Doctors can now detect hard-to-diagnose prostate cancer

August 9, 2012

Researchers have successfully developed and tested a new prostate cancer screening method that uses the combined power of a novel drug therapy and changes in PSA levels over time to identify men with a high PSA who are more likely to have aggressive prostate cancer despite negative biopsies.

The new study by researchers at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, published in the Journal of Urology, shows that PSA can be a much more effective marker for when an additional is used than it can as a stand-alone test, which is how it is currently used by physicians.

"At a time when the value of PSA is being increasingly debated, we have shown that when used in a specific way, it can be of great value in identifying with previously undetected prostate cancer," says the study's lead investigator, Dr. Steven A. Kaplan, the E. Darracott Vaughan Jr., Professor of Urology at Weill Cornell Medical College and director of the Iris Cantor Men's Health Center at NewYork-Presbyterian/Weill Cornell.

"We have shown that using PSA with these drugs can help us differentiate prostate cancer from benign prostate disease in patients who are difficult to diagnose," says Dr. Kaplan, who is also chief of the Institute for Bladder and Prostate Health at NewYork-Presbyterian/Weill Cornell. "It also demonstrates a better way to use both the and these powerful drugs."

Dr. Kaplan created the combination as a way to understand in men who have consistently abnormal PSA readings despite one or more negative biopsies. This patient population offers physicians a "diagnostic dilemma" he says -- "despite the fact that biopsies are becoming more and more effective at detecting cancer in the prostate, a significant number of patients with prostate cancer continue to have negative biopsies." He adds that the PSA () test alone is not a good indicator of prostate cancer. "It measures multiple factors associated with prostate disease, including enlargement of the prostate and inflammation."

The research team decided to see what would happen to after the use of two 5-alpha-reductase inhibitor drugs -- finasteride and dutasteride -- designed to reduce the size of an enlarged prostate. The theory is that these drugs might improve the usefulness of PSA in diagnosing prostate cancer. If the PSA remains persistently high even though the prostate has shrunk, or PSA rises after having reached its lowest level, it could indicate the presence of cancer. And when the gland is smaller, a biopsy can be more effective, according to researchers.

The study was conducted in two phases. It enrolled 276 men at NewYork-Presbyterian/Weill Cornell whose PSA was greater than 4, who had a normal digital rectal examination and two or more negative biopsies.

In the first phase, 97 patients, who were given 5 milligrams of finasteride or 0.5 milligrams of dutasteride daily, had their PSA measured at 6 and 12 months, a transrectal ultrasonography and a biopsy performed at 1 year. Study results show that a year of the drug therapy reduced PSA in all the men -- an average of 48 percent -- but the magnitude of reduction was significantly greater in men with benign prostate disease and significantly less in 28 percent of the patients whose prostate biopsy detected cancer.

In the second phase of the study, 179 patients received the same drug therapy but underwent a biopsy only if their PSA showed a change of 0.4 ng/dl. In all, 42 men (27 percent) had the biopsy, and 26 of those participants (54 percent) had cancer. Within that group, 77 percent of the patients had high-grade tumors.

Researchers successfully identified cancer cases in men who participated in the second phase study with the combined drug therapy and evaluation of PSA trends, by sending those with minimal changes for a biopsy. This meant that men who didn't need a biopsy did not have one – unlike all the men in phase one.

"Our study shows these drugs may be most helpful in helping us diagnose undetectable prostate cancer," Dr. Kaplan says.

Explore further: When rising PSA means prostate cancer is in patient's future

Related Stories

When rising PSA means prostate cancer is in patient's future

May 18, 2011
A man's rising PSA (prostate-specific antigen) level over several years – which had been seen as a possible warning sign of prostate cancer – has recently come under fire as a screening test because it sometimes ...

PSA test valuable in predicting biopsy need, low-risk prostate cancer

October 21, 2011
The prostate-specific antigen test, commonly known as the PSA test, is valuable in predicting which men should have biopsies and which are likely to be diagnosed with low-risk prostate cancer, a Mayo Clinic study has found. ...

New prostate cancer test gives more accurate diagnosis

April 6, 2011
In a large multi-center clinical trial, a new PSA test to screen for prostate cancer more accurately identified men with prostate cancer -- particularly the aggressive form of the disease -- and substantially reduced false ...

PSA test for men could get a second life for breast cancer in women

July 13, 2011
The widely known PSA blood test for prostate cancer in men may get a second life as a much-needed new test for breast cancer, the most common form of cancer in women worldwide, scientists are reporting in a new study in the ...

Recommended for you

Lung cancer triggers pulmonary hypertension

November 17, 2017
Shortness of breath and respiratory distress often increase the suffering of advanced-stage lung cancer patients. These symptoms can be triggered by pulmonary hypertension, as scientists at the Max Planck Institute for Heart ...

Researchers discover an Achilles heel in a lethal leukemia

November 16, 2017
Researchers have discovered how a linkage between two proteins in acute myeloid leukemia enables cancer cells to resist chemotherapy and showed that disrupting the linkage could render the cells vulnerable to treatment. St. ...

Computer program finds new uses for old drugs

November 16, 2017
Researchers at the Case Comprehensive Cancer Center at Case Western Reserve University School of Medicine have developed a computer program to find new indications for old drugs. The computer program, called DrugPredict, ...

Pharmacoscopy improves therapy for relapsed blood cancer in a first clinical trial

November 16, 2017
Researchers at CeMM and the Medical University of Vienna presented a preliminary report in The Lancet Hematology on the clinical impact of an integrated ex vivo approach called pharmacoscopy. The procedures measure single-cell ...

Wider sampling of tumor tissues may guide drug choice, improve outcomes

November 15, 2017
A new study focused on describing genetic variations within a primary tumor, differences between the primary and a metastatic branch of that tumor, and additional diversity found in tumor DNA in the blood stream could help ...

A new strategy for prevention of liver cancer development

November 14, 2017
Primary liver cancer is now the second leading cause of cancer-related death worldwide, and its incidences and mortality are increasing rapidly in the United Stated. In late stages of the malignancy, there are no effective ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.