A study published online by the journal Cancer reveals that up to one-quarter of men could avoid biopsies and their associated risks with prostate cancer screening that combines an adjusted blood test with other factors including, the patient’s family history, overall weight as well as the size of the gland.

According to the team led by Martin G. Sanda, MD, Director of the Prostate Center at Beth Israel Deaconess Medical Center and Professor of Urology at Harvard Medical School, other factors such as prostate size should be taken into consideration when determining which patient should have a biopsy, instead of using “one-size-fits-all” levels of PSA.

Other factors, such as prostate size, can significantly improve the ability of PSA testing to detect aggressive prostate cancers for which treatment is appropriate, while avoiding identification of indolent cancers that do not require treatment.

A second investigation published online in the journal Urologic Oncology, also led by Sanda, reveals that another way to determine if a biopsy is needed is testing for the presence of absence of genes commonly found in the urine of men in conjunction with a PSA test.

The novel suggested methods follow the United States Preventative Services Task Force expert panel conclusion that the present PSA-based prostate cancer screening causes harm through treatment or additional invasive testing, such as biopsies, and saves few or no lives.

Sanda explains:

“That’s because prostate cancers can vary in aggressiveness and more men die of other causes aside from that cancer, and because the PSA test alone can not determine how dangerous any particular cancer may be. The US Preventative Services Task Force threw the baby out with the bathwater by their blanket recommendation against prostate cancer screening.”

Sanda notes that, instead, PSA screening can be improved to identify only aggressive cancer for which treatment is indicated by adjusting PSA results for other considerations, such as size of prostate, obesity, and family history.

According to results from the multi-center study PSAD levels of less than 0.1 – in comparison to the unadjusted level of between 2.5 and 4 – can be a significant indicator of a potential cancer. Physicians determine the density by a using a digital rectal exam, allowing them to consider other factors like benign prostatic hyperplasia, an enlargement of the gland that affects all men as they age.

The researchers discovered that combining PSAD with the digital exam, an examination of the patient’s family history and a body mass index of 25 or less, would avoid biopsy in around one-quarter of biopsy-eligible men.

The researchers state:

“Urological practice, patient outcome and cost-effectiveness of health care would each benefit from new targeted strategies, such as nomograms (a predictive tool) that improve prediction of aggressive cancers, to enable selective identification of candidate for prostate biopsy that would improve the yield of clinically significant, histologically aggressive cancers warranting subsequent definitive treatment.”

In an additional multi-center investigation published in Urologic Oncology, investigators explain that a test taken after a digital rectal exam that looks for two specific genetic biomarkers (TMPRSS2:ERG and PCA3), could prevent biopsies in men whose PSA reading ranges between 2-10 and who poses both genes. This could potentially stop one-third of men undergoing unnecessary biopsies.

Sanda, explains:

“Urine testing for prostate cancer is
in its infancy”.

Further research is currently underway thanks to a $3.1 million grant from the National Institutes of Health. The study is assessing novel blood and urine test for prostate cancer in over 2,400 men over the next 5 years with the aim of resolving over-diagnosis and over-treatment.

One of the main focuses of proposed study involves a community outreach effort led by BIDMC primary care physician J. Jacques Carter, MD, MPH, Medical Director of the Dana Farber Cancer Institute Prostate Cancer Screening and Education Program and an Assistant Professor of Medicine at Harvard Medical School. A vital component of this investigation will be African-American men, who seem to develop prostate cancer more prevalently, and who have a higher risk of dying from prostate cancer.

Written by: Petra Rattue