Sophisticated prostate cancer tests are coming to market that might supplement the unreliable PSA test, potentially saving tens of thousands of men each year from unnecessary biopsies, operations, and radiation treatments.
Some of the tests are aimed at reducing the false alarms, and accompanying anxiety, caused by elevated PSA readings. Others, intended for use after a definitive diagnosis, probe the genetic workings of the cancer to distinguish dangerous tumors that need treatment from slow-growing ones that might be left alone.
The tests could provide a way out of the bitter debate over whether healthy men should be screened for prostate cancer.
The problem with the PSA blood test is that many of the cancers it detects are unlikely to cause harm. But there is no reliable way to identify them. So a large majority of men with positive tests undergo surgery or radiation treatment, and many suffer for years, needlessly, from complications like incontinence and erectile dysfunction.
In late 2011, the US Preventive Services Task Force, a government advisory body, provoked a furor by recommending against screening, saying that far more men were harmed by unnecessary biopsies and treatments than were saved from dying of cancer.
But if new tests can better determine risk, screening could become more useful.
“It’s not that screening doesn’t work; it’s that we haven’t done a great job of targeting treatments for the tumors that need it,’’ said Dr. Matthew R. Cooperberg, an assistant professor of urology at the University of California San Francisco who has been a consultant to some of the testing companies.
Reducing unnecessary treatments could also reduce the $12 billion in estimated annual spending related to prostate cancer.
Test developers hope that such savings will make their tests cost effective, even at prices that will exceed $3,000 in some cases.
More than a dozen companies have introduced tests recently or are planning to do so in the near future. Rather than looking at a single protein like PSA, which stands for prostate-specific antigen, many of these tests use advanced techniques to measure multiple genes or other so-called molecular markers.
“It’s the cancer for the next 18 to 24 months that will be transformed by molecular markers,’’ said Dr. Doug Dolginow, chief executive of GenomeDx Biosciences, a start-up planning to introduce a test later this year.