Icr And University Of Cambridge Reveal New Prostate Cancer Prediction Tool
The new study describing the model is published in the Journal of Clinical Oncology
Researchers from the The Institute of Cancer Research, London and the University of Cambridge have revealed a newly created comprehensive tool, CanRisk-Prostate, for predicting an individual’s risk of developing prostate cancer.
The scientists involved have said the tool will ensure that those placed at a higher chance of developing the condition will be offered appropriate testing, while also reducing potentially invasive testing for those placed at a very low risk.
CanRisk-Prostate will be incorporated into the groups established CanRisk web tool, which recently recorded its one millionth risk prediction. CanRisk is already used as a go-to prediction tool by healthcare professionals globally to aid risk prediction in breast and ovarian cancers.
As the most common form of cancer in men, prostate cancer accounts for around 52,000 cases diagnosed in the UK each year, with more than 12,000 deaths recorded annually.
Current prostate-specific antigen testing typically involves a blood test to detect the PSA protein made in the prostate gland, however, this test can be inaccurate.
Around three in four men with a raised PSA level will not have cancer according to the NHS, meaning that additional tests, such as tissue biopsies or MRI scans, are needed to confirm a diagnosis.
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What Causes Prostate Cancer
Researchers do not know exactly what causes prostate cancer. But they have found some risk factors and are trying to learn just how these factors might cause prostate cells to become cancer cells.
On a basic level, prostate cancer is caused by changes in the DNA of a normal prostate cell. DNA is the chemical in our cells that makes up our genes, which control how our cells function. We usually look like our parents because they are the source of our DNA. But DNA affects more than just how we look.
Some genes control when our cells grow, divide into new cells, and die:
- Certain genes that help cells grow, divide, and stay alive are called oncogenes.
- Genes that normally keep cell growth under control, repair mistakes in DNA, or cause cells to die at the right time are called tumor suppressor genes.
Cancer can be caused by DNA mutations that keep oncogenes turned on, or that turn off tumor suppressor genes. These types of gene changes can lead to cells growing out of control.
DNA changes can either be inherited from a parent or can be acquired during a persons lifetime.
What Does An Elevated Psa Level Mean If Ive Had Prostate Cancer In The Past
If youve ever had treatment for prostate cancer, youll have regular PSA screenings for the rest of your life. An increasing PSA level may mean the cancer has returned. Your care team may use other tests, including imaging scans and biopsies, to check for signs of cancer. If cancer returns, your team will discuss your treatment options with you.
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Pros And Cons Of Prostate Cancer Screening
The panel and other experts were concerned about the harm men face from false positive PSA results. This happens when your test shows a higher PSA level, but you donât actually have prostate cancer. If your result comes back with a false positive, your doctor will likely suggest a prostate biopsy, a test you donât need when youâre cancer-free.
In that biopsy, your doctor removes some prostate tissue to test it for cancer cells. Older men face more potential problems after a prostate biopsy, such as:
- Blood in seminal fluid
One study found that 40% of men had health problems after a prostate biopsy, but they werenât usually serious.
Thereâs also worry about overtreatment. Some men have prostate cancer but continue to live symptom-free. But if you have cancer treatment like surgery or radiation, you may risk other health issues, including loss of bladder and bowel control, and trouble getting or keeping an erection.
What Is The Psa Test
Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in a mans blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter of blood.
The blood level of PSA is often elevated in men with prostate cancer, and the PSA test was originally approved by the US Food and Drug Administration in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. In 1994, FDA approved the use of the PSA test in conjunction with a digital rectal exam to test asymptomatic men for prostate cancer. Men who report prostate symptoms often undergo PSA testing to help doctors determine the nature of the problem.
In addition to prostate cancer, a number of benign conditions can cause a mans PSA level to rise. The most frequent benign prostate conditions that cause an elevation in PSA level are prostatitis and benign prostatic hyperplasia . There is no evidence that prostatitis or BPH leads to prostate cancer, but it is possible for a man to have one or both of these conditions and to develop prostate cancer as well.
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Prostate Cancer Incidence By Age
Prostate cancer incidence is strongly related to age, with the highest incidence rates being in older men. In the UK in 2016-2018, on average each year around a third of new cases were in males aged 75 and over.
Age-specific incidence rates rise steeply from around age 45-49, peak in the 75-79 age group before dropping slightly and remaining stable in the oldest age groups.The highest rates are in in the 75 to 79 age group.
Prostate cancer , Average Number of New Cases per Year and Age-Specific Incidence Rates per 100,000 Male Population, UK, 2016-2018
For prostate cancer, like most cancer types, incidence increases with age. This largely reflects cell DNA damage accumulating over time. Damage can result from biological processes or from exposure to risk factors. A drop or plateau in incidence in the oldest age groups often indicates reduced diagnostic activity perhaps due to general ill health.
The age distribution of prostate cancer cases probably partly reflects the age groups in which prostate specific antigen testing and transurethral resection of the prostate are carried out.
Risk And Other Prostate Conditions
A common misconception is that the presence of non-cancerous conditions of the prostate will increase the risk of prostate cancer.
