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Pharmacogenomic Biomarkers in Docetaxel Treatment of Prostate Cancer: From Discovery to Implementation
Open AccessArticle

Gene‒Prostate-Specific-Antigen-Guided Personalized Screening for Prostate Cancer

1
Division of Urology, Department of Surgery, Yonghe Cardinal Hospital, New Taipei 23445, Taiwan
2
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 10055, Taiwan
3
School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei 24205, Taiwan
4
Medical Education Department, Far Eastern Memory Hospital, New Taipei 22060, Taiwan
5
School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan
*
Author to whom correspondence should be addressed.
Genes 2019, 10(9), 641; https://doi.org/10.3390/genes10090641
Received: 26 June 2019 / Revised: 16 August 2019 / Accepted: 19 August 2019 / Published: 24 August 2019
(1) Background: A simulation approach for prostate cancer (PrCa) with a prostate-specific antigen (PSA) test incorporating genetic information provides a new avenue for the development of personalized screening for PrCa. Going by the evidence-based principle, we use the simulation method to evaluate the effectiveness of mortality reduction resulting from PSA screening and its utilization using a personalized screening regime as opposed to a universal screening program. (2) Methods: A six-state (normal, over-detected, low-grade, and high-grade PrCa in pre-clinical phase, and low-grade and high-grade PrCa in clinical phase) Markov model with genetic and PSA information was developed after a systematic review of genetic variant studies and dose-dependent PSA studies. This gene‒PSA-guided model was used for personalized risk assessment and risk stratification. A computer-based simulated randomized controlled trial was designed to estimate the reduction of mortality achieved by three different screening methods, personalized screening, universal screening, and a non-screening group. (3) Results: The effectiveness of PrCa mortality reduction for a personalized screening program compared to a non-screening group (22% (9%‒33%)) was similar to that noted in the universal screening group (20% (7%‒21%). However, a personalized screening program could dispense with 26% of unnecessary PSA testing, and avoid over-detection by 2%. (4) Conclusions: Gene‒PSA-guided personalized screening for PrCa leads to fewer unnecessary PSA tests without compromising the benefits of mortality reduction (as happens with the universal screening program). View Full-Text
Keywords: effectiveness; prostate cancer; risk stratification; screening effectiveness; prostate cancer; risk stratification; screening
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Yang, T.-K.; Chuang, P.-C.; Yen, A. .-F.; Chen, H.-H.; Chen, S. .-S. Gene‒Prostate-Specific-Antigen-Guided Personalized Screening for Prostate Cancer. Genes 2019, 10, 641.

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