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Cancer Management and Research                                                                                                         Dovepress
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    Open Access Full Text Article                                                                               ORiginAL ReseARCh

Bioimpedance and chronoamperometry
as an adjunct to prostate-specific antigen
screening for prostate cancer
                                             This article was published in the following Dove Press journal:
                                             Cancer Management and Research
                                             19 April 2011
                                             Number of times this article has been viewed



Darci schiavon de Abreu                      Background: Bioimpedance is an electrical property of living tissue that has been shown
Department of Urology, hospital              to be a safe technique when used in a number of biomedical applications. The aim of this
Unimed de Limeira, sao Paulo, Brazil         research was to assess the utility of bioimpedance measurement as a rapid, cost-effective, and
                                             noninvasive adjunct to digital rectal examination and PSA in differentiating tumor from normal
                                             prostatic tissue.
                                             Methods: Three hundred men were examined for signs and symptoms of prostate disorders.
                                             147 patients with a digital rectal examination indicating a positive result underwent a prostate-
                                             specific antigen (PSA) test. A biopsy was advised for 103 of the men, of whom 50 completed the
                                             study. Before undergoing biopsy, an examination with the EIS (electro interstitial scan) system
                                             using bioimpedance and chronoamperometry was performed. In reference to the biopsy results
                                             (negative or positive), a statistical analysis of the EIS data and PSA was conducted using receiver
                                             operating characteristic curves to determine the specificity and sensitivity of each test.
                                             Results: The PSA test had a sensitivity of 73.9% and specificity of 51.9% using a cutoff value .4
                                             and a sensitivity of 52.2% and specificity of 81.5% using a cutoff value $5.7 and P = 0.03. The
                                             delta of the electrical conductivity (DE) of the left foot-right foot pathway had a sensitivity of
                                             62.5% and specificity of 85.2%, with a cutoff value #−5 and P = 0.0001. Algorithms comprising
                                             the delta of electrical conductivity and PSA showed a sensitivity of 91.5% and a specificity of
                                             59.3%, with a cutoff value #−10.52 and P = 0.0003.
                                             Conclusion: The EIS system had a very good specificity of 85.2%. However, the sensitivity
                                             of 62.5% would be a problem. Using a PSA reference .4.1 ng/mL, the adjunctive use of
                                             bioimpedance and chronoamperometry provided by EIS technology could raise the sensitivity
                                             from 73.9% to 91.5% and the specificity from 51.9% to 59.3% in prostate cancer screening.
                                             Keywords: prostate cancer screening, bioimpedance, delta of conductivity, electro interstitial
                                             scan system


                                             Introduction
                                             In the US, prostate cancer is the most commonly diagnosed malignancy and the second
                                             leading cause of mortality from cancer in men.1 In 1997, there were at least 209,900
                                             new cases of prostate cancer diagnosed and more than 41,800 deaths from prostate
                                             cancer.2 At present, a transrectal ultrasound with prostatic biopsy is recommended in
                                             men with an abnormal digital rectal examination and/or an elevated prostate-specific
                                             antigen (PSA) level, and who are potential candidates for therapy.
Correspondence: Darci schiavon de Abreu
Rua guararapes 951, Vila Claudia,                According to the US Bureau of the Census in 1998, there were an estimated
Limeira sP, CeP 13 480-405 Brazil            30 million men in the US over the age of 50 years.3 A subset of this population represents
Tel +55(19) 34415409
Fax +55(19) 3306-0308
                                             those men who should undergo screening according to recommendations made by the
email d.schiavon@gmail.com                   American Urological Association.4 In a study by Arcangeli et al,6 8%–15% of men


submit your manuscript | www.dovepress.com   Cancer Management and Research 2011:3 109–116                                                             109
Dovepress                                    © 2011 Abreu, publisher and licensee Dove Medical Press Ltd. This is an Open Access article
DOI: 10.2147/CMR.S19291                      which permits unrestricted noncommercial use, provided the original work is properly cited.
Abreu                                                                                                                  Dovepress


screened were estimated to have an abnormal PSA test (ie,          Materials and methods
serum PSA $ 4.1 ng/mL by monoclonal assay) or had an               This study was approved by the regional ethic committee
abnormal digital rectal examination, half of whom had no           (Pesquisa CONEP, 125/10), and adhered to the ethical
identifiable pathology on biopsy.5 A further study has shown       principles of the Declaration of Helsinki. Each patient
that about 66% of men with abnormally elevated PSA levels          signed an informed consent form, and confidentiality was
go on to have a negative biopsy,6 and another showed that          maintained for all participants.
19%–32% of men who agreed to undergo biopsy were found
to have prostate cancer.5 An indicator/marker adjunctive to the    subjects
digital rectal examination and PSA would help the clinician        Patients attending consultations for signs and/or symptoms of
in the decision to perform a biopsy.                               a prostatic disorder and not receiving any prostate treatment,
     Bioimpedance is an electrical property of living tissue       as well as responders to an advertisement were considered
that has been shown to be a safe technique when used               for enrolment into this study. Inclusion criteria were a high
in a number of biomedical applications, including for              PSA test result (.4 ng/mL) and/or a positive digital rectal
quantification of brain edema in neurosurgery7 and for             examination with a clinical recommendation of prostate
differentiating between cancer and pneumonia on discovery          biopsy. Patients were excluded if they had previously
of a pulmonary mass.8 Electric current is normally limited in      undergone prostate-related chemotherapy or surgery, were
living tissue by highly insulating cell membranes. However,        currently receiving treatment for a prostatic disorder, had
the abnormal architecture in cancerous tissue may impede           a neurological disorder precluding the ability to sign a
current differently and allow detection of differences between     consent form, if in the opinion of the investigator they were
normal and abnormal or malignant prostate tissue.9                 clinically unsuitable candidates for the trial, and/or had any
     The aim of this research was to assess the utility of         contraindications to use of the EIS system. Use of the EIS
bioimpedance measurement as a rapid, cost-effective, and           system is contraindicated in the presence of an external
noninvasive adjunct to digital rectal examination and PSA          defibrillator, skin lesions likely to come into contact with
in differentiating tumor from normal prostatic tissue.             the electrodes, excessive perspiration, sinusitis (particularly
     One explanation as to why bioimpedance increases in           frontal), cardiac pacemaker, electronic life support, any
cancer tissue is the distorted architecture of the gland, which    implanted electronic device, inability to remain still for
prevents flow of current. Histologically, the prostate can be      three minutes, metallic pins or prostheses in digits or joints,
thought of as being composed of multiple layers of hollow          pregnancy from the third trimester onwards, and absence
glands (ie, tubes). Solid or gross tumor tissue is also composed   of a limb.
of a histological array of tubes. The lumina in normal prostate        Three hundred patients of mean age 65 (range 49–90)
tissue are open and have relatively large diameters, providing     years were included in the study, and were examined
little resistance to flow. In contrast, as resistance increases,   in the office for signs and symptoms. A digital rectal
the current flow will decrease. Accordingly, in cancerous          examination was performed, and if indicated, the patients
prostate tissue, the normal architecture of the lumina becomes     were sent to the laboratory for a PSA test. If the attending
distorted. The lumina of the tubes become much smaller, the        clinician subsequently decided that a patient should have a
walls of the glands become crowded, and the flow of current        prostate biopsy, the patient underwent an EIS bioimpedance
is impeded.9                                                       measurement prior to the biopsy.
     The second explanation could be the electrochemical
reaction in the anode related to the Chloride ions migration.      Measurement of bioimpedance
The electrochemical reaction provides 4 H+ and is therefore        The parameter used by the EIS is the delta of the electrical
an acid environment.                                               resistance values between the pathway value for left foot to
     The pronounced elevations in prostatic tissue palmitoleic     right foot (anode to cathode) minus the pathway value for
acid in cancer patients highlight a possible role of this fatty    right foot to left foot (cathode to anode), expressed in numeric
acid in neoplastic processes.10                                    form on a scale from 0 to 100.
     We compared the results of PSA testing and biopsy                 The EIS is a programmable electromedical system
with the results of EIS measurement to determine if the EIS        comprising a USB plug and hardware including an interface
system could be used as an adjunct to screening for prostate       box, disposable electrodes, reusable plates, and reusable
cancer.                                                            cables, with software installed on a computer. The system



