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Novel prostate cancer marker spots cancer when the biopsy is negative
  By Megan Rauscher
NEW YORK (Reuters Health) - In men with elevated serum PSA and a negative biopsy, staining for a prostate cancer-associated nuclear structural protein may help determine the presence or absence of prostate cancer, research suggests. The sensitivity and specificity of the test for prostatic adenocarcinoma was 84% and 85%, respectively.
The negative biopsy in an individual with increased serum PSA "raises an important clinical dilemma, namely what to do with the patient at this time," investigators note in the April issue of The Journal of Urology. Typically, these patients undergo repeat biopsies depending on subsequent PSA readings.
Using antibodies they developed against EPCA, Dr. Robert Getzenberg from the University of Pittsburgh Cancer Institute and others stained 29 prostate tissue samples from patients with prostate cancer who had initial negative biopsies and 27 healthy control prostate tissue samples.
"The EPCA staining intensity in the samples analyzed from the patient cohort with prostate carcinoma were significantly different compared to controls (p < 0.001) with almost no overlap in staining results," the team reports.
Positive immunohistochemical staining for EPCA expression was statistically significantly associated with the presence of prostatic adenocarcinoma. Increased EPCA expression was observed in nearly all of the negative biopsies from patients subsequently found to have prostate cancer.
Moreover, EPCA staining "identified prostate cancer 5 or more years prior to its being diagnosed pathologically in these cases," Dr. Getzenberg told Reuters Health.
By comparison, non-diseased prostate tissue showed "few instances" with increased EPCA expression.
"The EPCA marker can be used to stain prostate biopsies that do not have pathological evidence of prostate cancer and determine if the patient does or does not have the disease," Dr. Getzenberg told Reuters Health. "This will save repeated biopsies in men that might have elevated PSA levels but do not have positive biopsies."
A multicenter trial assessing the value of EPCA in prostate cancer is planned. An immunohistochemical test for EPCA "could serve as an adjunct to the current diagnostic approach to a patient who undergoes prostate needle biopsy," Dr. Getzenberg and colleagues suggest in their report.
J Urology 2004;171:1419-1423.


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