Eduardo I. Canto

Biochemical staging of prostate cancer

PSA continues to be one of the most effective and widely used cancer screening tools available. Its popularity in prostate cancer screening, however, has eroded its usefulness in the staging of this disease. As more men are screened every year on a routine basis with DRE and PSA, the average PSA at diagnosis has drifted down to well below 10 ng/mL in many centers, including ours. This trend is likely to accelerate, as a PSA cut off for prompting biopsy of the prostate of 2.5 ng/mL gains more widespread acceptance. The recent realization that, at these levels, serum PSA is more reflective of the presence of BPH than of the extent of cancer and, therefore, does not provide additional staging information, has renewed the search for new biochemical markers that are capable of predicting prostate cancer stage and prognosis. Because of the heterogeneity of this disease, it is unlikely that a single biochemical marker that is capable of accurately staging all prostate cancer patients will be found. For this reason, nomograms that are capable of integrating various parameters to predict stage and prognosis will remain indispensable. As new biochemical markers that provide independent predictive information about stage or prognosis are identified, they can be incorporated into currently available nomograms. Of the biochemical markers discussed in this article, IL-6sR and TGF-beta1 are the most promising. By incorporating them into a preoperative nomogram designed to predict PSA recurrence, we found that they improved the ability to predict biochemical recurrence by a statistically and clinically significant margin. The ability to stage prostate cancer and predict response to therapy has improved dramatically over the last 3 decades. Nevertheless, there is still a need for new biochemical markers that will improve the ability to predict an individual patients stage and response to therapy. Incorporating these new markers into nomograms will enhance the ability to provide optimal care for each prostate cancer patient.

INTERLEUKIN-12: Opportunities for the Treatment of Bladder Cancer

Despite incomplete understanding of the human immune system, the rapid progress in tumor immunology provides a framework for more effective and safe interventions in the near future. Early approaches in patients with cancer that have focused on the nonspecific and broad stimulation of the immune system by interferons and IL-12 will be replaced by the highly specific stimulation of immune reactions targeting precisely defined tumor antigens. IL-12 has several biologic properties that seem useful in immune therapy for bladder cancer. The striking antitumor responses with IL-12 in preclinical animal models of bladder cancer provide optimism that future clinical trials involving this agent may impact on the risk and mortality associated with this disease.

Newly Recognized Forms of Prostate-Specific Antigen and Emerging Molecular Markers

Total PSA has been the mainstay of diagnostic laboratory investigation for prostate cancer. However, a number of isoforms of this molecule and other emerging markers offer the promise of improved diagnostic strategies.