110      submit your manuscript | www.dovepress.com                                           Cancer Management and Research 2011:3
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Dovepress                                                                                   Bioimpedance/chronoamperometry for prostate cancer


uses bioimpedance in bipolar mode with direct current,              Results
and measures the electrical conductivity of 11 pathways of          The results of this investigation showed that PSA had a
the body, each recorded twice from anode to cathode and             sensitivity of 73.9% and a specificity of 51.9% for the
then from cathode to anode. The pathways are measured               detection of prostate cancer using a cutoff value .4
between four large tactile reusable electrodes (.270 cm2)           (Figure 1) and a sensitivity of 52.2% and specificity of 81.5%
placed on the palms of the hands and soles of the feet, and         using a cutoff value $5.7 (P = 0.03) (Figure 2).
smaller disposable electrodes (15 cm2) placed on the left               The delta for the electrical conductivity (DE) of the
and right forehead. Electrode polarization does not affect          pathway from left foot to right foot had a sensitivity of
the bioimpedance measurement,11 and the transmission of             62.5% and a specificity of 85.2% using a cutoff value #−5
the current from the electrode to the hardware is performed         (P = 0.0001) (Figure 3).
by chronoamperometry.12                                                 The algorithms All (PSA Value multiplied by the
                                                                    delta value for the electrical conductivity) incorporating
eis and electrical conductivity/chronoamperometry                   the delta of electrical conductivity and PSA value had a
With direct current, the plasma membrane acts as an insulator       sensitivity of 91.5% and a specificity of 59.3% using a cutoff
and the current is not able to penetrate the cell, so most of the   value #−10.52 (P = 0.0003) (Figure 4).
current flows around the cell and therefore in the interstitial         Raw analysis of the EIS data as an adjunct to the PSA
fluid.13 Analysis of the direct current at the cathode and anode    value (Tables 1 and 2).
in electrolytic solution is performed at both the anode and
the cathode.13                                                      Discussion
                                                                    Although strategies for primary prevention of prostate cancer
Analysis at the cathode                                             are being tested, to date none are known to be effective. The
The electrochemical reaction at the cathode is:                     most common strategy for reducing the burden of prostate
                                                                    cancer is screening, but this remains controversial. Urologists
            2H2O + 2e = H2 (gas) + 2 OH-(base)                      are often faced with the dilemma of elevated PSA in young
                                                                    patients. This is a difficult situation, because these patients
Analysis at the anode                                               often do not want to undergo a prostate biopsy and fear a
The electrochemical reaction for water at the anode is:             diagnosis of prostate cancer due to the potential side effects
             2H2O = O2 (gas) + 4H+ + 4e-(acid)
                                                                                                                 PSA
Parameters analyzed                                                               100
Analysis of the specificity and sensitivity of the data was done
in accordance with the biopsy results. Receiver-operating
characteristic curves were constructed for the PSA value and                       80

tissue diagnosis and for the EIS data and tissue diagnosis,
                                                                                                                         Sensitivity: 73.9
and algorithms were constructed for the PSA-EIS data and
                                                                    Sensitivity




                                                                                   60                                    Specificity: 51.9
tissue diagnosis. Raw analysis of the EIS data as an adjunct
                                                                                                                         Criterion: >4
to the PSA value was also undertaken.
                                                                                   40

statistical analysis
Statistical analysis of the results was performed using
                                                                                   20
MedCalc software. The number of patients needed for
the study was calculated to be 50 on the basis of α = 5%,
at 80% power = F (∆, N, variability DS), taking into                                0
account the judgment criteria ∆ at approximately 50 DS                                  0                   40                            80
(5% error).                                                                                            100-specificity
    A P value of ,0.005 was accepted as being statistically         Figure 1 Receiver-operating characteristic curve: PsA cutoff value .4 ng/mL
significant.                                                        comparing positive biopsy group versus negative biopsy group.




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                                                          PSA
                100                                                                          ROC curve
                                                                                             Variable                                       PSA

                   80                                                                        Classification variable                        diagnosis

                                                                                             Sample size                                                                         50
  Sensitivity




                   60                                                                        Positive group:                               DIAGNOSIS = 1                         23
                                                                                             Negative group:                               DIAGNOSIS = 0                         27
                                             Sensitivity: 52.2
                   40                        Specificity: 81.5                               Standard Errora                                                     0.0763
                                             Criterion: >5.7                                 95% Confidence intervalb                                   0.548 to 0.816

                   20                                                                        z statistic                                                          2.544
                                                                                             Significance level P (Area = 0.5)                                    0.011
                                                                                             a
                                                                                                 DeLong et al., 1988
                    0
                                                                                             b
                                                                                                 Binomial exact

                          0                          40              80
                                                100-specificity
Figure 2 Receiver-operating characteristic curve and data analysis: PsA cutoff value .5.7 ng/mL comparing positive biopsy group versus negative biopsy group.




of treatment, including the possibility of urinary incontinence                                  •	 The potential for cure must be greater in patients detected
and erectile dysfunction.                                                                           by screening
    Criteria for a clinically useful screening test are:                                         •	 Improved outcomes related to screening must be shown
•	 The disease must constitute a serious public health                                              and, after these criteria are satisfied, the cost-effectiveness
    problem                                                                                         of the screening program must also be justified.14
•	 The disease must be able to be diagnosed during an                                                The importance of prostate cancer as a public health
    asymptomatic, localized phase                                                                problem and the fact that it can be diagnosed during an
•	 The screening test must have an appropriate sensitivity,                                      asymptomatic, localized stage easily satisfy using PSA and
    specificity, and predictive value                                                            digital rectal examination as screening tools for the first two


                                                             Delta
                   100                                                                            ROC curve
                                                                                                  Variable                               delta
                                                                                                  Classification variable                diagnosis
                    80
                                                                                                  Sample size                                                                   50
                                                                                                  Positive group:                        DIAGNOSIS = 1                          23
     Sensitivity




                    60                       Sensitivity: 65.2                                    Negative group:                        DIAGNOSIS = 0                          27

                                             Specificity: 85.2
                                                                                                  Disease prevalence (%)                                            46
                                             Criterion: < = −5
                    40
                                                                                                  Area under the ROC curve (AUC)                                 0.775
                                                                                                  Standard Errora                                               0.0676
                    20                                                                            95% Confidence intervalb                              0.634 to 0.881
                                                                                                  z statistic                                                    4.062
                                                                                                  Significance level P (Area = 0.5)                            <0.0001
                                                                                                  a
                                                                                                      DeLong et al., 1988
                    0
                                                                                                  b
                                                                                                      Binomial exact
                            0                           40            80
                                                   100-specificity
Figure 3 Receiver-operating characteristic curve and data analysis: Delta electrical conductivity (De) cutoff value #−5 comparing positive biopsy group versus negative
biopsy group.
*Deita of the electrical conductivity between the pathway conductivity ieft foot- right foot minus the pathway conductivity right foot-left foot expressed in numeric values from 0-100.



