Current prostate cancer screenings leave a lot to be desired, with its notorious inaccuracies giving men and their doctors a lot to worry about. Scientists are on it. The many newer tests currently trying to prove their accuracy and cost-effectiveness include:
PCA3 (for prostate cancer gene 3). This urine assay obtained after a digital rectal exam can detect a specific type of RNA produced by cancerous prostate cells at three times the rate of healthy prostate cells. A low score provides reassurance to men with a first, negative biopsy that it’s okay to defer a repeat.
phi (Prostate Health Index). This blood test measures and combines into a single score levels of three different blood chemicals: regular PSA, so-called “free” PSA, and a precursor PSA compound known as [-2]proPSA. Its maker claims its three times more accurate than PSA alone, which may or may not be saying much.
TMPRSS2:ERG fusion. This urine test looks for an abnormal merging of two genes found in some prostate cancers and rarely found in cells of men free of the disease. Researchers are still trying to determine its value in the clinical setting.
The 4Kscore. This new blood test tallies a man’s total PSA, free PSA, intact PSA, human kallikrein 2 (hK2), along with some other factors. Though more research is necessary to prove its benefits, a 2015 report in Reviews of Urology summarized the results of 10 peer-reviewed studies conducted so far in Europe and the US. The authors concluded it has considerable promise in discriminating between lethal and nonlethal prostate cancers and may one day allow physicians “safely avoid prostate biopsy in men whose cancers are better left alone, and focus intervention on men who are most likely to benefit from it.”
ConfirmMDx. This genetic test checks normal-appearing prostate tissues for cancerous changes in DNA. Biopsies are able to sample, at best, only 1 percent of the entire prostate, and doctors frequently worry that some patients may harbor cancer that the needle has simply missed. ConfirmMDx looks for tell-tale epigenetic changes, such as the silencing of key tumor suppressor genes, which can signal cancer even when a biopsy looks completely clean under the microscope. For guys who are truly clean, the test lets them off the hook for more prostatic pin-cushioning.
PCS, or Prostate Cancer Subtype. Though far from ready-for-prime-time yet, a team of researchers have identified three distinct patterns of gene activation in tumor cells, which they’ve dubbed PCS1, PCS2, and PCS3. “One type in particular, PCS1, is strongly associated with poorer outcomes,” explains Michael Freeman, PhD, director of Cancer Biology and Therapeutics Research in the Cedars-Sinai Department of Biomedical Sciences. In a study published last September in Cancer Research, Freeman and his team report that these subtypes are independent of Gleason scoring, appear to be fairly stable over time, and can be measured through blood tests as well as prostate sampling. A lot more work remains, says Freeman, “but we think our classification system could be a significant step forward in applying precision medicine to prostate cancer diagnostics and subtype-specific treatment strategies.”
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