PSA screening - can we do a better job with genomics?

A confusion of guidelines

A guide to PSA screening guidelines | THE "NEW" PROSTATE CANCER INFOLINK

For those who would like to have access to a sound summary of the recommendations of groups around the world on screening for prostate cancer, we can recommend a recent, relatively brief, and straightforward review article recently published in BJU  International.


This easy to follow, three-page article, by Dr. Stacy Loeb of New York University — a recognized authority on risk for and diagnosis of prostate cancer — is entitled “Guideline of guidelines: prostate cancer screening” and (at least at present) is freely accessible to anyone as a full-text article.

Guideline of guidelines: prostate cancer screening.pdf

Key Points

• Randomised trials have shown that PSA screening reduces metastatic prostate cancer and disease-related death.
• The USPSTF recommends against PSA screening, while most other  professional organizations recommend shared decision-making about PSA  screening. 
• PSA screening should be discontinued for men with  <10-year expectancy.="" year--="">
• Several guidelines now recommend baseline PSA testing for men in their 40 s for risk  stratification.
• Some guidelines also suggest a risk-adapted approach to screening  considering multiple risk factors along with PSA for clinical decisions.

Is Genetic testing ready to contribute to screening prostate cancer?

Skeptics say Not ready for practical use

Genetic profiling and the future management of prostate cancer | THE "NEW" PROSTATE CANCER INFOLINK

Our perspective is that we are most certainly learning a lot more about the genetics of prostate cancer, how genetics affects both risk for the disease, the management of clinically significant disease, and how to use genetics to characterize specific subsets of individuals who may respond better than the average patient to specific forms of treatment. But … We still believe that it will be many years before this type of genetic profiling can be accurately and cost-effectively applied in the routine clinical diagnosis, work-up, and management of prostate cancer. What one can already do at tertiary research institutions, when the costs of all the relevant tests are being paid for under research grants for small numbers of patients, is one thing. Translating that type of work into the community setting is quite another.

 In the lab identifies high risk population

Translating Genetic Risk for Prostate Cancer to the Clinic Abstract

Prostate cancer (PrCa) is the most commonly diagnosed cancer in the male UK population, with over 40,000 new cases per year. PrCa has a complex, polygenic predisposition, due to rare variants such as BRCA and common variants such as single nucleotide polymorphisms (SNPs). With the introduction of genome-wide association studies, 78 susceptibility loci (SNPs) associated with PrCa risk have been identified. Genetic profiling could risk-stratify a population, leading to the discovery of a higher proportion of clinically significant disease and a reduction in the morbidity related to age-based prostate-specific antigen screening. Based on the combined risk of the 78 SNPs identified so far, the top 1% of the risk distribution has a 4.7-times higher risk of developing PrCa compared with the average of the general population.

GenomeDx provides Decipher guidance for post operative radiation treatment

GenomeDx: Addressing challenges in prostate cancer treatment

Today, half of men diagnosed with localized prostate cancer will choose radical prostatectomy to treat their disease. Up to half will present after surgery with pathology or clinical features that put them at high risk for cancer recurrence, also referred to as metastasis². Current clinical practice guidelines recommend that these men be offered radiation treatment after surgery.

Although they are considered high risk, 9 out of 10 of those men will not develop metastases or die of prostate cancer, meaning that – if treated – these patients may receive no benefit, and may be subject to unnecessary prostate cancer treatment side effects³.

Decision-making and the timing around secondary therapy is complex, and it’s acknowledged that many patients may be over-treated. As such, there is a need for better stratification of high-risk men after surgery to enable more informed decision-making and optimized treatment selection.
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Decipher is a genomic test, which means it evaluates the activity of genes in the tumor that are shown to be involved in the development and progression of prostate cancer.
Decipher does this by measuring the expression levels of 22 RNA biomarkers involved in multiple biological pathways across the genome that are associated with aggressive prostate cancer.
Then, the Decipher Test uses the expression of these biomarkers to calculate the probability of clinical metastasis within 5 years of radical prostatectomy surgery, and within 3 years of successive PSA rise (biochemical recurrence).

Prostate Cancer | lncRNA Blog
RNA molecules found in urine, tissue that detect prostate cancer -- ScienceDaily
RNA biomarker may lead to urine test for prostate cancer - Medical News Today

A new biomarker for prostate cancer has been identified that can be detected in tissue and urine samples. Researchers at Sanford-Burnham Medical Research Institute in Orlando, FL, have found a set of RNA molecules detectable in prostate cancer patients but not in men without this cancer. They publish their findings in The Journal of Molecular Diagnostics.
Dr.  Vipul Patel concludes:
"There is a tremendous unmet clinical need for better non-invasive screening tools for early detection of prostate cancer to reduce the overtreatment and morbidity of this disease. Our findings represent a promising approach to meet this demand."
Other recent proposed alternatives to the PSA test include an "electronic noise" designed to differentiate between prostate cancer and benign prostatic hyperplasia, which share similar diagnostic properties.
Earlier this year, Medical News Today reported on the eNose and quoted researchers who claimed the device's results were on a par with those published for the PSA test and were "achieved rapidly and in a completely noninvasive manner."