The PSA blood test is often the first step in screening for prostate cancer, but unfortunately it is not without its problems and more importantly, it is not always accurate. It is included in a two-part screening process that also includes the digital rectal exam. According to Dr. David Samadi, Chairman of Urology and Chief of Robotic Surgery at Lenox Hill Hospital, a new urine test that tracks RNA molecules associated with prostate cancer, could revolutionize the way we detect this prominent illness.
The new study was conducted by the University of Leipzig and the Fraunhofer Institute for Cell Therapy and Immunology, and was presented this week at the annual European Association of Urology Congress. The German researchers presented on a series of non-coding RNA molecules which they identified that could potentially be turned into a urine test to detect prostate cancer. This new test is extremely promising, as currently biomarker tests fall short when it comes to sensitivity, specificity and accuracy. Scientists say that if a test can be developed that compliments the initial results, we could have a new and much better test for detecting prostate cancer.
Dr. Samadi says, “Until this new technology is put into practice all we have at our disposal is the PSA test. So how can we screen for prostate cancer, when a PSA test is not specific to prostate cancer? The truth is, a PSA alone is not an informative enough diagnostic tool to distinguish between prostate cancer and other benign prostate conditions. An elevated PSA can be the result of benign conditions such as prostatitis or an enlarged prostate. Other factors that affect the interpretation of a “high” PSA are things like age, ethnicity, and family history of prostate cancer. The only way to diagnose prostate cancer is with a prostate biopsy.”
Because the PSA blood test alone lacks specificity as a diagnostic tool, an elevated PSA level must be weighed against specific prostate cancer risk factors, as well as medical history, medication lists, symptoms, and lifestyle habits. Besides prostate cancer, several things can cause a PSA to rise, fluctuate or become elevated. For example, PSA levels can increase gradually as you age. Similarly, inflammation in the prostate, enlarged prostate, urinary tract infection, sex or prostate trauma.
“So, although the PSA test is mainly used to screen for prostate cancer, an elevated PSA is not a diagnosis for cancer,” according to Dr. Samadi. Things like evaluating a patient, knowing their medical and family history, following a PSA trend, as well as the velocity at which PSA changes can help a physician make an informed decision about what an elevated PSA might mean. The ability to make informed decisions and accurate interpretations, comes from education. Because PSA tests are not necessarily straightforward, simple or easy diagnostic tools, knowing your risk factors and tracking the changes in PSA can help you make informed decisions about your health, and can help you and your physician interpret a PSA properly.
Patients who are newly diagnosed with prostate cancer can contact world renowned prostate cancer surgeon and urologic oncologist, Dr. David Samadi, for a consultation at 212-365-5000.
