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Prostate Cancer - Diagnosis

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Prostate Cancer

Although there has been a 50% decline in prostate cancer mortality since the widespread adoption of prostate-specific antigen (PSA) testing[1], prospective randomized controlled trials have failed to demonstrate a significant survival benefit associated with PSA testing[2, 3] due to widespread contamination within these trials[4]. Nonetheless, both the National Comprehensive Cancer Network(NCCN) and the American Urological Association(AUA) advocate men to engage in discussion regarding prostate cancer screening starting at the age of 45 and 55 respectively[5, 6]. The AUA goes on to state that in men considered to be at a higher risk of prostate cancer to formulate an individualized approach to prostate cancer screening. Biomarkers may be used to further define the probability of clinically significant prostate cancer.

The diagnosis of prostate cancer is made on the basis of a prostate biopsy performed under ultrasound guidance generally in the physician's office. In patients with a prior negative biopsy, a multiparametric MRI of the prostate combined with an ultrasound fusion biopsy has been shown to increase the detection of clinically significant prostate cancer[7]. The PRECISION trial demonstrated that an MRI, with or without targeted biopsy, led to 28% fewer men undergoing biopsy, 13% less overdetection of clinically insignificant cancer, and 12% more clinically significant cancers being identified than did standard transrectal ultrasonography–guided biopsy[8].

Sources:

  • Welch, H.G., D.H. Gorski, and P.C. Albertsen, Trends in Metastatic Breast and Prostate Cancer--Lessons in Cancer Dynamics. N Engl J Med, 2015. 373(18): p. 1685-7.
  • Andriole, G.L., et al., Mortality results from a randomized prostate-cancer screening trial. N Engl J Med, 2009. 360(13): p. 1310-9.
  • Schroder, F.H., et al., Screening and prostate-cancer mortality in a randomized European study. N Engl J Med, 2009. 360(13): p. 1320-8.
  • Shoag, J.E., S. Mittal, and J.C. Hu, Reevaluating PSA Testing Rates in the PLCO Trial. N Engl J Med, 2016. 374(18): p. 1795-6.
  • Carroll, P.R., et al., NCCN Guidelines Insights: Prostate Cancer Early Detection, Version 2.2016. J Natl Compr Canc Netw, 2016. 14(5): p. 509-19.
  • Carter, H.B., et al., Early detection of prostate cancer: AUA Guideline. J Urol, 2013. 190(2): p. 419-26.
  • Siddiqui, M.M., et al., Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. JAMA, 2015. 313(4): p. 390-7.
  • Barry, M.J. and A.B. Rosenkrantz, MRI-Targeted versus Ultrasonography-Guided Biopsy for Suspected Prostate Cancer. N Engl J Med, 2018. 378(19): p. 1835-1836.