New Prostate Cancer Test: A Major Advance?

An article in the current issue of the journal Urology illustrates some of the hopes and barriers related to advancing our abilities to diagnose prostate cancer accurately through screening tests at the earliest possible time.

This particular article reports information about a prostate cancer protein found in the blood called EPCA-2.

The research, performed at Johns Hopkins in Baltimore -- recognized as one of the leading prostate cancer treatment and research centers in the world -- demonstrates that this new marker appears to be more sensitive and specific in detecting prostate cancer compared to the widely used PSA test.

But the question remains whether or not this is a major advance in the screening and diagnosis of prostate cancer.

An Imperfect Tool

The problem with the PSA test, which the article notes has been around and widely used for more than 25 years, is that, although it does detect prostate cancer through a fairly simple and routine blood test, it nonetheless is not particularly specific to prostate cancer.

That means that it frequently picks up other prostate conditions such as benign, or noncancerous, enlargement of the gland.

Another issue with the PSA test is what is normal and what is abnormal in terms of the PSA level in the blood.

We used to say that a PSA value on the blood test that was less than four was OK. More recent research suggests that even lower levels can be associated with prostate cancer.

When determining a "normal" PSA, the doctor should be considering the age of the patient and the change in the PSA value over time.

What that means is that if a young man (for this discussion, that would be someone in their 40s or early 50s) has a PSA of two, that may be abnormal, while a PSA slightly more than four in an 80-year-old man may not be of much concern.

It would be great if we had another simple test that helped solve some of these problems and allowed us to focus on those men who actually have prostate cancer as opposed to doing further investigations and evaluations on many men who don't have prostate cancer.

After all, these tests are not simple, inexpensive or painless. They involve rectal ultrasounds, biopsies, discomfort and risk, and even then, they can miss a prostate cancer if the biopsy doesn't "hit" the cancer when it is performed.

The researchers report in this current study that their new test is, in fact, more accurate in diagnosing prostate cancer, and it may also distinguish whether the cancer is still in an early stage when it is confined to the prostate gland, or if it is more advanced when it has broken through the capsule that surrounds the gland.

New Hope for Detection?

The next logical question is whether this test is really as good as it seems. And if it really is a major advance, you might be asking how soon the test will be available.

The answer to the first question is we hope it is. The answer to the second question is we don't know.

Frequently, when these types of papers appear in the literature, there are great claims made that the new test is a major advance and many folks get very excited about them.

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