What biomarkers or precision dx to get for prostate screening

For prostate cancer screening and diagnosis, there are several biomarkers and precision diagnostics that can provide helpful information:

• Prostate-Specific Antigen (PSA) Test - This is a blood test that measures the level of PSA, a protein produced by the prostate gland. While not perfect, elevated PSA levels may indicate prostate cancer. However, other conditions like prostatitis can also raise PSA.

• Prostate Health Index (PHI) - This is a formula that combines total PSA, free PSA, and [-2]proPSA measurements to better distinguish prostate cancer from benign conditions. It may help identify which men should have a biopsy.

• 4Kscore Test - This blood test measures 4 prostate-specific kallikrein proteins to estimate the probability of having high-grade prostate cancer if a biopsy were performed.

• PCA3 Test - This urine test detects the PCA3 gene that is overexpressed in prostate cancer cells. It helps determine if a prostate rebiopsy is needed after a negative initial biopsy.

• ExoDx Prostate IntelliScore (EPI) - A urine test that analyzes exosomal RNA strands to assess the risk of high-grade prostate cancer prior to an initial biopsy.

• Genomic Biomarkers - Tests like Prolaris, OncotypeDX, Decipher that analyze tumor genetics/genomics to predict aggression and guide treatment in diagnosed cases.

The NCCN and ASCO guidelines recommend considering these biomarkers and tests selectively based on factors like PSA levels and previous biopsy results when screening for prostate cancer. They can provide additional risk stratification beyond just PSA alone.