You Have an Elevated PSA Reading – Now What?

Thursday, 10 Apr 2014 12:25 PM

By Sylvia Booth Hubbard

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As part of their annual physicals, many men have a PSA (prostate-specific antigen) test for prostate cancer. The moment of truth comes if the reading is high, indicating the possibility of cancer. What should you do?
 
Should you test again to see if the levels drop? Should you undergo a painful biopsy? And most frightening of all – what if you have prostate cancer? Should you act quickly to treat it, risking impotency and incontinence?
 
Making these life-or-death decisions even more difficult is the fact that there is no clear consensus among experts on prostate cancer testing and treatment. In fact, many experts advise against having a PSA test at all because the results can lead to unnecessary biopsies and treatment. 

Editor's Note:: Prostate Cancer Is Almost Epidemic - Prevent It

 "A diagnosis of prostate cancer is devastating for men," says Jay Cohen, M.D., author of Prostate Cancer Breakthroughs: New Tests, New Treatments, Better Options. "But the situation isn't nearly as dire as it’s made it out to be."
 
Dr. Cohen speaks from personal experience. He was diagnosed with prostate cancer in 2011. His cancer is small, under control, and he has undergone no life-changing procedures. But, he took full advantage of new diagnostic breakthroughs.
 
"In the past few years, there has been a huge leap in the diagnosis and treatment of prostate cancer," said Dr. Cohen.
 
Elevated PSAs are often followed by conventional biopsies, which according to Dr. Cohen, are "a shot in the dark" and can miss cancers entirely. If biopsies indicate cancer, men are commonly given a choice of surgery or radiation. That's usually not necessary, he says.
 
"Prostate cancer grows so slowly that only about 15 to 20 percent of men are truly at risk, but up until now it's been impossible to tell dangerous cancers from non-threatening ones. We've been over-treating up to 85 percent of men and putting them at risk of becoming impotent or incontinent for no reason.
 
"That's changing," he says. "There is no more one-size-fits-all treatment for prostate cancer."
 
Two huge breakthroughs that can identify cancers much more accurately are making a big difference in knowing when to treat. The first is called advanced prostate MRI. "This was a real game-changer for me," says Dr. Cohen. "This new MRI technology can distinguish between prostate cancer and normal prostate cells."
 
The second breakthrough is color doppler ultrasound. "Ultrasounds can measure the size of prostates and guide biopsies, but the color doppler picks up increased blood flow which helps identify cancers because they are more metabolically active than normal cells," says Dr. Cohen. The new technology also allows suspicious areas to be precisely targeted and biopsied.
 
If you have an elevated PSA, Dr. Cohen advises the following steps:
 
• Ask your doctor to perform a digital rectal exam to see if there are any lumps or irregularities and get an ultrasound to measure the size of the prostate.
 
• If there's a possibility of an infection, treat with antibiotics, and then have a second PSA test.
 
• Undergo an advanced prostate MRI using a 3.0 Tesla machine. "This breakthrough technology is 85 to 90 percent accurate in identifying cancers as small as 5 millimeters."
 
• Consider getting a color doppler ultrasound to further pinpoint cancers.
 
• Get a targeted biopsy. Using information from the MRI and color doppler ultrasound, doctors can target biopsies for more accurate results.
 
• Take time to consider all of your test results before making a decision on how to proceed. Many men can avoid invasive treatment and choose "active surveillance" which includes regular PSA tests to indicate if the cancer is progressing.
 
If you decide to undergo treatment, get a second opinion and discuss options such as robotic-assisted prostatectomy, proton beam radiation, and cryotherapy.
 
"Men should have an annual PSA test because the disease can be deadly," he said. "But prostate cancer doesn't mean an end to your sex life, and it doesn't mean you'll be incontinent. In the great majority of cases, you can continue to live a perfectly normal life."
 
Editor's Note:: Prostate Cancer Is Almost Epidemic - Prevent It

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