Here’s the algorithm for screening for prostate cancer: Check your PSA annually. If it’s greater than 4.0 or rises dramatically from the prior year, off you go to the urologist who will monitor your level and decide if a biopsy is needed. Typically, the biopsy happens because the urologist doesn’t want to miss a cancer—fair enough.
One of my patients has had a chronically elevated PSA for years. The first biopsy he received showed he had prostate cancer. The second biopsy, done one year later, showed he didn’t have prostate cancer. His PSA will likely remain elevated for the rest of his life. Eventually, the algorithm will dictate that he be subjected to another potentially unnecessary biopsy. Problem is, biopsy has inherent risks—bleeding, scarring, erectile dysfunction, and problems with ejaculation.
What’s more, of the one million biopsies performed in the United States each year, only 20% of them detect aggressive prostate cancer. The remaining 80% are negative or detect non-life threatening prostate cancer. (This statistic actually led the US Preventive Services Task Force to recommend againstroutine prostate cancer screening in men.)
That’s not to say biopsies aren’t ever warranted. Of course they are. American men have great prostate-survival rates because we screen for it and can detect it early. But we want to strike the balance between screening appropriately and cutting into someone repeatedly.
My above-mentioned patient, predicting another prostate stabbing in his future, was not having it. He expressed his dissatisfaction with the status quo to a buddy, who happened to head the urology department at a big-time cancer hospital up North. The urologist clued him into a different screening tool: the 4Kscore test.
This simple blood test, prescribed for those who have PSAs greater than 3.0, calculates your risk of having aggressive prostate cancer. This data helps doctors clarify whether the patient needs a biopsy or not.
So the algorithm in my practice has changed. With the 4kscore test in my toolbox, I recently responded to another patient differently. His PSA suddenly jumped above 5.0. He was scheduled for a biopsy but said he didn’t want to go through with it. I drew the 4kscore to see if I needed to convince him to get the biopsy. His test result read borderline high, which gave me the confidence tosay, “You should do the biopsy.”
Physicians are looked upon to guide their patients. We also commit to expanding our education year after year. One of the ways we do this is by listening to our patients. I’m grateful my patient brought this diagnostic tool to my attention, and that it’s able to help all our patients.
-Radley Griffin, M.D.