While these conditions can cause symptoms similar to those of prostate cancer and should be evaluated by a physician, there is no evidence to suggest that having either of the following conditions will increase a mans risk for developing prostate cancer.
Benign Prostatic Hyperplasia is a non-cancerous enlargement of the prostate. Because the urethra runs directly through the prostate, enlargement of the prostate in BPH squeezes the urethra, making it difficult and often painful for men to urinate. Learn more about BPH.
Prostatitis, an infection in the prostate, is the most common cause of urinary tract infections in men. Most treatment strategies are designed to relieve the symptoms of prostatitis, which include fever, chills, burning during urination, or difficulty urinating. There have been links between inflammation of the prostate and prostate cancer in several studies. This may be a result of being screened for cancer just by having prostate-related symptoms, and currently, this is an area of controversy. Learn more about prostatitis.
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Risk Factors You Cant Control
Age: The risk of developing prostate cancer increases with age. One in 10,000 men younger than 40 will be diagnosed with prostate cancer, but one in 15 men in their 60s will be diagnosed with the disease.
Family history: Being born with a gene mutation is one of the unavoidable risks of prostate cancer. Two of them include the BRCA1 and BRCA2 gene mutations. BRCA and other inherited mutations, including HOXB13 and DNA mismatch repair genes, may explain why prostate cancer runs in families. Having a father or brother with prostate cancer may double a mans risk, especially if that relative was diagnosed before age 55.
Prostatic intraepithelial neoplasia :
Race: Studies show that African-American men are about 70 percent more likely to develop prostate cancer in their lifetime than Caucasian or Hispanic men.
Prostate Cancer Cases On The Rise In Uae Doctors Urge Men To Go For Regular Checkups
Prostate cancer is among the top five most common cancers among men in the United Arab Emirates, and its incidence is currently on the rise, a UAE-based doctor told Al Arabiya English, urging men to do regular checkups.
On the occasion of Mens Health Awareness Month, also known as Movember, Al Arabiya English spoke to doctors in the UAE who weighed in on the current state of mens health and the incidence of prostate cancer in the Gulf country.
Mens health is often ignored as men are generally under a lot of stress. They are busy with their work, so they dont pay much attention to their health, Dr. Deepak Janardhanan, Consultant Urologist at Dubais Medeor Hospital, told Al Arabiya English.
We see only a small number of patients who come for regular health checkups. We are missing a majority of the people who would benefit from doing a routine health checkup or a regular prostate checkup so that any cancer within the prostate can be identified. Mens Health Awareness Month is a golden opportunity to care for their health and lead healthy lives, he added.
Prostate cancer is the second most common cancer in men across the world. Men may be putting themselves at risk for prostate and testicular cancers by not knowing the symptoms of these diseases and failing to schedule regular checkups, doctors told Al Arabiya English.
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Other Reasons For An Elevated Psa Test
In addition to urinary tract infection and prostatitis, there are other reasons that can cause a high PSA level. These include:
- Benign prostatic hyperplasia Benign prostatic hyperplasia, also known as BPH, is enlargement of the prostate caused by aging. An enlarged prostate can produce higher levels of PSA. There are treatments available for BPH.
- Medical procedures A prostate exam or digital rectal exam can result in inflammation of the prostate and increased PSA levels. A urinary catheter or urethral scope can also cause higher PSA levels. For accurate results, wait a few weeks after having a medical procedure done before having a PSA test.
- Age It is normal for PSA levels to gradually trend up with age. If the rise in your PSA level is slow, and consistent with your age, there is likely no concern.
- Cancer An elevated PSA level does not mean you have cancer but most men with prostate cancer do have an elevated PSA level. If you have an elevated PSA level your doctor may perform a digital rectal exam to check for lumps on the prostate. They will also likely order another PSA test to see if your level continues to rise. They may order imaging tests to check for cancer on the prostate. If you are receiving treatment for prostate cancer, your doctor will likely monitor your PSA level to help determine how effective treatment is. If PSA decreases, it can indicate that treatment is effective.
Medical Procedures Can Cause Psa To Rise
Anything that traumatically interferes with the architecture around the prostate gland can make PSA go up, says Dr. Milner. One of the most common causes of significantly high PSA from this type of trauma is the placing of a catheter into the bladder.
Another cause is a prostate or bladder exam that involves passing a scope or taking a biopsy.
Since it takes about two to three days for PSA to go down by half, you should wait two to three weeks after this type of trauma to do a PSA test, Milner says.
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Who Is At Risk For Prostate Cancer
All men are at risk for prostate cancer, but African-American men are more likely to get prostate cancer than other men.
All men are at risk for prostate cancer. Out of every 100 American men, about 13 will get prostate cancer during their lifetime, and about 2 to 3 men will die from prostate cancer.
The most common risk factor is age. The older a man is, the greater the chance of getting prostate cancer.
Some men are at increased risk for prostate cancer. You are at increased risk for getting or dying from prostate cancer if you are African-American or have a family history of prostate cancer.
