Thanks to new blood and urine biomarkers and improvements in MRI imaging, diagnosing prostate cancer has become easier and more accurate than ever before. For most men, however, detecting prostate cancer still begins with a digital rectal exam and a PSA blood test. If you are a man over 45, don’t let anyone talk you out of getting an annual digital rectal exam and a PSA test. Yes, it’s true. Both of these tests are “old school” and imprecise, but they remain the front line of defense against prostate cancer. These two tests are usually performed during a routine physical or because a man is experiencing urinary symptoms such as: Waking up in the middle of the night to pee (Nocturia) Urinary frequency (having to pee more often than normal) Urinary urgency (must pee NOW!) Low flow (weak urine stream) Painful urination (Dysuria) Difficulty peeing or emptying your bladder Itching/burning during urination These symptoms can be caused by advanced prostate cancer and four non-threatening conditions: Prostatitis (prostate inflammation/infection) Enlarged Prostate (BPH) Pelvic Floor Dysfunction (urinary sphincter) Urinary strictures (scar tissue in the urethra) It’s a doctor’s job to figure out which condition (or conditions) is causing a man’s elevated PSA numbers or any of the symptoms above. Ten years ago, if a man had a higher than normal PSA number (with or without any of the symptoms described above), he was an automatic candidate for a prostate biopsy. This type of needle biopsy involves shooting 10-20 needles through the wall of the rectum, into the prostate, to take tissue samples from the prostate. If this procedure sounds demoralizing, it feels worse. Even when the local anesthetic works correctly, a prostate biopsy feels like what it is: a bunch of needles being shot through your rectum and into your prostate — not a holiday. I’ve had three of these biopsies. During the last one, the surgeon botched the local anesthetic, so it felt like a knife fight was going on in my backside. A week after that biopsy, I developed sepsis (a systemic blood infection), which almost killed me. The ER doctor said I was 6-12 hours away from complete organ failure. So it’s easy to understand why avoiding a prostate biopsy is a good idea — unless other tests indicate a biopsy is needed. Thanks to dozens of blood and urine biomarker tests, doctors have a new arsenal of tools that pick up where PSA testing leaves off. An abnormally high PSA number tells you that something is wrong, but it doesn’t tell you what. It could be cancer or an infection or an enlarged prostate or something else. A blood test like the 4KscoreTest identifies biomarkers for advanced prostate cancer, and urine tests like PCA3 or SelectMDx can accurately identify men who should have a prostate biopsy because of an increased risk of finding cancer during a biopsy. Multi-parametric MRI combines four different types of imaging (anatomic, metabolic, diffusion weighted, and dynamic contrast enhanced) to deliver a more accurate picture of the prostate — and any areas that contain cancer. When used before a prostate biopsy, multi-parametric MRI can accurately identify suspicious areas of the prostate for a “targeted biopsy,” which is 70-75 percent more likely to detect cancer than a standard biopsy, if cancer is present. In other words, a multi-parametric MRI does a much better job of finding prostate cancer. Both blood/urine biomarkers and multi-parametric MRI give doctors better tools to locate prostate cancer (if it is there) or rule it out (if it’s not). In the next blog, we’ll look at how to pair the right type of treatment with the kind of prostate cancer a man has. Mark B. Saunders is a writer, editor, publisher, public speaker, and 11-year cancer survivor. As an active surveillance prostate cancer patient, Mark did not receive traditional treatment like surgery or some form of radiation. Instead, he dramatically overhauled his lifestyle and his cancer went away and hasn’t come back since. As a prostate cancer survivor, Mark has dedicated his life to sharing what he has learned about health and wellness. A journey that he calls, Inside out, round-about, and back again. Mark is the co-author of Prostate Cancer: A New Approach to Treatment and Healing and Do You Have Prostate Cancer: A Compact Guide to Diagnosis and Health
By Mark Saunders As a prostate cancer survivor and co-author of two books on the subject, I think it’s important to bring a little “awareness” to National Prostate Cancer Awareness Month. The art and science of prostate cancer diagnosis and treatment are changing rapidly. For example, in July of this year, the New England Journal of Medicine published an article stating that the 10-year mortality rate for men with low-risk, low-volume, prostate cancer who elected to “observe” their cancer (In this study, observation ranged from doing nothing to making drastic lifestyle changes.) and those who had a “radical prostatectomy” (surgery) had statistically similar outcomes. In other words, approximately the same number of men died in both groups. Fifteen years ago, that information would have been considered heresy, and any doctor who prescribed “observation” to their prostate cancer patients would have been sued for malpractice and drummed out of the profession. Today, it’s state-of-the-art information. The general consensus on PSA testing has flip-flopped from “heaven sent” to a test that promotes too many invasive procedures like prostate biopsies and surgeries (which can leave men with lifelong “harms” such as incontinence and sexual dysfunction) to a good first line of defense against prostate cancer that signals there’s a problem going on in the prostate — without identifying what the problem actually is. Today, there several new highly specific biomarker tests that pick up where PSA testing leaves off (PCA3, SelectMDx, and 4Kscore). These blood and urine tests can identify whether a man is likely to have prostate cancer or not; eliminating the need to jump straight from an elevated PSA test to a prostate biopsy. If you or someone you know recently had a higher than normal PSA test, please let them know about these recent advances in biomarker testing. There are also several new tests that enhance a prostate biopsy’s ability to detect the presence of prostate cancer — especially if the biopsy results come back negative (25% of negative biopsies are “false negatives”). Even if the biopsy comes back positive for low-grade, low-risk prostate cancer, there are additional tests to determine if the cancer really truly is “low-grade, low-risk” — or if it is more aggressive (a wolf in sheep’s clothing). This type of leading-edge information provides men (and the people who love them) with the ability to make smart prostate treatment decisions. Without this kind of information, people are likely to make their treatment decisions based on whatever the first doctor they see tells them to do. In my opinion, National Prostate Cancer Awareness Month ought to begin with helping men become aware of their treatment options based on the kind of cancer (or other prostate condition) they have. Mark B. Saunders is a writer, editor, publisher, public speaker, and 11-year cancer survivor. As an active surveillance prostate cancer patient, Mark did not receive traditional treatment like surgery or some form of radiation. Instead, he dramatically overhauled his lifestyle and his cancer went away and hasn't come back since. As a prostate cancer survivor, Mark has dedicated his life to sharing what he has learned about health and wellness. A journey that he calls, Inside out, round-about, and back again.