New test may diagnose prostate cancer from urine with a high level of accuracy

Medical scientists in Korea have employed AI-learning to create a new prostate cancer screening that they claim has an accuracy rate of near 100%.

The breakthrough, which is a simple urine strip, could possibly revolutionize testing, as some existing methods can be inaccurate and can result in over-diagnosis and necessitate invasive biopsies.

The current method is a PSA test, which stands for “prostate-specific antigen”. It tests the levels of this particular protein in the blood. This test can have a high misdiagnosis rate.

PSA is produced from both cancerous and non-cancerous prostate cells, and even if the test detects cancerous PSA, there is a risk that it’s diagnosing tumors that would never produce symptoms during a lifetime.

In addition, other conditions such as inflammation of the prostate, an infection, or an enlarged prostate, can also fool a standard PSA test.

Designed at the Korea Institute of Science and Technology, this potential breakthrough utilizes a urine test strip containing an electrical-signal-based ultrasensitive biosensor. AI analysis is also used to quantify the values of four separate prostate cancer factors.

The AI uses an algorithm to determine whether or not the values add up to something that truly indicates cancer. This process led to a very bigh accuracy rate across 76 different tests.

Patient preferences in protocol for prostate cancer active surveillance

Almost 200,000 men in the United States are expected to learn they have prostate cancer in 2021. Many will have a type of the disease that’s not immediately life-threatening. These are the patients that may be candidates for active surveillance.

A high percentage of the active surveillance patients won’t require additional treatment that could cause sexual and urinary side effects. However, the patients will still require ongoing follow-up so if their disease progresses, a potentially curative intervention would be possible. This is the reason that a carefully designed active surveillance protocol is so important.

With impressive medical advances such as biomarker identification, genomic testing and improved imaging, identifying which men make the best candidates for active surveillance has become much clearer in recent years.
What is less clear is how men feel about active surveillance and their ideas on preferences for what it should involve. Research can provide that insight and lead to the development of patient-centered active surveillance protocols.

Improving care and understanding patient experiences

Researchers hope to get input from 50 to 100 prostate cancer patients who are currently being followed with active surveillance. Using a combination of interviews and questionnaires, the researchers’ goal is to learn more about men’s perceptions of different aspects of active surveillance, and to use what they learn to encourage greater participation by the men in those protocols.

Researchers are simply trying to see how being on active surveillance affects patients’ quality of life and determine whether there are things that could make their experience better.

This type of surveillance for prostate cancer includes ongoing PSA tests and digital rectal exams. Periodic biopsies and transrectal ultrasounds are necessary to determine if prostate cancer is progressing or may pose a greater risk than initially thought, necessitating further treatment.

Biopsy not only carries a small risk of infection, it can be uncomfortable, both physically and mentally as well. And for some men, the thought of living with cancer in their body may be mentally uncomfortable. Understanding how all of this affects patients is important to this study.

A focus on quality of life

To qualify for the study, the male participants must be diagnosed with low-risk prostate cancer. They must also have chosen not to have treatment with prostatectomy or radiotherapy within the first year months of their diagnosis.
Researchers will ask those who complete an extensive questionnaire to participate in a qualitative interview to get more direct feedback on their experience.

Putting patients first

A lot of time and effort goes into bringing patients the latest advances in diagnosing and treating cancer, but there is more to providing good care. This study helps put the patients’ thoughts and feelings into the equation.

FDA approval given for new prostate cancer imaging technique

This new imaging method has been called a “game changer” and could become the new standard of care.

A new imaging technique for prostate cancer that locates cancer lesions in the pelvic area and other parts of the body to which the tumors have migrated has just been approved by the FDA.

The technique is known as prostate-specific membrane antigen PET imaging, or PSMA PET. This technique uses positron emission tomography in conjunction with a PET-sensitive drug that is highly effective in detecting prostate cancer throughout the body. This means that it can be better and more selectively treated. The PSMA PET scan also identifies cancer that is often missed by current standard-of-care imaging techniques.

It is now possible to provide a more effective imaging test for men who have prostate cancer. Because the PSMA PET scan has proven to be more effective in locating these tumors, it may eventually become the new standard of care for men who have prostate cancer, for initial staging or localization of recurrence.