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                                                    ALL
                         100
                                                                                   ROC curve
                                                                                   Variable                                    ALL
                                                     Sensitivity: 91.3
                         80                                                        Classification variable                     diagnosis
                                                     Specificity: 59.3
                                                     Criterion: < = −10.52
                                                                                   Sample size                                                                              50
           Sensitivity
                         60                                                        Positive group:                             DIAGNOSIS = 1                                23
                                                                                   Negative group:                             DIAGNOSIS = 0                                27

                         40                                                        Area under the ROC curve (AUC)                                            0.757
                                                                                   Standard Errora                                                          0.0706
                                                                                   95% Confidence intervalb                                         0.615 to 0.867
                         20                                                        z statistic                                                               3.636
                                                                                   Significance level P (Area = 0.5)                                        0.0003
                                                                                   a
                                                                                       DeLong et al., 1988
                          0                                                        b
                                                                                       Binomial exact

                               0      20      40           60    80          100
                                           100-specificity
Figure 4 Receiver-operating characteristic curve and data analysis: Test All cutoff value #−10.52 comparing positive biopsy group versus negative biopsy group.
*ALL Delta of the electrical conductivity value multiplied by the PsA value.



of the above-listed criteria, but there are no clear answers                                  than 50 years. The prevalence of these unsuspected prostate
for the rest.                                                                                 cancers is consistently estimated to be about 33%.15 These
    An autopsy study in Detroit men found previously                                          high rates of unsuspected prostate cancers are in sharp
undiagnosed prostate cancer in 30% of men in the age                                          contrast with the 3.64% estimated lifetime risk of dying
range 20–40 years, and in more than one half of men older                                     from prostate cancer, as well as the 1.8% detection rate


Table 1 Analysis of the positive patients group
Patient          Age           Positivie test = 1     Delta     PSA      ALL                  Delta              PSA $-4             ALL                   Current
code                           Negative test = 0      DE                 [DE-PSA]             DE #-0.5                               [DE - PSA]            treatment
                                                                         ,-10.52                                                     #10.52
1Zh05            57            1                      −6        200.2    −1201.2              X                  X                   X                     no treatment
1ZM13            90            1                      2         45       90                                      X                                        Diuretics/furosemide
1ZD19            67            1                      −9        26.0     −234                 X                  X                   X                    ACe
1ZL06            79            1                      −4        4.4      −17.6                                   X                   X                    no treatment
1Zd26            62            1                      −3        19       −57                                     X                   X                    Diuretics/furosemide
1Zs19            66            1                      −8        3.1      −24.8                X                                      X                    no treatment
1ZT15            64            1                      −8        11       −88                  X                  X                   X                    no treatment
1ZA31            69            1                      −6        3.0      −18.06               X                                      X                    no treatment
1ZL01            89            1                      −6        4.1      −24.6                X                  X                   X                    ACe, insulin nPh
1ZB08            76            1                      −10       3.5      −35                  X                                      X                    ACe, diuretics
1ZC30            56            1                      −8        3.5      −28                  X                                      X                    no treatment
1ZA10            52            1                      −8        3.3      −26.4                X                                      X                    simvastatin, omeprazole
1ZF06            84            1                      −2        7.5      −15                                     X                   X                    ACe, ranitidine
1Zs04            80            1                      −4        14       −56                                     X                   X                    Diuretics, ACe
1ZF03            57            1                      −8        2.3      −18.4                X                                      X                    Angiotensin ii antagonists,
                                                                                                                                                          Crestor
1Zs02            62            1                      −5        14.0     −70                  X                  X                   X                    no treatment
1Zx17            68            1                      −1        4.9      −4.9                                    X                                        ACe, diuretics
1Zs28            76            1                      −6        319      −1914                X                  X                   X                    Metformin ACe,
                                                                                                                                                          Diuretics
1ZD22            74            1                      −10       6.5      −65                  X                  X                   X                    ACe, simvastatin
1ZR25            50            1                      −2        5.26     −10.52                                  X                   X                    no treatment
1ZF28            71            1                      −5        6.0      −30                  X                  X                   X                    no treatment
1ZM11            59            1                      −2        9        −18                                     X                   X                    Alpha blockers
1WR28            55            1                      −5        4.2      −21                  X                  X                   X                    ACe, selozok
Note: X = Right results in reference to the biopsies.



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Table 2 Analysis of the negative patients group
Patient       Age        Positive test = 1               Delta   PSA    All         Delta       PSA .4      All          Correct treatment
code                     Negative test = 0               DE             (DE-PSA)    DE #-5                  (DE-PSA)
                                                                        #-10.52                             #-10.52
1Ze22         55         0                               −3      3.2    −9.6        X           X           X           no treatment
1ZC01         57         0                               1       3.3    3.3         X           X           X           insulin, corticosteroid, ACe,
                                                                                                                        Diuretics, metformin
1ZL10         73         0                               −4      16     −64         X                                   no treatment
1ZB11         65         0                               0       2.6    0           X           X           X           no treatment
1Zd08         64         0                               6       4.9    29.4        X                       X           no treatment
1ZD11         60         0                               −6      4.4    −26.4                                           ACe, imipcamin, ranitidine
1Zd30         64         0                               −4      4.7    −18.8       X                                   no treatment
1ZC20         68         0                               3       5.52   16.56       X                       X           ACe
1ZP09         81         0                               −6      5.61   −33.66                                          Angiotensin ii inhibitor,
                                                                                                                        simvastatin
1ZL20         76         0                               5       2.8    14          X           X          X            ACe
1ZA04         62         0                               −2      3.1    −6.2        X           X          X            no treatment
1Zd18         63         0                               −2      2.7    −5.4        X           X          X            no treatment
1Zg21         67         0                               0       3.2    0           X           X          X            simvastatin, bromazepan
1ZB01         71         0                               −4      4.7    −18.8       X                                   Chondroitin
1ZA26         77         0                               −5      7.0    −35         X                      X            Cefalexin
1ZF11         69         0                               −4      3.0    −12         X           X          X            Digoxin, ACe
1ZA09         53         0                               −10     4.2    −42                                             no treatment
1ZD11         54         0                               −1      3.3    −3.3        X           X          X            no treatment
iZdi8         68         0                               −4      7.1    −28.4       X                                   no treatment
1ZL11         73         0                               −4      4      −16         X           X                       ACe
1ZC11         69         0                               3       5.7    17.1        X                      X            no treatment
1Zg13         62         0                               −2      3.1    −6.2        X           X          X            no treatment
1Zi28         61         0                               −2      2.9    −5.8        X           X          X            Omeprazol
1ZD10         69         0                               −4      23     −92         X                                   ACe
1ZL14         62         0                               2       10     20          X                      X            Angiotensin ii inhibitor,
                                                                                                                        Ranitidine
1ZM03         53         0                               −3      2.8    −8.4        X           X          X            Angiotensin ii inhibitor
1ZA31         49         0                               −2      3.5    −7          X           X          X            simvastatin, omeprazole
Note: X = Right results in reference to the biopsies.




of prostate carcinoma in pooled data from a recent meta-                           and 47% of men with histologically proven benign prostate
analysis. Once regional lymph node involvement is present,                         hyperplasia have PSA levels .4 ng/mL, and up to 43% of
the probability of death from prostate cancer is 70%, and                          men with prostate cancer will have a PSA level ,4 ng/mL.
50% of men with regional lymph node involvement will                               This overlap makes it harder to differentiate benign prostate
die in two years. Prostate cancer is a real risk for the aging                     hyperplasia from prostate carcinoma in the absence of a
man, because almost 10% of men older than 50 years are                             biopsy. PSA values also increase with age.17
likely to develop clinically serious disease. Therefore, it                            With prostate cancer, the risk of overdiagnosis is likely
should be detected at an early stage,16 and to improve early                       to be much more relevant than with other types of cancer
detection rates it is necessary to increase the sensitivity of                     screening, because in men aged 55–60 years, the risk of
the screening tests used.                                                          death from other causes is considerably higher than that
    In the current study, the sensitivities of PSA and digital                     from prostate cancer. It is estimated that for every patient
rectal examination screening were 72.1% and 53.2%,                                 who dies of prostate cancer, at least 380 others have prostate
respectively. Reducing the PSA cutoff point from 4 ng/mL                           cancer that cannot be detected clinically.18 The treatment of
to 3 ng/mL can increase the sensitivity, but doing so will                         prostate cancer consists of radical surgery or radiotherapy,
reduce further the positive predictive value.16 It is also well                    and both can cause complications, including a high frequency
known that PSA values for prostate cancer and benign                               of sexual impotence, rectal and urinary dysfunction, as well
prostate hyperplasia overlap considerably. Between 21%                             and a mortality risk of 1%–2%.



