Prostate This

New Approaches to Prostate Testing

The US Preventive Services Task Force (USPSTF), a division within the Department of Health and Human Services, has the responsibility of evaluating medical tests and screenings to determine if they are useful in the prevention of disease, and thereby necessary to be performed on a regular basis. The USPSTF’s work carries the additional responsibility of evaluating these procedures in light of the cost of the procedures to determine if there is a net benefit for performing the tests. Of consequence, the USPSTF also applies a filter to these tests to determine at which age band the tests are most useful and effective.

The USPSTF has had a profound, and occasionally controversial impact, in the area of routine medical checks. For example, a few years ago their recommendations on limiting breast cancer exams met with considerable resistance. In 2012, the USPSTF advised that men need not be screened using PSA and digital exams for detection of prostate cancer at all. They determined that the costs of the tests, combined with the number of false positives and false negatives, which might then lead to unnecessary surgical procedures was not warranted without the presence of other risk factors.

Prostate cancer, if detected, is highly curable. In many cases, however, the cancer is so slow growing that a man could well live a full and normal life without treatment. Dr Stacy Loeb of New York University School of Medicine, with the advent of certain new testing procedures, has said “The solution is not to stop screening. The better idea is to use more specific tests.”

The new sorts of testing that Dr Loeb and others are recommending consist of using blood, urine, and tissue samples. These can accompany PSA testing, but go well beyond with the goal to inform men if they have prostate cancer and if it is aggressive enough the warrant treatment. The test, it should be noted, use the same techniques that show up in Gleason scores for biopsies, which classify the risk of the cancer.

It should be noted that these additional test, particularly the biopsy are expensive — costing in the range of $1000, but all have the potential of missing cancers. Other tests check multiple PSA-related proteins in blood samples; urine tests looking for protein fragments from a cancer; another looks for exosomes chemicals that presages a cancer’s spread; combination of MRI and ultrasound imaging.

What is right for you — this should be an important  discussion with your urologist.

For more detail, you can read more of this article in the Wall Street Journal’s 5/10/2016 edition, Personal Journal section.