How the new imaging technique works

For those patients who are initially diagnosed with prostate cancer or who were previously treated but who have experienced a recurrence, one critical step is to understand the extent of the cancer. Medical imaging is used to locate cancer cells so they can be treated.

PSMA PET works using a radioactive tracer drug, which is injected into the body and attaches to proteins known as prostate-specific membrane antigens. Because the prostate cancer tumors over-express these proteins on their surface, it allows the tracer to enable physicians to pinpoint their location.

As of late 2020, UCSF and UCLA are the only two medical centers in the U.S. that can offer PSMA PET to the public through this FDA approval. However, more hospitals will have the opportunity to adopt the technology, but only after applying for expedited FDA approval

Prostate cancer patients can benefit greatly from exercise post-treatment

The therapies and procedures that prostate cancer patients go through can have a negative effect on their physical capabilities to complete normal activities of daily living. Side effects of treatments can include: fatigue, loss of muscle mass, increased body fat percentage and perceived decline of function of daily activities. A great way fight against these unwanted side effects is by exercising.

In one recent study 155 men were randomly assigned to either a control group (no exercise intervention) or a 12-week exercise program including resistance training three days per week. The men in the group who participated in exercise reported less frequency and less severity of fatigue from normal activities of daily living. These same men also demonstrated increases in upper body and lower body muscular strength and endurance.

Resistance exercise has been widely reported as having beneficial effects on increasing muscle mass, muscle strength and muscle endurance in prostate cancer patients. It is also known to have positive effects on maintaining bone and connective tissue health which may help men reduce their risk of injuries while exercising and in everyday life.

It is highly recommended that men talk with their doctor or other health care provider before starting an exercise routine. The guidance of a fitness professional with certifications and experience working with the sub-specialty of cancer survivorship is also very helpful.

Question: How long can surgery for high-risk prostate cancer be safely delayed?

According to a study published in 2020, prostate cancer surgery for patients with high-risk disease can be safely delayed up to six months following diagnosis.

Because of the COVID-19 pandemic there have been widespread delays in medical treatments, including for cancer. The delays in surgery for low-risk prostate cancer have been found to result in minimal harm to the patient.

Unfortunately, however, there has been a lack of data regarding the association between surgical delay time with clinical outcomes in patients with localized, high-risk prostate cancer.

In this recent study, researchers used data from the US National Cancer Database to identify 32,184 patients with clinically localized high-risk prostate adenocarcinoma who were diagnosed between 2006 and 2016 and who received radical prostatectomy, or the removal of the prostate gland and surrounding tissues.

The surgery delay time (SDT) was defined as the number of days between initial cancer diagnosis and prostate cancer surgery, and was categorized into five groups: 31-60, 61-90, 91-120, 121-150, and 151-180 days. The primary outcomes were adverse pathological outcomes following surgery, including pT3-T4 disease, pN-positive disease, and positive surgical margin. The secondary outcome was overall survival.

When compared with an SDT of 31 to 60 days, longer SDTs were not associated with higher risks of any adverse outcomes (odds ratio 0.95; 95% confidence interval [CI] 0.80-1.12; P=0.53). An SDT of 151 to 180 was not associated with worse overall survival (hazard ratio 1.12; 95% CI 0.79-1.59; P=0.53). These same researchers also performed subgroup analysis for patients with very high-risk disease and found similar results.

The conclusion that the researchers reached was that in this large, contemporary cohort study of 32,184 patients with clinically high-risk localized prostate cancer who underwent radical prostatectomy within 180 days of diagnosis, increased SDT was not associated with higher risks of adverse pathological features or lower OS. Therefore, they concluded that radical prostatectomy for high-risk prostate cancer could be safely delayed up to 6 months after diagnosis.

Blood Test Could Make Early Detection of Cancer Possible

In the future an experimental blood test could make early detection of cancer possible. Two research studies published in 2020 show exciting advances in DNA methylation analysis, which is a method that examines biochemical alterations of genetic material for the presence of cancer.