114         submit your manuscript | www.dovepress.com                                                       Cancer Management and Research 2011:3
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Dovepress                                                                            Bioimpedance/chronoamperometry for prostate cancer


    The EIS technique, when used as a screening test,              Conclusion
meets the requirements of the World Health Organization            Using the EIS system as an independent predictor of
guidelines stating that a screening test should be acceptable      prostate cancer, it has a good specificity of 85.2%. However,
to the population, be rapidly performed (no more than two          the sensitivity of 62.5% will be a problem. Using the
minutes), cost-effective and noninvasive, and that the total       PSA reference of $4.1 ng/mL, adjunctive use of the EIS
cost of finding a case should be economically balanced in          system measuring bioimpedance and chronoamperometry
relation to medical expenditure as a whole.                        could raise the sensitivity from 73.9% to 91.5% and the
    In the present study, the positive predictive values for       specificity from 51.9% to 59.3% in prostate cancer screening.
PSA and digital rectal examination were about 25% and              To our knowledge, this is the first study using a noninvasive
18%, respectively, which means one of four or five biopsies        bioimpedance-chronoamperometry technique for prostate
is unnecessary. Unnecessary biopsies can lead to multiple          cancer screening. A longitudinal study is now under way to
invasive procedures, anxiety for the patient, procedure-           confirm our findings.
related complications, and a high cost of health care delivery.
To reduce further unnecessary procedures, a meta-analysis19        Acknowledgments
has proposed use of transrectal ultrasonography in                 Thanks are extended to all the people who contributed to this
patients with elevated PSA levels but benign digital rectal        investigation, Dr Daniel Ianni Filho for collecting the data
examination findings, followed by biopsy only of visible           for this study, Labclin Laboratorio de Análises Clínicas for
abnormal lesions. If findings on digital rectal examination are    PSA testing, CEAP Hospital for the biopsies, and LapMed
abnormal, the patient should undergo transrectal ultrasound        for analysis of the biopsies.
and then a biopsy, regardless of the PSA value. A small,
organ-confined prostate tumor has an estimated doubling            Disclosure
time of about four years. Thus, it will take about 15 years        This study was sponsored by LD Technology, Miami, FL.
for a 1 mL tumor to become life-threatening. It would be           Otherwise; the author reports no conflicts of interest in
more straightforward to say that until there is evidence for       this work.
effectiveness of screening in decreasing mortality, based
on these growth rates, a man would need to have at least
15 years of remaining life expectancy to benefit from PSA
                                                                   References
                                                                   1. Wingo PA, Landis S, Ries LA. An adjustment of the 1997 esti-
screening.                                                            mate for new prostate cancer cases. CA Cancer J Clin. 1997;47:
    In the US, there are 30.8 million men older than 50 years         239–242.
                                                                   2. Parker SL, Tong T, Bolden S, Wingo PA. Cancer statistics, 1997. CA
of age who qualify for PSA screening.20 According to our              Cancer J Clin. 1997;47:5–27.
calculations, based on fees charged at one urologist’s office in   3. US Bureau of the Census, Population Division. Resident population of the
                                                                      United States: Estimates, by age and sex. Washington, DC: US Bureau
New Jersey, the cost of PSA screening in all these men would          of the Census, Population Division, release PPL-91. Available at: http://
be $3.1 billion. Of this population, 10.1% (approximately             www.census.gov/population/estimates/nation/intfile2-1.txt. Accessed
3.1 million men) will have PSA levels .4 ng/mL. Assuming              March 21, 2011.
                                                                   4. Catalona WJ, Smith DS, Ratliff TL. Measurement of prostate specific
all patients with abnormal PSA levels are referred to a               antigen in serum as a screening test for prostate cancer. N Engl J Med.
urologist for further evaluation, the first visit will cost $275      1991;324:1156–1161.
                                                                   5. Catalona WJ, Richie JP, Ahmann FR, et al. Comparison of digital rectal
(for the office visit, urine analysis, and culture). The second       examination and serum prostate specific antigen in the early detection
visit will involve sonography of the prostate, bladder, pelvis,       of prostate cancer: Results of a multicenter clinical trial of 6,630 men.
and renal organs, as well as guided needle biopsy, which              J Urol. 1994;151:1283–1290.
                                                                   6. Arcangeli CG, Ornstein DK, Keetch DW, Andriole GL. Prostate specific
can cost $2170 per patient. Therefore, the total cost of these        antigen as a screening test for prostate cancer. The United States
two visits would exceed $7.6 billion for 3.1 million men.             experience. Urol Clin North Am. 1997;24:299–306.
                                                                   7. Ko HW, Smith DG, Skura JP. In vitro measurements of brain edema with
Of 3.1 million biopsies performed, 75%, ie, 2.3 million will          the magnetic bio-impedance method. Presented at the annual conference
be negative for prostate carcinoma.                                   of the IEEE Engineering in Medicine and Biology Society, Amsterdam,
    In our study, the EIS delta parameter had a good                  The Netherlands, October 31–November 3, 1996.
                                                                   8. Kimura S, Morimoto T, Uyama T, Monden Y, Kinouchi Y Iritani T.
specificity of 85.2% and a sensitivity of 65.2%, although we          Application of electrical impedance analysis for diagnosis of a pulmonary
noted that for the eight positive patients, none of which were        mass. Chest. 1994;105:1679–1682.
                                                                   9. Halter RJ, Schned A, Heaney J, Hartov A, Schutz S, Paulsen KD. Electri-
identified by the delta parameter, four are undergoing diuretic       cal impedance spectroscopy of benign and malignant prostatic tissues. J
treatment and one is receiving an alpha-blocker treatment.            Urol. 2008;179:1580–1586.



