The holy grail will be the ability to predict which cancers are aggressive, based on cell biology. Meanwhile, the new test is an advance on the PSA. A new prostate cancer screening test will be a definite advance on the PSA, and promises to reduce unnecessary biopsies, a prominent urologist says. Professor Phillip Stricker, chairman […]
The holy grail will be the ability to predict which cancers are aggressive, based on cell biology. Meanwhile, the new test is an advance on the PSA.
A new prostate cancer screening test will be a definite advance on the PSA, and promises to reduce unnecessary biopsies, a prominent urologist says.
Professor Phillip Stricker, chairman of the Department of Urology at Sydney’s St Vincent’s Clinic, said the test, dubbed the STHLM3, would go some way to improving the detection of aggressive tumours when combined with newer imaging techniques.
The combination test analyses six currently available protein markers and over 200 genetic markers, along with demographic factors, and will become available March next year in Sweden.
“You can’t do an MRI on everyone, but hopefully combining tests like these with imaging tests will be more how it’s going to look in five years’ time,” Professor Stricker said.
Professor Stricker was referring to Swedish study of 60,000 men that found the test performed significantly better than PSA alone for detection of cancers with a Gleason score of at least 7.
In future, “imaging tests will be much more meaningful in terms of screening for prostate cancer and ensuring that we don’t find the unimportant ones,” he told The Medical Republic.
The test reduced the number of biopsies by 32% without compromising patient safety, and could avoid 44% of benign biopsies, the Karolinksa Institute researchers wrote.
In the population study, the test was compared with the PSA in men aged 50-69, where it was found to pick up aggressive cancers in men with low PSA values (1-3ng/mL).
Professor Ian Olver, Director of the Sansom Institute for Health Research in South Australia, said the test was a good interim measure, and one that would cut down on overtreatment and its associated health problems.
“The trouble at the moment is that the PSA test isn’t accurate enough, and so a raised PSA is leading to biopsy, and biopsy is leading to treatment,” Professor Olver said.
While cutting unnecessary biopsies would save money associated with hospital costs and complications from infections and bleeding, Professor Olver says the ‘holy grail’ was the ability to predict which cancers will be aggressive based on the biology of the cells.
Regardless of the improvements on the new test, Associate Professor Ian Haines, a Senior Medical Oncologist and Palliative Care Physician at Monash University, remained firm that asymptomatic men should not be screened.
“Yes it could reduce [biopsies], but that is still a huge number of unnecessary biopsies and we haven’t proven that even with high risk cancer that aggressive treatment prevents deaths,” Professor Haines said.
“Stop sending all these well men to get potentially harmful biopsies,” he said. “I don’t know any oncologists that would have a PSA and I wouldn’t have one.”
“I’d personally tell patients to understand that you’re strapping yourself into a rollercoaster once you have a PSA, and once you strap yourself into the rollercoaster it’s very hard to get off.”
Lancet Oncology 2015; online November 9
