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Benefits Of Phi Testing

The Prostate Health Index (phi) in Prostate Cancer Risk Assessment [Hot Topic]

The PSA test is a widely used screening tool for prostate cancer. However, given the PSA tests limited specificity for cancer, a more precise tool is needed for prostate cancer detection. The phi score provides better risk stratification to identify patients who need a biopsy. The appropriate use of phi can significantly modify physicians behavior patterns and improve their ability to diagnose and manage their patients. phi is another tool to help their patients decide if a biopsy is right for them.2

International Studies On Phi In Prostate Cancer Screening

Several large international studies have also reported on PHI, including the PRO-PSA Multicentric European Study. Among 646 European men from five centers undergoing prostate biopsy for a PSA of 210 ng/ml or suspicious DRE, Lazzeri and colleagues showed that using p2PSA or PHI significantly improved the prediction of biopsy outcome over total and free PSA . While the use of %p2PSA or PHI would reduce the number of unnecessary biopsies by 15% at 90% sensitivity, PHI would miss the fewest high-grade tumors.

The same authors also reported a subset of men from this multicenter PROMEtheuS trial to specifically evaluate men with a positive family history of prostate cancer . They found that proPSA and PHI were significant independent predictors of prostate cancer in this high-risk population. When added to a model containing PSA and prostate volume, p2PSA and PHI led to a 8.7% and 10% increase in accuracy, respectively . In addition, p2PSA and PHI were associated with Gleason score on biopsy, suggesting their potential utility to reduce unnecessary biopsies in men with a positive family history. Additional study is warranted to further examine the potential utility of PHI in other high-risk populations, including men of African descent.

About The 4kscore Test

The 4Kscore® Test gives you and your physician the information needed to make confident treatment decisions. Find out more about this valuable diagnostic tool.

The 4Kscore® Test is available through physicians nationwide.

Reference

1. American Cancer Society.

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What Is The Phi Test

The PHI or Prostate Health Index test is a blood test that is used to predict the risk of having prostate cancer in men. The PHI test is used instead of the traditional PSA test. The Prostate Health Index test is actually derived from the PSA test. The PHI test is a combination of the free PSA, total PSA, and the proPSA isoform of free PSA. These 3 tests are mathematically combined in a formula that results in a Prostate Health Index or PHI score. The PHI score is a better predictor of prostate cancer than the total PSA test alone or the free PSA test alone. The Prostate Health Index is also a better predictor of prostate cancer risk than the free PSA to total PSA ratio or the free PSA ratio.

The PHI test offers better sensitivity as well as better sensitivity for prostate cancer. This means that men with a low score are less likely to have prostate cancer and those with a higher score are much more likely to have prostate cancer.

Us Studies On Phi In Prostate Cancer Screening

Sharp Increase in Guardant Health

In 2011, Catalona and colleagues published the results of a large multicenter trial of PHI for prostate cancer detection in 892 men with total PSA levels from 2 to 10 ng/ml and normal digital rectal examination who were undergoing prostate biopsy . The mean PHI scores were 34 and 49 for men with negative and positive biopsies, respectively. Setting the sensitivity at 8095%, PHI had greater specificity for distinguishing prostate cancer on biopsy compared with PSA or percentage free PSA . On receiver operating characteristic analysis, PHI had an area under the curve of 0.70, compared with 0.65 for %fPSA and 0.53 for PSA. Although the PHI test has been approved by the US Food and Drug Administration only in the 4 -10 ng/ml PSA range, this study showed that PHI performed well in the 2-10 ng/ml PSA range. .

Since the aforementioned results came from a large multicenter trial, it is important to note that PHI has also been examined in a grassroots population with consistent findings. Specifically, Le and colleagues compared PHI with to its individual components in men undergoing a prostate biopsy with PSA levels from 2.5 to 10 ng/ml and negative DRE from a prospective screening population of 2034 men . On ROC analysis, PHI had the highest AUC compared with p2PSA , %fPSA and PSA for prostate cancer detection.