Cancer Management and Research 2011:3                                                             submit your manuscript | www.dovepress.com
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10. Mamalakis G, Kafatos A, Kalogeropoulos N, Andrikopoulos N,                           16. Scardino PT. Early detection of prostate cancer. Urol Clin North Am.
    Daskalopulos G, Kranidis A. Prostate cancer vs hyperplasia: relationships                1989;16:635–655.
    with prostatic and adipose tissue fatty acid composition. Prostaglandins             17. Cochran WG. Sampling Techniques. 3rd ed. New York, NY: John
    Leukot Essent Fatty Acids. 2002 May–Jun;66 (5–6):467–477.                                Wiley & Sons; 1977.
    Cole KS, Li CL, Bak AF. Electrical analogues for tissues. Exp Neurol.                18. Zappa M, Ciatto S, Bonardi R, Mazzotta A. Overdiagnosis of prostate
    1969;24:459–473.                                                                         carcinoma by screening: An estimate based on the results of the
11. Grimmes S, Martinsen ØG. Electrolytics In Bioimpedance and                               Florence screening pilot study. Ann Oncol. 1998;9:1297–1300.
    Bioelectricity Basics. San Diego, CA: Academic Press; 2000.                          19. Alan W, Partin MD, Michael W, et al. Combination of Prostate-Specific
12. Cottrell FG. Application to the Cottrell equation to chronoamperometry.                  Antigen, Clinical Stage, and Gleason Score to Predict Pathological
    Z Physik Chem. 1902;42:385.                                                              Stage of Localized Prostate Cancer. JAMA. May 14,1997;277(18):
13. Gabriel S, Lau RW, Gabriel C. The dielectric properties of biological                    1445–1451.
    tissues: III. Parametric models for the dielectric spectrum of tissues.              20. Kishor Mistry, Greg Cable. Meta-Analysis of Prostate-Specific Anti-
    Phys Med Biol. 1966;41:2271–2293.                                                        gen and Digital Rectal Examination as Screening Tests for Prostate
14. Svetec D, Thompson IM. PSA screening – current controversy. Ann                          Carcinoma. The Journal of the American Board of Family Practice.
    Oncol. 1998;9:1283–1288.                                                                 2003;16:95–101.
15. Godley PA. Prostate cancer screening: Promise and peril – a review.
    Cancer Detect Prev. 1999;23:316–324.




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EIS Technology: bioimpedance chronoamperometry in adjunct to screen the prostate cancer

