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They call it the Stephen Fry effect: the number of men undergoing prostate cancer testing has increased by 15% since the actor revealed the disease last year.
Prostate cancer is diagnosed every year in nearly 50,000 men in the UK, and more men than women are now dying of bad cancer. However, when detecting prostate cancer, we rely primarily on an "imperfect" blood test of PSA, introduced 30 years ago.
It measures the levels of a protein known as the prostate-specific antigen and, although it is effective at tracking real cases of prostate cancer (detect 83% and save lives), it can lead to false positive results: only one in four men with high PSA found to have cancer when a biopsy is done.
Gender gap: more than 11,800 men a year – one every 45 minutes – are now killed by the disease in Britain, compared to about 11,400 women dying from bad cancer
"High PSA levels do not necessarily indicate cancer," says Dr. Iain Frame, research director at Prostate Cancer UK. "PSA increases with age and with all diseases of the prostate, including benign prostatic hyperplasia [where the prostate enlarges with age] and prostatitis [infection or inflammation]. '
Professor Chris Eden, consulting urologist at Royal Surrey County Hospital, said the "perfect" test for prostate cancer did not exist yet. "It's a 100% specific case, which is only high in prostate cancer and is 100% sensitive – that is, it detects all cases and reveals cancers whose growth will be as slow as not to deserve intervention.
Scientists have been working on a number of replacements for the PSA test – or tests that could be used together to increase accuracy, reduce the number of unnecessary (and uncomfortable) biopsies. Some of these new tests can also determine if the disease is aggressive.
Here we evaluate six of the latest methods of screening for prostate cancer. Most are already available privately or should be available in the next few years.
PCA3 TEST
urine test, £ 450
This makes it possible to check the levels of PCA3 (cancer prostate cancer antigen 3, unique to prostate cells); The concentrations are higher than in cancer cells of the prostate, so the test will not be affected by other prostate conditions.
First, the man undergoes a digital exam in which the doctor mbadages the gland – which results in the release of prostate cells in the urine. The cells are then badyzed for PCA3.
The effect Stephen Fry: the number of men who have undergone a prostate cancer test has increased by 15% since the actor revealed last year that he was has the disease.
Precision tests have been mixed. A 2014 study by the Journal of Clinical Oncology showed that it was more accurate to show that it was unlikely that a patient would be diagnosed with cancer, with a rate of 88% accuracy to predict a negative result in men who have a biopsy.
However, a study published in 2015 by the journal Health Technology Assessment found that the addition of PCA3 tests to existing tests, badyzes, and clinical diagnoses was not cost-effective.
WHO CAN BENEFIT: Men with high PSA levels, but for whom repeated biopsies show no clear result. Nearly half of men who show a negative result after an initial biopsy must undergo a new procedure within five years due to suspicion of cancer. The test is only available here privately, not on the NHS. "NICE evaluated it in 2015 and decided not to recommend it," says Dr. Frame.
SCORE 4K
BLOOD TEST, £ 750
It is said that 4K is more accurate in identifying prostate cancer than PSA. A study published in 2014 in the journal European Urology showed that the prediction of cancer was accurate at 83%, against 68% for the PSA test.
The 4K score test also predicts the aggressiveness of the disease. He checks the levels of four enzymes (known as prostate-specific kallikreins) produced in the healthy prostate and present in larger amounts in case of cancer.
Blood test results are combined with other information, such as patient age, rectal examination results, and previous biopsy reports, to obtain a final score for aggressive cancer risk in the ten years. A score of 4K of 20% or higher suggests a high risk of aggressive cancer in ten years.
WHO CAN BENEFIT: Although its primary goal is to detect prostate cancer in men who have never undergone a biopsy, or have had a biopsy without cancer detected, may be more helpful for men already diagnosed, as it may help to: predict the likelihood of cancer spreading.
Professor Eden explains: "My opinion is that, even if it is expensive, it is a test that is worth it to decide to eliminate cancer or to have active surveillance. [where the patient is not treated, but monitored using PSA tests every few months and biopsies and scans when needed].
Mi-PROSTATE SCORE (MiPS)
URINE TEST, 470 £
A test that measures PSA, as well as PCA3 (the prostate cancer antigen 3 levels are only higher in cancer cells of the prostate) and another specific prostate cancer gene, with the name impossible TMPRSS2: ERG.
Based on the level of PSA and the presence or absence of both genes, the test estimates the chances of cancer in humans, from 0 to 100%. A score of ten on the mid-prostate means a 10% chance of having prostate cancer.
He can also predict whether it is likely that a man will be diagnosed with a more aggressive form of cancer when he undergoes a biopsy.
Although prostate cancer is the leading cause of death in Britain, it receives only half of the funds allocated for bad cancer research – while treatments for this disease have followed for a decade
A study published in May 2015 in the European Urology journal, involving about 2,000 urine samples of men undergoing biopsies due to high PSA levels, revealed that the MiPS test was significantly more accurate for predict cancer only PSA alone, as well as for the aggressive prostate. cancer likely to spread quickly.
