Originally Posted by JohnR41
If someone has a high PSA, they are usually advised to get an invasive needle biopsy.
Not so fast...
The American Urological Association (AUA), in their free online document titled "Prostate Specific-Antigen Best Practice Statement: 2009 Update" calls on doctors to take several steps in-between so as to minimize needless biopsies. I'll quote:
"...the current policy no longer recommends a single, threshold value of PSA which should prompt prostate biopsy. Rather, the decision to proceed to prostate biopsy should be based primarily on PSA and Digital Rectal Examination (DRE) results, but should take into account multiple factors including free and total PSA, patient age, PSA velocity, PSA density, family history, ethnicity, prior biopsy history and comorbidities."
All of Sub-Section 6 of the document' Early Detection section is dedicated to "When is a prostate biopsy indicated?"
The free and total PSA test is a simple blood test which increases specificity for prostate cancer.
I agree that at that point the MRI-S would give another possible indication that prostate cancer might or might not be present. The free and total PSA test cost would be around $100 (round numbers), and the MRI-S cost might be a couple of thousand dollars. The T3 MRI-S equipment costs around $2-2.5 million, plus the roughly $0.5 million in installation costs. Don't get me wrong, it's got some good uses, but for a doctor who has invested in it, it might be an expensive solution looking for a problem to solve. (looks to me like this is the Wheeler business-model; just an opinion/observation based on how aggressively he is in "sell" mode)
If you are trying to determine whether you have prostate cancer or not, get the free PSA test first, as the AUA recommends. Then, don't be afraid of the biopsy; it's a bit "uncomfortable", but not painful. If you have an endless stream of personal time and money, there is a long list of other tests one could also get which all indicate the possibility of cancer, but they don't confirm it. Could be worthwhile.
Added information later on the free PSA
test as an edit for the sake of completeness…recognizing that not everyone will be familiar with it.
When someone gets a “PSA test”, the result is the “total PSA” (tPSA) in their bloodstream. The total PSA is, however, made up of two components: the “complex” PSA and the “free” PSA.
• Complex PSA (cPSA) is the amount of PSA in one’s blood that is bound to other proteins. cPSA has no value in measuring risk for prostate cancer.
• Free PSA (fPSA) is the amount of PSA in one’s blood that is freely circulating as a protein and that is not bound in any way to other proteins.
Mathematically, tPSA = cPSA + fPSA
Once both total and free PSA tests are completed (blood draw), a doctor compares the free PSA to the total PSA result to determine the % free PSA.
• The smaller the % free PSA, the more likely the patient is to have prostate cancer. Below 10% is a pretty sure sign of PC.
• Conversely, in men with elevated PSA (total PSA), the greater the % free PSA, the more likely the patient is to have an enlarged prostate or BPH. Above 25% is a pretty sure sign of no PC.