  • 1. Cancer Management and Research Dovepress open access to scientific and medical research Open Access Full Text Article ORiginAL ReseARCh Bioimpedance and chronoamperometry as an adjunct to prostate-specific antigen screening for prostate cancer This article was published in the following Dove Press journal: Cancer Management and Research 19 April 2011 Number of times this article has been viewed Darci schiavon de Abreu Background: Bioimpedance is an electrical property of living tissue that has been shown Department of Urology, hospital to be a safe technique when used in a number of biomedical applications. The aim of this Unimed de Limeira, sao Paulo, Brazil research was to assess the utility of bioimpedance measurement as a rapid, cost-effective, and noninvasive adjunct to digital rectal examination and PSA in differentiating tumor from normal prostatic tissue. Methods: Three hundred men were examined for signs and symptoms of prostate disorders. 147 patients with a digital rectal examination indicating a positive result underwent a prostate- specific antigen (PSA) test. A biopsy was advised for 103 of the men, of whom 50 completed the study. Before undergoing biopsy, an examination with the EIS (electro interstitial scan) system using bioimpedance and chronoamperometry was performed. In reference to the biopsy results (negative or positive), a statistical analysis of the EIS data and PSA was conducted using receiver operating characteristic curves to determine the specificity and sensitivity of each test. Results: The PSA test had a sensitivity of 73.9% and specificity of 51.9% using a cutoff value .4 and a sensitivity of 52.2% and specificity of 81.5% using a cutoff value $5.7 and P = 0.03. The delta of the electrical conductivity (DE) of the left foot-right foot pathway had a sensitivity of 62.5% and specificity of 85.2%, with a cutoff value #−5 and P = 0.0001. Algorithms comprising the delta of electrical conductivity and PSA showed a sensitivity of 91.5% and a specificity of 59.3%, with a cutoff value #−10.52 and P = 0.0003. Conclusion: The EIS system had a very good specificity of 85.2%. However, the sensitivity of 62.5% would be a problem. Using a PSA reference .4.1 ng/mL, the adjunctive use of bioimpedance and chronoamperometry provided by EIS technology could raise the sensitivity from 73.9% to 91.5% and the specificity from 51.9% to 59.3% in prostate cancer screening. Keywords: prostate cancer screening, bioimpedance, delta of conductivity, electro interstitial scan system Introduction In the US, prostate cancer is the most commonly diagnosed malignancy and the second leading cause of mortality from cancer in men.1 In 1997, there were at least 209,900 new cases of prostate cancer diagnosed and more than 41,800 deaths from prostate cancer.2 At present, a transrectal ultrasound with prostatic biopsy is recommended in men with an abnormal digital rectal examination and/or an elevated prostate-specific antigen (PSA) level, and who are potential candidates for therapy. Correspondence: Darci schiavon de Abreu Rua guararapes 951, Vila Claudia, According to the US Bureau of the Census in 1998, there were an estimated Limeira sP, CeP 13 480-405 Brazil 30 million men in the US over the age of 50 years.3 A subset of this population represents Tel +55(19) 34415409 Fax +55(19) 3306-0308 those men who should undergo screening according to recommendations made by the email d.schiavon@gmail.com American Urological Association.4 In a study by Arcangeli et al,6 8%–15% of men submit your manuscript | www.dovepress.com Cancer Management and Research 2011:3 109–116 109 Dovepress © 2011 Abreu, publisher and licensee Dove Medical Press Ltd. This is an Open Access article DOI: 10.2147/CMR.S19291 which permits unrestricted noncommercial use, provided the original work is properly cited.
  • 2. Abreu Dovepress screened were estimated to have an abnormal PSA test (ie, Materials and methods serum PSA $ 4.1 ng/mL by monoclonal assay) or had an This study was approved by the regional ethic committee abnormal digital rectal examination, half of whom had no (Pesquisa CONEP, 125/10), and adhered to the ethical identifiable pathology on biopsy.5 A further study has shown principles of the Declaration of Helsinki. Each patient that about 66% of men with abnormally elevated PSA levels signed an informed consent form, and confidentiality was go on to have a negative biopsy,6 and another showed that maintained for all participants. 19%–32% of men who agreed to undergo biopsy were found to have prostate cancer.5 An indicator/marker adjunctive to the subjects digital rectal examination and PSA would help the clinician Patients attending consultations for signs and/or symptoms of in the decision to perform a biopsy. a prostatic disorder and not receiving any prostate treatment, Bioimpedance is an electrical property of living tissue as well as responders to an advertisement were considered that has been shown to be a safe technique when used for enrolment into this study. Inclusion criteria were a high in a number of biomedical applications, including for PSA test result (.4 ng/mL) and/or a positive digital rectal quantification of brain edema in neurosurgery7 and for examination with a clinical recommendation of prostate differentiating between cancer and pneumonia on discovery biopsy. Patients were excluded if they had previously of a pulmonary mass.8 Electric current is normally limited in undergone prostate-related chemotherapy or surgery, were living tissue by highly insulating cell membranes. However, currently receiving treatment for a prostatic disorder, had the abnormal architecture in cancerous tissue may impede a neurological disorder precluding the ability to sign a current differently and allow detection of differences between consent form, if in the opinion of the investigator they were normal and abnormal or malignant prostate tissue.9 clinically unsuitable candidates for the trial, and/or had any The aim of this research was to assess the utility of contraindications to use of the EIS system. Use of the EIS bioimpedance measurement as a rapid, cost-effective, and system is contraindicated in the presence of an external noninvasive adjunct to digital rectal examination and PSA defibrillator, skin lesions likely to come into contact with in differentiating tumor from normal prostatic tissue. the electrodes, excessive perspiration, sinusitis (particularly One explanation as to why bioimpedance increases in frontal), cardiac pacemaker, electronic life support, any cancer tissue is the distorted architecture of the gland, which implanted electronic device, inability to remain still for prevents flow of current. Histologically, the prostate can be three minutes, metallic pins or prostheses in digits or joints, thought of as being composed of multiple layers of hollow pregnancy from the third trimester onwards, and absence glands (ie, tubes). Solid or gross tumor tissue is also composed of a limb. of a histological array of tubes. The lumina in normal prostate Three hundred patients of mean age 65 (range 49–90) tissue are open and have relatively large diameters, providing years were included in the study, and were examined little resistance to flow. In contrast, as resistance increases, in the office for signs and symptoms. A digital rectal the current flow will decrease. Accordingly, in cancerous examination was performed, and if indicated, the patients prostate tissue, the normal architecture of the lumina becomes were sent to the laboratory for a PSA test. If the attending distorted. The lumina of the tubes become much smaller, the clinician subsequently decided that a patient should have a walls of the glands become crowded, and the flow of current prostate biopsy, the patient underwent an EIS bioimpedance is impeded.9 measurement prior to the biopsy. The second explanation could be the electrochemical reaction in the anode related to the Chloride ions migration. Measurement of bioimpedance The electrochemical reaction provides 4 H+ and is therefore The parameter used by the EIS is the delta of the electrical an acid environment. resistance values between the pathway value for left foot to The pronounced elevations in prostatic tissue palmitoleic right foot (anode to cathode) minus the pathway value for acid in cancer patients highlight a possible role of this fatty right foot to left foot (cathode to anode), expressed in numeric acid in neoplastic processes.10 form on a scale from 0 to 100. We compared the results of PSA testing and biopsy The EIS is a programmable electromedical system with the results of EIS measurement to determine if the EIS comprising a USB plug and hardware including an interface system could be used as an adjunct to screening for prostate box, disposable electrodes, reusable plates, and reusable cancer. cables, with software installed on a computer. The system 110 submit your manuscript | www.dovepress.com Cancer Management and Research 2011:3 Dovepress
