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New Test May Reduce Need For Some Prostate Cancer Biopsies BALTIMORE, MD -- May 19, 1998 -- A new prostate specific antigen (PSA) test that measures the percentage of free PSA in the blood not bound to other proteins could spare up to 200,000 men a year in the United States the pain, anxiety and inconvenience of a surgical biopsy to detect cancer. Results of multicentre trials of the test, funded by its makers, Hybritech Inc., of San Diego, CA., appear in tomorrow’s issue of the Journal of the American Medical Association. According to Alan Partin, M.D., associate professor of urology at Johns Hopkins, one of the several centres involved in the trials, the new test should only apply to men whose prostates feel normal on digital rectal exams, but whose standard PSA levels are elevated and between four and 10. "These are the men in the diagnostic grey zone," he said. "They're at risk for prostate cancer on the basis of the PSA levels, but experience shows that 75 percent of the time, their biopsies will be negative for cancer." The researchers were led by William Catalona, M.D., of Washington University School of Medicine in St. Louis, MO. The test measures a form of PSA, called free PSA, that is lower in men with cancer than in those without cancer or with benign prostate enlargement, Partin said. "Now we can figure with more accuracy who not to biopsy," he said, adding in the past using the percentage of free PSA (%FPSA) to determine risk was clouded by such factors as prostate size and the total amount of PSA. "The study demonstrated that men in the diagnostic grey zone should probably be biopsied only if their %FPSA is at or below 25 percent," Partin said. "At that level, we can detect 95 percent of cancers while excusing men with benign diseases from the need for a biopsy." Prostate cancer screening tests, Partin says, must be sensitive enough to find as many potentially curable cancers as possible, even if they fail to detect microscopic, inactive cancers that pose no threat. "By using this test to zero in on men in a certain group most likely to have active cancer, there is the potential to cut the cost of prostate screening dramatically," Partin said. "We also spare those men the possible complications of biopsies, such as infection, bleeding and fever." The test also can help determine the need for repeat biopsies. For example, if a man's first biopsy is negative, but his father and brothers have prostate cancer and his %FPSA value is 25 or less, he still might be advised to undergo a second biopsy. "About 20 percent of cancers are missed on the first biopsy, so having a %FPSA measurement test will help us decide if a second biopsy is necessary," he said. In the study, the test for %FPSA was tried on blood samples from 773 men, ages 50 to 75, who had normal results on digital rectal exam and had received no treatment for prostate disease. Because all had a previous record of PSA levels between four and 10, all had been biopsied. A total of 379 were found by the test to have prostate cancer, while 394 men did not. E-mail this page to a friend or colleague! To print, use this version