**7. Acknowledgements**

We acknowledge Yasmin Taher and Mohamed Mohamed for their support as research assistants and Ms Margaret Oldfield for editing the manuscript's text.

Funding: Faculty of Community Services Publications Grant, Ryerson University and Faculté des sciences d'éducation, Université Laval.

#### **8. References**


In this chapter, we presented a multidisciplinary view of men's health literacy in prostate cancer, drawing from the disciplines of medical anthropology, education, and nursing. We intended to expand readers' vision of health literacy beyond measurable personal skills toward a view of health literacy as a personal asset that individuals build throughout social interactions within the multiples spheres of their lives. We also intended to portray men's experience of prostate cancer as an experience that goes beyond failures and improvement in sexual performance to a much broader and more significant masculine experience. Health literacy for older men with prostate cancer can preserve their moral integrity, social identity, and self-perception of masculinity. Health education for men with prostate cancer should expand their awareness of health challenges, guide them in correctly interpreting prostate cancer information, and create new ways of enjoying life after prostate cancer. Uncertainties, challenges, and doubts are shared with significant others, who may also have difficulty talking openly about the impacts of prostate cancer, present and future, on the men they love and care for. For this reason, significant others should also be educated about prostate cancer. To create collaboration among men, health educators, social and health professionals, and significant others to improve men's prostate cancer literacy, it will be necessary to redesign current communication approaches. Communication needs to be innovative, creative, and sensitive to men's social networks, age, cultures, general literacy, and, of course, gender. Men differ in the way they understand and live their own masculinity. Not all men are equally health literate; health literacy depends on the collective project of health education. The kind of prostate cancer literacy that we envision is one that will liberate men from any sense of powerlessness and hopelessness, enabling men to

We acknowledge Yasmin Taher and Mohamed Mohamed for their support as research

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**4** 

Philipp Wolf

*Germany* 

**Prostate Specific Membrane Antigen** 

**as Biomarker and Therapeutic** 

*Department of Urology, University Medical Centre Freiburg* 

The Prostate Specific Membrane Antigen (PSMA) is considered to be the most well established target antigen in prostate cancer, since it is highly and specifically expressed at all tumor stages on the surface of prostate tumor cells. This chapter outlines the structure, function, and expression of PSMA, its relevance as prognostic and diagnostic biomarker,

PSMA, also known as Glutamate Carboxypeptidase II (GCPII, EC 3.4.17.21), N-acetyl-α-linked acidic dipeptidase I (NAALADase) or folate hydrolase, is a type II transmembrane protein, which is anchored in the cell membrane of prostate epithelial cells (Carter et al., 1996; Pinto et al., 1996). In 1998, the gene encoding PSMA was mapped to chromosome 11p11-p12, where it encompasses 19 exons spanning about 60 kb of genomic DNA (O'Keefe et al., 1998). The cDNA of PSMA codes for a glycoprotein of 750 amino acids (aa) with a molecular mass of about 100 kDa. The protein is partitioned into a small intracellular domain of 19 aa, a transmembrane domain of 21 amino acids, and a large extracellular domain of 707 aa. Crystallization data revealed that the extracellular domain of PSMA folds into three distinct structural and functional domains: a protease domain (aa 56-116), an apical domain (aa 117- 351), and a C-terminal domain (aa 592-750). Furthermore, it was shown that PSMA is expressed as a compact homodimer, which is highly glycosylated with oligosaccharides

accounting up to 25% of the molecular weight (Davis et al., 2005; Mesters et al., 2006).

PSMA contains a binuclear zinc site and can act as glutamate carboxypeptidase or folate hydrolase, catalyzing the hydrolytic cleavage of glutamate from poly-γ-glutamated folates (Ghosh & Heston, 2003). Therefore, PSMA is thought to play a role in the folate metabolism of the prostate. This hypothesis is supported by recent studies, where PSMA expression correlated with proliferation and folate uptake of PSMA transfected cells (Yao & Bacich,

In contrast to other prostate-related antigens, like prostate specific antigen (PSA), prostate acidic phosphatase (PAP) or prostate secretory protein (PSP), PSMA is not secreted into

and different therapeutic approaches targeting this antigen.

**2. The Prostate Specific Membrane Antigen (PSMA)** 

**2.1 Structure, function and expression** 

**1. Introduction** 

2006; Yao et al., 2009).

**Target for Prostate Cancer** 

