All posts by Darren K

Prostate biopsies could be avoided with MRI

https://www.yahoo.com/news/prostate-biopsies-could-avoidable-mris-study-090415741.html

A quarter of men suspected of having prostate cancer could avoid invasive and potentially dangerous biopsies with the help of MRI scans, researchers reported Friday.

Magnetic resonance imaging (MRI) could also reduce the number of men over-diagnosed with the disease by five percent, they detailed in a study published in The Lancet.

More PSA Tests

My PSA has risen to 4.4 as of my most recent test, roughly 10% above the test over a year ago.  Anything over 4 is officially considered high for my age group.   My PSA has been rising almost 10% a year on average for almost 9 years.  Best I can tell, this simply means that my prostate has been growing almost 10% a year, most likely due to a common benign condition known as BPH.  A sudden increase on PSA or detection of lumps on a DRE by a physician would likely lead to additional testing.

PSA testing is still controversial, with new studies and policies recommending against routine testing.  There are also experts who still think it is a valuable tool, highlighted by Ben Stiller’s recent comments.

http://www.livescience.com/56371-ben-stiller-prostate-cancer-psa.html

One problem with the PSA test is that it often suggests that men have prostate cancer when they do not have cancer, according to the USPSTF. About 75 percent of men with abnormally high levels of PSA do not have cancer. These so-called false positive results can lead to anxiety and unnecessary follow-up tests, the USPSTF says.

 

 

Aspirin and Prostate Cancer

Can Aspirin reduce the risk of aggressive prostate cancers?

 

The analysis found that regular aspirin resulted in a 24% lower risk of developing lethal cancer after being diagnosed with an early stage of the disease, and a 39% reduced risk of dying from prostate cancer.

But aspirin had little effect when researchers looked at overall incidence of prostate cancer among the participants. “It was after diagnosis of prostate cancer that there appeared to be a benefit,” said Christopher Allard, lead author of the study and a urologic oncology fellow at Harvard Medical School. “It doesn’t affect the incidence, but it affects the progression.”

http://www.wsj.com/articles/regular-use-of-aspirin-may-lower-mens-risk-of-advanced-prostate-cancer-1451946945

More on the 4KScore

Since Medscape saw fit to remove their content from our previous post, here’s a newer article about how the 4KScore may help reduce unecessary prostate biopsies:

clinicaloncology.com

“The role of the 4Kscore,” explained Sanoj Punnen, MD, an assistant professor in the Department of Urology at the University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, in Florida, “is to determine which patients are most likely to have an aggressive cancer and would, therefore, benefit from … biopsy. This allows us to forgo biopsies in men who are unlikely to ever suffer any serious consequences from a high-grade cancer.”

More on the 4KScore here:

http://4kscore.opko.com/

Another new biomarker for prostate cancer

This one is a little different than some others.  University of Michigan researchers may have found a way to distinguish aggressive and less aggressive cancers:

“If this biomarker does indeed control the growth of prostate cells, it’s a new signal that’s not been seen before and could provide a potential new drug target for prostate cancer,” Franceschi said. “It could also be a potential biomarker to discriminate between fast and slow growing tumors.”

 

 

The 4Kscore? Is it Better than What We Had Before?

It seems like there is a new test every few months.  I’ve had a few of them as you may have seen in the archives of this blog.  Now there is a 4KScore test,

A newly available commercial blood test performs better than a commonly used online risk calculator in predicting which men with an elevated prostate-specific antigen (PSA) level will ultimately turn out, on biopsy, to have high-grade disease.

 

http://www.medscape.com/viewarticle/825626

PSA Testing a Hoax?