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Getting The 4kscore Test Is Simple

1. Talk to your physician to find out if The 4Kscore® Test is right for you.

2. Have your blood drawn at your physician’s office, a conveniently located Patient Service Center, or at your home or office using Scarlet.

3. Discuss your 4Kscore® Test results with your physician to evaluatethe next steps regarding your prostate health.

Prolaris By Myriad Genetics

Prolaris is a genetic test showing expression of 31 genes involved in cell-cycle progression , an important regulatory step in the development of cancer.

A study examining the Prolaris panel in prostate biopsy specimens from 582 men with prostate cancer demonstrated that the test was a very strong predictor of later clinical outcomes including disease recurrence and progression to metastasis following surgery

What does the Prolaris test tell you? The probability of more aggressive disease in the prostate, say, Gleason 7 or higher, that was not picked up by needle biopsy. Also, the Prolaris test helps determine if patients are a candidate on active surveillance and the 10-year risk of developing metastasis following definitive treatment (prostatectomy or radiation. The report provides a Prolaris score which will fall between 0 and 10 with a higher score indicating more aggressive cancer. For every one unit increase in the Prolaris Score, the patients mortality risk doubles.

Who qualifies for the Prolaris test? Patients who have had a prostate biopsy within the last three years and had a positive result for prostate cancer with a low to intermediate grade disease meaning, in general, a Gleason 6 or Gleason 7 .

How to order the Prolaris test? The physician completes the requisition form, sends in for the pathology report to Myriad, and the prostate sample is sent in by the pathology lab where biopsy prostate tissue is stored.

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What Are Psa Tests

A first step in testing for prostate cancer is a prostate-specific antigen test. PSA is a protein made by the prostate, the small gland underneath the bladder.

In some cases, an elevated PSA level can be a sign of prostate cancer. However, not all elevated PSA levels is a sign of prostate cancer. PSA is also found in enlargement of the prostate , infections, and inflammation of the prostate .

Since PSA is found in the blood, a PSA test is usually taken with a finger prick.

A PSA test will not provide enough information for a diagnosis, but it may help your doctor decide if cancer is likely and what to do next. While PSA tests once required you to be present in a lab or at your doctors office, you can now administer a test from your own home.

PSA tests can also be used to assess the effectiveness of treatments and monitor progress. The tests could be done to monitor for recurrence of cancer or other conditions.

Do False Negatives And False Positives Happen

Prostate Health Index density improves detection of clinically significant prostate cancer

The PSA test is not a fool-proof method to test for prostate cancer.

When prostate cancer develops, PSA levels often rise about 4.0 ng/mL, but there are exceptions to the rule.

A showed that some people with PSA levels below 4.0 ng/mL had prostate cancer, while some with higher levels did not.

The ACS states that about of people with a PSA below 4 will have prostate cancer.

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The Test Is Often Not Needed

Most men with high PSAs dont have prostate cancer. Their high PSAs might be due to:

  • An enlarged prostate gland.
  • Recent sexual activity.
  • A recent, long bike ride.

Up to 25% of men with high PSAs may have prostate cancer, depending on age and PSA level. But most of these cancers do not cause problems. It is common for older men to have some cancer cells in their prostate glands. These cancers are usually slow to grow. They are not likely to spread beyond the prostate. They usually dont cause symptoms, or death.

Studies show that routine PSA tests of 1,000 men ages 55 to 69 prevent one prostate cancer death. But the PSA also has risks.

What Is A Normal Psa By Age Range

Theres no specific level that classifies as abnormal, but levels can be helpful in determining if a biopsy is needed. According to the National Cancer Institute, most doctors used to consider PSA levels of 4.0 ng/mL and lower as normal.

Various factors, like medication and physical activity, can cause PSA levels to rise, so your doctor may look at a variety of factors before deciding to perform additional tests.

