A Better Prostate-Cancer Test?

Excerpt:

“When Al Piazza learned he had prostate cancer, his first thought was, ‘Let’s get this out and be done with it,’ he says. But his urologist, Jeremy Lieb, said the side effects of treatment could be more harmful than the cancer itself.

“Dr. Lieb ran a genetic test on the patient’s biopsy sample, which calculated that Mr. Piazza, then 70 years old, had only a 3% chance of dying from prostate cancer over the next 10 years if he left the tumor untreated.

“Four years later, the retired AT&T manager from Discovery Bay, Calif., has been monitoring his cancer with regular blood tests and imaging scans and says he is comfortable leaving it alone. ‘My feeling is—it’s there, but it’s not going to kill me,’ Mr. Piazza says.”

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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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Urine Biomarkers May Reduce Repeat Biopsies for Prostate Cancer

“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.”


Tests to Gauge Genetic Risks for Prostate Cancer Now Are Feasible

“Men with an elevated, genetically inherited risk for prostate cancer could be routinely identified with a simple blood or urine test, scientists at UC San Francisco and Kaiser Permanente Northern California have concluded, potentially paving the way to better or earlier diagnosis.

“The study, which compared 7,783 men with prostate cancer to 38,595 men without the disease, is available online and will be published in an upcoming issue of the journal Cancer Discovery.

“The new study is one of the first to come out of the collaboration between UCSF and Kaiser Permanente Research Program on Genes, Environment, and Health (RPGEH), which analyzed genetic samples and health records from more than 100,000 volunteers, making it one of the largest research projects in the United States to examine the genetic, health and environmental factors that influence common diseases such as prostate cancer.

“The researchers modeled using 105 specific bits of DNA that commonly vary among individuals and that they confirmed are associated with prostate cancer risk. While they estimated that each of these genetic variants only modestly alters risk, they determined that men with combinations of these DNA variants that placed them among the highest 10 percent for risk were more than six times as likely to be diagnosed with prostate cancer compared to the men who ranked among the lowest 10 percent for prostate cancer risk.”


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.”


Inexpensive, Accurate Way to Detect Prostate Cancer: At-Home Urine Tests

Early screening for prostate cancer could become as easy for men as personal pregnancy testing is for women, thanks to UC Irvine research published today in the Journal of the American Chemical Society.