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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MRI Can Rule Out Need for Biopsy in Men with High PSA

Excerpt:

“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.”

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New Marker May Identify Men Who Require More Aggressive Prostate Cancer Treatment

Excerpt:

“A prostate-specific antigen (PSA) nadir (the lowest level a PSA drops following treatment) greater than 0.5 ng/mL following radiation and androgen deprivation therapy seems to identify men prior to PSA failure who are at high-risk for death, and would thus require more aggressive treatment for their prostate cancer, according to the results of a recent study in JAMA Oncology.

“The study looked at data from a randomized trial of 206 men treated with either radiation or radiation plus 6 months of hormonal therapy and compared early markers of prostate cancer death to identify men at risk of dying early.”

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New Prostate Cancer Tests Aim to Reduce the Death Rate

Excerpt:

“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.”

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French Trial Shows Benefit of Adding Short-Term Hormone Therapy to Salvage Radiotherapy for Rising PSA After Prostatectomy

Excerpt:

“In the phase III GETUG-AFU 16 trial reported in The Lancet Oncology, Carrie et al found that adding short-term androgen suppression therapy to salvage radiotherapy was associated with improved biochemical or clinical progression-free survival among patients with prostate cancer who exhibited rising prostate-specific antigen (PSA) levels after radical prostatectomy.

“In the open-label trial, 743 patients from 43 sites were randomized between October 2006 and March 2010 to receive radiotherapy alone (n = 374) or with goserelin (Zoladex; n = 369). Patients had received no previous androgen-deprivation therapy or pelvic radiotherapy and had a rising PSA level of 0.2 to < 2.0 μg/L after having a level < 0.1 μg/L for at least 6 months after surgery with no evidence of clinical disease.

“Treatment consisted of three-dimensional (3D) conformal radiotherapy or intensity-modulated radiotherapy at 66 Gy in 33 fractions 5 days per week for 7 weeks or radiotherapy plus 10.8 mg of goserelin by subcutaneous injection on the first day of radiotherapy and 3 months later. The primary endpoint was progression-free survival in the intention-to-treat population.”

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NewYork-Presbyterian and Weill Cornell Medicine Urologists Urge Reconsideration of Prostate Cancer Screening After Finding Critical Flaw in Landmark Study

Excerpt:

“Evidence now favors that prostate specific antigen (PSA) testing can help reduce the number of fatal cases of prostate cancer, contrary to earlier recommendations based on a landmark national study. Researchers from NewYork-Presbyterian and Weill Cornell Medicine discuss their findings related to PSA screening in this week’s New England Journal of Medicine.

“In their letter to the editor, published May 5, the investigators question the results of a large-scale clinical trial assessing the value of PSA screening — which served as the basis for the U.S. Preventative Services Task Force’s 2012 recommendations against routine prostate cancer screening. They say limitations in the study’s methodology underscore the need for healthcare policy leaders to reevaluate the nation’s approach to PSA screening.

“Prostate cancer remains the second leading cause of cancer death among American men and is the most common cancer in men other than skin cancer.”

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Urine Test Improves Prediction of High-Grade Prostate Cancer

Excerpt:

“An experimental urine test that detects genetic changes associated with prostate cancer identified 92 percent of men with elevated PSA (prostate-specific antigen) levels who had high-grade cancers, according to a study published today in JAMA Oncology online.

“ ‘The test has the potential to be a significant improvement over PSA alone in distinguishing between low- and high-grade prostate cancer, especially in the PSA gray zone patient. It could reduce hundreds of thousands of invasive biopsies each year. Given the pain and risks associated with performing a prostate biopsy, that’s not a trivial thing,’ said first author James McKiernan, MD, the John K. Lattimer Professor and chair of urology at Columbia University Medical Center (CUMC) and urologist-in-chief at NewYork-Presbyterian/Columbia. In addition, the test is the only urine-based assay that does not require a digital rectal exam prior to collection and is easily integrated in the clinic environment.”

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Prostate Cancer: A Patient's Journey

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.


'Bipolar' Therapy: New Twist in Advanced Prostate Cancer

“Preliminary data suggest that a new twist on manipulating hormones in prostate cancer shows some benefit. The standard approach to treatment is androgen deprivation therapy (ADT), but the new approach intersperses this with bipolar androgen therapy (BAT) with intramuscular testosterone injections.

“Results from a small phase 2 study in 29 men with advanced hormone-sensitive prostate cancer show that the primary endpoint was met, with nearly 60% of men achieving a prostate-specific antigen (PSA) level <4 ng/mL after undergoing two cycles of BAT.

“The findings, which were presented at Genitourinary Cancers Symposium (GUCS) 2016, also suggest that BAT may have a positive impact on quality of life.”