According to Richard Albin, PhD, who discovered the PSA in 1970, current testing standards may indeed be a hoax.

http://www.amazon.com/The-Great-Prostate-Hoax-Medicine/dp/1137278749/?tag=prostateblog-20

Every year, more than a million  men undergo painful needle biopsies for prostate cancer, and upward of 100,000 have radical prostatectomies, resulting in incontinence and impotence. But the shocking fact is that most of these men would never have died from this common form of cancer, which frequently grows so slowly that it never even leaves the prostate. How did we get to a point where so many unnecessary  tests and surgeries are being done? In The Great Prostate Hoax, Richard J. Ablin exposes how a discovery he made in 1970, the prostate-specific antigen (PSA), was co-opted by the pharmaceutical industry into a multibillion-dollar   business. He shows how his discovery of PSA was never meant to be used for screening prostate cancer, and yet nonetheless the test was patented and eventurally approved by the FDA in 1994. Now, doctors and victims are beginning to speak out about the harm of the test, and beginning  to search for a true prostate cancer-specific  marker.

MRI-Ultrasound Fusion Biopsy

It’s called the Artemis System or the UroNav Fusion Biopsy System with DynaCAD software, and it may be coming to a hospital or urologist near you.  I had a similar procedure a few years ago at the NIH, though this research was also exploring the use of high definition MRI as a non-invasive alternative to biopsy.  Will it reduce the number of false negatives for prostate biopsies or improve localization of a known tumor?  We can only hope so!

“As with PCs in 1975,” said Dr. Marks, “there are some deniers, but not many once they see the dramatic results of fusion-guided biopsies. Despite the cost, the learning curve, the new technology, and the time investment, the train has left the station.”

In fact, he said that his department believes MRI-ultrasound fusion represents the gold standard for prostate biopsies today. Nationally, said Dr. Marks, urologists use MRI-ultrasound fusion in less than 1% of the 1 million prostate biopsies performed yearly. But that will change quickly, he said, as heavyweight imaging companies continue putting their marketing muscle behind the technology.”

http://urologytimes.modernmedicine.com/urology-times/news/mri-guiding-future-prostate-cancer-diagnosis?page=full

PSA Testing: Down, but not out!

http://www.bloomberg.com/news/2013-08-07/prostate-test-warrants-rational-use-doctors-say.html

 

“Abandonment of PSA testing would lead to a large increase in men presenting with advanced prostate cancer and a reversal of the gains made in prostate-cancer mortality over the past three decades,” the doctors said in the statement. Deaths from the disease have declined by more than 30 percent since testing started, they said.

New Prostate Biopsy Tests Improve Results of Traditional Biopsy

Two new tests are now available that screen material from biopsy samples.  One attempts to reduce the possibility of false negatives in a biopsy that had a negative result for cancer.  The ConfirmMDx test essentially increases the range of a biopsy sample, allowing the laboratory to detect cancer from genetic markers in tumors that may not have been directly sampled and otherwise missed.  This can reduce the need to retest in a future biopsy.  From Reuters.com:

When a prostate biopsy is performed for appropriate indications, there may be concern that the cancer may have been missed, despite the usual 10-14 core sampling. Tests which can improve the negative predictive value for a 1st time biopsy have clinically significant benefit, thus potentially avoiding unnecessary repeat biopsies,” said Neal Shore, MD, FACS, CPI, Medical Director at the Carolina Urologic Research Center. “ConfirmMDx is a valuable addition to our armamentarium and addresses an unmet need in diagnostic evaluation.  Many men are subjected to unnecessary repeat biopsies, with the attendant morbidity and cost, as a result of an elevated PSA as well as the concern of missing an undetected cancer.  ConfirmMDx assists in the avoidance of unnecessary repeat biopsies.”

 

The second test, Oncotype DX, uses genetic information on a positive biopsy result to help distinguish aggressive prostate cancer from slow growing tumors.  This may help a patient and physician choose a treatment plan.  From Reuters.com:

The results of our study showed that the individual biological information from the Oncotype DX prostate cancer test tripled the number of patients who can more confidently consider active surveillance and avoid unnecessary treatment and its potential side effects. The test also identified a smaller number of patients who, despite seemingly low-risk clinical factors, had more aggressive disease and, would suggest that they consider immediate treatment,” said Peter Carroll, M.D., MPH, professor and chair, Department of Urology, UCSF and principal investigator of this validation study.  “With these new study results, I believe we may be able to significantly increase the use of active surveillance, which has been limited to some extent by the absence of a validated genomic tool to more accurately distinguish low and high risk disease at the time of biopsy.