For the past 25 years, PSA-based screening for prostate cancer has been widely implemented. While annual PSA testing has reduced deaths from prostate cancer, we now recognize that it is possible to significantly improve the overall efficiency of screening by reducing unnecessary prostate biopsies and by avoiding unnecessary treatments.

Better solutions

The main tools that will improve PSA-based screening are new markers and better prostate biopsy. Together, these tools provide more accurate assessment as to whether the patient has prostate cancer and more accurately characterize the cancer in terms of its size, location and aggressiveness. Therefore, the patient and his physician now are in a much better position to determine whether a patient has prostate cancer, whether treatment is necessary and what type of treatment is appropriate.

“Since these new tools have become available, physicians are poised to significantly improve the overall effectiveness of PSA-based screening”

Answers inside the body

The new biomarkers can be measured from blood, urine or from the prostate tissue itself. Blood tests, such as the Prostate Health Index (PHI) and the Four Kallikrein (4K) test, may be used to determine whether a biopsy is necessary in men who have an abnormal PSA.

Urinary tests (PCA3 and Select MDx) may also be used for this purpose as can MRI scans of the prostate. MRI has the added advantage of informing the urologist about the exact region of the prostate to biopsy. This type of MRI-guided biopsy using GPS-like software has been shown to improve the accuracy of biopsy and is more likely to accurately find and characterize the cancer in terms of its size, location and aggressiveness — if one is present.

If diagnosed

If cancer is discovered on a prostate biopsy, genetic tests (Prolaris, Oncotype GPS, or Decipher) that assess which genes are active in the cancer are useful to determine whether treatment is necessary. Many men with PSA-detected cancers can avoid aggressive treatments and we can now identify them more precisely.

Since these new tools have become available, physicians are poised to significantly improve the overall effectiveness of PSA-based screening for prostate cancer. As a result, fewer men will undergo unnecessary prostate biopsies and fewer men will undergo unnecessary treatments while preserving the benefits of screening.