Details of HTA project
Last updated: 1 July 2008 - Next update due: 8 July 2008
Research type: |
HTA Technology Assessment Report |
Project title: |
Use of classical and novel biomarkers as prognostic risk factors for prostate cancer |
Project ref: |
06/27/01 |
Cost: |
This project has been commissioned by the HTA programme on a call-off contract basis. |
Chief Investigator : |
School of Health and Related Research (ScHARR-TAG), University of Sheffield |
Start Date: |
November 2006. |
Publication date: |
September 2008. This project is at the editorial review stage. Delays in the review process can cause the forecast publication date to be delayed. |
Plain English Summary |
Prostate cancer is the most prevalent malignancy in men worldwide and is a leading cause of cancer death. However, many men with early stage prostate cancer will never suffer any symptoms or adverse effects of the disease. Treatment itself, usually surgery (prostatectomy) or radiotherapy, commonly results in erectile dysfunction (up to 90% of patients) and urinary leakage (up to 60% of patients). Most healthy men currently have treatment. The problem is to determine which men have fast growing cancers which really need treatment, and which men have slow growing cancers which will never trouble them. Biomarkers, which are found in blood, urine or tissue samples, can help to identify fast and slow growing cancers. Markers currently used are prostate specific antigen (PSA), cancer stage (or extent of the cancer within and beyond the prostate), and histopathological evaluation from diagnostic biopsy including Gleason grade (a classification system based on the appearance of the cancer tissue from a biopsy specimen) and extent of tumour in biopsy cores. PSA kinetics (e.g. PSA doubling time) is becoming increasingly well established. A systematic review of these markers will assess their value in predicting outcomes of prostate cancer (prognosis) in men with early stage prostate cancer (confined within the prostate). Advances in molecular and genetic science have also led to the discovery of many other potential prognostic markers in prostate cancer. The most significant and promising of these novel markers will be reviewed and summarised. |
Abstract: |
Prostate cancer is the most prevalent malignancy in men worldwide and is a leading cause of cancer death. Treatment for prostate cancer is intensive, with radical prostatectomy causing erectile dysfunction (up to 90% of patients) and urinary leakage (up to 60% of patients). Many patients with early localised disease (T1/T2/T3N0M0) have a good prognosis without treatment but because of the difficulties in identifying this group of patients, the majority will require radical local treatment. Biomarkers may help to determine which cancers are benign, and therefore not requiring treatment. Whilst they are of most value at this stage, some are directed towards detecting prognosis immediately after radical therapy, in order to determine if adjuvant therapy is required. The most well-known cancer biomarker that has been used to assess prognosis (as well as detection of early disease) is prostate-specific antigen (PSA). This has provided the greatest impact on the management and evaluation of prostate cancer. Other "classical markers" are Gleason grade and tumour stage. These classical biomarkers are used singly and combined in models to predict biochemical (PSA) recurrence (signifying disease progression) and mortality. Recent advances in molecular biology have identified a large number of novel biomarkers, which might have prognostic significance. The focus of this work will be on classical biomarkers, as well as some newer markers which are becoming increasingly used in clinical practice. These include PSA kinetics and the extent of tumour found in biopsy cores. Models of combinations of these biomarkers will also be evaluated. Systematic reviews of novel biomarkers will be evaluated and summarised. To summarise, the purpose of the review will be to: -Assess the quality of the research to date and make recommendations as to how future studies may be improved -Identify, assess, summarise and synthesise the existing evidence -Identify, where possible, markers or classes of markers which are candidates for further research. The National Coordinating Centre for HTA commissioned this technology assessment report on behalf of the HTA Programme Director. |
NRR* number, if applicable: |
N0484190636 (*National Research Register) |
Project Protocol: |
Project protocol not available |
URL of this page: |
http://www.hta.ac.uk/1614 |
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