregnated Fe-based material and the Ca-Mn-based material, respectively. Although the degree of elutriation was high for both materials, the actual fines production (
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| 8. |
- Moldenhauer, Patrick, 1983, et al.
(författare)
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Oxygen carrier development of calcium manganite-based materials with perovskite structure for chemical looping combustion of methane
- 2017
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Ingår i: Proceedings of the 42nd International Technical Conference on Clean Energy, Clearwater, FL, USA, June 11-15, 2017. ; , s. 12-
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Chemical-looping combustion (CLC) of gaseous fuels could be of interest in industrial processes for heat, power or hydrogen production with carbon capture. For instance, production of steam or hydrogen from refinery gas are possible applications. A series of collaborate European projects has been carried out since 2002, which focused on oxygen-carrier development and upscaling of both theCLC process and oxygen-carrier production with methane or natural gas as fuel. Most recently, in the FP7 SUCCESS project (2013-2017), Ca-Mn-based materials with perovskite structure, CaMnO3, were produced at a larger scale and with cheap and commercial raw materials. The main advantage with this type of oxygen carrier is the ability to release oxygen to the gas phase, hence promoting reactivity in the fuel reactor. In the project, a significant number of such materials were produced and tested. It was found that a perovskite structure can be obtained relatively easy with widely different raw materials for Ca, Mn, Ti and Mg. The produced materials generally had high reactivities and high attrition resistances, but were prone to sulfur poisoning.In this paper, selected results are presented from the different stages of material development and upscaling, i.e., from bench-scale reactors with batch and continuous operation, respectively, as well as from a laboratory-scale unit with continuous operation and a nominal fuel input of 10 kWth. In the 10 kW unit, the gas velocities in the riser and in the grid jet zone of the gas distributor come close to gas velocities of industrial-scale units and, therefore, this unit is used to assess particle lifetime. Results from the 10 kW unit show that very high degrees of fuel conversion can be reached while achieving very high lifetimes.
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| 9. |
- Moldenhauer, Patrick, 1983, et al.
(författare)
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Oxygen-Carrier Development of Calcium Manganite–Based Materials with Perovskite Structure for Chemical-Looping Combustion of Methane
- 2020
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Ingår i: Energy Technology. - : Wiley. - 2194-4296 .- 2194-4288. ; 8:6
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Tidskriftsartikel (refereegranskat)abstract
- The present work is related to the upscaling of calcium manganite–based oxygen-carrier materials, which have a perovskite structure, both with respect to the use of inexpensive raw materials, i.e., instead of pure chemicals, and the upscaling of production to multitonne batches. Results are presented from the two different stages of material development, i.e., raw material selection and upscaling. The evaluation involves both operation in chemical-looping combustor units of 300 W and 10 kW, and material characterization. In the latter unit, the gas velocities in the riser and in the grid-jet zone of the gas distributor come close to gas velocities of industrial-scale units and, therefore, this unit is also used to assess particle lifetime. Results from the various chemical-looping combustion units and oxygen-carrier materials produced from various raw materials of both high and low purity show that very high degrees of fuel conversion can be reached while achieving very high oxygen-carrier lifetimes. The composition of the oxygen-carrier materials seems robust and flexible with respect to the precursors used in its manufacturing.
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| 10. |
- Simpkin, Andrew J, et al.
(författare)
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Development, validation and evaluation of an instrument for active monitoring of men with clinically localised prostate cancer : systematic review, cohort studies and qualitative study
- 2015
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Ingår i: Health Services and Delivery Research. - : National Institute for Health Research. - 2050-4349 .- 2050-4357. ; 3:30
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Tidskriftsartikel (refereegranskat)abstract
- Background:Active surveillance [(AS), sometimes called active monitoring (AM)],is a National Institute for Health and Care Excellence-recommended management option for men with clinically localised prostate cancer (PCa). It aims to target radical treatment only to those who would benefit most. Little consensus exists nationally or internationally about safe and effective protocols for AM/AS or triggers that indicate if or when men should move to radical treatment.Objective:The aims of this project were to review how prostate-specific antigen (PSA) has been used in AM/AS programmes; to develop and test the validity of a new model for predicting future PSA levels; to develop an instrument, based on PSA, that would be acceptable and effective for men and clinicians to use in clinical practice; and to design a robust study to evaluate the cost-effectiveness of the instrument.Methods:A systematic review was conducted to investigate how PSA is currently used to monitor men in worldwide AM/AS studies. A model for PSA change with age was developed using Prostate testing for cancer and Treatment (ProtecT) data and validated using data from two PSA-era cohorts and two pre-PSA-era cohorts. The model was used to derive 95% PSA reference ranges (PSARRs) across ages. These reference ranges were used to predict the onset of metastases or death from PCa in one of the pre-PSA-era cohorts. PSARRs were incorporated into an active monitoring system (AMS) and demonstrated to 18 clinicians and 20 men with PCa from four NHS trusts. Qualitative interviews investigated patients’ and clinicians’ views about current AM/AS protocols and the acceptability of the AMS within current practice.Results:The systematic review found that the most commonly used triggers for clinical review of PCa were PSA doubling time (PSADT) < 3 years or PSA velocity (PSAv) > 1 ng/ml/year. The model for PSA change (developed using ProtecT study data) predicted PSA values in AM/AS cohorts within 2 ng/ml of observed PSA in up to 79% of men. Comparing the three PSA markers, there was no clear optimal approach to alerting men to worsening cancer. The PSARR and PSADT markers improved the model c-statistic for predicting death from PCa by 0.11 (21%) and 0.13 (25%), respectively, compared with using diagnostic information alone [PSA, age, tumour stage (T-stage)]. Interviews revealed variation in clinical practice regarding eligibility and follow-up protocols. Patients and clinicians perceive current AM/AS practice to be framed by uncertainty, ranging from uncertainty about selection of eligible AM/AS candidates to uncertainty about optimum follow-up protocols and thresholds for clinical review/radical treatment. Patients and clinicians generally responded positively to the AMS. The impact of the AMS on clinicians’ decision-making was limited by a lack of data linking AMS values to long-term outcomes and by current clinical practice, which viewed PSA measures as one of several tools guiding clinical decisions in AM/AS. Patients reported that they would look to clinicians, rather than to a tool, to direct decision-making.Limitations:The quantitative findings were severely hampered by a lack of clinical outcomes or events (such as metastases). The qualitative findings were limited through reliance on participants’ reports of practices and recollections of events rather than observations of actual interactions.Conclusions:Patients and clinicians found that the instrument provided additional, potentially helpful, information but were uncertain about the current usefulness of the risk model we developed for routine management. Comparison of the model with other monitoring strategies will require clinical outcomes from ongoing AM/AS studies.Funding:The National Institute for Health Research Health Services and Delivery Research programme.
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