“An analysis of two influential studies of prostate cancer screening concludes that the much-debated test “significantly” reduces deaths from the disease, suggesting that current recommendations against routine PSA screening might be steering men away from a lifesaving procedure.
“The analysis, published Monday in Annals of Internal Medicine, drew wildly different reactions, as is often the case with research on PSA screenings. Some experts in cancer screening and statistics said its novel approach was “on shaky ground” and used a “completely unverifiable” methodology that they had “never seen before,” but others praised its “intriguing and innovative approach.” There was one area of agreement, however: “I imagine it’s going to generate some buzz,” said biostatistician Ted Karrison of the University of Chicago.”
“Men with advanced prostate cancer who respond poorly to one taxane-based chemotherapy regimen may benefit from switching to another, a small randomized trial reported.
“Nearly half of the men who did not achieve a ≥30% decline in prostate-specific antigen (PSA) level while receiving either docetaxel or cabazitaxel achieved a ≥50% decline when they switched to the other drug, said Emmanuel Antonarakis, MBBCh, of Johns Hopkins University in Baltimore, and colleagues.”
“A new study led by researchers at UC San Francisco and Kaiser Permanente has identified genetic predictors of normal prostate-specific antigen (PSA) levels in healthy men, which could be used to improve the accuracy of PSA-based prostate cancer screening tests.
“Until recently, PSA tests for prostate cancer were considered an exemplar of successful early cancer detection leading to improved treatment outcomes. But over the past five years, a series of studies has suggested that the tests are not sensitive enough: frequent false positives lead to too many unnecessary medical procedures, and false negatives give men a false sense of security. In 2012, the test was given a ‘D’ rating by the U.S. Preventive Task Force, and the test is no longer covered by some insurers.”
“After surgery to remove the prostate, more than 30 percent of men have a recurrence, and until now there has not been clear evidence about the best way to stop the disease from killing them. Most are given radiation, but prescribing drugs to counter the effects of male hormones has been inconsistent.”
“One in four men presenting with elevated prostate-specific antigen (PSA) may be able to safely avoid prostate biopsy if they have triage testing with multi-parametric magnetic resonance imaging (MP-MRI) first, researchers said.
“The use of MP-MRI might also improve the detection of clinically significant cancer compared with transrectal ultrasound-guided prostate biopsy (TRUS-biopsy) and reduce over-diagnosis of clinically insignificant prostate cancer, the multicenter, paired-cohort, confirmatory PROMIS (PROstate MR Imaging Study) showed.”
“The FDA today approved Axumin, an injectable radioactive diagnostic agent used to detect recurrent prostate cancer.
“The agent is indicated for PET imaging in men who have suspected prostate cancer recurrence based on elevated PSA levels following treatment.
“The FDA based its decision on results of two studies that evaluated the safety and efficacy of Axumin (Blue Earth Diagnostics). One study compared 105 Axumin scans to histopathology obtained by prostate biopsy and by biopsies of suspicious imaged lesions in men suspected of having prostate cancer recurrence. In the second study, researchers evaluated 96 Axumin scans with C11 choline scans in patients with a median PSA of 1.44 ng/mL.”
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When I was in my ’30s, I worked as a medical writer at the Chicago Sun-Times. I occasionally wrote articles about the troublesome prostate gland.
Here’s what I knew about the prostate:
A normal healthy gland is about the size of a walnut.
Older men often have enlarged prostates that cause them to wake up frequently at night to urinate. (I once overheard my father and father-in-law quietly discussing how their prostates kept them up at night.)
Advanced prostate cancer could spread into the bones and cause unbearable pain.
In most cases the disease grows slowly, which means men typically died with, but not from prostate cancer.
What did I know about my own prostate? Again, not much.
“Incorporating scores from two urine-based biomarker assays may reduce the number of biopsies men with clinically localized prostate cancer need to undergo without greatly affecting 10-year survival rates, according to the results of a decision analysis.
“ ‘Results from recent studies have demonstrated the potential clinical utility of the urine-based PROGENSA prostate cancer antigen 3 (PCA3) assay (Gen-Probe, Inc.) to predict repeat biopsy outcomes in men with elevated serum PSA levels and previous negative biopsy findings,’ Brian T. Denton, PhD, associate professor of industrial and operations engineering at University of Michigan, and colleagues wrote. ‘A recent literature review reported current evidence suggesting that the PCA3 test is clinically useful for selecting which patients should undergo repeat biopsy. Several studies have determined that urine assessment of [T2:ERG] is also associated with biopsy outcome and may be better at discriminating between low-grade and high-grade cancers.‘ “
“Denton and colleagues performed a decision analysis using a decision tree to evaluate the clinical value of using PCA3 and T2:ERG scores to determine the need for repeat biopsy in men with clinically localized prostate cancer who had at least one prior negative biopsy. Researchers estimated the probability for cancer by using the Prostate Cancer Prevention Trial Risk Calculator.”
“A recently developed drug was significantly better at detecting recurring prostate cancer in early stages, in research published in the August 2015 issue of The Journal of Nuclear Medicine. In the study, the imaging agent—Ga-68 prostate-specific membrane antigen (Ga-68 PSMA)—used with positron emission tomography and computed tomography (PET/CT), changed management in 44% more cases than another widely used agent.
” ‘This is the first prospective comparative trial evaluating detection rates and management impact of the more widely available radiopharmaceutical F-18 fluoromethylcholine (FMC) and the recently developed Ga-68 PSMA PET tracer agent in men with prostate cancer,’ said Joshua James Morigi, MD, lead author of the study. ‘We specifically addressed men with prostate cancer and low PSA levels, at which current imaging techniques struggle in detecting disease.’ “