Blood-Based Assays Are Addition, But Not Replacement for Lung Tissue Biopsies

Excerpt:

“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.’ ”

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Multi-Parametric MRI Could Avoid Second Prostate Biopsies in Some Men

Excerpt:

“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.”

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Finding Skin Cancer in a Flash

Excerpt:

“The typical nude skin cancer checks with long photo sessions at your dermatologist’s office to track any suspicious skin marks just got a lot more accurate, while reducing the chance of unnecessary biopsies.

“UConn Health is the only institution to date in Connecticut to offer the latest advanced smart technology that hunts for  and keeps an eye on changing moles.

“An integrated body-scanning camera and smart software technology “helps us find skin cancer in a flash,” says Dr. Jane Grant-Kels, professor and vice chair of UConn Health’s Department of Dermatology and director of the UConn Cutaneous Oncology Center and Melanoma Program.”

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Testing After DCIS Needle Biopsies: $35 Million Boondoggle

Excerpt:

“In the United States, a common practice in the management of ductal carcinoma in situ (DCIS) costs an estimated $35 million a year, but is unnecessary, according to a new study.

“Automatically testing core needle biopsy DCIS specimens for hormone receptors is wasteful for a variety of reasons and should be abandoned, say the researchers, led by Pedram Argani, MD, a surgical pathologist at Johns Hopkins Hospital in Baltimore.

“The study was published online June 13 in the American Journal of Surgical Pathology.

“Core biopsy testing is not needed because the results do not influence the next step in standard therapy — surgical excision. Testing can be done later, if needed, on the larger excised specimen, Dr Argani and his colleagues explain.”

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New Test for Prostate Cancer Significantly Improves Prostate Cancer Screening

“A study from Karolinska Institutet in Sweden shows that a new test for prostate cancer is better at detecting aggressive cancer than PSA. The new test, which has undergone trial in 58,818 men, discovers aggressive cancer earlier and reduces the number of false positive tests and unnecessary biopsies. The results are published in the scientific journal The Lancet Oncology.

“Prostate cancer is the second most common cancer among men worldwide, with over 1.2 million diagnosed in 2012. In number of men diagnosed with prostate cancer increases and within 20 years over 2 million men are estimated to be diagnosed yearly. Currently, PSA is used to diagnose prostate cancer, but the procedure has long been controversial.”


Kallikrein Markers Improve High-Grade Prostate Cancer Detection, Reduce Unnecessary Biopsies

“A statistical model using kallikrein markers better predicted high-grade prostate cancer in men with elevated PSA levels and reduced unnecessary biopsies compared with PSA level and age alone, according to the results of a prospective analysis.

“ ‘Risk of death from prostate cancer is strongly associated with levels of PSA in blood measured in middle-aged men,’ Hans Lilja, MD, PhD, of Memorial Sloan Kettering Cancer Center, and colleagues wrote. ‘Evidence from randomized screening trials in Europe shows that PSA-based screening can reduce deaths from prostate cancer, but also leads to overdiagnosis and the risk of overtreatment among elderly men with a limited life expectancy.’

“Previous retrospective studies identified four kallikrein markers — free PSA, intact PSA, total PSA and human kallikrein-related peptidase 2 (hK2) — that can predict biopsy outcomes, according to study background.”


Prostate Screening: Combining MRI with Conventional Prostate Surveillance Effective, Study Suggests

“Initial results from the Göteborg randomised screening trial indicates that using MRI (Magnetic Resonance Imaging) alongside conventional prostate cancer screening seems to offer improved cancer detection and can help avoid unnecessary biopsies.

“Prostate cancer is the third most common male cancer in Europe, accounting for over 92,000 deaths in 2012 (9% of male deaths). Screening for prostate cancer is a controversial issue, with until recently, little clear evidence that existing screening procedures, using PSA (to be followed by biopsies), were effective. In general, either the screening has tended to miss many cancers, or to give false positives, meaning that many men are subject to invasive testing and perhaps treatment which was just not necessary.

“The Göteborg Trial is the Swedish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC), which is the largest randomized prostate cancer screening trial in the world. In 2014 results from this trial showed a significant mortality reduction with prostate-specific antigen (PSA) screening for men aged 55-69 years of age. Now new work, presented at the European Association of Urology Conference in Madrid, shows that using MRI may further improve the accuracy of prostate cancer screening. This research has been awarded the EAU’s First Prize for the Best Abstract by a Resident.”


Sentinel Lymph Node Biopsy Doesn't Up Survival for People with Melanoma of the Head and Neck

The gist: A procedure called sentinel lymph node biopsy (SLNB) might not be necessary for patients with melanoma of the head and neck. A study found that SLNB did not improve survival rates for these patients.

“For patients with melanoma arising in head and neck subsites (HNM), there is no association between sentinel lymph node biopsy (SLNB) and disease-specific survival (DSS), according to research published in the December issue of JAMA Otolaryngology-Head Neck Surgery.

“Steven M. Sperry, M.D., from the University of Iowa in Iowa City, and colleagues examined the correlation of SLNB with survival for HNM. They compared U.S. patients with HNM meeting current recommendations for SLNB, treated with either SLNB with or without neck dissection or no SLNB or neck dissection, in a propensity score-matched retrospective cohort study. Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) database for 7,266 patients.

“Treatment cohorts were matched using propensity scores modeled on 10 covariates known to be associated with SLNB treatment or melanoma survival. The researchers found that in the intermediate thickness cohort, 2,808 patients with HNM were matched and balanced by SLNB treatment: the five-year DSS was 89 percent for those treated by SLNB versus 88 percent for those undergoing nodal observation (log-rank P = 0.30). For those undergoing SLNB, the hazard ratio for melanoma-specific death was 0.87 (P = 0.31). No significant differences were seen in DSS for any of the cohorts analyzed, including those with thin and thick melanomas.”


PCA3 May Have Role Predicting Prostate Biopsy Outcome

“The use of a prostate cancer antigen 3 (PCA3) urine test could help men avoid undergoing unnecessary repeat biopsies, and could help physicians predict which men undergoing initial biopsy will be positive for cancer.

“John T. Wei, MD, of the University of Michigan, and colleagues published the results of the National Cancer Institute Early Detection Research Network validation of PCA3 trial in the Journal of Clinical Oncology.

“According to Wei, how physicians decide to send a patient for prostate biopsy is continuing to evolve. Although in the past, an abnormal PSA test resulted in an order for a biopsy, the discovery and validation of new biomarkers is changing that precedent.

“ ‘Prostate cancer tests such as the PCA3, an FDA approved, commercially available urine assay for prostate cancer, are allowing doctors to more accurately determine if a man has prostate cancer prior to a biopsy,’ Wei told Cancer Network. ‘Based on our findings, using PCA3, many fewer men will need to undergo a repeat prostate biopsy. On the other hand, PCA3 may also indicate an elevated risk of prostate cancer in other men, prompting them to undergo a prostate biopsy when its needed.’

“In the study, Wei and colleagues evaluated 859 men scheduled for diagnostic prostate biopsy between 2009 and 2011. The researchers evaluated whether the PCA3 urine test had a high positive predictive value at initial biopsy and a high negative predictive value at repeat biopsy.”