Scoring System Could Reduce Prostate Biopsies

Low score equals lower odds of tumor

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HealthDay Reporter

(HealthDay is the new name for HealthScoutNews.)

WEDNESDAY, Aug. 27, 2003 (HealthDayNews) -- A scoring system developed by Oregon physicians could help doctors eliminate nearly 25 percent of painful biopsies to confirm the presence of cancer in the prostate.

The system uses a rectal exam, age, ultrasound imaging and blood work -- and, as on the golf links, lower is better.

"Routinely, what urologists have done is biopsy all [men with suspicious prostates]," says study leader Dr. Mark Garzotto, director of prostate cancer research at the Portland VA Medical Center. "When we do that we find a lot of cancer, but more often what we find is no cancer."

Only one in four of the roughly 1 million American men referred each year to specialists on suspicion of having the disease in fact have cancer. The rest undergo biopsies unnecessarily, at pain and discomfort to themselves and tremendous cost to the health-care system.

Currently, about half of biopsies are triggered by abnormal rectal exams, the rest by elevated scores on a blood test called PSA. This test measures levels of prostate-specific antigen, a protein that spikes in men with cancer of the gland. However, it also rises in men whose prostate is enlarged for other, noncancerous reasons, making it not especially reliable as a detector of tumors.

Garzotto says his system -- called a nomogram -- would only be used in men who already had an abnormal rectal exam, a high PSA score or both. "It's not going to incur additional costs or procedures," says Garzotto, who also holds a faculty post at Oregon Health and Science University.

The nomogram includes four categories: the texture and size of the prostate on a rectal exam; the appearance of the gland on an ultrasound test; a ratio of PSA to the density of the prostate; and the man's age, since older men are at increased risk of prostate cancer regardless of the other three indicators.

The more points a man gets, the higher his odds of having cancer. Lower scores are more likely to be benign prostate conditions that don't require biopsy.

Garzotto and his colleagues tested their scorecard in 1,237 men who'd undergone a prostate biopsy. It correctly identified about 95 percent of the ones with cancer -- a rate as good as the best available tools, he says. Using the method, the researchers say, could eliminate 24 percent of unnecessary biopsies. They are now trying to refine the model to whittle that number down even further. A report on the findings appears in the October issue of Cancer.

Prostate cancer is the second most common cancer in men, now affecting more than 220,000 in this country each year. Of those, roughly 29,000 will die of the disease. Many who survive suffer a variety of nonlethal but troubling symptoms, ranging from sexual dysfunction to urinary incontinence.

More information

The National Cancer Institute and the American Cancer Society have more on prostate cancer.

SOURCES: Mark Garzotto, M.D., assistant professor, urology, Oregon Health and Science University, and director, prostate cancer research, Portland VA Medical Center, Portland; Oct. 1, 2003, Cancer

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