New Blood Test Is More Accurate in Predicting Prostate Cancer Risk Than PSA

Excerpt:

“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.”

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Decision Aid Including Information on Overdetection Increases Informed Choice in Breast Screening and Reduces Intention to Be Screened

“In a study reported in The Lancet, Hersch et al found that use of a decision aid containing information on overdetection in breast cancer screening was associated with an increased rate of informed choice regarding screening, a reduced rate of positive attitudes toward screening, and reduced intention to be screened.

“In the community-based trial conducted in New South Wales, Australia, 879 women aged 48 to 50 years who had not had mammography in the past 2 years and did not have a personal or strong family history of breast cancer were randomly assigned between January 2014 and July 2014 to receive an intervention decision aid including evidence-based explanatory and quantitative information on overdetection, breast cancer mortality reduction, and false-positives (n = 440) or a control decision aid including information on breast cancer mortality reduction and false-positives (n = 439). The primary outcome was informed choice, defined as adequate knowledge and consistency between attitudes and screening intentions. Participants were interviewed via telephone at 3 weeks after randomization. The primary outcome was analyzed in all women who completed all follow-up interview questions.

“Among the two cohorts, 21 women in the intervention group and 20 in the control group were lost to follow-up, and 10 and 11 did not answer all interview questions. Among 409 women in the intervention group and 408 in the control group, 99 vs 63 (24% vs 15%, difference = 9%, P = .0017) were considered to have made an informed choice regarding screening. Compared with the control group, significantly more women in the intervention group met the threshold for adequate overall knowledge (29% vs 17%, difference = 12%, P < .0001), significantly fewer expressed positive attitudes toward screening (69% vs 83%, difference = 14%, P < .0001), and significantly fewer intended to be screened (74% vs 87%, difference = 13%, P < .0001).”


Increase in PSA after Prostate Cancer Surgery May Not Lead to Metastasis in Some Men's Lifetimes

“Some prostate cancer patients whose prostate-specific antigen (PSA) levels increase after a radical prostatectomy may die of causes unrelated to prostate cancer before they are diagnosed with a prostate cancer metastasis, and therefore treating them for recurrence may not be beneficial, according to a study published in Clinical Cancer Research, a journal of the American Association for Cancer Research.

” ‘Previous studies have indicated that the interval from PSA recurrence to metastasis is quite long, with a median of more than eight years, even in the absence of any treatment for the recurrence,’ said Ruth Etzioni, PhD, full member of the Public Health Sciences Division at Fred Hutchinson Cancer Research Center in Seattle, Washington. ‘Given that the majority of prostate cancer patients are older, we expect that many would die of other causes before reaching the point of metastasis.

” ‘Much like the issues with PSA screening and overdetection of prostate cancer, overdetection of recurrence after primary treatment poses some concerns as well. We have attempted to quantify the risk associated with overdetection of recurrence,’ said Etzioni.

“Using prostate cancer patients’ data from different sources, the authors created a simulation model and found that at least 9.1 percent and 15.6 percent of prostate cancer patients whose PSA levels increase after five years and 10 years of initial treatment, respectively, may not have a metastatic disease in their lifetime, and therefore are overdetected for recurrence. Among those older than 70 with a PSA recurrence within 10 years of first diagnosis, the model projected that at least 31.4 percent were overdetected.”