The co-authors of Invasion of the Prostate Snatchers, blog alternate posts weekly. We invite you to post your comments.

Tuesday, June 2, 2015

The Premature Biopsy Blues


As 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.

Prostate 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."

Yet 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.

So 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.

Some 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.    

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