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Prostate Cancer Research Foundation

Research Funding Strategy October 2005

Our aims

• To fund research that helps to find the cure or cures
• To fund research that contributes towards finding the cause or causes
• To fund the best quality research
• To fund research that offers better outcomes to men that are diagnosed with prostate cancer
• To enable prostate cancer specialists to share information on a regular basis

History

Prostate Cancer Research Foundation was founded in 1991. The aim of the Foundation is to promote research into the causes of prostate cancer, particularly by linking together scientists and clinicians in all relevant fields throughout the world at biennial forum.

The Foundation has a volunteer scientific and clinical advisory committee with the two-fold purpose of supervising the existing research projects, and evaluating new, worthwhile projects for support. The process of awarding funding is stringent and involves independent peer review of grant applications.

Funding

The Foundation funds research into prostate cancer and will consider applications for up to £100,000 per year, over a maximum of three years

To apply for a grant, research proposals must demonstrate:

• Excellence - Usually Alpha rated by peer review process
• Sustainability - Conducted in a University, Medical School, hospital
• Relevance - Clear pathway from hypothesis to potential alleviation/treatment of prostate cancer
• Originality and a clear case of fully justified financial need

The Prostate Cancer Research Foundation is a member of the Association of Medical Research Charities (AMRC) – a membership organisation of the leading medical and health research charities in the UK. www.amrc.org.uk

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Obese men may have prostate cancer despite relatively low values on a prostate cancer screening test called the PSA test, a new study suggests.

The PSA test detects PSA -- prostate-specific antigen -- in the blood. Only prostate cells give off PSA. PSA levels can rise as prostate tumors grow. "Being a big guy, you have enormous blood volume, so PSA is diluted," Freedland tells WebMD. "Obese men having these lower PSA values due to the dilution factor means we are going to miss some of them early on."

The researchers reviewed medical records from some 14,000 men with prostate cancer who had their prostate glands removed. Based on the men's body mass index, and adjusting for differences in the men's clinical conditions and prostate pathology, the researchers used pre-operative PSA test values to calculate the actual amount of PSA in the men's blood.

They found that obese men had lower PSA values than did non-obese men even though they had equal or even higher amounts of PSA in their blood.

"What this suggests is if we use the same PSA threshold for obese and normal-weight men, we may be missing some cancers," Freedland says. "For example, a PSA score of 4.1 in an obese man would be diluted down to a 3.3."

Alan R. Kristal, DrPH, one of the researchers investigating the link between obesity and prostate cancer, strongly disagrees with Freedland's calculation. Kristal is associate head of the cancer prevention program at Seattle's Fred Hutchinson Cancer Research Center.

"This is an over-interpretation of the data. Most studies show the difference is much smaller," Kristal tells WebMD. "Doctors will look not just at the PSA level but the speed of PSA increase over time, the PSA relative to other men the same age, findings from a digital rectal exam, and other information before they make a decision on whether to do biopsy. These teeny-tiny differences due to obesity have no impact."

It's an important dispute to resolve. As Freedland points out, there soon will be other blood tests for other kinds of cancer. "This issue is something we need to keep in mind as we move forward with blood-based cancer screening," Freedland says.

 
>>> Prostate Test

With men of older age the prostate gland can become a serious threat for their health. Besides prostate cancer, several other disorders can be diagnosed in an early phase, which increases the chance of successful treatment. For men between 45 and 70 years old it can be useful to test the prostate periodically. The prostate gland influences a man's ability to urinate and can also affect his sexual activity.

This Complete Home Prostate disease Screening Test gives an indication of the levels in the blood of PSA (Prostate specific Antigen.)

Raised levels of PSA are an indicator of Prostate disease or inflamation.

The home PSA test pack contains everything required to measures the amount of PSA in a sample of blood taken with a simple finger prick lancet device (supplied).

Simple and easy to use home test to screen for prostate disease, supplied with full instructions.

P.S.A. is a substance produced by the prostate and a small amount normally leaks into the blood. Men with disease of the prostate tend to have more P.S.A. in their blood.

