Over-diagnosis and over-treatment are two common problems in the field of prostate cancer. Yes, a man’s PSA level increases when a tumor takes over the prostate, but it also increases as a result of other conditions, such as benign prostatic hyperplasia. More than one million men with elevated PSA levels undergo prostate biopsies to test for cancer each year. Prostate biopsies, however, can fail to detect cancer that has metastasized or spread to other parts of the body. When surgery to remove the prostate is recommended for patients with whom the cancer has unknowingly metastasized, the treatment is generally unsuccessful.
Significant advancements are being made in the research of new diagnostic tests that help identify which patients with elevated PSA levels require a biopsy for further workup. Among the new tests being studied are urine-based tests that detect genetic abnormalities present in prostate cancer. Researchers have found a fusion between two genes – TMPRSS2:ERG – that is present in prostate cancer patients. They’ve found that whether or not this gene fusion is apparent and how much is detected is a good indication of whether a man has prostate cancer and the level of aggressiveness thereof.
Continued research into this and other gene fusions found in prostate cancer cases is well underway. The hope is that these gene fusions will serve as biomarkers that can be added to urine-based tests to improve prostate cancer detection rates.