In Austria, approximately 4,700 men develop prostate cancer every year and during this time frame approximately 1,146 succumb to the disease. The diagnosis of prostate cancer can be made through the analysis of blood for the prostate-specific antigen (PSA); this PSA test, however, is not completely reliable.
“Although the PSA is not an ideal marker, it is still the best diagnostic bio-marker across the whole of oncology. At a younger age, i.e., around 40 – 45 years, it is very useful in terms of predicting the risk of prostate cancer. The data also confirms this. Since the PSA screening test was introduced, deaths from prostate cancer have fallen by 40 percent. So the question isn’t about whether PSA screening should be carried out or not. It’s more about doing it cleverly,” said the study’s lead author Dr. Shahrokh Shariat in a news release.
The PSA test fails on reliability because a high PSA level does not necessarily indicate an increased risk for developing prostate cancer. Currently, if PSA levels are high, the patient is subjected to aggressive therapy, which can result in side effects like erectile dysfunction or incontinence. To avoid this “overtherapy,” the team developed a program comprising methods of personalized medicine, meaning the customization of the healthcare system (treatment, decision-making, etc.) focused on the individual patient.
To avoid unnecessary therapy while still controlling eventual tumor development, the program established that a patient who is young in age or who has slightly raised PSA levels should only be actively monitored through regular follow-up assessments. If the PSA values are so high that physicians consider performing a biopsy, the test is repeated within twelve weeks and other bio-markers besides PSA are assessed and mathematical models applied, before making a decision.
“In addition to the PSA test, we use the new molecular methods in imaging and pathology to create a comprehensive biological profile of the cells. This enables us to make a precise risk assessment in the MDT, localize the tumor accurately and determine its molecular structure. We also use special calculation models in formulating a prognosis,” explained Dr. Shariat.
Based on this new program, unnecessary treatments and subsequent side effects are avoided and physicians can make a more informed decision regarding treatment and estimate the patient’s response to surgical or drug-based therapy.
In case the MDT recommends surgery, Dr. Shariat strongly recommends that it is performed in a specialist hospital with experience in this type of medical procedure. “These hospitals also have the latest specialist equipment. The MedUni Vienna and the Vienna General Hospital, for example, have the latest Da Vinci robots, which make the procedure more precise and more tolerable for the patient, who is of course at the centre of everything,” concluded Dr. Shariat.