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School of Medicine
Prostate Cancer: Advancements in Screenings
You may know that prostate cancer is one of the most common cancer types in men. The good news is that there are many treatment and management options, even if the cancer is caught at a later stage.
What you may not know: There are several options when it comes to prostate cancer screening. After considering multiple factors, your doctor may recommend the prostate-specific antigen (PSA) test, and/or one of the newer screening tests that are now available.
Johns Hopkins urologist Christian Pavlovich, M.D., explains what you should know.
PSA Test: The Current Prostate Screening Standard
Before recommending when you should be screened for prostate cancer, your doctor will consider many factors, such as:
- Family history, particularly whether any of your family members have had prostate cancer
- Race, as African-American men have a higher risk of developing prostate cancer
If your doctor determines you should undergo screening, he or she will most likely recommend the PSA test. For more than 30 years, the PSA test has been the gold standard in prostate cancer screening. This simple blood test measures how much prostate-specific antigen is in your blood.
New Prostate Cancer Blood Test
If you have an abnormal PSA score, your doctor may recommend another newer test that gives a better sense of your prostate cancer risk. The prostate health index (PHI) is one such test that is a more accurate blood test and measures your risk for having prostate cancer. It’s approved by the FDA for men who have PSA scores between 4 and 10.
What are the benefits of the PHI test?
- Fewer unnecessary biopsies: Some men who have elevated PSA scores are unsure about getting an invasive biopsy. This tool can be used to better determine whether your risk is high enough to warrant a biopsy.
- More accurate: This test is better at detecting prostate cancer. It can also detect whether you have a more aggressive type of cancer. This information can guide doctors to a more targeted treatment plan for you.
If you score low on the PHI test, your doctor may recommend monitoring you over time to see if your levels rise enough to cause concern.
Prostate Cancer Urine Test
This test detects the gene PCA3 in your urine and can also help your doctor better assess your prostate cancer risk.
PCA3 is a prostate-specific noncoding RNA. It’s a gene that’s only in your prostate. If the gene is “overexpressed” (meaning there are too many copies of it), then there’s a greater chance you have prostate cancer.
Like PSA and PHI tests, this isn’t definitive, either. But data suggest that when cancer is present, the PCA3 will be positive 80 percent of the time. This test can also help your doctor determine whether a biopsy is necessary.
Both of these new tests are more accurate than the PSA test. Your doctor may recommend one or more than one, based on the specifics of your case.
Prostate Biopsy Changes
To definitively confirm a prostate cancer diagnosis, you’ll need to have a biopsy, which is when doctors remove a tissue sample from the prostate. Advancements here, too, are ensuring more accuracy, so there is less risk of misdiagnosis.
In a prostate biopsy, doctors have traditionally taken eight to 12 needle biopsies along the prostate, in a random sample. It’s a good, but not perfect, picture of prostate cancer.
Due to imaging improvements, doctors can now use MRI imaging technology before a biopsy to look for areas in the prostate that are suspicious for cancer. Newly available technology can fuse MRI images with real time ultrasound to help guide the prostate needle biopsies to any areas of specific concern.