Help For Men Who Need Repeat Biopsies

Alan K. Meeker

There is no question that our ability to detect prostate cancer is better than ever. But ask a man who has had an unnecessary biopsy — or two, or three, which probably means at least 36 needle sticks in his prostate, a dozen with each biopsy — and he will tell you that there is still room for improvement. “Today, the decision to biopsy is driven by abnormal findings on a digital rectal exam, or a PSA test,” says scientist Alan K. Meeker, Ph.D. Unfortunately, both of these can be abnormal even if a man doesn’t have prostate cancer; in scientific terms, they are “lacking in specificity.”

Worse, although it may feel extremely thorough to the man who undergoes it, “the biopsy only samples a small portion of the prostate,” Meeker adds, “and it can miss cancer.” About one-third of men who turn out to have prostate cancer have a falsely negative result on their first biopsy. “On the other hand, many men who have a negative biopsy truly do not have prostate cancer, despite suspicious physical exam or PSA results.”

Ask a man who has had an unnecessary biopsy — or three, which probably means
at least 36 needle sticks in his prostate — and he’ll
tell you that there is still room for improvement.

Thus the biopsy dilemma: “Currently, we lack effective means for distinguishing patients who are at high risk for harboring cancer from those who are unlikely to have it.” Which brings us back to the poor man at the beginning of this story, who has had one or more repeat biopsies. With every procedure, he and his family experience anxiety, wondering if there will be cancer this time — and if so, what should he do — or if it will be another negative result, with still another biopsy looming on the horizon in the near future.

Meeker, with colleagues Christian Pavlovich and Kazutoshi Fujita, is working on a simple urine test that may help. “Prostate cancer cells can be shed into the urine,” he says, “and detecting them would provide a convenient, noninvasive means of improving diagnosis.” In fact, scientists attempted such a test decades ago, but were unsuccessful. Today’s technology — with the discovery of new molecular markers for prostate cancer, and new staining techniques so they can be seen under the microscope — is much better.

The scientists’ plan is to find the most promising markers for cell staining, to “combine as many useful markers as possible to provide a robust method for cancer cell identification,” and to test them in the lab with human urine samples, Meeker explains. Once he and colleagues have determined the best way to do the testing, they will study urine samples collected in the clinic, from men with suspected prostate cancer who are undergoing their first biopsy. Their results will then be compared with the pathology results from this and any subsequent biopsies. “If we are successful, this noninvasive test will provide valuable additional information to help these men and their doctors,” says Meeker.

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