  • 3. Dovepress Bioimpedance/chronoamperometry for prostate cancer uses bioimpedance in bipolar mode with direct current, Results and measures the electrical conductivity of 11 pathways of The results of this investigation showed that PSA had a the body, each recorded twice from anode to cathode and sensitivity of 73.9% and a specificity of 51.9% for the then from cathode to anode. The pathways are measured detection of prostate cancer using a cutoff value .4 between four large tactile reusable electrodes (.270 cm2) (Figure 1) and a sensitivity of 52.2% and specificity of 81.5% placed on the palms of the hands and soles of the feet, and using a cutoff value $5.7 (P = 0.03) (Figure 2). smaller disposable electrodes (15 cm2) placed on the left The delta for the electrical conductivity (DE) of the and right forehead. Electrode polarization does not affect pathway from left foot to right foot had a sensitivity of the bioimpedance measurement,11 and the transmission of 62.5% and a specificity of 85.2% using a cutoff value #−5 the current from the electrode to the hardware is performed (P = 0.0001) (Figure 3). by chronoamperometry.12 The algorithms All (PSA Value multiplied by the delta value for the electrical conductivity) incorporating eis and electrical conductivity/chronoamperometry the delta of electrical conductivity and PSA value had a With direct current, the plasma membrane acts as an insulator sensitivity of 91.5% and a specificity of 59.3% using a cutoff and the current is not able to penetrate the cell, so most of the value #−10.52 (P = 0.0003) (Figure 4). current flows around the cell and therefore in the interstitial Raw analysis of the EIS data as an adjunct to the PSA fluid.13 Analysis of the direct current at the cathode and anode value (Tables 1 and 2). in electrolytic solution is performed at both the anode and the cathode.13 Discussion Although strategies for primary prevention of prostate cancer Analysis at the cathode are being tested, to date none are known to be effective. The The electrochemical reaction at the cathode is: most common strategy for reducing the burden of prostate cancer is screening, but this remains controversial. Urologists 2H2O + 2e = H2 (gas) + 2 OH-(base) are often faced with the dilemma of elevated PSA in young patients. This is a difficult situation, because these patients Analysis at the anode often do not want to undergo a prostate biopsy and fear a The electrochemical reaction for water at the anode is: diagnosis of prostate cancer due to the potential side effects 2H2O = O2 (gas) + 4H+ + 4e-(acid) PSA Parameters analyzed 100 Analysis of the specificity and sensitivity of the data was done in accordance with the biopsy results. Receiver-operating characteristic curves were constructed for the PSA value and 80 tissue diagnosis and for the EIS data and tissue diagnosis, Sensitivity: 73.9 and algorithms were constructed for the PSA-EIS data and Sensitivity 60 Specificity: 51.9 tissue diagnosis. Raw analysis of the EIS data as an adjunct Criterion: >4 to the PSA value was also undertaken. 40 statistical analysis Statistical analysis of the results was performed using 20 MedCalc software. The number of patients needed for the study was calculated to be 50 on the basis of α = 5%, at 80% power = F (∆, N, variability DS), taking into 0 account the judgment criteria ∆ at approximately 50 DS 0 40 80 (5% error). 100-specificity A P value of ,0.005 was accepted as being statistically Figure 1 Receiver-operating characteristic curve: PsA cutoff value .4 ng/mL significant. comparing positive biopsy group versus negative biopsy group. Cancer Management and Research 2011:3 submit your manuscript | www.dovepress.com 111 Dovepress
  • 4. Abreu Dovepress PSA 100 ROC curve Variable PSA 80 Classification variable diagnosis Sample size 50 Sensitivity 60 Positive group: DIAGNOSIS = 1 23 Negative group: DIAGNOSIS = 0 27 Sensitivity: 52.2 40 Specificity: 81.5 Standard Errora 0.0763 Criterion: >5.7 95% Confidence intervalb 0.548 to 0.816 20 z statistic 2.544 Significance level P (Area = 0.5) 0.011 a DeLong et al., 1988 0 b Binomial exact 0 40 80 100-specificity Figure 2 Receiver-operating characteristic curve and data analysis: PsA cutoff value .5.7 ng/mL comparing positive biopsy group versus negative biopsy group. of treatment, including the possibility of urinary incontinence • The potential for cure must be greater in patients detected and erectile dysfunction. by screening Criteria for a clinically useful screening test are: • Improved outcomes related to screening must be shown • The disease must constitute a serious public health and, after these criteria are satisfied, the cost-effectiveness problem of the screening program must also be justified.14 • The disease must be able to be diagnosed during an The importance of prostate cancer as a public health asymptomatic, localized phase problem and the fact that it can be diagnosed during an • The screening test must have an appropriate sensitivity, asymptomatic, localized stage easily satisfy using PSA and specificity, and predictive value digital rectal examination as screening tools for the first two Delta 100 ROC curve Variable delta Classification variable diagnosis 80 Sample size 50 Positive group: DIAGNOSIS = 1 23 Sensitivity 60 Sensitivity: 65.2 Negative group: DIAGNOSIS = 0 27 Specificity: 85.2 Disease prevalence (%) 46 Criterion: < = −5 40 Area under the ROC curve (AUC) 0.775 Standard Errora 0.0676 20 95% Confidence intervalb 0.634 to 0.881 z statistic 4.062 Significance level P (Area = 0.5) <0.0001 a DeLong et al., 1988 0 b Binomial exact 0 40 80 100-specificity Figure 3 Receiver-operating characteristic curve and data analysis: Delta electrical conductivity (De) cutoff value #−5 comparing positive biopsy group versus negative biopsy group. *Deita of the electrical conductivity between the pathway conductivity ieft foot- right foot minus the pathway conductivity right foot-left foot expressed in numeric values from 0-100. 112 submit your manuscript | www.dovepress.com Cancer Management and Research 2011:3 Dovepress
  • 5. Dovepress Bioimpedance/chronoamperometry for prostate cancer ALL 100 ROC curve Variable ALL Sensitivity: 91.3 80 Classification variable diagnosis Specificity: 59.3 Criterion: < = −10.52 Sample size 50 Sensitivity 60 Positive group: DIAGNOSIS = 1 23 Negative group: DIAGNOSIS = 0 27 40 Area under the ROC curve (AUC) 0.757 Standard Errora 0.0706 95% Confidence intervalb 0.615 to 0.867 20 z statistic 3.636 Significance level P (Area = 0.5) 0.0003 a DeLong et al., 1988 0 b Binomial exact 0 20 40 60 80 100 100-specificity Figure 4 Receiver-operating characteristic curve and data analysis: Test All cutoff value #−10.52 comparing positive biopsy group versus negative biopsy group. *ALL Delta of the electrical conductivity value multiplied by the PsA value. of the above-listed criteria, but there are no clear answers than 50 years. The prevalence of these unsuspected prostate for the rest. cancers is consistently estimated to be about 33%.15 These An autopsy study in Detroit men found previously high rates of unsuspected prostate cancers are in sharp undiagnosed prostate cancer in 30% of men in the age contrast with the 3.64% estimated lifetime risk of dying range 20–40 years, and in more than one half of men older from prostate cancer, as well as the 1.8% detection rate Table 1 Analysis of the positive patients group Patient Age Positivie test = 1 Delta PSA ALL Delta PSA $-4 ALL Current code Negative test = 0 DE [DE-PSA] DE #-0.5 [DE - PSA] treatment ,-10.52 #10.52 1Zh05 57 1 −6 200.2 −1201.2 X X X no treatment 1ZM13 90 1 2 45 90 X Diuretics/furosemide 1ZD19 67 1 −9 26.0 −234 X X X ACe 1ZL06 79 1 −4 4.4 −17.6 X X no treatment 1Zd26 62 1 −3 19 −57 X X Diuretics/furosemide 1Zs19 66 1 −8 3.1 −24.8 X X no treatment 1ZT15 64 1 −8 11 −88 X X X no treatment 1ZA31 69 1 −6 3.0 −18.06 X X no treatment 1ZL01 89 1 −6 4.1 −24.6 X X X ACe, insulin nPh 1ZB08 76 1 −10 3.5 −35 X X ACe, diuretics 1ZC30 56 1 −8 3.5 −28 X X no treatment 1ZA10 52 1 −8 3.3 −26.4 X X simvastatin, omeprazole 1ZF06 84 1 −2 7.5 −15 X X ACe, ranitidine 1Zs04 80 1 −4 14 −56 X X Diuretics, ACe 1ZF03 57 1 −8 2.3 −18.4 X X Angiotensin ii antagonists, Crestor 1Zs02 62 1 −5 14.0 −70 X X X no treatment 1Zx17 68 1 −1 4.9 −4.9 X ACe, diuretics 1Zs28 76 1 −6 319 −1914 X X X Metformin ACe, Diuretics 1ZD22 74 1 −10 6.5 −65 X X X ACe, simvastatin 1ZR25 50 1 −2 5.26 −10.52 X X no treatment 1ZF28 71 1 −5 6.0 −30 X X X no treatment 1ZM11 59 1 −2 9 −18 X X Alpha blockers 1WR28 55 1 −5 4.2 −21 X X X ACe, selozok Note: X = Right results in reference to the biopsies. Cancer Management and Research 2011:3 submit your manuscript | www.dovepress.com 113 Dovepress
  • 6. Abreu Dovepress Table 2 Analysis of the negative patients group Patient Age Positive test = 1 Delta PSA All Delta PSA .4 All Correct treatment code Negative test = 0 DE (DE-PSA) DE #-5 (DE-PSA) #-10.52 #-10.52 1Ze22 55 0 −3 3.2 −9.6 X X X no treatment 1ZC01 57 0 1 3.3 3.3 X X X insulin, corticosteroid, ACe, Diuretics, metformin 1ZL10 73 0 −4 16 −64 X no treatment 1ZB11 65 0 0 2.6 0 X X X no treatment 1Zd08 64 0 6 4.9 29.4 X X no treatment 1ZD11 60 0 −6 4.4 −26.4 ACe, imipcamin, ranitidine 1Zd30 64 0 −4 4.7 −18.8 X no treatment 1ZC20 68 0 3 5.52 16.56 X X ACe 1ZP09 81 0 −6 5.61 −33.66 Angiotensin ii inhibitor, simvastatin 1ZL20 76 0 5 2.8 14 X X X ACe 1ZA04 62 0 −2 3.1 −6.2 X X X no treatment 1Zd18 63 0 −2 2.7 −5.4 X X X no treatment 1Zg21 67 0 0 3.2 0 X X X simvastatin, bromazepan 1ZB01 71 0 −4 4.7 −18.8 X Chondroitin 1ZA26 77 0 −5 7.0 −35 X X Cefalexin 1ZF11 69 0 −4 3.0 −12 X X X Digoxin, ACe 1ZA09 53 0 −10 4.2 −42 no treatment 1ZD11 54 0 −1 3.3 −3.3 X X X no treatment iZdi8 68 0 −4 7.1 −28.4 X no treatment 1ZL11 73 0 −4 4 −16 X X ACe 1ZC11 69 0 3 5.7 17.1 X X no treatment 1Zg13 62 0 −2 3.1 −6.2 X X X no treatment 1Zi28 61 0 −2 2.9 −5.8 X X X Omeprazol 1ZD10 69 0 −4 23 −92 X ACe 1ZL14 62 0 2 10 20 X X Angiotensin ii inhibitor, Ranitidine 1ZM03 53 0 −3 2.8 −8.4 X X X Angiotensin ii inhibitor 1ZA31 49 0 −2 3.5 −7 X X X simvastatin, omeprazole Note: X = Right results in reference to the biopsies. of prostate carcinoma in pooled data from a recent meta- and 47% of men with histologically proven benign prostate analysis. Once regional lymph node involvement is present, hyperplasia have PSA levels .4 ng/mL, and up to 43% of the probability of death from prostate cancer is 70%, and men with prostate cancer will have a PSA level ,4 ng/mL. 50% of men with regional lymph node involvement will This overlap makes it harder to differentiate benign prostate die in two years. Prostate cancer is a real risk for the aging hyperplasia from prostate carcinoma in the absence of a man, because almost 10% of men older than 50 years are biopsy. PSA values also increase with age.17 likely to develop clinically serious disease. Therefore, it With prostate cancer, the risk of overdiagnosis is likely should be detected at an early stage,16 and to improve early to be much more relevant than with other types of cancer detection rates it is necessary to increase the sensitivity of screening, because in men aged 55–60 years, the risk of the screening tests used. death from other causes is considerably higher than that In the current study, the sensitivities of PSA and digital from prostate cancer. It is estimated that for every patient rectal examination screening were 72.1% and 53.2%, who dies of prostate cancer, at least 380 others have prostate respectively. Reducing the PSA cutoff point from 4 ng/mL cancer that cannot be detected clinically.18 The treatment of to 3 ng/mL can increase the sensitivity, but doing so will prostate cancer consists of radical surgery or radiotherapy, reduce further the positive predictive value.16 It is also well and both can cause complications, including a high frequency known that PSA values for prostate cancer and benign of sexual impotence, rectal and urinary dysfunction, as well prostate hyperplasia overlap considerably. Between 21% and a mortality risk of 1%–2%. 114 submit your manuscript | www.dovepress.com Cancer Management and Research 2011:3 Dovepress
