Let's say like many men, you've been getting your PSA checked every year as part of your
routine check-up. In the past, it's always hovered around 2 or maybe as high as 3, and
suddenly it's up to 5! Or maybe this is your first PSA test. Everyone knows that 4.0 is
the magic number. Anything above that means something's not right with your prostate,
right? Actually, it's a lot more complicated than that, but for this video, we'll take
that as a given.
Okay, so the number is high. What do you do? Well, if you're like many men your first instinct
might be something like this "AAAAAH! I've got prostate cancer! Cut the ******* thing
out!" Unfortunately, there are a bunch of people in the medical community that will
support and even encourage that instinct. It's the wrong instinct. Wait, slow down,
take a deep breath.
Now just to be clear, this video is not advocating any kind of wonder cure and we're not downplaying
how serious prostate cancer can be. Everything we'll talk about here is backed up by good
science, the latest technology, and highly trained medical professionals. Let's stop
and talk for a second about the prostate. No offense to our creator or to evolution
or whatever you believe about human origins, but you couldn't find a worse place to situate
an organ, especially one that's prone to problems. It's "down there" and it's in the middle of
everything "down there." Your urethra, that tube that carries urine from the bladder runs
right through it. As do a couple of nerve bundles that control your ability to get and
maintain an erection. And it's located right in there close to the rectum, so right in
the middle of three really important systems.
Okay, back to your story. You've got the high PSA number, what's likely to happen now? Your
general practitioner is probably going to want to refer you to a urologist. Your urologist
is almost certainly going to want to perform a needle biopsy and usually right away. It's
cancer, there's urgency, right? Not really, but we'll get to that in a future video. For
now, just know that for the overwhelming majority of men prostate cancer is very slow-growing.
You have time.
Here's your first step in taking control, and that's what this is all about: Taking
control of your own health care. Unless your PSA number is crazy high, above 20 for example,
or your GP has felt that something is wrong during the digital rectal exam—or DRE, that's
the finger up your butt exam that we all adore—you need to tell him or her that you want another
PSA test. You see, that test measures the substance in the blood that the prostate gives
off when it's aggravated and it can be aggravated by quite a few things other than cancer—sexual
activity, inflammation, certain types of heavy lifting, even riding a bike. So you want to
wait a few weeks, take it easy for the last few days, refrain from sex for 48 hours (you
can do it) and retake the test. If your number has gone back down to its normal level, you're
done for now. Just make sure you keep getting those yearly PSA tests and DREs.
If it remains high, then it's time to move on to the next step: Biopsy, right? Nope,
not if you can help it. The random needle biopsy, as it's called, involves sticking
a rather large needle into the area just in front of the rectum 12 times to remove samples
called cores from different areas of the prostate. Okay, it sounds horrible but to be honest,
it's not terribly painful and it's usually over in 10 or 15 minutes. A visit to the dental
hygienist is probably just as uncomfortable, but it is invasive. 3% of men undergoing needle
biopsies get infections, some of which are very serious. More importantly though is the
fact that the random needle biopsy is not very accurate. It can miss serious cancer
or it can pick up low-level non-aggressive cancers that really don't require treatment.
We'll talk about types of prostate cancer in a future video. The doctors who use random
needle biopsies don't do it because they're mean or ignorant, maybe just a little slow
to change. Until the last couple of years, the needle biopsy was the best diagnostic
tool we had.
Recent advances in MRI imaging, however, have changed everything. The latest generation
of MRI machines called "three Tesla" or 3T machines scan at a much higher resolution
than the earlier machines. They enable radiologists to see all but the tiniest tumors. The tumors
that they can't see almost certainly don't matter. What improvements in imaging mean
is that biopsies, when they are needed, can be targeted right to the suspicious area in
the prostate. No more random poking. So to summarize, if your PSA number comes back high
schedule a second PSA test. Start doing some research. A good place to start is PCRI.org.
If the number is still high after the second test, find an MRI center that does multiparametric
testing using a 3T scanners. A list of approved centers is available at PCRI.org. The MRI
report will provide two types of important information. First, the MRI measures the size
of the prostate. The scan report will enable you to determine if your PSA elevation is
proportionate to your prostate size. We'll talk about this more in another future video.
As regards cancer, there are three possible outcomes: No high-grade cancer - further monitoring
without biopsy is okay, a high-grade lesion is detected - a targeted biopsy is now needed,
an ambiguous area is detected - another MRI in 6 months may be appropriate. Scanning the
prostate in men with PSA elevation is a brand new approach that's more reliable than the
old-fashioned method of using the twelve random needle sticks; however, this claim is only
accurate when using the very latest state-of-the-art MRI technology at approved centers. This technology
is so new that finding doctors willing to abandon the old random needle biopsy approach
is still a major challenge, but keep trying. Even so, there's a big payoff: Being able
to bypass those needles, those infections, and that inaccuracy is worth it.