BY RALPH BLUM
I have said many times I am no fan of biopsies, but to most urologists, an
elevated PSA calls for an immediate biopsy. A majority of urology practices
rush men into biopsy despite the risks and discomfort involved, and despite the
fact that there are other, far less invasive indicators to help determine what
is going on in the prostate before doing a biopsy. If these indicators point to
the presence of an aggressive cancer, submitting to a biopsy to get further
information is appropriate. But in most cases, it is not appropriate, and
almost inevitably gets you a first class ticket on the Overtreatment Express.
cancer is different from other cancers and, in a majority of cases, far less
malignant. Accumulating studies show that approximately 30% of men in their
fifties, and as many as 70% of eighty-year-old men, harbor microscopic amounts
of the disease. In fact, in the opinion of one well-known urologist, "If
you are over seventy, and you don't have prostate cancer, chances are
you're a woman."
despite the fact that so many men have it, less than 3% of men in the U.S. die
from it, and the mortality rate is dropping every year.
if your PSA is elevated, take a deep breath and don't panic. Rather than triggering
an immediate biopsy, an elevated PSA should set a risk assessment process in
motion. More than half the biopsies in this country are done for evaluation of
an elevated PSA coming from BPH—an enlarged prostate. And there are various
other non-cancerous causes of an elevated PSA. So check them out and repeat the
test. Still elevated? Insist on having an OPKO-4k blood test. Studies show that
the OPKO-4K can not only demonstrate the presence or absence of cancer, it
gives a readout on the likelihood of higher-grade cancer, the kind of cancer
that should be treated rather than watched.
major cancer centers use 3-Tesla, multi-parametric MRI as a diagnostic tool. Also
to be considered is another form of imaging—color Doppler ultrasound—that is
comparable in quality to MP-MRI, is easier to perform, takes less time, can be
done in the doctor's office. Color
Doppler provides higher resolution images than the usual gray-scale ultrasound
machines, and also shows areas of increased blood flow associated with
higher-grade or more aggressive prostate cancers. If a suspicious lesion is
detected a targeted rather than a
random biopsy can be performed.
PSA is a remarkable
tool. However PSA testing alone frequently gives an inconclusive message. So if
your PSA is slightly elevated, instead of submitting immediately to a random
needle biopsy that would likely lead to un-called-for radical treatment for a
non-threatening cancer, ask your urologist to slow down. Now is the time to
gather more information by testing with OPKO-4K and color Doppler ultrasound.
Never forget that prostate cancer is the tortoise of cancers, so don’t be
frightened into making a decision you might regret. This is one situation where
taking the Local may provide a better ride than the Express.