Excess Weight Obesity & Cancer Risk
Being overweight or obese has long been known to cause changes in the body that can lead to cancer. These changes include chronic inflammation and abnormally high levels of insulin and other hormones. Cancer risk increases the more overweight or obese a person is and the longer they carry extra weight.
In early 2019, the American Cancer Society reported that obesity-related cancers were on the rise in people under 50. The research indicated that young people today are twice as likely to develop obesity-related cancers than several decades ago. These cancers include breast, esophageal, colorectal, gallbladder, stomach and kidney cancer.
The increase in obesity-related cancers in younger people is directly tied to a rise in obesity itself. Reasons for higher rates of obesity include:
- Sedentary lifestyles: More people today lead lifestyles that involve prolonged sitting and a lack of exercise.
- Western-style diet: Many people follow a Western-style diet high in saturated fat, red meat, processed foods and sugar, while low in fruits, vegetables, whole grains and fiber.
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What Are Psa Levels
Cells in the prostate gland produce PSA, and levels typically remain below 4 nanograms per milliliter .
Most individuals with prostate cancer have PSA levels above 4 ng/mL. However, some men with prostate cancer have a normal PSA level. Similarly, some men with a higher than average PSA do not have prostate cancer.
These variations mean that a PSA test alone cannot rule out or diagnose prostate cancer. However, the PSA test can identify whether a person has a higher risk of developing the disease.
Initial testing may include both a PSA test and a DRE.
During a DRE examination, a doctor inserts a finger into the rectum to check the prostate for anomalies.
If both of these tests suggest prostate cancer, then the doctor will arrange for a biopsy to confirm the diagnosis.
Increasing Rates Of Post
A new study by Shoag, et al. explore the current landscape of post-biopsy infections. Using SEER-Medicare linked records from 2001-15 for 30-day infection rates plus emergency department, hospital and ICU admissions, they ascertained that infections increased during the years 2001 to 2007 from 5.9% to 7.2%. This is roughly the same period in which sextant biopsies were abandoned in favor of 8, 10 or 12 needle biopsies, so it does not seem surprising that there were more infections despite advances in prevention and antibiotic use. After 2007, the rate stabilized through 2015, so thats good news.
However, the Shoag study contains bad news: post-biopsy emergency room visits rose from 0.2% to 0.5%, hospitalizations rose from 0.5% to 1.3%, and intensive care unit admissions increased from 0.1% to 0.3%.
The source of infection in TRUS-guided biopsies is the transfer of rectal/bowel bacteria into the prostate, prostatic urethra, and abdominal cavity through the rectal wall. The increase in the rate is believed to be due to both under-utilized pre-biopsy rectal swab and culture, and the growing number of patients who carry bacteria that is resistant to the ciproflaxin drugs that used to effectively prevent infection and infection-related complications use medical dollars to the tune of $4,129 .
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How Is Active Surveillance Done
Although the protocol can vary, recommendations for active surveillance generally call for routine PSA tests and prostate biopsies to check for any indication that the cancer might be growing.
For example, patients at Montefiore Health System in New York City get a PSA test every 36 months, at least initially, and an MRI-guided biopsy a year after diagnosis, said Kara Watts, M.D., a urologist at the hospital who specializes in treating prostate cancer but was not involved in the study.
After the initial PSA tests and biopsy, how often they are performed depends largely on the patients particular situation, Dr. Watts explained.
We have a flexible protocol, particularly for people at both ends of the spectrum, she continued. For a man in his 70s and a life expectancy of 510 years , she said, additional PSA tests or biopsies may only be conducted every few years or only if he has symptoms. An otherwise healthy man in his 50s, on the other hand, will usually continue to have PSA tests and MRI-guided biopsies on a schedule similar to the initial protocol.
At the NIH Clinical Center, where Dr. Parnes sees patients, in addition to routine PSA testing, MRI-guided biopsies are used to help inform decisions around whether to pursue active surveillance and as part of the surveillance protocol.
What A High Psa Level Means If Its Not Prostate Cancer
A high PSA level can be the first sign of prostate cancer, but it can also be a sign of a less-serious condition. Find out why else you may have an abnormal PSA reading.
PSA tests measure a protein in your blood called prostate specific antigen. Prostate cancer makes PSA levels go higher, but a high PSA test result doesnt always mean a man has prostate cancer.
Sometimes PSA readings are elevated because of something benign, such as ejaculating within 24 hours of the test, or because of a problem that needs treatment, such as a urinary tract infection, but that isnt cancer.
Because the test cant distinguish between serious causes of elevated PSA and other causes, the United States Preventive Services Task Force has historically recommended against prostate specific antigen testing in healthy men that is, men who have no family history, known risk factors, or symptoms of prostate cancer.
But in 2017 the USPSTF released new draft guidelines that encourage doctors to discuss the potential benefits and harms of using the PSA test to screen for cancer in men ages 55 to 69. The final recommendation statement is now being developed.
In the meantime, here are seven reasons, besides prostate cancer, your PSA level could be above normal.
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