Issue link: https://viewer.e-digitaledition.com/i/142244
special clinical secTion: meN'S heAlTh "PSA is one of the most successful biomarkers in the history of medicine. It's not going anywhere. Can we do better? yes — by using PSA screening more appropriately and coupling it with accurately targeted treatment." — Matthew Cooperberg, MD, MPH, assistant Professor of Urology at the University of California, San Francisco in men between ages 50 and 74, the risk of overdiagnosis decreased one percentage point. Increasing the length of screening intervals in men with low PSA levels reduced the number of screenings by 59 percent and false positives by 50 percent. Other strategies for improving the prostate cancer screening process include using hybrid imaging techniques that combine MRI and ultrasound technology to direct biopsies more effectively — a process currently being utilized at the University of California, Los Angeles — and implementing active surveillance for men whose prostate cancer is thought to be nonaggressive. "At this time, we can identify high-risk cancers about 75 percent of the time," Dr. Cooperberg says. "There are several new blood tests, tissue tests and urine tests in development or on the market, and a lot of them are quite exciting. The ultimate goal is to create a comprehensive, personalized risk-assessment tool that can be clinically validated." One of the most studied additional prostate cancer biomarkers is prostate cancer antigen 3 (PCA3), which was discovered at the University Hospital Nijmegen urology research laboratory in the Netherlands in 1999. This marker, which can be found both in prostate tissue and urine, has undergone multiple studies in diverse populations and has shown to repeatedly help identify both the possibility of prostate cancer and the aggressiveness of individual cases more effectively than PSA screening alone. Several additional tests designed to help enhance the prostate cancer screening process have appeared in the past few years, or are being prepared for market release. Two of the heavy hitters, Genomic Health and Myriad Genetics, are developers with successful track records of deploying tests for breast cancer risk assessment. "The goal of new technologies, and of PSA screening, is to get men the right diagnosis, staging and grading as early as possible," Manarite says. "It's important to recall that while these new tests can add information to the process, none diagnoses prostate cancer. Only pathology can do that." ■ WhIle The AmeRICAN academy of Family Physicians and Centers for Disease Control and Prevention have spoken out in support of the U.S. Preventive Services task Force stance against prostate-specific antigen screening, the following groups have released statements against the recommendation: + adMetech Foundation + american Cancer Society + american Society for radiation oncology + american Urologic association + Johns Hopkins Medicine + Mayo Clinic + Prostate Cancer research institute + Prostate Cancer roundtable + Society of Urologic oncologists + State of new Jersey + veterans Health Council mDNeWS.Com ■ MD News Mid Hudson | 15