As a breakthrough in andrological diseases, researchers from New York-Presbyterian Hospital/Weill Cornell Medical University successfully designed an innovative prostate malignancy screening method. This technique employs administration of novel drugs for suspected patients with prostate malignancies. 

As a breakthrough in andrological diseases, researchers from New York-Presbyterian Hospital/Weill Cornell Medical University successfully designed an innovative prostate malignancy screening method. This technique employs administration of novel drugs for unconfirmed prostate malignancies. Patients with biopsy-negative but with underlying aggressive malignancies exhibit high levels of Prostate Specific Antigen (PSA). 

The study reported that PSA is a ‘gold-standard’ biomarker in prostate cancer diagnosis. The biomarker is effective, and the exact values of PSA can be diagnosed when an adjuvant drug therapy is administered, when compared to current clinical diagnosis. 

According to Dr. Steven A Kaplan, Professor of Urology and investigator, the study is a breakthrough in undetected prostate cancer and explored importance of PSA diagnosis despite many controversies that questioned the benefits of PSA in prostate cancer screening. 

Increased PSA levels are not an indicator of prostate cancer and inflammation due to many underlying diseases can contribute to high PSA levels. Dr. Kaplan designed a new technique to diagnose prostate cancer in biopsy-negative patients but with high PSA levels.

The researchers studied the levels of PSA after administration of Finasteride and Dutasteride, the 5 – α inhibitor drugs that decrease the size of enlarged prostate. They found increased levels of PSA despite a decrease in prostate size or even to normal size, which is a classical feature of prostate malignancy. In normal size of prostate, the biopsy results are more likely to be accurate. 

In this study, 276 participants with an enlarged prostate are studied who are presented with PSA levels more than four but with normal trans-rectal scan reports and negative biopsies. The study was conducted as two phases, and the first phases were conducted with 97 participants. They received 5 mg of Finasteride or 0.5 mg of Dutasteride for a year and the levels of PSA are studied, and trans-rectal scans are also performed in the initial stage and the end of the study. The results found dramatic decrease in the prostate of about 48% of participants who presented with benign conditions. In biopsy-positive prostate cancer patients, the magnitude of decrease is considerably less in 28% of patients. 

In the second phase, 179 participants received the same drug treatment but biopsy was performed only if changes in PSA level of 0.4 ng/dl. In this group, 27% of participants underwent biopsy, of which, 54% participants are diagnosed with high-grade tumors. In this phase, only patients with abnormal PSA even after drug administration underwent biopsy. The study can decrease the need of biopsy in all prostate enlargement cases but only for patients with increased PSA levels after drug therapy. 

The combination of novel drugs and increased PSA levels, in response to drug administration, can differentially diagnose the prostate cancer from benign cases, and biopsy-negative patients and the combinations are believed to be superior to any other methods of screening, Dr. Kaplan says.  

In this study, all the suspected cancer patients are diagnosed and ruled out benign cases. The study was published in Journal of Urology, a peer-reviewed medical journal.