The Prostate Health Index (phi), a blood test that combines 3 PSA measurements into a single score, improves detection of clinically significant prostate cancer (PCa) and could help decrease the number of unnecessary prostate biopsies, researchers reported.

In a study of 658 men aged 50 years and older with PSA levels of 4–10 ng/mL, Stacy Loeb, MD, of New York University, and colleagues investigated whether phi can improve specificity for detecting clinical significant PCa and reduce PCa over diagnosis. The researchers used the Epstein definition of clinically significant PCa (Gleason score 7 or higher, 3 or more positive cores, and more than 50% involvement of any core).

The test measures total, free, and [-2]proPSA (p2PSA), the latter being an isoform of free PSA identified as the most PCa-specific form found in tumor extracts.

Phi outperformed its individual components in detecting clinically significant PCa, the researchers reported in The Journal of Urology (2015;193:1163-1169). Using a 90% sensitivity cutoff for significant versus insignificant PCa (a phi threshold of 28.6) could potentially avoid 30% of biopsies with indolent or no PCa compared with 21.7% using free PSA alone, the investigators reported.

The new study builds on previous research showing that phi improves specificity and provides a greater net benefit for PCa detection compared with total and percent free PSA, the researchers pointed out.

“Phi is a simple blood test that we recommend for use as part of a multivariable approach to reduce unnecessary biopsies and over diagnosis,” the authors concluded.

Dr. Loeb's group acknowledged some study limitations, including the use of biopsy criteria to define clinical significance. “Although biopsy criteria are frequently used, these end points are not perfect and other factors such as life expectancy also have a key role in defining over diagnosis,” they wrote.

With regard to study strengths, the researchers noted that their study used a prospectively enrolled source population, including a large number of men from multiple centers across the United States.

The study population had a median age of 63 years. Of the 658 men, 324 (49.2%) had PCa detected on biopsy. Among the men with PCa, 52.5% had clinically significant disease and 33.7% had Gleason 7 or higher tumors.

The study was funded by Beckman Counter Inc., of Carlsbad, Calif., which markets the phi test. The test received FDA premarket approved in June 2012 and the company announced the test's availability in the United States in May 2014.

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Bionomics to present BNC105 trial results of metastatic renal cancer at Asian ... News-Medical.net Bionomics Limited (ASX: BNO, OTCQX: BNOEF) today announced that it will present a poster with new data on the DisrupTOR-1 trial of BNC105 in patients with metastatic renal cancer at the 7th Asian Oncology Summit being held from April 10-12, 2015 in ... BNC105 Biomarker Data to Be Presented at Asian Oncology Conference SYS-CON Media (press release) all 5 news articles »

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(HealthDay News) -- Although most health care staff feel that extended treatment time on hemodialysis is beneficial, many nurses do not recommend it, according to a study published online in the Journal of Renal Care.

Seema Singh, from Imperial College Healthcare National Health Service Trust in London, and colleagues conducted a local survey of dialysis nurses (56 nurses) and a national survey of multidisciplinary hemodialysis staff (15 dialysis providers) across the United Kingdom. The authors sought to examine opinions about extended treatment time.

The researchers found that most respondents felt that extended treatment time was clinically beneficial; however, only 42% of nurses and 95% of non-nursing health care professionals would recommend extended treatment time (P < 0.0001). 

45% of nurses and 75% of non-nursing health care professionals felt that it was well-tolerated (P < 0.05). 83% of nurses noted the negative impact on service provision, citing the need to facilitate shifts within a finite time period and pressure to find session spaces.

"There is conflict between the understanding that extended treatment time is clinically beneficial and its prescription and delivery to patients," the authors write. "In-center hemodialysis has been designed to maximize patient throughput and we may need to consider more flexible settings in which to deliver longer treatment time: Home hemodialysis may be a solution."

Source

1. Singh, S, et al. Published online by Journal of Renal Care, March 16, 2015; doi: 10.1111/jorc.12115.

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Margaret and Kerry Maisey are annoyed by the lack of free parking near the Midland Dialysis centre.

A decision by the City of Swan to give chronically ill patients free parking two blocks away from a treatment centre in Midland has been slammed as "impractical" by those struggling to walk.

Kalamunda residents Margaret and Kerry Maisey have been making the trip to the centre on Stafford Street for the past six months and Mrs Maisey said her husband would have to be on dialysis for the rest of his life.

Mrs Maisey said her husband could not get a kidney replacement because of his heart condition and that the couple had to visit the centre three times a week and stay for at least five hours.

"I have to help Kerry inside and stay with him because a couple of times he's had a heart attack on the machine and he gets a bit panicky," she said.

"He needs my support and it's ridiculous that I have to keep popping out every hour to move my car.

"Kerry's coming up to 80 and when he comes off his machine I can't expect him to walk to a parking spot down the road, when he's just not feeling well."

Parking across the road is $1.50 per hour and Mrs Maisey said the cost of five hours a day, three days a week, would be sorely felt by the pensioners.

She said the city should give the centre permits so patients could park on Stafford Street for the time they were in for dialysis.

"I have seen a couple of permits along here at times so why not give [them to] dialysis patients?" she said.

Mrs Maisey was so upset when she got two parking tickets for parking on Stafford Street that Midland Dialysis Centre manager Deanne Zyla wrote to the city on her behalf to ask for the ticket to be overturned.

"Could you please withdraw these infringements as she is usually able to move her car but wasn't able to on these two occasions," Ms Zyla said in an email.

But the request was rejected in a letter advising there were no grounds for withdrawal as the one-hour time limit was exceeded.

"The city has assessed the application for withdrawal in accordance to the city's withdrawal guidelines and unfortunately there are no grounds to withdraw this infringement," the city said in a letter.

"Should you wish to dispute this infringement further please advise the city in writing that you wish to have this matter heard by a court." 

City of Swan chief executive officer Mike Foley said each application was assessed on its own merits but he would not say on what grounds people could successfully appeal a parking ticket.

"These are confidential as set by council," Mr Foley said.

Mr Foley said the city provided 24 free parking permits to Midland Dialysis for its patients but Mrs Maisey had not used one of the free parking bays allocated to the centre.

But Ms Zyla said the permits given to the centre by the city were for parking on the Midland Oval, which was two-and-a-half blocks away.

She said the parking allocation site was a logistical problem for chronically ill patients who were not able-bodied enough to walk, particularly after treatment when their blood pressure was low.

"It's not a practical location – a lot of our patients have walking frames and wheelchairs," she said.

Mr Foley said information provided by Midland Dialysis showed only about 20 per cent of patients drove themselves to the centre for treatment.

But Ms Zyla said the peak time for the centre was between 11am and 2pm, when it was hard to get a parking spot, even at the Midland Oval.

She said the people getting tickets were helping frail relatives.

"There's only been two parking fines that I'm aware of but it's the relatives that are parking close to pick up their family members who are asking for some lenience on the time," she said.

"The city could provide permits for Stafford Street, which is right outside our door to allow people the time they need.

"We want people to be able to walk in and be involved in the treatment of their loved ones.

"There should be a bit of licence for people with a chronic illness."

- From the Echo News

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