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    PCa biomarkers: Hope for at-risk men

    Stacy Loeb, MD, MScStacy Loeb, MD, MSc

    Dr. Loeb, a member of the Urology Times Editorial Council, is assistant professor of urology and population health at New York University School of Medicine, New York.

     

    African-American men are at a substantially greater risk of prostate cancer, with an incidence of 208.7 per 100,000 compared to 123.0 per 100,000 U.S. Caucasian men (CA Cancer J Clin, epub ahead of print, Feb. 22, 2016). Meanwhile, African-American men also have a significantly higher risk of prostate cancer death, with a rate of 47.2 per 100,000 compared to 19.9 per 100,000 U.S. Caucasian men. These figures highlight the importance of optimizing early prostate cancer detection in the African-American population. 

    Related: Utility of PCa markers in African-Americans differs

    Several new biomarkers are commercially available to aid in prostate biopsy decisions. These include blood tests such as the 4Kscore and Prostate Health Index (phi), which studies consistently show to be more specific than total PSA for clinically significant prostate cancer (Eur Urol 2015; 68:464-70; J Urol 2015; 193:1163-9). Both the 4Kscore and phi are included in the 2015 National Comprehensive Cancer Network guidelines as optional secondary tests for initial or repeat prostate biopsy decisions. The PCA3 urine test is another commercially available marker that can be used to aid in repeat prostate biopsy decisions.

    Also see: PCa castration study fuels surgery vs. GnRHA debate

    Comparative studies from Europe have shown that the 4Kscore and phi perform similarly to predict biopsy outcome (Eur Urol 2015; 68:139-46), and that phi outperforms PCA3 for the identification of clinically significant disease (Prostate 2015; 75:103-11). In fact, one of the key drawbacks of using PCA3 in clinical practice is the conflicting data on its relationship with aggressive disease. What we need most are markers that selectively identify significant cancers, in order to reduce unnecessary biopsies and over-diagnosis.

    Next: "Less is known about the comparative performance of these new markers in the African-American population."

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