  • 7. Dovepress Bioimpedance/chronoamperometry for prostate cancer The EIS technique, when used as a screening test, Conclusion meets the requirements of the World Health Organization Using the EIS system as an independent predictor of guidelines stating that a screening test should be acceptable prostate cancer, it has a good specificity of 85.2%. However, to the population, be rapidly performed (no more than two the sensitivity of 62.5% will be a problem. Using the minutes), cost-effective and noninvasive, and that the total PSA reference of $4.1 ng/mL, adjunctive use of the EIS cost of finding a case should be economically balanced in system measuring bioimpedance and chronoamperometry relation to medical expenditure as a whole. could raise the sensitivity from 73.9% to 91.5% and the In the present study, the positive predictive values for specificity from 51.9% to 59.3% in prostate cancer screening. PSA and digital rectal examination were about 25% and To our knowledge, this is the first study using a noninvasive 18%, respectively, which means one of four or five biopsies bioimpedance-chronoamperometry technique for prostate is unnecessary. Unnecessary biopsies can lead to multiple cancer screening. A longitudinal study is now under way to invasive procedures, anxiety for the patient, procedure- confirm our findings. related complications, and a high cost of health care delivery. To reduce further unnecessary procedures, a meta-analysis19 Acknowledgments has proposed use of transrectal ultrasonography in Thanks are extended to all the people who contributed to this patients with elevated PSA levels but benign digital rectal investigation, Dr Daniel Ianni Filho for collecting the data examination findings, followed by biopsy only of visible for this study, Labclin Laboratorio de Análises Clínicas for abnormal lesions. If findings on digital rectal examination are PSA testing, CEAP Hospital for the biopsies, and LapMed abnormal, the patient should undergo transrectal ultrasound for analysis of the biopsies. and then a biopsy, regardless of the PSA value. A small, organ-confined prostate tumor has an estimated doubling Disclosure time of about four years. Thus, it will take about 15 years This study was sponsored by LD Technology, Miami, FL. for a 1 mL tumor to become life-threatening. It would be Otherwise; the author reports no conflicts of interest in more straightforward to say that until there is evidence for this work. effectiveness of screening in decreasing mortality, based on these growth rates, a man would need to have at least 15 years of remaining life expectancy to benefit from PSA References 1. Wingo PA, Landis S, Ries LA. An adjustment of the 1997 esti- screening. mate for new prostate cancer cases. CA Cancer J Clin. 1997;47: In the US, there are 30.8 million men older than 50 years 239–242. 2. Parker SL, Tong T, Bolden S, Wingo PA. Cancer statistics, 1997. CA of age who qualify for PSA screening.20 According to our Cancer J Clin. 1997;47:5–27. calculations, based on fees charged at one urologist’s office in 3. US Bureau of the Census, Population Division. Resident population of the United States: Estimates, by age and sex. Washington, DC: US Bureau New Jersey, the cost of PSA screening in all these men would of the Census, Population Division, release PPL-91. Available at: http:// be $3.1 billion. Of this population, 10.1% (approximately www.census.gov/population/estimates/nation/intfile2-1.txt. Accessed 3.1 million men) will have PSA levels .4 ng/mL. Assuming March 21, 2011. 4. Catalona WJ, Smith DS, Ratliff TL. Measurement of prostate specific all patients with abnormal PSA levels are referred to a antigen in serum as a screening test for prostate cancer. N Engl J Med. urologist for further evaluation, the first visit will cost $275 1991;324:1156–1161. 5. Catalona WJ, Richie JP, Ahmann FR, et al. Comparison of digital rectal (for the office visit, urine analysis, and culture). The second examination and serum prostate specific antigen in the early detection visit will involve sonography of the prostate, bladder, pelvis, of prostate cancer: Results of a multicenter clinical trial of 6,630 men. and renal organs, as well as guided needle biopsy, which J Urol. 1994;151:1283–1290. 6. Arcangeli CG, Ornstein DK, Keetch DW, Andriole GL. Prostate specific can cost $2170 per patient. Therefore, the total cost of these antigen as a screening test for prostate cancer. The United States two visits would exceed $7.6 billion for 3.1 million men. experience. Urol Clin North Am. 1997;24:299–306. 7. Ko HW, Smith DG, Skura JP. In vitro measurements of brain edema with Of 3.1 million biopsies performed, 75%, ie, 2.3 million will the magnetic bio-impedance method. Presented at the annual conference be negative for prostate carcinoma. of the IEEE Engineering in Medicine and Biology Society, Amsterdam, In our study, the EIS delta parameter had a good The Netherlands, October 31–November 3, 1996. 8. Kimura S, Morimoto T, Uyama T, Monden Y, Kinouchi Y Iritani T. specificity of 85.2% and a sensitivity of 65.2%, although we Application of electrical impedance analysis for diagnosis of a pulmonary noted that for the eight positive patients, none of which were mass. Chest. 1994;105:1679–1682. 9. Halter RJ, Schned A, Heaney J, Hartov A, Schutz S, Paulsen KD. Electri- identified by the delta parameter, four are undergoing diuretic cal impedance spectroscopy of benign and malignant prostatic tissues. J treatment and one is receiving an alpha-blocker treatment. Urol. 2008;179:1580–1586. Cancer Management and Research 2011:3 submit your manuscript | www.dovepress.com 115 Dovepress
  • 8. Abreu Dovepress 10. Mamalakis G, Kafatos A, Kalogeropoulos N, Andrikopoulos N, 16. Scardino PT. Early detection of prostate cancer. Urol Clin North Am. Daskalopulos G, Kranidis A. Prostate cancer vs hyperplasia: relationships 1989;16:635–655. with prostatic and adipose tissue fatty acid composition. Prostaglandins 17. Cochran WG. Sampling Techniques. 3rd ed. New York, NY: John Leukot Essent Fatty Acids. 2002 May–Jun;66 (5–6):467–477. Wiley & Sons; 1977. Cole KS, Li CL, Bak AF. Electrical analogues for tissues. Exp Neurol. 18. Zappa M, Ciatto S, Bonardi R, Mazzotta A. Overdiagnosis of prostate 1969;24:459–473. carcinoma by screening: An estimate based on the results of the 11. Grimmes S, Martinsen ØG. Electrolytics In Bioimpedance and Florence screening pilot study. Ann Oncol. 1998;9:1297–1300. Bioelectricity Basics. San Diego, CA: Academic Press; 2000. 19. Alan W, Partin MD, Michael W, et al. Combination of Prostate-Specific 12. Cottrell FG. Application to the Cottrell equation to chronoamperometry. Antigen, Clinical Stage, and Gleason Score to Predict Pathological Z Physik Chem. 1902;42:385. Stage of Localized Prostate Cancer. JAMA. May 14,1997;277(18): 13. Gabriel S, Lau RW, Gabriel C. The dielectric properties of biological 1445–1451. tissues: III. Parametric models for the dielectric spectrum of tissues. 20. Kishor Mistry, Greg Cable. Meta-Analysis of Prostate-Specific Anti- Phys Med Biol. 1966;41:2271–2293. gen and Digital Rectal Examination as Screening Tests for Prostate 14. Svetec D, Thompson IM. PSA screening – current controversy. Ann Carcinoma. The Journal of the American Board of Family Practice. Oncol. 1998;9:1283–1288. 2003;16:95–101. 15. Godley PA. Prostate cancer screening: Promise and peril – a review. Cancer Detect Prev. 1999;23:316–324. Cancer Management and Research Dovepress Publish your work in this journal Cancer Management and Research is an international, peer-reviewed studies, reviews & evaluations, guidelines, expert opinion & commen- open access journal focusing on cancer research and the optimal use of tary, case reports & extended reports. The manuscript management preventative and integrated treatment interventions to achieve improved system is completely online and includes a very quick and fair peer- outcomes, enhanced survival and quality of life for the cancer patient. review system, which is all easy to use. Visit http://www.dovepress.com/ The journal welcomes original research, clinical & epidemiological testimonials.php to read real quotes from published authors. Submit your manuscript here: http://www.dovepress.com/cancer-management-and-research-journal 116 submit your manuscript | www.dovepress.com Cancer Management and Research 2011:3 Dovepress