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Prostate cancer test improved

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A new approach may help to improve the accuracy of tests for the number one cancer in men.

Prostate cancer holds an unenviable title: it is the most common cancer in men in the UK comprising just under one quarter of all newly diagnosed cancer cases in men. In 2008 around 101 men were diagnosed with cancer in the UK every day but the heartening news is that only one in 26 men die of prostate cancer; they are more likely to die with it than from it.

One difficulty that doctors and their patients face is that diagnosing this particular cancer is not an exact science. A Prostate Specific Antigen (PSA) test, to look for raised PSA levels in your blood is the most commonly used but a raised level doesn’t necessarily mean you have cancer. The majority of men who do have the disease don’t have raised PSA levels and over 65 percent of men with a raised level don’t have cancer.

There are other tests, including a digital rectal examination (DRE), where your doctor feels for changes in the surface of your prostate gland by putting a finger up your bottom. If your GP thinks you are at risk of having prostate cancer they will refer you to a hospital for further tests. The test you are most likely to have is the transrectal ultrasound-guided biopsy (TRUS). Using an ultrasound probe your doctor will take tissue samples from your prostate.

The prostate

The prostate

A recent study from the University of Michigan Comprehensive Cancer Center and the Michigan Center for Translational Pathology may provide cancer specialists with another, more reliable means of diagnosing prostate cancer. The new test looks for gene fusion – TMPRSS2:ERG – to give the scientific name. This fusion is believed to cause prostate cancer – studies of prostate tissue have shown its presence nearly always indicates cancer.

Because TMPRSS2:ERG only occurs in about 50 percent of prostate cancers, the scientists added PCA3, another marker, to their test. These combined elements were better at predicting cancer than either used on its own.


“Testing for TMPRSS2:ERG and PCA3 significantly improves the ability to predict whether a man has prostate cancer,” says lead author Scott Tomlins, MD, PhD, a pathology resident at the University of Michigan. “We think this is going to be a tool to help men with elevated PSA decide if they need a biopsy or if they can delay having a biopsy.”

“Many more men have elevated PSA than actually have cancer but it can be difficult to determine this without biopsy. This test will help in this regard. The hope is that this test could be an intermediate step before getting a biopsy,” explained senior study author Arul Chinnaiyan, MD, PhD, director of the Michigan Center for Translational Pathology.

The test isn’t available yet, but the University of Michigan hope to be able to offer it to their patients within the year.

New simple test for prostate cancer

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A urine test could soon help doctors detect prostate cancer early and better evaluate a patient”s treatment options, according to a new study involving an Indian-origin scientist.

Prostate cancer screening is currently based on a blood test to detect prostate-specific antigen (PSA). But that test often produces false results and leads to unnecessary biopsies.

The new test developed by the University of Michigan Comprehensive Cancer Center and the Michigan Center for Translational Pathology appears to be better at detecting prostate cancer, and could help some men delay or avoid a needle biopsy while pointing out men at highest risk for clinically significant prostate cancer.

The test looks for a genetic anomaly that occurs in about half of all prostate cancers, an instance of two genes changing places and fusing together.

This gene fusion, TMPRSS2:ERG, is believed to cause prostate cancer.

Prostate cancer cells

Prostate cancer cells

Studies in prostate tissues show that the gene fusion almost always indicates cancer. But because the gene fusion is present only half the time, the researchers also included another marker, PCA3. The combination was more predictive of cancer than either marker alone.

“Testing for TMPRSS2:ERG and PCA3 significantly improves the ability to predict whether a man has prostate cancer,” said lead author Scott Tomlins, M.D., Ph.D., a pathology resident at the U-M Health System.

“We think this is going to be a tool to help men with elevated PSA decide if they need a biopsy or if they can delay having a biopsy and follow their PSA and urine TMPRSS2:ERG and PCA3,” he added.

The researchers looked at urine samples from 1,312 men at three academic medical centers and seven community-based hospitals. The men all had elevated PSA levels and had gone on to receive either a biopsy or prostatectomy, surgery to remove their prostates.


The researchers evaluated the urine samples for TMPRSS2:ERG and PCA3 and stratified patients into low, intermediate and high scores, indicating their risk of cancer. They then compared this to biopsy results.

Biopsies indicated cancer in 21 percent of men from the low-score group, 43 percent in the intermediate group and 69 percent in the high group.

Further, the urine test scores correlated with how aggressive the cancer was.

“Many more men have elevated PSA than actually have cancer but it can be difficult to determine this without biopsy. This test will help in this regard. The hope is that this test could be an intermediate step before getting a biopsy,” said senior study author Arul Chinnaiyan, M.D., Ph.D., director of the Michigan Center for Translational Pathology and S.P. Hicks Professor of Pathology at the U-M Medical School.