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Prostate Cancers That are Dangerous & Need Early Treatment May be Identified by Sex Hormone-Binding Globulin (SHBG) Blood Test

Health In Focus   - G J E 4
  • New blood test found to predict the prostate cancer
  • Prostate cancer is the second most common cancer among Indian men
  • Some prostate cancers are harmless and aggressive treatment is unnecessary
  • The average age of diagnosis of prostate cancer among men is 66 years
A new study from Dr Marco Moschini and colleagues from Milan has shown that for
local prostate cancers treated with radical prostatectomy you can preoperatively predict the aggressiveness of the prostatic disease, via a simple blood test using the sex hormone level of a binding globulin or protein ( SHBG).
Prostate Cancers That are Dangerous & Need Early Treatment May be Identified by Sex Hormone-Binding Globulin (SHBG) Blood Test
Prostate Cancers That are Dangerous & Need Early Treatment May be Identified by Sex Hormone-Binding Globulin (SHBG) Blood Test
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This recent study is based on a previous study that highlighted the importance of discriminating between aggressive forms of prostate cancer from harmless variations. The study titled "What is the Need for Prostatic Biomarkers in Prostate Cancer Management" was published in the journal The Current Urology Report in December 2015.

‘Prostate cancer is the second most common cancer among Indian men and early identification using a blood test such as levels of sex-hormone-binding globulin (SHBG) can help identify aggressive forms of the cancers may become a game changer.’
The study found that 417,000 men were diagnosed as having prostate cancer in Europe in the year 2012, while 90,000 men died of prostate cancer every year.
  • This indicated that 1 in 5 (or 20%) of men with prostate cancer patients died.
  • 4 out of 5 ( or 80%) men had prostate tumors which were relatively harmless.
  • Genomic alterations in prostate cancer have been well understood along with the development of newer diagnostic tools.
  • Since prostate cancer is clinically heterogeneous, it is important to identify a tool that can distinguish between prostate cancers that are harmful against those that are harmless.
  • Many kits are available, but they haven't been used in the clinical diagnosis yet.
Dr Marco Moschini and colleagues felt that an effective diagnostic tool was required to differentiate between prostate cancer that was aggressive and the ones that were harmless as
  • Early detection of aggressive forms would help treat these cancers effectively. Identification of harmless forms will prevent the need for aggressive treatment options and would qualify for watchful waiting.
The Italian researchers have been able to show that hypogonadism (which is low levels of the sex hormone testosterone) predicts that the patient will have a high Gleason score - which indicates a poor outcome after treatment.

The test that is used currently to determine the extent of aggressiveness of the prostate cancer is a biopsy of the tumor. The prostate biopsy report has a Gleason score that is used to indicate the extent of tumor progression. Score 1 on the Gleason scale indicates the presence of a large amount of normal cells while a Gleason score of 5 indicates a large amount of tumor cells and poor prognosis. Two most common type of cells are studied and a combined score is given to the clinician to decide on the treatment methods. Though this test is effective, it is invasive and sometimes can lead to problems such as bleeding, infection, fever and urinary retention.

After adjusting for age, they found that the hypogonadism status and levels of
sex-hormone-binding globulin (SHBG) was able to predict patients with Gleason pattern 5 (OR 1.79, p=0.025).

In their study, 1000 patients who underwent radical prostatectomy surgery at the San Raffaele hospital were the study participants. This surgery is performed to remove the affected prostate gland as well as the surrounding tissue.

The parameters that were studied using a blood test aided in identifying 118 patients from among the 1000 patients who had a Gleason score of 5.

According to Marco Moschini, "We found that hypogonadism, and the levels of SHBG, were able to predict whether or not patients had Gleason factor 5, which is the worst Gleason score. This association will allow us to predict what the outcome will be before we decide to treat a patient with surgery. Potentially, this can be helpful to identify patients with the most aggressive prostate cancer before surgery."

Dr Marco Moschini and colleagues presented their study at the Munich meeting of European Association of Urology this year.

This study could be another important milestone towards better detection and classification of prostate cancer as the test is less invasive and provides a clear distinction between harmful and relatively harmless prostate tumor.

Dr. Sunil Shroff, a leading urologist from Chennai, India, commenting on the study said, "Currently, there are no tests to know which prostate cancers are low-risk and indolent and which are aggressive. The indolent ones require waitful watching while the aggressive ones require treatment such as radical prostatectomy." He added that, "This research could show us a way forward and avoid over-treatment for prostate cancer that is currently being practiced in the western world." He, however, added that further research and studies are required to substantiate these claims. "One must remember that though prostate cancer is the most common cancer in men, not all prostate cancers are high-risk cancers and the chances of a patient with prostate cancer dying of the cancer is less than 20% and in some studies, less than 10%."

Another important aspect of the study that needs to be highlighted is whether the treatment for hypogonadism could lower the risk of prostate cancer. This would be another path breaking discovery that will aid prostate cancer patients from across the world.

References:
  1. Shalu Jain, Sunita Saxena and Anup Kumar "Epidemiology of prostate cancer in India"; Meta Gene. 2014 Dec
  2. Martin Spahn, Silvan Boxler, Steven Joniau, Marco Moschini, Bertrand Tombal, and R. Jeffrey Karnes, "What is the Need for Prostatic Biomarkers in Prostate Cancer Management?", Curr Urol Rep. 2015

Source: Medindia

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