Controversy has swirled around the prostate-specific antigen (PSA) test for years now.
Not because there’s anything wrong with the test… but because overzealous doctors have used the results to justify overtreatment of what is ultimately a very common—and in many cases, not very aggressive—cancer.
Truth is, no doctor should be making recommendations based on PSA results alone—it’s just one piece of the larger puzzle where prostate cancer prognosis is concerned. So when guidelines discourage PSA testing altogether, all they’re doing is throwing the baby out with the bathwater.
That’s why I’m happy to report that, after more than a decade of arguing over the best way to determine prostate cancer treatment courses, we finally have some extra tools in our bag…
Biopsies cut by half
I’ve said it before and I’ll say it again: Men are far more likely to die with prostate cancer rather than because of prostate cancer.
Of course, there are exceptions to every rule. But for far too long, prostate cancer was so overdiagnosed and so overtreated that a lot of men were “cured”—and left with horrific side effects, like incontinence and impotence—when they would have been better off letting sleeping dogs lie.
The trick is figuring out just who needs to be treated and who doesn’t. And now, we have some new non-invasive tests to help us decide exactly that without risky biopsies or unnecessary surgeries.
Research shows, for example, that urine levels of a polyamine called spermine are inversely associated with both prostate cancer and aggressive, high-grade prostate cancer (which, in this case, was defined by a Gleason score of 7 or higher).
When combined with PSA testing, spermine testing performed with a negative predictive value of nearly 97 percent and cut the number of unnecessary biopsies in half.
(“Negative predictive value” refers to the likelihood that subjects who screen negative for prostate cancer truly don’t have the disease—so the higher this number is, the better.)
PHI works as well as MRI
Spermine levels aren’t the only new way to get a clearer picture of your prostate cancer.
There’s another test, called the PHI prostate cancer biomarker, which research shows is as accurate as multiparametric (mp) MRI, both independently and in combination with PSA scores.
In combination with other parameters like PSA, this test was able to predict prostate cancer up to 85 percent of the time. And while it’s not perfect, it could cut the need for MRI by a quarter, and reduce unnecessary biopsies by nearly half. (Which means it would cut costs and risks… all while still catching significant prostate cancers.)
It’s also worth pointing out that while the PHI alone missed cancer 8 percent of the time, mp MRI misses it 9 percent of the time—so technically, it works even better than some currently available tests. (Sure, that one percent doesn’t sound like a lot, but when you consider there are millions of men with prostate disease, the actual numbers are nothing to sniff at.)
And finally, if your PSA level is high, ask your doctor for a PCA3 test (a simple urine test performed after prostate massage) and a 4K test (another blood test).
Both of these tests have proved critical in helping to give context to PSA results. (I personally use them with my patients to help make more accurate calls as to who needs a biopsy and who doesn’t.)
The bottom line? We may be better off than we were a decade ago in the fight against prostate cancer—but there are still way too many men out there whose lives are being ruined for no good reason.
Still, any progress is good progress. And hopefully, with these new testing options, we’re that much closer to getting it right every single time.
P.S. I also reveal a real secret weapon in the war on prostate cancer in the June 2018 issue of my monthly newsletter, Logical Health Alternatives (“REVEALED: The real facts behind the latest “prostate panic”). Subscribers have access to this and all of my past content in the archives. So if you haven’t already, consider becoming one today. Click here now!
“Beyond PSA: New Prostate Cancer Screening Options.” Medscape Medical News, 08/07/2020. (medscape.com/viewarticle/935323)