Tuesday, February 27, 2007; 9:31 PM

PORTLAND, Ore. -- Oregon scientists say a simple test can identify men
at high risk of life-threatening prostate cancer even after a biopsy
finds no signs of it.

The key, researchers say, is "PSA density," which compares the size of a
man's prostate with his levels of a cancer-related protein called
prostate-specific antigen.

Men with the highest PSA densities were much more likely to later be
diagnosed with aggressive cancers than men with lower scores in an
Oregon study, even though both groups had clean prostate biopsies.

If it survives scientific review, it could help save the lives of men
with serious cancers and avoid repeated biopsies in others.
"It's that 1-in-10 men that do have a life-threatening cancer that we
wanted to identify," said Dr. Mark Garzotto, an Oregon Health & Science
University Cancer Institute researcher, who recently presented the study
at a cancer conference in Florida.

Prostate cancer will kill about 27,000 U.S. men this year. Doctors
usually check for tumors with a prostate biopsy, which uses needles to
gather cells from the gland.

More than a million U.S. men get prostate biopsies each year. The tests
find more than 200,000 tumors, meaning many cancer-free men get unneeded
biopsies.

Studies estimate that the test fails to find the tumor in 20 percent to
33 percent of men who have one, usually because the needles sample only
bits of the gland.
"With less than 1 percent of the prostate sampled, we're trying to get
the pathologist to tell us if the guy has cancer or not, which is an
impossible task," said Garzotto. So doctors recommend second biopsies a
few months after a clean test.

To narrow the need for repeat tests, Garzotto and co-workers studied 511
patients at the Veterans Affairs Medical Center, where he works. All the
men had clear initial prostate biopsies. But 112 were later found to
have cancer, 52 of them aggressive tumors that can be deadly.

The scientists found that "PSA density, by itself, was the best
discriminator between guys in the high-risk group and the guys in the
low-risk group," Garzotto said.

By 2 years after their clean biopsy, 23 percent of the men in the
high-risk group had aggressive cancer compared with 4 percent of
low-risk men, Garzotto said.

At four years, the rate was 36 percent in the high-risk group and 9
percent in the other.
"I feel more comfortable now about recommending repeat biopsies to this
(high-risk) group," he said.
Another simple test may identify which men with advanced prostate cancer
have the worst outlook, according to a different OHSU study presented at
the Florida conference.

Dr. Tomasz Beer found that among men with advanced cancer, those with
the highest level of C-reactive protein died significantly sooner than
men with lower levels.

C-reactive protein is a sign of inflammation, which doctors increasingly
think is "associated with cancer progression and cancer resistance to
treatment," Beer said. He urged more studies.

T.J. Koerner, director of research information management for the
American Cancer Society, cautioned that the OHSU findings are initial
reports that need confirmation by other scientists: "It definitely does
not mean next month people will have new treatment options available to
them," he said.
___
Information from: The Oregonian, http://www.oregonlive.com

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."
http://community.webtv.net/PALMER_ENT/doc