We see patients who have risk factors for prostate cancer and desire detailed counseling, those who may have had a prior normal biopsy with ongoing concerns, and those with a prior diagnosis of “low-risk" prostate cancer who are being followed with an observational strategy, such as active surveillance.
A prostate-specific antigen or PSA test is a blood test that helps to determine risk of prostate cancer as well to actively monitor men who have already been diagnosed with the disease. It is a common component of routine health maintenance for many men along with a digital rectal exam to assess for firmness or irregularity of the prostate. A high PSA does not necessarily reflect prostate cancer, but higher levels are associated with higher risk. An elevated PSA will often provoke additional investigations to clarify whether a prostate biopsy is needed. Similarly, a bump or irregularity on the prostate as detected by digital rectal exam may warrant additional testing. If a primary care physician suspects prostate cancer, he or she may refer a patient to the Genitourinary Oncology Program to discuss options.
More information on the PSA test (National Cancer Institute)
When evaluating prostate cancer risk, we individualize the discussion to a man's particular risk factors. We review laboratory data, physical exam findings, medical history, family history, demographic information, and available imaging findings to determine options and yield of additional testing. Not all elevated PSA values require additional testing or a prostate biopsy! The PSA may be elevated for diverse reasons including prostate enlargement, inflammation, infection, recent procedures, and recent ejaculation, among others. Our approach is to use "shared decision-making" to determine the role of additional testing and possibly biopsy.
PSA screening controversy
There has been considerable discussion regarding the usefulness of PSA testing for early detection of prostate cancer. As prostate cancer is very common in men as they age, and most prostate cancers are slow growing, there is a concern for "over-diagnosis," or detection of cancers that were never destined to cause harm. This concern, however, requires balance against the important interest of detecting more aggressive or dangerous types of prostate cancer. Ultimately there are pros and cons of PSA testing for early detection of prostate cancer, and a nuanced discussion between patient and provider is needed to ensure his individualized risk factors are considered and his preferences are met. Some men should be more scrutinized for their risk (e.g., men of African American descent, those with a father or brother diagnosed with prostate cancer < 65 years old). See the American Urological Association guidelines for early detection of prostate cancer
For patients desiring a prostate biopsy based on concern for prostate cancer, we provide detailed counseling regarding risks and benefits, and can generally offer a biopsy on the same day as initial consultation. Patients receive phone calls within a week regarding the result of biopsy and whether follow-up consultation is needed.
Additional testing that may be offered to patients include novel blood tests or urine tests, genetic tests, or advanced imaging techniques that may clarify whether a cancer is present and guide subsequent biopsy approaches.
If a prostate cancer is detected through biopsy, follow-up consultation will be scheduled to discuss the best treatment approach. We offer multi-disciplinary counseling by urological surgery and radiation oncology to review all treatment approaches. Our team includes experienced providers in surgical and radiation therapy. We have state-of-the-art technology that enables optimal care for patients regardless of their selected treatment.