“Freddie Hamdy, MBChB, a leading prostate cancer researcher and head of urology at University of Oxford, blew my mind when I spoke with him the other day.
“He told me we are on the cusp of a revolution in active surveillance (AS) for prostate cancer — one that will in effect ‘cure’ my cancer with a swipe of a pen as cancer will be redefined.
“A prostate cancer diagnosis with a low-risk Gleason 6 changed my life in December 2010. My first urologist offered to rush me to the OR. I declined and got a second opinion. Instead, I opted for AS and have been on it ever since.”
“The most common complication of prostate biopsy is infection, with mild bleeding also reported, according to an update of the American Urological Association White Paper published in the August issue of The Journal of Urology.
“Michael A. Liss, M.D., from the University of Texas Health Science Center San Antonio, and colleagues conducted a literature review to examine the prevalence and prevention of common complications of prostate needlebiopsy. They focused on infection, bleeding, urinary retention, needle tract seeding, and erectile dysfunction in 346 articles identified for full text review and 119 articles that were included in the final data synthesis.”
“The boom of blood-based biomarkers has led to a turning point in clinical practice for physicians treating patients with non–small cell lung cancer (NSCLC). While tissue biopsies remain the standard approach, plasma assays—if positive—can direct patients to a first-line targeted treatment quicker.
” ‘Blood-based testing does have a role in patients with NSCLC,’ said Leora Horn, MD, MSc. ‘The blood can be potentially used as a surrogate for markers for directing for therapy. But if blood testing is negative, it is not enough to say that a patient is not positive. Those patients do need to go on to get a biopsy.’ ”
“Testing for combined urinary PCA3 and TMPRSS2:ERG (T2:ERG) RNA can improve detection of prostate cancer, according to a study published online May 18 in JAMA Oncology.
“Martin G. Sanda, M.D., from the Emory University School of Medicine in Atlanta, and colleagues conducted a multicenter diagnostic evaluation and validation in academic and community-based ambulatory urology clinics. A sample of men presenting for first-time prostate biopsy without preexisting prostate cancer were enrolled: 516 in the developmental cohort and 561 in the validation cohort. Urinary PCA3 and T2:ERG RNA were measured before prostate biopsy.”
“A team of researchers from Cleveland Clinic, Louis Stokes Cleveland VA Medical Center, Kaiser Permanente Northwest, and other clinical sites have demonstrated that a new blood test known as IsoPSA detects prostate cancer more precisely than current tests in two crucial measures — distinguishing cancer from benign conditions, and identifying patients with high-risk disease.
“By identifying molecular changes in the prostate specific antigen (PSA) protein, the findings, published online last month by European Urology, suggest that once validated, use of IsoPSA may substantially reduce the need for biopsy, and may thus lower the likelihood of overdetection and overtreatment of nonlethal prostate cancer.”
“The use of multi-parametric magnetic resonance imaging (mpMRI) could help avoid a repeat prostate biopsy in some men, according to a new study. The imaging test has a high sensitivity for clinically significant cancers, but could miss some and overdiagnose insignificant cancers as well.
” ‘The prostate cancer diagnostic pathway is very different to that of almost all other solid organ cancers, in that it is calibrated to detect subclinical disease but often misses clinically important disease,’ wrote study authors led by Lucy A. M. Simmons, MBBS, MRCS, of University College London. That imprecision arises from the use of transrectal ultrasound-guided (TRUS) biopsy, which is considered standard in men with elevated prostate-specific antigen (PSA) levels.”
Liquid biopsies, virtually unknown even a year or two ago, are becoming common tools in precision diagnostics for cancer. Here, I will try to explain some of the more important differences between liquid and “traditional” tumor biopsies.
Biopsies of solid tumors (e.g., lung, breast, or brain tumors) involve surgically removing a small part of a tumor and sending it to pathology lab. In the last few years, doctors have also started to send some tumor samples to special service labs that analyze tumor DNA for the presence of cancer-related mutations.
By definition, regular biopsies can be intrusive and are sometimes associated with side effects, such as bleeding or infection. However, they provide some really essential information; i.e., the histology and grade of the tumor and other tumor characteristics necessary to determine the best choice of treatment. For lung cancer, for example, a biopsy determines the type of tumor—adenocarcinoma, squamous cancer, small-cell lung cancer, or another, less common type. For breast cancer, a routine test will determine if the tumor expresses estrogen, progesterone receptors, and a protein called HER2. These tests are critically important in guiding treatment choices. If mutational analysis of cancer-related genes is also performed (which doesn’t always happen, unfortunately), it may guide treatment with targeted drugs. Continue reading…
“About a dozen new medical tests are coming to market that aim to more accurately diagnose prostate cancer and go well beyond the standard PSA (prostate-specific antigen) blood screenings used today. Several of them may even allow men to forego getting a biopsy that more than 1 million men diagnosed with prostate cancer undergo each year. That’s because these new tests will help doctors distinguish between aggressive disease and slow-growing tumors.”
“In patients with advanced non-small cell lung cancer (NSCLC) treated at Penn’s ACC, mutations detected from liquid biopsies (cell-free circulating tumor DNA (ctDNA) captured from blood) closely paralleled the mutations from tissue biopsies identified in next generation sequencing tests: EGRF, TP53, and ALK, to name a few. What’s more, in several cases, liquid biopsies captured clinically relevant mutations not found in tissue biopsies as patients’ disease progressed.”
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