Prostate Cancer

Things You Should Know About Prostate Cancer

Prostate Cancer Facts and Figures

For US men, prostate cancer is the most common non-cutaneous cancer and the second leading cause of cancer death. About one man in 9 will be diagnosed with prostate cancer during his lifetime.

Estimated for 2019:

  • New cases of prostate cancer diagnosed: 174,6501
  • Prostate cancer deaths: 31,6201

Key Statistics About Prostate Cancer

1 in 9

About 1 man in 9 will be diagnosed with prostate cancer during his lifetime1

65 or Older

About 60% of prostate cancer cases are diagnosed in men aged 65 or older1

3 Million

Nearly 3 million men in the US are believed to be currently living with prostate cancer1

Screening

Cancer screening for most men may begin at ages 45 to 50, or earlier for higher-risk men

Prostate Cancer: Indolent vs Aggressive

Indolent Prostate Cancer

Cancer cells grow slowly and generally stay within the prostate without spreading to other parts of the body. It is the most common type of prostate cancer and with this cancer, most men live normal full lives without treatment. Prostate cancer that remains localized in the prostate has a greater than 99% 5-year survival rate.

Aggressive Prostate Cancer

Characterized by fast-growing cancer cells that spread to other areas of the body. This type of prostate cancer can be lethal, but is generally treatable if diagnosed early. The 5-year survival rate, once it has spread outside the prostate, is around 30%.

Main Risk Factors for Prostate Cancer

While all men are at risk for prostate cancer, certain factors can elevate the threat:

  • Age: Risk increases with age
  • Race & Ethnicity: Certain groups, such as African American men, are at an increased risk
  • Family History: Close relatives, especially first-degree relatives (father, brother, paternal grandfather)
  • Lifestyle: Obesity, smoking, excessive alcohol intake, and diets high in red meat or high-fat dairy products and low in fruits and vegetables are all factors that may contribute to prostate cancer risk

Leading Urologists on the Value of 4Kscore®

Badrinath Konety, MD

Badrinath Konety, MD

Chair, Department of Urology

University of Minnesota

Peter Scardino, MD

Peter Scardino, MD

Chairman, Department of Surgery

Memorial Sloan-Kettering Cancer Center

Ali Kasraeian, MD

Ali Kasraeian, MD

Urologist

The Kasraeian Urology Practice

James Daitch, MD

James Daitch, MD

Urologist

Arizona Urology Specialists

David Albala, MD

David Albala, MD

Medical Director

Associated Medical Professionals

Greg Thoreson, MD

Greg Thoreson, MD

Urologist

Urology Clinics of North Texas

Stephen-Zappalla

Stephen Zappala, MD

Clinical Professor of Urology

Tufts University

The Biopsy Decision

Today, many physicians follow a three-stage approach for diagnosing aggressive prostate cancer.

1. Initial Screening for Prostate Cancer

Screening age-appropriate men for prostate cancer usually begins with a Prostate Specific Antigen (PSA) blood test. Considerations when selecting men for screening include age, family history, race, genetic risk, and other findings that may indicate a higher or lower risk of prostate cancer. 

An estimated 20 million PSA tests are performed annually in the US, and while PSA is an effective initial screening test for prostate cancer, it poses significant diagnostic challenges.

PSA test results may be abnormal for a number of reasons not related to prostate cancer, including prostate infection, inflammation, or benign prostatic hyperplasia (BPH), which is a common condition found in older men. As a result, many prostate biopsies performed due to an elevated PSA find no prostate cancer. In addition, PSA is a poor differentiator between indolent prostate cancer, which does not require further treatment, and aggressive, high-grade cancer, which requires early detection to prevent metastasis and mortality.

Because of PSA’s lack of specificity for differentiating aggressive prostate cancer from indolent or no cancer, many men undergo prostate biopsies that could be avoided. With close to a million prostate biopsies performed in the US annually, approximately 75% will result in diagnosing indolent prostate cancer or no cancer at all.

2. Testing to Detect Risk of Aggressive Prostate Cancer

The goal for physicians is to diagnose aggressive prostate cancer as early as possible, when treatment is most effective. The 4Kscore® Test is a blood test developed to improve patient care by providing a man’s risk for aggressive prostate cancer after an abnormal PSA or other screening result, and prior to making a prostate biopsy shared decision. 4Kscore® provides physicians and patients with highly accurate, actionable information to make better-informed clinical decisions.

The 4Kscore® Test:

  • Is used as a follow-up test after an abnormal PSA and has excellent sensitivity and Negative Predictive Value (NPV) for aggressive prostate cancer, demonstrated in large prospective US based trials
  • Has been shown to stratify long-term risk (up to 20 years after the test result) for developing metastatic cancer or dying from prostate cancer
  • Provides important, clear information for shared decision-making between patient and physician about the individualized risk of aggressive prostate cancer prior to making a prostate biopsy decision
  • Reduces prostate biopsies in low-risk men, along with overtreatment of indolent cancer
  • Identifies high-risk men for early evaluation, potentially preventing spread of the cancer outside the prostate
  • If the 4Kscore® Test indicates low risk for aggressive prostate cancer, the physician and patient may decide to forego a prostate biopsy after evaluating all pertinent clinical information. For a man found to be at elevated risk for aggressive prostate cancer by their 4Kscore®, further diagnostic testing should be considered, including a prostate biopsy.

3. The Prostate Biopsy

A conclusive diagnosis of aggressive prostate cancer is made through a prostate biopsy, which in most cases examines 10 or more prostate tissue “cores” usually taken through the rectum or perineum. Prostate biopsies are guided by an ultrasound, MRI, or a combination of these modalities. Tissue specimens obtained are reviewed by a pathologist to determine if prostate cancer is present and then to grade the cancer with a Gleason score. A Gleason 6 or lower is generally considered low grade, while Gleason 7-10 are high-grade cancers.

The prostate biopsy procedure has its limitations. Pathologists can only diagnose and grade prostate cancer if cancer is present in the biopsy specimen, which samples a small part of the prostate. Therefore, if cancer is present in an area of the prostate that is not sampled by the biopsy, or if the biopsy misses the aggressive sections of the cancer, then the report will not truly reflect the tumor aggressiveness. This results in instances of undiagnosed or “under graded” prostate cancer. Accurate identification of prostate cancer and tumor aggressiveness is one of the greatest challenges in prostate cancer diagnosis today.

Like any invasive medical procedure, there are risks associated with a prostate biopsy. The potential for pain, bleeding, sepsis, and hospitalization can all occur after a prostate biopsy. Although most serious complications are rare, they occur to the detriment of the patient’s health and comfort. Therefore, it is ideal to perform a biopsy only when the benefits clearly outweigh the risks.

It is essential that physicians find diagnostic tools that better target candidates for a prostate biopsy by improving specificity for aggressive prostate cancer and reducing the number of avoidable biopsies in low-risk men. The 4Kscore® Test fills the diagnostic gap between PSA as a screening test and biopsy as an invasive procedure with associated complications and cost. By providing the risk of aggressive prostate cancer in men with an elevated PSA, it reduces avoidable prostate biopsies in low-risk men, while identifying high-risk men for further evaluation.

 

Reference

1. American Cancer Society. https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html