Smarter Screening for Prostate Cancer - 4K Score

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Veteran Member

Date Joined Jan 2011
Total Posts : 929
   Posted 3/28/2013 9:38 PM (GMT -7)   

An article from Memorial Sloan-Kettering: Department of Surgery Chair Peter Scardino on Smarter Screening for Prostate Cancer


Here’s an excerpt:


“we should consider better, smarter ways to use the tool (PSA testing) to continue to give patients the benefit of early detection and effective treatment for dangerous prostate cancers, while reducing the risk of harm from overdiagnosis and overtreatment.”


"In the future, new blood markers now in development such as free-to-total PSA ratios, the 4K score, 

and the Prostate Health Index may be able to increase the accuracy of PSA testing in predicting the presence of cancer, especially aggressive disease."


Link to the article:


I wish the article explained the 4K score and the Prostate Health Index.  Anybody hear of either of these before?


-- Tigerfan


Post Edited (Tigerfan53) : 3/28/2013 11:48:26 PM (GMT-6)

Elite Member

Date Joined Oct 2008
Total Posts : 25341
   Posted 3/28/2013 9:44 PM (GMT -7)   
the article said:

This includes men with a family history of the disease, men with a genetic predisposition to prostate cancer, and African American men.

These risk factors have always been there and known, trying to understand the rest of it, what would make this different. Knowing for sure what cancers were indolent and what cancers were aggressive on an individual basis is what is needed in screening and at diagnosis.

Thanks for sharing this.

Age: 60, 56 at PC dx, PSA 16.3
3rd Biopsy: 9/8 7 of 7 Positive, 40-90%, 4+3
open RP: 11/8, Catheter in 63 days
Path Rpt: 3+4, pT2c, 42g, 20% tumor, 1 pos margin
Incont & ED: None
Surgery Failed, recurrence within 9 months
Salvage Radiation 10/9-11/9, SRT failed within 9 months, PSA 4/12 = 37.x
Spent total of 1 ½ years on 21 catheters, Ileal Conduit Surgery 9/10,
7 other PC-related surgeries
Member of Prostate Cancer & Chronic Pain HW Communities since 10/2008
“I live in the weak and the wounded” – Session Nine (Movie)

Veteran Member

Date Joined Jan 2011
Total Posts : 929
   Posted 3/28/2013 11:00 PM (GMT -7)   

David - you're right, most of the material in the article we already know, but I've never heard of the 4K Score or the Prostate Health Index and the ability of these tools to increase the accuracy of PSA testing and in predicting aggressive PCa. That's what I'd like to know more about.

-- Tigerfan


Veteran Member

Date Joined Dec 2012
Total Posts : 677
   Posted 3/29/2013 12:43 AM (GMT -7)   
I did a Google search & found this article. I will paste an excerpt down below of a few grafs that explain how it works. The article came from an investment site & I'll paste the URL at the end of this post. To let you know in advance, you have to join their site to have full access to the article.

Article is below bracketed by asterisks..............

****************Opko's new diagnostic test gives urologists what they have been looking for, a more accurate tool for predicting prostate cancer. Here's how it works: if a patient has a high PSA score, the doctor will recommend Opko's new test rather than automatically ordering a biopsy. This test consists of four blood-based biomarkers that give the doctor what Opko calls a 4KScore.

If a patient then has a high 4KScore, the doctor will go ahead and order the biopsy. But if the patient has a low 4KScore, no biopsy will be necessary because there is a 99.4% chance that the patient does not have a dangerous form of prostate cancer. The patient will simply be put on an active surveillance program with regular checkups. In this way, doctors should be able to eliminate at least 50% of the unnecessary biopsies, thus saving insurance companies and patients billions of dollars.

How do we know Opko's new test works?

In a groundbreaking clinical study, over 10,000 men with high PSA scores were tested using Opko's 4KScore. The 4KScore trials were pivotal clinical trials. Biopsies were performed on all 10,000 men, and the results were compared to the patient's 4KScores. Here's what scientists discovered:

Men who had high 4KScores usually did have prostate cancer.

Only .6% of men who had low 4KScores had a dangerous form of prostate cancer. This represents an accuracy level of 99.4%, extremely good for any diagnostic tool.***************************

I hope this helps explain this promising new technique.

Tall Allen
Veteran Member

Date Joined Jul 2012
Total Posts : 8943
   Posted 3/29/2013 1:36 AM (GMT -7)   
PHI, Prostate Health Index, was approved by the FDA last year. Beckman-Coulter will make the test available in the US soon, I hope (it's already available in Europe). It's a refinement of the % free PSA test that detects a particular form of free PSA called -2 Pro PSA that, unlike PSA, isn't affected by prostatitis or BPH. It is much more sensitive than PSA. It's a computed value:
PHI= (-2 proPSA/free PSA ) x √PSA
At a cut-off value of 35, it will only have about 35% false negatives or false positives, which is much more accurate than PSA and will lead to many fewer unnecessary biopsies. It predicts post-RP Gleason score, Stage, Tumor Volume and Metastases. It is not associated with age or prostate volume.
•3rd biopsy (4/2010):
PSA=7.3, prostate volume=55cc, 8 of 17 cores G6 5-35% involvement
•SBRT (5x8Gy) at UCLA, 10/2010 at age 57
•PSA since treatment:
+3 mos:3.9 +4 mos:3.5 +7 mos:3.0 +10 mos:3.7 +13 mos:3.6 +19 mos:1.18 +23 mos:1.29 +29 mos:.37
• Side Effects of treatment:
+2 wks: Grade 1 urinary & rectal last 1 wk
+1 yr: Grade 1 urinary last 2 months
no ED

Veteran Member

Date Joined Sep 2012
Total Posts : 1249
   Posted 3/29/2013 2:52 PM (GMT -7)   
I appreciate your posting this article on a screening approach. I didn't see any mention of the 2.6 million Vietnam vets who have the same risk as those with a family history..The psa test and dre are the most cost effective/simplest tests to administer..It's not the test that's the problem it's how to utilize the information..Targeting is a complete cop-out!
Here is how my medical institution handles the problem of screening:
Age 40--A dre and baseline psa test--every year after for African-American and those with a
family history..Every other year if psa remains less than 1.0
Age 50--A dre and psa should be offered each year..Frequency will be decided by patient and
his doctor..
Summary: Sounds simple and effective to me!! I'll go for it.
Age 71--a "well" seasoned vet
Dx'd Sept 2010--PSA 4.89--5 G8's and 4 G7's out of 10 cores..High volume with extra capular extension present..79.2Gys IMRT completed in Feb 2011 with 6 months casodex and 3 years lupron--1 year lupron to go. .06 after radiation and now <.03

Veteran Member

Date Joined Jan 2011
Total Posts : 929
   Posted 3/29/2013 4:51 PM (GMT -7)   
Chuck & Allen -- Thanks for the imformation; very helpful.

Allen -- Why are Vietnam vets at higher risk for PCa?
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