Movember moustaches may help find new prostate cancer tests

Money raised through pastMovembermen's health campaigns is helping fund the search for alternatives toPSAscreening for prostate cancer.

That search has taken on added importance now that an official task force has recommended not usingPSAtesting to screen for prostate cancer.

Prostate-specific antigenorPSAtesting measures the amount of that protein enzyme in blood. Higher levels may indicate the presence of cancer or infection in the prostate. Or sometimes they may not.

The test costs an individual about $30. In B.C., the province covers the costs, and its billed about $11.

Prostate cancer is the most common cancer in men (excluding the skin cancers) and ranks third in number of deaths, after lung andcolorectalcancer.

While the recommendations by the Task Force on Preventive Health Care don't mean the end ofPSAtesting they are opposed by groups like Prostate Cancer Canada and the Canadian Cancer Survivor Network efforts to develop other diagnostic tools are well underway.

For StuartEdmondsof Prostate Cancer Canada, "PSAisn't the bad actor in this, it's actually decision-making along the process that's part of the problem, how thePSAis being interpreted or how men are being pushed or choosing to have treatment when actually treatment may not be necessary."

And JackieManthorne, theCanadian Cancer Survivor Network's president and CEO, says: "Don't throwPSAtests out the window until we have something viable to replace it with.

• PSAtest should be abandoned as screen for prostate cancer, task force says
• Backgrounder onPSAtesting

This year,Edmonds' organizationhas already directedMovemberFoundation-funded grants worth $10 million toward research on alternative diagnostic tools for prostate cancer. TheMovember campaign,best known for the moustaches grown to raise awareness about men's health issues, starts today.

Spending on all prostate cancer research in Canada totalled more than $36 million in 2011, according to the Canadian Cancer Research Alliance.

Diagnosing prostate cancer withDREsandMRIs

At present, besides thePSAtest, the only other widely used diagnostic technique is the digital rectal exam, orDRE. TheDREcan only be done on the back of the prostate gland, although that's the site of 85 per cent of prostate cancers.

During theDRE, the doctor is feeling for lumps or hardened areas, which, if caused by cancer, meanthe disease is more advanced.

Edmondssays theDREcertainly has some value but notes, "current screening studies do not consider DRE in addition to PSA screening."

Men have been diagnosed with prostate cancer by aDRE, he notes, which is then confirmed by a biopsy.

Testing is also underway to show how effective magnetic resonance imaging, MRI, can be for detecting prostate cancer,Edmondssays.

A research article published by the medical journal The Lancet in August says, "A promising approach lies in the development ofmultiparametricMRI imaging technology of the prostate, which at present claims to selectively diagnose aggressive prostate cancers and avoid the diagnosis of many non-significant cancers."

If it happens, the price tag will likely be high. However, distinguishing between cancers that can killand ones that men can live withis critically important when deciding treatment.

"Overdiagnosisoccurs in roughly 40 per cent of cases detected by screening," according to The Lancet article.

Cutting edge research

One of thoseMovembergrants gives $5 million to a cross-Canada team for research to better identify "men who do or do not need aggressive treatment by providing accurate information about risk at diagnosis," and to "develop novel molecular diagnostic tests to predict which men are likely to develop aggressive cancer," says Prostate Cancer Canada.

The team is led by John Bartlett of the Ontario Institute of Cancer Research.

A smaller grant went to a team headed by Dr. John Lewis at the University of Alberta. Its goal is to develop tests that look at a particular protein to predict the outcome of a prostate cancer when it's diagnosed.

"These tests could tell us if the patient is at high risk for developing aggressive metastatic disease or if that patients disease is in a benign state," Lewis says.

Lewis says they hope to have an initial clinical test within three years and a blood test in less than 10 years.

New diagnostic tests

Two otherMovembergrants in Canada are going to research onbiomarkersthat may lead to a new test to diagnose prostate cancer.

Robert Day at the University ofSherbrookeis looking at developing a diagnostic test that Prostate Cancer Canadasays could "complement or even replacePSA."

Their research will focus on an enzyme Day's team discovered,sPACE4, that shows up at abnormally high levels with prostate cancer and can be correlated with the severity of the tumour.

A team from the University Health Network in Toronto, under Bharati Bapat, has a grant to develop a DNA-based biomarker test that can predict if a patient has an agressive prostate cancer.

They are studying genes called microRNAs found in a patient's urine, for example, and comparing them to the patient's symptoms, etc.

They hope that couldlead to a test that can predict if a man has prostate cancer and how aggressive it will be.

Edmondssays genetic testing "is one of the areaswherethere are likely to be big breakthroughs in the future."

Meanwhile, MatsDaugaardat the Vancouver Prostate Centre is researching a sugar structure,CSA, that is found at high levels when prostate cancer is present.

Daugaardsays he is very optimistic his research will lead to "making diagnosis more accurate and making it, possibly, earlier."

He says studying the sugar could also lead to better therapy to target the cancer. His research grant comes from funds donated at Safeway stores.

Prostaticstones

A brand new area of research that has promise for detecting prostate cancer involves analyzing prostatic stones.

These poppy-seed-sized stones, mostly consisting of calcium phosphate, have been found in almost all surgically removed prostate glands.

But now, scientists with the Centre National de la Recherche Scientifique and Tenon Hospital in France have found that with infrared spectroscopy and scanning electron microscopy, they can determine whether there is or has been an infection of the prostate, even asymptomatic infections.

This is potentially important because scientists have linked infection-related inflammation with cancer of the prostate, as well as other organs.

To apply this knowledge to diagnosis, Dominique Bazin, research director at the CNRC, says doctors could find the stones with a CT scan. If present, that should "trigger an investigation by doctors," Bazin told CBC News.

Bazin said his team recently used the same techniques to examine small calcium deposits in breast tissue and says the initial findings, not yet released, are "quite exciting" for early detection of breast cancer.