Hi, I'm Dr. Scholz. Let's talk about prostate cancer.
In this video, we're going to talk about the four things that you need to know when you're
considering doing PSA screening for prostate cancer. The four things we'll be covering
[are]: What PSA actually is, all the controversy surrounding PSA, a protocol on how to do screening,
and then of course what to do if the PSA is high.
PSA stands for prostate-specific antigen. PSA is a protein manufactured in a man's prostate.
Several things can cause PSA levels to rise besides cancer including gland enlargement
with aging and nonspecific inflammation called prostatitis.
You would think everyone would want to find prostate cancers at the earliest possible
stage and everyone agrees that PSA can help accomplish this. The reason it's controversial
is actually PSA is more accurate than it even needs to be in one sense because doctors are
finding little tiny cancers that don't need to be treated and will never cause harm, but
because there's a large industry out there poised to treat men with high PSA levels a
lot of men are getting unnecessary radical treatment and that radical treatment can cause
problems with sexual function, urinary function, and other issues that can be permanent.
We're going to be covering ways to try and extract the value from PSA without incurring
the dangers of being told you have a cancer and getting an unnecessary treatment. There's
really no disputing that PSA itself has value in detecting prostate cancer at an earlier
stage. So there's nothing wrong with the PSA test itself; it's how doctors and patients
respond to the information it provides.
So what are the nuts and bolts of PSA testing? Well first, how high is the PSA? If you have
a blood test and it's above the 2 and a half to four range that is thought to be a concern.
It's not a precise issue though because higher levels are allowed as men get a little older
and lower levels are expected when men are younger.
When should you start testing? What age? And this is somewhat controversial as well. Some
people say age 40, other age 45 or 50. One compromise is to consider age 40 in people
that have a family history or are of African-American descent, and then reserve a higher age of
45 or 50 for people without those risk factors.
Be aware that recent sexual activity can cause PSA to elevate and has nothing to do with
cancer, and so men need to abstain from sexual activity for a day or two prior to testing.
Lastly, since PSA can jump around on its own for reasons we don't fully understand—if
you have a high PSA, wait a week or two and consider repeating it to see if it falls back
into the normal range without any intervention at all.
And finally, some doctors are fans of giving antibiotics to men with high PSA levels. I
personally don't ascribe to that belief because the antibiotics that are typically used can
occasionally cause serious problems, so I'm much more a fan of waiting and seeing if the
PSA will back down on its own—waiting two to four weeks and repeating the PSA.
What's the next step if after repeating testing the PSA is staying about the normal range—that's
two and a half to four depending on a man's age and the answer to that is—for most doctors—
is to do something called a random biopsy where needles are stuck in the prostate 12
times trying to cover the whole gland. About a million men undergo random biopsies in the
United States every year and this has been the standard approach for 30 years. That is
changing. Recent studies show that modern MRIs are more accurate than random biopsies
and you can see the advantages because when people are sticking needles in the prostate
there is, of course, a risk of infection, bleed that's quite uncomfortable, unfortunately
in some men, it can cause erectile dysfunction. So doing an MRI at a quality center is a much
more accurate and a far safer way to evaluate a high PSA.
Is there anything else you can do short of an MRI? And the answer is yes. There is a
blood test called OpCo 4k which can give an idea of whether prostate cancer is in the
prostate with somewhat greater accuracy than what a PSA can offer you. So if men undergo
testing with this blood test, OpCo 4k, maybe 10 to 20% of men will have such a favorable
score that they don't even need an MRI. They don't need a biopsy. They can just continue
monitoring. Four out of five men that have an OpCo test, however, will have some degree
of abnormality and risk and should therefore proceed and get an MRI.
So you can see that doing PSA screening to detect prostate cancer at an early stage is
somewhat complex but if you use a systematic approach and you're careful in how you use
this information it can benefit you and you can avoid the risks and the dangers that are
associated with overtreatment of prostate cancer.
Thanks for watching. Don't forget to subscribe to our channel, and of course, visit our website
which is filled with useful information about prostate cancer.