Former President Joe Biden announced this weekend that he has been diagnosed with an aggressive form of prostate cancer, the second leading cause of cancer death for men in the United States.
About 1 in 8 men will be diagnosed with the disease in their lifetime and 1 in 44 will die from it, according to the American Cancer Society. For early detection, screenings are recommended every two to three years for men aged 55-69 using a process called a prostate-specific antigen test.
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The PSA test, which has been used for about 30 years, is a blood test measuring the levels of a protein found in cancer cells. Patients with a high PSA score often undergo a biopsy. If cancer is found in that analysis, it will be assigned a grade based on how abnormal it appears and a treatment will be determined.
However, that protein can be caused by noncancerous cells. Factors such as an enlarged prostate, rigorous exercise, a urinary tract infection, medications and age can also cause high levels of PSA. Some cancers found in the tests won't cause symptoms or lead to death, causing overdiagnosis and possible unnecessary treatment. The PSA test can also miss some larger, more aggressive types of cancer, according to the Institute of Cancer Research, and it's possible to have normal PSA levels even with prostate cancer.
To help, a number of scientists and researchers across the world are developing new ways to detect prostate cancer and determine its severity.
Spit test
In April, the results of a study published in the New England Journal of Medicine showed the potential for an at-home saliva test for prostate cancer. Using this method, men would spit into a tube and then mail it off for analysis. Instead of testing for signs of the disease inside the body, the saliva test searches for 130 mutation common in men's DNA that can increase the risk of developing prostate cancer.
During the study, 6,000 men in the United Kingdom aged 55-59 were tested and given a risk score, and those with the highest 10% of scores were asked to test with a biopsy and MRI. The saliva test proved to be able to better identify participants with clinically significant disease than PSA testing.
Ros Eeles, a professor of oncogenetics at the Institute of Cancer Research in London, said it could "turn the tide" for prostate cancer.
"We have shown that a relatively simple, inexpensive spit test to identify men of European heritage at higher risk due to their genetic makeup is an effective tool to catch prostate cancer early," Eeles said. "Building on decades of research into the genetic markers of prostate cancer, our study shows that the theory does work in practice — we can identify men at risk of aggressive cancers who need further tests and spare the men who are at lower risk from unnecessary treatments."
Researchers noted it could be years before the test would be widespread, as it is still in early stages. They would like to expand testing, as this study primarily focused on patients with European ancestry. Black men, though, are twice as likely to die from prostate cancer than their white counterparts.
Urine test
Another new option for screening is a urine test, which can detect the gene PCA3. When that gene is over expressed, meaning there are too many copies, there's a higher chance of prostate cancer. It's not definitive, but the test will be positive 80% of the time when there is cancer present, according to Johns Hopkins Medicine, and can help determine if a biopsy is necessary.
Recently, there's also been promising results in performing urine tests for prostate cancer at home, which could improve access for patients in rural areas or who are homebound and prefer telehealth. Researchers at Vanderbilt and the University of Michigan found an at-home test that analyzes and identifies 18 genes associated with prostate cancer was highly accurate.
A test from 2024 collected the urine following a digital rectal exam, but the new iteration found similar accuracy without the need for the exam. Researchers said the urine test would have prevented 34-53% of unnecessary biopsies for patients with high PSA levels.
'Tiger' test
Prostate cancer is more complex than other cancers so it can be difficult to determine more deadly forms after it's first detected. Researchers at the University of East Anglia created a new approach to improve accuracy through biopsy.
Using a small sample about the size of a pinhead, scientists will search for patterns in the genes that signal a cancer is a more aggressive, "tiger" type. The team at UEA used a new type of mathematical approach to find the commonalities in what they call "poor prognosis" varieties of cancer.
This type of testing is still in the very early stages. In December 2024, the BBC reported that researchers hoped create a pilot program at the Norfolk and Norwich University Hospital in 2025 and expand into the rest of the United Kingdom within two to three years.
