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Urine Test May Help Avoid Unnecessary Prostate Cancer Biopsies

A urine test providing information on prostate cancer grade may help men with no prostate cancer or low-grade cancer that is likely to grow slowly avoid unnecessary biopsies, HealthDay reported. In a study published online April 18 in JAMA Oncology, test results from a urine-based test that examines 18 genes for signals associated with high-grade prostate cancer were found to have high sensitivity in detecting the Gleason grade of prostate cancers, indicating the likelihood of the cancer to grow and spread to other parts of the body. “If you’re negative on this test, it’s almost certain that you don’t have aggressive prostate cancer,” said co-senior author Arul M. Chinnaiyan, a pathology researcher at Michigan Medicine, in a press release from the institution. While some prostate cancers are aggressive and should be treated right away, many low-grade cancers grow very slowly, if at all, and are often monitored with no immediate medical treatment. The18-gene panel test, branded MyProstateScore2.0, was found effective in detecting tumors Gleason grade 2 or higher and correctly identified 100% of Gleason grade 1 tumors, HealthDay reported. The test was also more effective than current options at helping patients avoid negative biopsies. “Four of 10 men who would have a negative biopsy will have a low risk [MyProstateScore2.0] result and can confidently skip a biopsy,” said study co-senior author John Wei, a urologist at Michigan Medicine. The test works even better for men who have already had a biopsy, Wei said, where it identified half of those who would have gone for a subsequent negative biopsy.

States Explore New Models of Palliative Care

California and Hawaii are among the states expanding palliative care coverage to provide better and more efficient health care, according to a report in Undark. Frequently mistaken for end-of-life care, palliative care aims to prevent and treat symptoms of chronic and serious diseases as well as side effects of treatments to improve quality of life and reduce pain and discomfort. This can come in many forms that vary with the needs of the person. Some states are increasing access to this care in a bid to improve patient health and save money by addressing health issues before they need more expensive interventions. California’s palliative care interventions can be traced to a 2006 law that enabled families to get in-home palliative care for children with serious illnesses. In 2014 they expanded that coverage to certain health conditions in adults covered by Medi-Cal, the state’s Medicaid agency, and the model was taken up by Blue Shield of California, a private insurer, for the 1.5 million people enrolled through the California Public Employees’ Retirement System. Meanwhile Hawaii’s Medicaid agency, Med-QUEST, is waiting for federal approval to list palliative care as a benefit. “Palliative care is a preventive service,” Torrie Fields, whose consulting firm, TF & Associates, worked on the Hawaii plan, told Undark. “It doesn’t just save money; it actually prevents suffering.” According to the Undark story, findings in lung cancer showed that palliative care improved quality of life and mood, and the National Academy for State Health Policy estimates that palliative benefits for Medicaid users can save up to $1,165 per person each month, a result of less spending on emergency department visits and inpatient services. “It’s cheaper to send someone to your house than to send you to a hospital,” said Marian Grant, a senior regulatory adviser with the Coalition to Transform Advanced Care.

Blood Tests Are Already Being Used to Detect Cancer

Blood tests that can detect signs of cancer before people experience symptoms are already being used in some health centers, but limited accuracy and outstanding questions mean they are unlikely to reach widespread use soon, according to a report in the Washington Post. Blood tests, sometimes called liquid biopsies, look for fragments of cancer DNA that enter the bloodstream. Their promise is greater convenience, the ability to test for multiple cancers with a simple blood draw, and the ability to find cancers early that don’t have established screening tests and that may not cause symptoms until they have grown to a stage where treatment is less likely to succeed. “It opens up a whole new world,” said Eric Klein, a scientist at Grail who developed the company’s multi-cancer detection test. “It’s the unmet need we face in cancer.” The tests still underperform traditional screening tests, and there is concern that false positives will drive invasive and costly tests while false negatives will leave people with a false sense of security. One blood test from Guardant was found to detect cancer in 100% of people with stage II and III colorectal cancers but only 71% of cases with stage I cancers and 13% of people with advanced polyps, which can be detected and removed in a colonoscopy. The Food and Drug Administration has not approved any of the tests for wide use, but they are available as a “lab-based” test that allows their use in certain settings. A coalition of cancer centers has joined under the banner of the Cancer Screening Research Network in the hopes of running a test to determine if blood tests can improve survival. It plans to launch a pilot study this year with 24,000 participants. “Will we see these as part of a routine physical exam? We are not there yet, not at all,” N. Jewel Samadder, a gastroenterologist and co-director of precision oncology at the Mayo Clinic Comprehensive Cancer Center in Phoenix, told the Washington Post. “Will we get there? That is the hope.”