Called “liquid biopsies” by some researchers, one of the experiments accurately predicted the emergence of 50 cancers and detected the area where the tumor was growing in thousands of people. The other experiment made predictions up to four years before symptoms occurred. The existence of a single test that can potentially screen for multiple cancers at once could be a huge breakthrough and lead to early interventions and treatments that save lives.

Early Detection of Cancer

A handful of cancer screening tests already exist. Mammograms look for early signs of breast cancer, colonoscopies check for colon cancer and Pap tests screen for cervical cancer. Undergoing these types of tests before symptoms appear can make a difference.

Unfortunately, all of these current cancer screening tests return an unacceptably high rate of false positives. A study, showed that over a period of 10 years 10 to 12 in 100 men screened for prostate cancer have false-positive results.

These new approaches currently being researched could provide accurate and early detection of cancer long before abnormal tissue or cells appear.

DNA Methylation Analysis

This type of early cancer detection could be possible because of a biochemical process, called methylation, which is the transfer of four atoms — one carbon atom and three hydrogen atoms (CH3) – from one substance to another. This transfer to and from substances work as a kind of biological switch, turning on and off a host of systems in the body. Because this process occurs in tens of millions of known places in the body, it has the potential to offer a global view of cancer.

This research showed that up to four years before the study subjects walked into the hospital, there were already signatures in their blood that showed they had cancer.

Although much more research is needed, DNA methylation analysis could fundamentally change cancer treatment. When taken into consideration that caner t is the second leading cause of death worldwide, the progress marks one of the most exciting possibilities in the early detection of cancer.

Vanished or hidden prostate cancer and the outcomes

An important question in prostate cancer is “Can early-stage prostate cancer “vanish” during follow-up?”

It seems more likely that the cancer is just “hidden”–either way, negative biopsies during active surveillance for prostate cancer are associated with excellent long-term outcomes, reports a study in The Journal of Urology®

For men undergoing active surveillance, negative biopsies indicate low-volume disease and lower rates of disease progression. These ‘hidden’ cancers can have excellent long-term outcomes and remain ideal for continued active surveillance.

Excellent long-term outcomes with negative biopsies on active surveillance have been noted

During active surveillance, prostate cancer is carefully monitored for signs of progression through regular prostate-specific antigen (PSA) screening, prostate exams, imaging, and repeat biopsies. The goal is for men to be able avoid or delay treatment-related side effects without compromising such long-term outcomes as cancer progression or survival.

In some cases, men undergoing active surveillance have negative biopsies showing no evidence of prostate cancer. And while these patients may believe their cancer has “vanished,” they most likely have low-volume or limited areas of prostate cancer that were not detected in the biopsy sample.

To evaluate the long-term significance of negative biopsies, researchers recently analyzed 514 men undergoing active surveillance for early-stage prostate cancer at UCSF between 2000 and 2019. All these patients had at least three surveillance biopsies after their initial prostate cancer diagnosis (total four biopsies). The median follow-up time was nearly ten years.

Thirty-seven percent of these patients had at least one negative biopsy during active surveillance, including 15 percent with consecutive negative biopsies. The men with negative surveillance biopsies had more favorable clinical characteristics, including low PSA density and fewer samples showing cancer at the initial prostate biopsy.
The negative biopsies were also associated with good long-term outcomes. At 10 years, the rates of survival with no need for prostate cancer treatment (such as surgery or radiation) were 84 percent for men with consecutive negative biopsies, 74 percent for those with one negative biopsy, and 66 percent for those with no negative biopsies. After adjusting for other factors, men with one or more negative biopsies were much less likely to have cancer detected on a later biopsy.

However, having negative biopsies didn’t mean that the cancer had “vanished” – even some men with consecutive negative biopsies later had positive biopsies or were diagnosed with a higher stage of cancer. Therefore, surveillance, although less intense, is still recommended rather than “watchful waiting” for men in good health. Higher PSA density and suspicious findings on prostate magnetic resonance imaging (MRI) scans were associated with a higher risk of cancer detected on later biopsies.

Negative surveillance biopsies in men on active surveillance indicate low-volume prostate cancer with very favorable outcomes. A less-intensive surveillance regimen should be supported in these patients after discussion of risks and benefits, particularly in those with low PSA density and adequate MRI-targeted sampling.

