Other indicators instead of just PSA?

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Joined: Sun Apr 24, 2016 2:44 pm

Other indicators instead of just PSA?

Postby stephen.dawes » Sun May 01, 2016 4:12 pm

Relying on PSA seems like more trouble than it's worth, to me at least. Reading the forums and the Prostate Cancer Guide on this website I've come to realise that a) you can have prostate cancer with a PSA of zero b) a high PSA doesn't mean you have prostate cancer! :roll: :lol:

Is there anything more reliable we can use as an indicator before an MRI/invasive biopsy?any new tests/techniques on the horizon?

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Joined: Sun Apr 24, 2016 2:40 pm

Re: Other indicators instead of just PSA?

Postby professoreden » Sun May 01, 2016 6:11 pm

Hi, Stephen and thanks for the question.

PSA has certainly come in for a lot of criticism recently for not being completely specific for detecting prostate cancer but urologists have always recognised that a number of factors cause it to rise apart from prostate cancer. These include increased age, increased size of prostate, urinary infection, urinary obstruction, prostate injury (such as biopsy) and ejaculation. Urologists have also known for decades that many men with an elevated PSA don't have prostate cancer but that it at least identifies men in whom we need to take a greater interest. After all, prostate cancer kills 10,000 men each year in the UK so its an important condition to check for.

The most compelling reason to check a man's PSA after the age of 40, whether he has urinary symptoms or not, comes from the European Randomised study of Screening for Prostate Cancer (ERSPC). This trial recruited 182,000 men and randomised (allocated to either group randomly) them to be screened for prostate cancer or not. Screened men had a 29% lower death rate due to prostate cancer than non-screened patients. However, in the 20,000 Swedish patients in this study who had the longest follow-up (14 years) the reduction in the prostate cancer specific death rate was 44% with a 42% reduction of rate of metastasis (distant spread). The number of patients necessary to treat (NNT) to save one life from prostate cancer in these men was 12, which compares very favorably to the NNT for cancers that we already screen for: breast cancer (18); bowel cancer (29) and cervical cancer (10).

Although there are a number of biomarkers other than PSA under active investigation (you can download a good review at http://www.mdpi.com/1422-0067/14/6/11034), including free PSA, PCA3, EN2, the 4K score and STHLM 3, it looks as though PSA is going to remain a very useful test for many years to come. It can quite literally save your life.

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