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Oncotype Dx By Genomic Health

The Oncotype is a genetic test that provides a Genetic Prostate Score after prostate biopsy.

In studies performed at UCSF, this 17-gene signature was a reliable and helpful tool in assessing candidates for treatment or active surveillance without re-sampling or removing the entire prostate

The GPS is on a scale of 1-100, where higher scores are more suggestive of less than optimal pathology. It is important to remember that a GPS score is a measurement of gene expression within prostate tumors and must be interpreted within the context of other relevant clinical factors.

In 395 prostate cancer patients with low and intermediate risk who underwent a radical prostatectomy was validated for its ability to predict men who have high-grade or high-stage prostate cancer at diagnosis and may help men diagnosed with PCa decide between active surveillance and immediate definitive treatment.

What does the Oncotype Dx tell you? The probability of more aggressive disease in the prostate, say, Gleason 7 or higher, that was not picked up by needle biopsy. The report provides a GPS score from 0 to 100. The lower the score, the less likelihood there is advanced prostate cancer somewhere in the prostate.

How to order the Oncotype Dx test? The physician completes the requisition form, sends in for the pathology report to and the prostate sample is sent in by the pathology lab where biopsy prostate tissue is stored.

Who qualifies for the Oncotype Dx?

What Is The Prostate Health Index Test

Prostate Health Index is a test that predicts the risk of having prostate cancer. It is used instead of the PSA test for prostate cancer detection and prostate cancer screening. PHI provides more useful information than PSA alone and is more specific for prostate cancer. When the Prostate Health Index test is elevated, there is a greater likelihood of having prostate cancer than when a PSA test is elevated.

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How Long Does It Take To Lower Psa Levels

The amount of time it takes to lower PSA levels depends on whats causing the elevated levels. Mild changes in PSA could return to normal within a few days.

However, if the elevation in PSA is due to prostate cancer, PSA levels will not decrease. For prostate cancer treated with surgery, PSA is expected to be undetectable after 1 month. For prostate cancer treated with radiation, PSA will reach its lowest level after 17 months on the average.

If due to benign prostatic hyperplasia, PSA may not decrease, as prostate size naturally increases with age.

For other conditions, like prostate cancer, it could take 1-2 years after treatment for levels to lower.

What Does Phi Score Mean

Table 1 represents clinical study data analyzed to estimate an individual patient’s probability of having detectable prostate cancer based on Beckman Coulter phi results when that patient has a PSA in the diagnostic gray zone between 4 and 10 ng/mL.3 At phi cutoffs between 27 to 55, the probability of cancer ranged from 16.8 to 50.1%. For example, a patient with a phi result below 27 has a 90% chance that his prostate biopsy will be negative.

Table 1. Probability of Prostate Cancer Based on phi Results Between 4 and 10 ng/mL1

phi Range*

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Harvard Expert Urges Caution For Use Of New Prostate Cancer Test

The FDA has approved a new kind of PSA test for prostate cancer. The company that developed it, Beckman Coulter, claims the test can help doctors do a better job of telling the difference between prostate cancer and benign prostate conditions. In theory, a more cancer-specific PSA test would reduce unnecessary biopsies.

The test, called the Prostate Health Index , has been available in Europe since 2010. With the FDAs approval, it should become available in the U.S. later this summer. The PHI combines measurements of three kinds of prostate specific antigen , a protein produced by the prostate gland. The FDA approved the PHI test for use in men 50 years and older with above-normal total PSA readings between 4.0 and 10 nanograms per milliliter , and who had a digital rectal exam that did not find signs of cancer.

A PSA result between 4 and 10 leaves a man in a gray zone: it could indicate prostate cancer, or it could be a variety of other, less frightening things, including infection or an enlarged prostate gland. In men with PSA levels in the 4.0 to 10 range, biopsy confirms cancer about 25% of the time. This needlessly exposes the remaining 75% of men to discomfort, anxiety, and the risk of infection and/or bleeding.

