Most men cringe at the thought of any type of painful procedure involving their “private parts.” So the idea of a prostate biopsy–involving multiple punctures taking around 12 pieces of prostate tissue with a long needle–doesn’t sound like much fun (even though it doesn’t take long and the area is numbed). Men of all ages will be happy to know that a new study published in The Journal of Urology shows that a simple urine test may eliminate the need for some prostate biopsies.
Prostate Cancer
Prostate cancer is the most common cancer (other than skin cancer) that affects men. It is the second leading cause of death from cancer in men, right behind lung cancer. About 1 out of 8 men will be diagnosed with prostate cancer in his lifetime, and about 1 in 41 men will die of prostate cancer.
That’s why screening for prostate cancer is so important. Screening should start at 50 for all men, and at 45 for men who are at high risk for prostate cancer, including African-American men or men who have a first-degree relative (father or brother) who have been diagnosed with prostate cancer before 65. Those at even higher risk (more than one first-degree relative with prostate cancer before 65) should start screening at 40.
Current Screening Process
The screening process for prostate cancer usually starts with a PSA (prostate-specific antigen) blood test. This test measures the levels of a certain protein in the blood. Though there is no specific cutoff point that means a man definitely has prostate cancer, a level under 4 is considered to be “good,” with minimal chance of cancer being present. With a level between 4 and 10, a man should talk to his urologist about further testing as the chances run about 25% that there may be prostate cancer. With a level over 10, a man has about a 50% chance of having prostate cancer and definitely needs further screening.
Another type of screening for prostate cancer is a digital rectal exam. This involves a urologist inserting a gloved, lubricated finger into the rectum to physically check the prostate for enlargement, a sign of cancer.
Before making the decision to biopsy, your urologist may use mp-MRI imaging to determine if a biopsy is needed as well as to discover which areas to focus on if a biopsy is necessary.
If these tests are cause for suspicion, the next test is usually a prostate biopsy. This test involves taking about 12 samples of prostate tissue with a long needle inserted through the rectum or the peritoneum. The urologist uses imaging to guide the needle to any suspicious tissues. If the results of the biopsy show cancerous cells, treatment for prostate cancer is likely to be recommended.
The Study
The study showed that a urine test called MyProstateScore could avoid up to one-third of unnecessary prostate biopsies. This simple urine test looks for certain cancer-specific genes (a fusion of TMPRSS2 and ERG) that signal that prostate cancer may be present. According to research by the University of Michigan, half of all prostate tumors have this marker. Another test of this type is called the SelectMDx test. If the urine test is positive, prostate biopsy is the next step in screening.
Conclusion
No prostate screening test is perfect, including this new urine test. The study authors found that biopsy could have likely been avoided in 387 men by using the urine test first. However, the urine test would have missed cancers in about 10 men. However, for many men, using this non-invasive procedure could avoid the costs, discomfort, and possibility of complications that come with a prostate biopsy.
References
- Screening Tests for Prostate Cancer
- Key Statistics for Prostate Cancer
- Use of the MyProstateScore Test to Rule Out Clinically Significant Cancer: Validation of a Straightforward Clinical Testing Approach
- Tests to Diagnose and Stage Prostate Cancer
- Prostate-Specific Antigen (PSA) Test
- What Is Screening for Prostate Cancer?
- Current techniques of prostate biopsy: an update from past to present
- Study: New Prostate Cancer Test Could Avoid Unnecessary Biopsies