4Kscore Predicts the Grade and Stage of PCa.

[pjoshea13]

New study below.

I have been pushing the 4Kscore test for so long, it might seem that I have a financial interest (I don't).

Sooner or later, U.S. PCa screening will pick up again, & it will involve PSA plus markers that improve specificity. The test will eliminate most biopsies. (The ultimate test might eliminate the need for any biopsy. The cancer leaves plenty of clues in blood & urine.)

Not really a subject for this group, I suppose.

Will the 4Kscore bevome the standard test? At the moment, insurance will not reimburse.

Biopsies are not cheap & urologists will be loathe to stop doing them. But Medicare could refuse to pay for a biopsy unless the 4K or similar test warrants one. Thirty years into the PSA era, we deserve something better.

This American study, involving someone from Memorial Sloan Kettering Cancer, was published in the journal "European Urology Focus", which " is a new sister journal to European Urology". A bit obscure, perhaps? But Europeans (even the British) might be early adoptors of the 4Kscore.

Anyway:

"In a subset of men who underwent RP, the 4Kscore was significantly associated with pathologic grade and extracapsular extension in the surgical specimen, with higher scores associated with higher grade and more aggressive histology. The 4Kscore test may be helpful in selecting men who are likely to have adverse pathologic features at RP that may preclude them from being safely observed."

-Patrick

ncbi.nlm.nih.gov/pubmed/287...

Eur Urol Focus. 2017 Feb;3(1):94-99. doi: 10.1016/j.euf.2015.12.005. Epub 2016 Jan 6.

The 4Kscore Predicts the Grade and Stage of Prostate Cancer in the Radical Prostatectomy Specimen: Results from a Multi-institutional Prospective Trial.

Punnen S1, Nahar B2, Prakash NS2, Sjoberg DD3, Zappala SM4, Parekh DJ2.

Author information

1

University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL, USA. Electronic address: [e-mail].

2

University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL, USA.

3

Memorial Sloan Kettering Cancer Center, New York, NY, USA.

4

Andover Urology, Andover, MA, USA.

Abstract

BACKGROUND:

The 4Kscore accurately predicts aggressive prostate cancer (PCa) on prostate biopsy.

OBJECTIVE:

We assessed how well the 4Kscore predicts pathology at radical prostatectomy (RP).

DESIGN, SETTING, AND PARTICIPANTS:

Among 1312 men who prospectively underwent a 4Kscore and biopsy of the prostate at 26 sites throughout the United States from October 2013 to April 2014, we selected men who were diagnosed with cancer and underwent RP.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:

The primary outcome was the presence of high-grade PCa or extracapsular extension. We assessed the association between the 4Kscore and the grade and extent of PCa at RP using the Wilcoxon rank sum test. We used logistic regression to investigate the added value of the 4Kscore in predicting a high-grade or non-organ-confined tumor when added to available postbiopsy clinical predictive tools.

RESULTS AND LIMITATIONS:

A total of 144 men were diagnosed with PCa and underwent RP. Higher 4Kscores were associated with higher grade at RP. For men with Gleason scores ≥6, 7, and 8 cancers in the surgical specimen, the median 4Kscores were 7% (interquartile range [IQR]: 4-2), 25% (IQR: 12-38), and 47% (IQR: 24-66) (p<0.0001), respectively. The median 4Kscore among men with non-organ-confined cancer was significantly higher then men with organ-confined cancers (36% [IQR: 19-58] vs 19% [IQR: 9-35]; p=0.002). The 4Kscore did not significantly add to available clinical prediction tools for determining the likelihood of a high grade or non-organ-confined cancer; however, we were limited by a small sample size for this analysis.

CONCLUSIONS:

In a subset of men who underwent RP, the 4Kscore was significantly associated with pathologic grade and extracapsular extension in the surgical specimen, with higher scores associated with higher grade and more aggressive histology. The 4Kscore test may be helpful in selecting men who are likely to have adverse pathologic features at RP that may preclude them from being safely observed.

PATIENT SUMMARY:

Among men with prostate cancer who underwent removal of the prostate, the 4Kscore was associated with the final grade and extent of cancer.

Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.

KEYWORDS:

High grade; Prostate cancer; Radical prostatectomy

PMID: 28720374 DOI: 10.1016/j.euf.2015.12.005

[Sisira]

Patrick,

Sometime ago I was very much attracted to a Press Release posted by OPKO ( multinational biopharmaceutical and diagnostics company ) in June 2015 regarding this unique 4Kscore Test. I took a printout from the web page. The following paragraph I copy from same may add further clarity to your post.

"About the 4Kscore Test :

The 4Kscore is the only blood test that accurately identifies an individual patient's risk for aggressive prostate cancer, the lethal form of prostate cancer. The 4Kscore uses a proprietary algorithm that incorporates the blood levels of four different prostate-derived kallikrein proteins : Total PSA, Free PSA, Intact PSA and Human Kallikrein-2 (hK2 ), plus the patient's age, Digital Rectal Exam ( DRE ) status ( nodule / no nodule ), and prior negative biopsy status ( yes / no ) to calculate the percentage risk ( probability ) of finding a Gleason Score 7 or higher grade of prostate cancer. The four kallicrein panel of biomarkers utilized in the 4Kscore Test is based on over a decade of research conducted by scientists at Memorial Sloan-Kettering Cancer Center and leading European institutions and is established as a recommended standard of care in the 2015 NCCN Prostate Cancer Early Detection Guidelines. The 4Kscore Test provides individualized risk for the presence of aggressive prostate cancer and adds new information to the shared decision making discussion between the Urologist and the patient. "

They claim that this test has been studied on over 22,000 patients and is very useful before making a decision to do a biopsy or not and also in a situations of negative biopsies - in our efforts to detect aggressive prostate cancer.

Thank you Patrick. Please follow up on the latest developments on this Test and keep us informed. Although we are not going to make use of it now, long after our diagnosis, it can be very useful to our sons, relations and friends and also for those who are struggling with negative biopsies but are in doubt for prostate cancer.

Best regards

Sisira

[S103462]

The cost of the 4Kscore test is relatively low with its recent drop in price. Perhaps a good additional affordable screening tool: 4kscore.com/news/announcing...