What Is A Dangerous Psa Level

In My Opinion: Biomarkers for the Diagnosis of Prostate Cancer

The higher your PSA level, the higher the risk for prostate cancer. While PSA levels may fluctuate during your lifetime, a consistent rise in PSA over time can indicate prostate cancer.

If you have a PSA level , youre considered to be in the borderline range, according to the ACS. You have a 1 in 4 chance of having prostate cancer.

If PSA levels rise above 10, theres a 50 percent chance you have prostate cancer.

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Overview Of Genes And Mutations

Your genes contain DNA, which carries instructions for every chemical process in your body. Literally, everything, including the color of your eyes to finding an ridding the body of cancer cells. As your cells grow and divide, they make copies of their DNA and its not uncommon for some minor mistakes to occur.

Normal, healthy cells have mechanisms to recognize mistakes and repair them. But people who inherit one of the abnormal genes lack the ability to repair these minor mistakes. An accumulation of these mistakes leads to increasing genetic damage within cells and eventually can lead to the cells becoming cancerous.

The DNA can become mutated, meaning damaged, from what is inherited from your parents or environmental chemicals like radiation, and all sorts of different chemicals.

So, for instance, a gene called PTEN is supposed to protect your body from cancer cells. When this gene stops working, that can be one of the causes of cancer. Same with the BRCA gene and many others.

These are the main genes associated with potentially aggressive prostate cancer when mutated:

BRCA 2, BRCA 1 , ATM CHEK2 BRCA1, RAD51D, PTEN, and PALB2.

On this post, Id like to discuss material I lectured on to a group of naturopathic oncologist on February 17, 2019.

The focus was on how to use genetics to better make decisions on what is next for men who may have prostate cancer.

Here we go

When Is A Psa Test Needed

If you are age 50 to 74, you should discuss the PSA test with your doctor. Ask about the possible risks and benefits.

Men under 50 or over 75 rarely need a PSA test, unless they have a high risk for prostate cancer.

  • You are more likely to get prostate cancer if you have a family history of prostate cancer, especially in a close relative such as a parent or sibling.
  • Your risks are higher if your relative got prostate cancer before age 60 or died from it before age 75. These early cancers are more likely to grow faster.
  • If you have these risks, you may want to ask your doctor about getting the PSA test before age 50.

This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

04/2014

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What Other Test Are Available For Men At Risk For Prostate Cancer

While traditionally, the options available to men at risk for prostate cancer were limited to PSA blood test and a prostate exam , a number of exciting innovative options are now available.

PSA is still a useful test but is being supplanted by more informative tests such as 4KScore and PHI , both of which incorporate the traditional PSA test as well. Thus, the report will list both the traditional PSA test and the 4KScore or PHI score respectively.

PHI is a new test that provides an incremental improvement over the PSA test alone when it comes to predicting the risk of prostate cancer. It can be used to reduce the need for unnecessary biopsies in some men.

If you have any questions, to schedule a consultation or if you need a second opinion, pleasecontact us or call:

How Can I Prepare For An At

Most at-home PSA kits recommend that you collect blood samples first thing in the morning, but no fasting is required.

While no food or drinks are proven to skew results, imaware notes that some supplements and medications may raise or lower PSA levels.

You should consult with your doctor if youre undergoing chemotherapy or taking any of the following medications or supplements:

  • nonsteroidal anti-inflammatory drugs

Heavy exercise can also temporarily increase PSA levels, leading to inaccurate results. According to LetsGetChecked, even seemingly simple activities, like riding a bike, may increase your PSA level. Its best to refrain from exercise for a few days prior to testing.

Prostate infections, urinary retention, urologic procedures, or recent pelvic injuries can also impact your PSA levels, so its best to consult with your doctor if youre experiencing an infection or taking antibiotics.

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