With all of tests currently available for prostate cancer detection and management, many patients (and even their physicians) are confused and overwhelmed by it all. What are biomarkers? How are they useful? Which tests are appropriate, and when? How do they fit in with other tests such as PSA, prostate MRI and MRI-guided fusion biopsy? Hopefully this will help provide some clarity.
Biomarkers are blood, urine and tissue-based tests developed for patients with an elevated PSA or prostate cancer to provide a general assessment of disease risk. Ultimately, these tests are used to evaluate a patient’s risk for clinically significant prostate cancer.
For men with an elevated PSA, biomarkers help determine which men need further evaluation – i.e. who should undergo a prostate MRI or biopsy. For men who have already been diagnosed with prostate cancer, these tests provide critical risk stratification to better determine those who can be followed with active surveillance vs. those who should undergo prostate cancer treatment.
Only approximately 1/3 of men with a PSA > 4 mg/dl actually have prostate cancer, so there is a real need to improve the specificity of PSA testing for prostate cancer detection. Many men have an elevated PSA from causes other than cancer, such as prostate enlargement (BPH), prostate inflammation or prostate infection (prostatitis). Biomarkers can provide better risk stratification of these patients and help guide the decision to perform a prostate MRI and /or biopsy. Biomarkers useful in this situation include Prostate Health Index (phi), 4K score, and PCA-3. The PCA-3 test is specifically indicated for men with a rising PSA despite a negative prior biopsy.
When men are diagnosed with prostate cancer, the decision between treatment and close observation with active surveillance can sometimes be difficult. The pathology report is often not sufficient to truly understand how aggressive the cancer really is. Biomarker testing evaluates the genetic profile of the cancer to provide insight into its aggressiveness and potential for malignant spread. These tests ultimately help determine the need for cancer treatment. Biomarkers useful in this situation include Prolaris, Oncotype DX, ConfirmDX, PTEN, ERG and Decipher test.
Some patients who undergo radical prostatectomy for prostate cancer are at high risk for eventual cancer recurrence. Certain biomarkers can effectively identify those men and ultimately guide adjuvant cancer treatment such as radiation therapy. The Decipher test is helpful in this situation.
Some biomarker tests are covered by insurance while others involve some out-of-pocket cost. For more details on these biomarkers, visit SarasotaProstate.com.