Buenos Aires, Argentina (UroToday.com) Badrinath Konety, Professor at University of Minnesota, argues the use of biomarkers to detect prostate cancer is not ready for prime time given lack of adequate cost effectiveness and high level evidence (i.e. randomized controlled trial). As an example, PCA3 requires aggressive digital exam, PCA3 increases with age, HGPIN can effect PCA3 and finasteride can alter results. TMPRSS2:ERG has varying sensitivity and specificity with AUC improved by 0.08 to 0.10 over PSA gives concern regarding the utility of this biomarker improving detection of prostate cancer. ExoDx is a 3 gene signature in urine with negative predictive value of 88% but need at least 6 analyzable cores. We moved forward with advanced biomarkers without appropriate high quality level one evidence to guide the utility of these biomarkers. Moreover, given increased costs associated with these tests limits widespread use in a financially limited health care environment. To compare costs urologists receive approximately $1200 for a radical prostatectomy and Confirm MDx is $3300. An important equation evaluating these biomarkers would include ability to detect clinically significant prostate cancer divided by costs followed by a ranking of each of these biomarkers to then determine which (when compared to PSA) is superior. Unfortunately, the research at present cannot provide conclusive information. Given this uncertainty we should be cautious prior to implementation or replacing PSA with any of these biomarkers.
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Written By: Stephen B. Williams, M.D., Assistant Professor in Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish Kamat, M.D. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.