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Vial of blood being tested

Prostate Cancer Screening and the 4Kscore Test

Prostate cancer is the second most common cancer in men in the United States — in fact, it is estimated that 1 in 9 men will be diagnosed with prostate cancer in his lifetime.1 Early detection of prostate cancer may lead to a better prognosis. However, there is no general consensus on whether or not to regularly test healthy men for prostate cancer.2,3

Diagnosing prostate cancer

There are typically several diagnostic tests used to determine if a patient has prostate cancer. Screening methods may include:3

  • Digital rectal exam (DRE) — This is a manual exam, where a doctor uses a gloved, lubricated finger inserted into the rectum to examine the prostate gland. If texture, shape, or size abnormalities are detected, further tests may be ordered
  • Prostate-specific antigen (PSA) test — This is a blood test to check for the level of PSA in your blood. Though a small amount if PSA is normal, a higher level may indicate infection, inflammation, or potentially cancer of the prostate
  • Ultrasound — A secondary step to prostate cancer diagnosis, a doctor may use a transrectal ultrasound to evaluate your prostate. This involves inserting an ultrasonic wand into the rectum to use sound waves to create a picture of the prostate gland
  • Prostate biopsy — Your doctor may recommend a needle biopsy procedure to extract cells from the prostate to look for the presence of cancer cells
  • MRI Fusion — This is a newer technology that is gaining more presence in the detection of prostate cancer. Fusion technology blends the images from an MRI scan with those from a transrectal ultrasound to create a clearer image of the prostate

What is the 4Kscore test?

A new development in prostate cancer screening may be able to use a simple blood draw to indicate a man’s risk for developing prostate cancer. This may guide healthcare professionals as to whether further or regular screening should be recommended. The 4Kscore test is a blood test that identifies the presence of four different PSA markers—total PSA, free PSA, intact PSA, and human kallikrein-related peptidase.4,5 These four markers have been shown to indicate a man’s risk for aggressive prostate cancer.5 What’s even more interesting is that the 4Kscore has also been shown to detect prostate cancer risk even if a DRE is not conducted.4 Prostate biopsy is an invasive procedure that is not always conclusive. If used in at-risk patients or patients with other indicators of prostate cancer, the 4Kscore test may be a useful diagnostic tool for aggressive prostate cancer cases.5

How does the 4Kscore test impact screening?

Many clinical studies have shown that the 4Kscore is effective in predicting a man’s risk for aggressive prostate cancer. Prostate cancer biopsies are performed often to screen for prostate cancer, but only 23% successfully detect aggressive prostate cancer.4 In addition, because the 4Kscore does not require a biopsy, biopsies may be able to be reduced in clinical practice as a diagnostic tool of the 4Kscore test is used. Alternatively, a high-risk 4Kscore may be used to refer a patient for biopsy and detect cancer at an earlier stage, possibly preventing a negative outcome for the patient. And men with a low-risk score may be able to safely skip an unnecessary diagnostic biopsy.4,5

  1. American Cancer Society. Key statistics for prostate cancer. https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html. Accessed February 8, 2019.
  2. Seattle Cancer Care Alliance. Prostate cancer prevention and early detection. https://www.seattlecca.org/diseases/prostate-cancer/early-detection-prevention. Accessed February 8, 2019.
  3. Mayo Clinic. Prostate cancer. Diagnosis.https://www.mayoclinic.org/diseases-conditions/prostate-cancer/diagnosis-treatment/drc-20353093. Accessed February 8, 2019.
  4. Zappala SM, Dong, Y, Linder V, et al. The 4Kscore blood test accurately identifies men with aggressive prostate cancer prior to biopsy with or without DRE information. IJCP. 2017;71(6):e12943. https://onlinelibrary.wiley.com/doi/full/10.1111/ijcp.12943?fbclid=IwAR34ZasMnJe4ksfbvkcuET-XeeRPUfCe1iyDqrusp5lh7agAxOmv2p0F-kw&. Accessed February 8, 2019.
  5. Punnen S, Pavan N, Parekh DJ. Finding the wolf in sheep’s clothing: the 4Kscore is a novel blood test that can accurately identify the risk of aggressive prostate cancer. Rev Urol. 2015;17(1):3-13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4444768/. Accessed February 8, 2019.
  6. Pincus, M. Rheumatology Advisor. Thyroid syndromes. https://www.rheumatologyadvisor.com/rheumatology/thyroid-syndromes/article/626390/. Accessed February 6, 2019.
  7. American Thyroid Association. Hypothyroidism (underactive). https://www.thyroid.org/hypothyroidism/. Accessed February 6, 2019.
  8. American Thyroid Association. Hyperthyroidisum (overactive. https://www.thyroid.org/hyperthyroidism/. Accessed February 6, 2019.
  9. Khan SR, Bano A, Wakkee M, et al. The association of autoimmune thyroid disease (AITD) with psoriatic disease: a prospective cohort study, systematic review and meta-analyisi. Euro J Endo. 2017;177(4):347-350. https://eje.bioscientifica.com/view/journals/eje/177/4/EJE-17-0397.xml. Accessed February 6, 2019.
  10. Chiriac A, Chiriac AE, Pinteala T, Foia L. Prevalence of thyroid abnormalities amont psoriatic patients. Endocrine Abstracts. 2014;35:262. https://www.endocrine-abstracts.org/ea/0035/ea0035p262. Accessed February 6, 2019.
  11. Acay A, Ulu MS, Ahsen A, et al. Assessment of thyroid disorders and autoimmunity in patients with rheumatic diseases. Endo Meta Immun Dis. 2014;14(3):182-186. http://www.eurekaselect.com/122956/article. Accessed February 6, 2019.
  12. Fallahi P, Ferrari SM, Ruffilli I, et al. Increased incidence of autoimmune thryroid disorders in patients with psoriatic arthritis: a longitudinal follow-up study. Immunol Res. 2017;65(3):681-686. https://link.springer.com/article/10.1007/s12026-017-8900-8. Accessed February 6, 2019.

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