Currently at St Vincent's Clinic in Sydney, Golovsky is coordinating an Australasian trial of a second generation PSA test that can distinguish between the antigen from benign prostate tissue and one generated by malignant cells. And at South Australia's Flinders Cancer Centre, Professor Villis Marshall and Dr Wayne Tilley are developing a test for another protein that may also help distinguish between benign prostate problems and cancer. Different scales are used to estimate the extent of a prostate tumor. Cells with well-defined borders are generally less aggressive than those with irregular borders. The Gleason score is a bell-shaped curve from two to ten, with higher numbers indicating more aggressive cancer.
Patients usually fall within the range of five to seven.
Most urology clinics now take into account the Gleason score, PSA level and the TNM scale to gauge whether a tumour has spread. On the presumption that prostate-cell DNA circulating in the blood shows that the cancer has spread, doctors in Australia and overseas are evaluating a new blood test called reverse transcriptose polymerase chain reaction. Examining DNA may also prove useful. At Flinders Cancer Centre, Tilley and Marshall are investigating a gene that drives prostate growth to determine whether abnormalities or mutations mark particular people as having a higher risk of developing prostate cancer. Already Dr David Quinn and colleagues from Sydney's Garvan Institute of Medical Research, in collaboration with St Vincent's Clinic, have compiled a tissue bank and database of over 900 men with prostate cancer.