Biomarker Tests Allow for a Personalized Approach to Prostate Cancer Diagnosis

Over the past three decades, the field of oncology has made remarkable strides in diagnosing and treating prostate cancer. Research has shown that early detection is linked with an increase in prostate cancer survival rates for those at higher risk. The success of the prostate-specific antigen (PSA) test, the gold standard in screening, is a driving factor in cutting the prostate cancer death rate in half since 1993.

It’s accepted that the higher the PSA level, the greater likelihood of prostate cancer. But PSA only tells part of the story. Occasionally, people with a low PSA do have prostate cancer. Also, an elevated PSA level can occur for reasons other than prostate cancer, such as an enlarged prostate gland or prostate infection. In fact, three in four men with an elevated PSA do not have prostate cancer, and research has shown that prostate-specific antigen testing may also result in false positives (overdiagnosis), leading to unnecessary prostate biopsies, or false negatives for a variety of reasons.

So, how can doctors expand their knowledge of a patient’s condition to provide the kind of care he needs? The answer often lies in taking a personalized approach. Technological innovations have enabled a more individualized approach to prostate cancer diagnosis, early detection, and treatment. These precision-medicine methods commonly rely on biomarker tests.

What’s a biomarker?

The National Cancer Institute defines a biomarker (short for “biological marker”) as a biological molecule found in tissue, blood, or other bodily fluids that “is a sign of a normal or abnormal process, or of a condition or disease.” Biomarkers can be as simple as blood pressure or heart rate.

On a molecular level, biomarkers are protein molecules or genes that are altered through mutation, rearrangement, or fusion. Testing for biomarkers is useful because biomarkers can help doctors predict or diagnose a disease, monitor disease progression, choose the most effective treatment, or measure how well a treatment is working. They can also provide additional insight into whether a prostate biopsy is needed or if active surveillance is sufficient.

For example, prostate-specific antigen is a biomarker found via blood test that provides information about the prostate, including the likelihood of prostate cancer. In recent years, liquid biomarker tests, which use urine samples, have been developed to provide more information about the likelihood of prostate cancer. Research has shown that urine following a digital rectal exam (DRE) is enriched with prostate cancer biomarkers; these can indicate prostate cancer risk. Urinary biomarker tests use personalized information to determine the likelihood that you could have clinically significant prostate cancer that needs immediate treatment.

Why are liquid biomarker tests important?

Advancements in technology have made liquid biomarker testing relatively easy. A simple urine test has the potential to provide additional data that can be significant in diagnosing clinically significant prostate cancer.

A 2017 study states, “Urinary biomarkers for CaP [prostate cancer] represent a promising alternative or an addition to traditional biomarkers.”

Providing a urine sample is a relatively simple, noninvasive process that gives you and your doctor more information to decide whether or not additional, more invasive testing–such as a prostate biopsy–is necessary. According to a recent study, initial urine screening lowered the number of unnecessary biopsies by up to 42 percent.

High PSA level: What’s next?

Because of all the variables that come into play with prostate cancer screening and diagnosis, most experts recommend that decisions be made on a case-by-case basis, as clinicians and patients work together to determine the best care plan for each person.

It’s important to talk to your doctor about the screening methods that are right for you. The PSA test remains a great starting point, and Congress is considering legislation that would require insurance companies to cover prostate cancer screenings for those at high risk for the disease without any out-of-pocket costs.

In the meantime, the Prostate Cancer Foundation offers guidance on financial assistance for treatment and diagnosis.