The importance of exercise for prostate cancer patients

Patients who have been diagnosed with prostate cancer often wonder whether they can exercise during — and after — their treatment. The answer, in both cases, is an emphatic yes. Physical activity can help patients live longer, improve their quality of life and help alleviate some of the side effects of prostate cancer therapies.

In general, it is always beneficial for prostate cancer patients to have an exercise regimen and for the majority of men they are completely physically able to participate as long as patients don’t overdo it.

Exercise has positive effects for prostate cancer patients

More than 3 million men are currently living with prostate cancer, a cancer that develops in the small, walnut-sized gland located below the bladder and in front of the rectum. It’s one of the most common types of cancer in America; about 1 in 9 men will develop the disease at some point in their lives, according to the American Cancer Society.

Research shows that for people who have prostate cancer, exercise can reduce the risk of dying from any cause. That research, published February 2011 in the Journal of Clinical Oncology, also found that vigorous exercise can lower the risk of dying from prostate cancer itself — men who did at least three hours of vigorous activity a week were 61 percent less likely to die of prostate cancer than people who did less than one hour a week.

More recently, a January 2016 European Urology study followed people with prostate cancer for up to 17 years and found that, among those who survived at least two years, the patients who were more physically active after diagnosis lived longer.

Exercise also helps protect against other health issues including heart disease, which can occur in people who have prostate cancer or have had it in the past, according to the American College of Cardiology.

Exercise is also recommended for people with prostate cancer who are doing “active surveillance,” i.e., monitoring their cancer closely with regular blood tests, rectal exams and biopsies. This is mostly because exercise has been shown to be helpful for prostate cancer in general. At this time, it’s still unclear whether exercise can help keep prostate cancer from progressing. Experts think that exercise may aid in preventing prostate cancer recurrence if it leads to weight loss for people who are overweight or obese.

Historic Veterans’ Prostate Cancer Bill Passes in the House of Representatives

The House unanimously passed H.R. 6092, also called the Veterans’ Prostate Cancer Treatment and Research Act which is designed to establish a national clinical pathway for prostate cancer. This standardized system of care has been designed to enhance treatment and increase access to clinical trials via a registry for the most commonly diagnosed cancer in the Veterans Health Administration.

The prostate cancer rate for veterans is nearly double that of civilians. These service members have dedicated their lives to the American people and they deserve to receive the same high quality care any one of us would expect when faced with a diagnosis of prostate cancer. The House of Representatives has helped to ensure that the nearly half a million veterans facing prostate cancer are no longer subjected to the risks of an unorganized health system.
This effort was sponsored by Congressman Neal Dunn, M.D. who is a former urologist. No timetable has been set for when the Senate may vote on the measure, but it’s expected to move quickly through the Senate.

Tips For Prostate Cancer Survivors; Keep An Eye On Cancer

There are more than 3.6 million prostate cancer survivors in the United States. Thanks in part to reliable diagnostic tests and numerous treatment options, nearly 100 percent of men are still alive five years after a prostate cancer diagnosis, 98 percent are alive 10 years after diagnosis, and about 96 percent are alive 15 years after diagnosis.

Prostate cancer survivors need regular follow-up tests to determine whether their prostate cancer has recurred or progressed. According to experts at the National Comprehensive Cancer Network (NCCN), most prostate cancer survivors should have a prostate-specific antigen (PSA) test every six to 12 months for the first five years after active treatment ends, then annually thereafter. Also, a yearly digital rectal examination (DRE) is recommended for some men, although this exam is not as important as PSA testing.

Prostate cancer survivors also need to be checked regularly for any new cancers that may develop. As an example, men treated with radiation therapy, particularly external beam radiation therapy (EBRT), have a slightly higher risk of developing bladder cancer than those who had a radical prostatectomy. In addition, the risk of developing colon or rectal cancer may be slightly higher for these patients.

The American Cancer Society (ACS) recommends following cancer screening guidelines for higher risk individuals where they exist. If any new symptoms develop in prostate cancer survivors, such as blood in the urine or rectal bleeding, those patients need to report them to the doctor right away.