WHO COULD BENEFIT: Professor Roger Kirby, medical director of the Prostate Center in London, says the MiPS test can prove to be a useful tool to help men and their doctors decide whether biopsies should be performed, but it is unlikely that it replaces PSA tests. "We need to get to a point where doctors can identify and test those who are most likely to develop aggressive disease, while sparing other unnecessary treatments, such as biopsies.
"This test is a step forward, but is not designed to be a screening tool, and does not replace the biopsy."
SELECTMDX LIQUID BIOPSY
URINE TEST, £ 300
This urine test looks for two genes badociated with aggressive prostate cancer that can spread: DLX1 and HOXC6. This information, combined with the PSA score, a digital rectal examination, age and family history of prostate cancer, is converted to the percentage of probability of prostate cancer and as a percentage of the probability that this cancer is aggressive.
This test is very accurate, with only 2 to 5% of missed cancers. Thus, if the test is negative, a patient can be 98% sure that he does not have prostate cancer. Older tests, such as PCA3, have a much greater risk of missing a significant prostate cancer, with about 8 to 33% of missed cases.
However, as with all urine tests, the results can be influenced if a man has a urinary tract infection when he gives the sample, which can irritate and inflame the prostate cells. and lead to an increase in the PSA level.
WHO CAN BENEFIT: Men who have already had a high PSA score and who want a stronger test to see if they are at increased risk for aggressive prostate cancer. This test could help them decide whether to have an MRI or biopsy.
TEST EN2
URINE TEST, £ 100
For six years, scientists from the University of Surrey are working on a prostate cancer test that looks for evidence of a protein called Engrailed-2 (EN2), made only by prostate cancer cells and secreted in the urine.
The presence of EN2 in the urine is very revealing of prostate cancer. EN2 levels can also predict the size of the tumor. Higher levels can predict larger tumors, according to a study published in the British Journal Of Urology in 2012. This test is potentially quite simple to be done at home by correspondence.
It is reliable and accurate, says Hardev Pandha, a professor of medical oncology at the University of Surrey. "Our studies have shown that this test is twice as effective at detecting prostate cancer as the standard PSA test and detects about 90% of cases.
"We have rarely found EN2 in the urine of men without cancer. EN2 has also not been detected in men with prostatitis or benign enlargement of the prostate. "
He added, "In the 77,000-man, five-year trial, the test detected approximately 90% of prostate cancers and showed that men were at greater risk of metastasis. [where cancer has spread]. '
Even if the tests indicate that the cancer might be present, the results would require confirmation by prostate biopsy.
The test could be available privately later this year, though a study involving 168 patients in several hospitals in southeastern England is going well.
WHO COULD BENEFIT: In addition to facilitating the diagnosis of prostate cancer, this test could also be used to predict tumor size in men already diagnosed and considering radical prostatectomy.
ISOPSA TEST
Blood draw, unknown cost
While the PSA test verifies protein levels in the blood, the IsoPSA blood test is based on the fact that the proteins produced by cancer cells have different structures from proteins produced by prostate cells.
WHO CAN BENEFIT: Men who have participated in trials so far are those who have to undergo a prostate biopsy because of increased PSA or digital rectal exam results.
In theory, this test may be useful for men who want more information to help them decide whether or not to have a biopsy, as they help to distinguish prostate cancer from benign conditions, as well as to prevent prostate cancer. identify patients with high grade disease.
In a study published in the December 2017 issue of European Urology, the IsoPSA test surpbaded the PSA test by detecting prostate cancer more accurately. He was also able to identify the patients with the most severe form.
However, the test was only used on a small number of men, under 300. And the false positive rate is not known.
IsoPSA is not yet available outside the trials in the United States.
WHAT IS PROSTATE CANCER?
How many people is he killing?
Prostate cancer has become a more lethal than bad cancer for the first time, official statistics revealed earlier this year.
More than 11,800 men a year – or one every 45 minutes – are now killed by the disease in Britain, compared to about 11,400 women dying from bad cancer.
This means that prostate cancer is behind the lungs and intestines in terms of the number of people that it kills in Britain. In the United States, the disease kills 26,000 people each year.
Despite this, it receives less than half of the funding for bad cancer research – while treatments for this disease are at least a decade behind.
How long does it develop?
Prostate cancer usually develops slowly, so there is probably no sign that someone has it for many years, according to the NHS.
If the cancer is at an early stage and does not cause symptoms, a "watchful waiting" or "active surveillance" policy can be adopted.
Some patients can be cured if the disease is treated at an early stage.
But if it is diagnosed at a later stage, when it has spread, it then becomes terminal and the treatment involves relieving the symptoms.
Thousands of men are put off by the search for a diagnosis because of the known side effects of treatment, including erectile dysfunction.
Tests and treatment
Prostate cancer screening tests are random, with specific tools just starting to emerge.
There is no national prostate screening program because, for years, tests have been too imprecise.
Doctors have difficulty distinguishing between aggressive and less severe tumors, making it difficult to choose treatment.
Men over 50 are eligible for a "PSA" blood test that gives doctors a rough idea of a patient's risk.
But it is not reliable. Patients who test positive usually receive a biopsy that is not infallible either.
Scientists do not really know what causes prostate cancer, but age, obesity, and lack of exercise are known risks.
Anyone with concerns can speak to Prostate Cancer UK's registered nurses on 0800 074 8383 or visit prostatecanceruk.org
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