OPTIMISATION of the prostate-specific antigen (PSA) test has been earmarked through the utilisation of methods from personalised medicine, which may minimise the drawbacks of the number one marker for prostate cancer diagnosis.
Criticism has been levelled at the inaccuracy of the PSA test. An elevated PSA level does not always indicate an increased risk of prostate cancer or even the presence a cancer, and in the past, aggressive therapy has be used, with side-effects including incontinence and erectile dysfunction.
“At a younger age, i.e. around 40-45 years, it [the PSA test] is very useful in terms of predicting the risk of prostate cancer. The data also confirms this. Since the PSA screening test was introduced, deaths from prostate cancer have fallen by 40%. So the question is not about whether PSA screening should be carried out or not. It is more about doing it cleverly,” said Dr Shahrokh Shariat, Head of the Department of Urology, Medical University of Vienna, Vienna General Hospital, and member of the Comprehensive Cancer Center, Vienna, Austria.
The new method aims to avoid unnecessary procedures, deploying frequent follow-ups and active observation of a young patient with a raised PSA level. This serves to avoid ‘overtherapy’ while still looking out for malignant tumour development, and if the PSA level rises significantly enough to warrant a biopsy, then the test is repeated within 12 weeks, and the use of additional biomarkers and mathematical calculation models assists the a decision-making process.
Using this method doctors are able to better estimate if treatment is required and would be useful, as well as the likelihood that the patient will respond to surgical or drug-based treatment. “In addition to the PSA test, we use the new molecular methods in imaging and pathology to create a comprehensive biological profile of the cells. This enables us to make a precise risk assessment in the multidisciplinary team, localise the tumour accurately and determine its molecular structure. We also use special calculation models in formulating a prognosis.” added Dr Shariat.
According to Dr Shariat, if surgery is highlighted as the treatment of choice, this should be done at a specialist hospital housing clinician expertise and applicable diagnostic procedures.
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