MANHATTAN — Researchers from New York-Presbyterian/Weill Cornell Medical Center have successfully developed new prostate cancer screening method, according to findings published Thursday in the Journal of Urology.
They found that prostate-specific antigen (PSA) testing over time, along with a novel drug therapy to shrink the prostate, can be more effective in detecting difficult to diagnose prostate cancer, especially for men with consistently high PSA readings, who are more likely to have aggressive prostate cancer despite negative biopsies.
Prostate cancer, which is most common form of male cancer besides skin, is the second leading cause of cancer death in men. One in 6 men will be diagnosed with the disease in their lifetime.
Because it is so common, researchers at Weill Cornell have been trying to solve the diagnostic problems of PSA testing, hospital officials said.
Doctors currently use PSA as a stand-alone test, but Weill Cornell team found it can be a more effective marker for prostate cancer when additional drug therapy is used, and that’s it’s particularly helpful in cases of patients who are difficult to diagnose.
“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 men with previously undetected prostate cancer,” Steven A. Kaplan, the study’s lead investigator and director of the Iris Cantor Men's Health Center at New York-Presbyterian/Weill Cornell, said in a statement.
Kaplan created the combination screening method as a way to understand cancer risk in men who have consistently abnormal PSA readings even though they have one or more negative biopsies.
These patients have been considered “diagnostic dilemmas,” Kaplan noted.
“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 said.
The PSA test alone, which “measures multiple factors associated with prostate disease, including enlargement of the prostate and inflammation,” is not a good indicator of prostate cancer, he said.
The researchers studied PSA levels after using two 5-alpha-reductase inhibitor drugs (finasteride and dutasteride) that are designed to reduce the size of an enlarged prostate. When PSA remained high even though the prostrate shrank or if PSA rose after reaching its lowest level, it could indicate the presence of cancer, according to the study.
Researchers noted that when the gland was smaller, a biopsy could be more effective.
"Our study shows these drugs may be most helpful in helping us diagnose undetectable prostate cancer," Kaplan said.
The two-phase study was conducted with 276 men at Weill Cornell whose PSA was greater than 4, had a normal digital rectal examination and two or more negative biopsies, according to researchers.