Testing for prostate cancer
Prostate cancer is diagnosed using a range of tests, including the PSA blood test. A normal prostate secretes a protein into the ejaculate called prostate specific antigen (PSA). This protein helps to nourish sperm in the ejaculate and only tiny amounts of PSA leech into the bloodstream. However, cancer cells in the prostate interfere with proper functioning and cause large amounts of PSA to enter the blood.

In around one in three cases, a high PSA level is caused by cancer. Another common cause of elevated PSA is a prostate condition called benign prostatic enlargement. For this reason, the PSA blood test isn’t used in isolation when checking for prostate cancer. A digital rectal examination (DRE) is recommended together with a PSA test to detect prostate cancer. If a PSA test or a DRE is abnormal, further investigation such as a tissue biopsy is needed to confirm the diagnosis.

Normal PSA levels
The prostate slowly enlarges with age, so the production of PSA rises accordingly. It is usually recommended that a PSA greater than 4ng/ml (nanograms per millilitre) should be followed up with further tests. Generally, the healthy upper limits of PSA levels in the blood increase with age. One US study suggests the following 95 per cent limits:

• 40–49 years – 2.0ng/ml
• 50–59 years – 3.0ng/ml
• 60–69 years – 4.0ng/ml
• 70–79 years – 5.5ng/ml.

Other factors that influence PSA levels
The PSA blood test isn’t conclusive. It is possible, although rare, to have prostate cancer without elevated PSA levels in the blood. A higher than normal PSA level doesn’t automatically indicate prostate cancer either. PSA can be raised by other factors, including:

• Infection of the prostate (prostatitis)
• Benign prostatic enlargement (BPE).

Tests – apart from PSA
Apart from the PSA blood test, other diagnostic tests for prostate cancer include:

• Rectal examination (DRE) – the doctor feels for enlargement of the prostate gland or other changes.
• Biopsy – small samples of tissue are removed from the prostate and examined.

Further tests
If cancer is diagnosed, the following tests may be used to determine the stage of progression of the cancer:

• Bone scan – to check whether or not cancer cells have migrated to the bones.
• Computerised tomography (CT) scan – a specialised x-ray.
• Pelvic lymph node dissection – a nearby lymph node is removed and examined to check whether or not cancer cells have entered the lymphatic system (this is only done during surgery on the prostate).

Early detection and screening
Prostate cancer is typically slow-growing. High PSA levels can occur five to 10 years before the onset of prostate cancer symptoms, and early prostate cancer often has no symptoms. The PSA test can detect cancer at this early stage. At present, however, health authorities do not recommend widespread screening for prostate cancer. This is because we don’t yet have reliable evidence that screening reduces death from prostate cancer. However, that evidence may come in the near future with the reporting of large-scale trials of screening currently underway.

Most authorities suggest that a man makes his own choice about whether or not to be ‘screened’ (tested regularly) for prostate cancer. This should be done in discussion with your doctor, after considering the benefits and uncertainties of testing and your own risk from the disease.

Other forms of PSA testing
Researchers are devising ways to make the PSA blood test more accurate in diagnosing prostate cancer. One promising test is the ‘free to total’ PSA test. In both healthy men and those with prostate cancer, the prostate specific antigen in the bloodstream latches onto protein. In men with benign prostatic enlargement, the prostate specific antigen tends to be free of protein.

The ‘free to total’ PSA test compares the amount of bound to unbound PSA to see whether the elevated levels are caused by prostate cancer or benign disease. The lower the ‘free to total’, the higher the probability of prostate cancer. The probability of cancer is higher if the ‘free to total’ ratio is less than 20–25 per cent.

The rate of change of PSA (PSA velocity) can also be helpful in finding prostate cancer. In men with PSA above 4ng/ml, a velocity of greater than 0.75ng/ml/yr is thought to indicate a higher risk of cancer. This threshold may be lower in men with a PSA below 4ng/ml.

Monitoring cancer
After a diagnosis of cancer, regular PSA blood tests are also used to monitor the cancer activity in a man’s body. Generally, prostate cancer prompts higher and higher levels of blood-borne PSA as it grows. Regular blood tests can indicate whether the tumour is shrinking or enlarging, and if the current treatment is working or not.

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