As you know, I still believe strongly in the PSA test. That said, there’s no denying that this screening tool has contributed to the overdiagnosis and overtreatment problems running rampant in mainstream medicine today.
Consequently, millions of men have had their prostates butchered, based on a test that offers valuable but limited information. And they’re now irreversibly incontinent and/or impotent because of it.
But like I’ve also said before, doing away with the PSA test isn’t the answer here. Because it’s not the PSA test’s fault that these men had unnecessary surgery to treat a cancer that wouldn’t likely have killed them anyway. The blame here lies with overzealous doctors making dubious treatment decisions.
The simple fact is, most cases of prostate cancer don’t require any action unless the benefits outweigh the risks. And that circumstance only applies to the most aggressive, lethal forms of the disease.
And how do you know if your prostate cancer is the aggressive variety? Well, a major breakthrough in testing just made it a whole lot easier.
This new blood test, called the Prostate Health Index (PHI), is based on prostate-specific antigen (PSA). But it factors in several different measurements—including total PSA, proenzyme PSA, and free PSA—to generate a single score that provides a more complete picture than any one individual measure.
Basically, if your free PSA is lower while the other forms of PSA are elevated, then you are more likely to have “clinically significant”—i.e., aggressive and potentially deadly—prostate cancer.
According to a number of different studies, this method of testing offers greater specificity than a single PSA test alone. It outperforms “regular” PSA testing when it comes to predicting high-grade prostate cancer. And it can also predict the likelihood that your cancer will progress. Both of which dramatically reduce the risk of unnecessary procedures in cases of low-risk disease.
Needless to say, the PHI showed up at just the right time. As of last year, prostate cancer was a leading cause of cancer death among American men. So we really can’t afford to do away with testing simply because too many doctors are doing more harm than good.
So here’s the bottom line: If your PSA is between 2 and 10 and you’re wondering what to do, ask your doctor about this new testing.
It’s FDA approved. But I’m not sure yet whether Medicare and other insurance carriers will cover it. So I’ll be sure to keep you posted on that. But in the meantime, I’d like to share some news about another new prostate test that every man should also know about…
If you’re like me and most of my patients, the thought of a prostate biopsy leaves you cold. True, it can offer valuable information regarding the aggressiveness of your prostate cancer. But at what cost?
I know you probably hate statistics, but this is an important one: Roughly 1.6 million American men get an annual blood test to assess for prostate cancer. Of these men, about 1 million will go on to get a biopsy. Out of that group, 750,000 men test negative.
Unfortunately, false negatives are common—so repeat biopsies are often carried out. But biopsies are invasive and painful. Not to mention the fact that aggravating cancer cells in this way can potentially cause them to spread.
But now there’s a new, less invasive way to get the same information you could get from repeat biopsies.
It’s called the ConfirmMDx—and it assesses changes that happen to your DNA when cancer cells multiply.
According to researchers, the ConfirmMDx can tell doctors which patients have truly negative biopsies and which are at higher risk. And because of that, it can reduce repeat biopsies in patients who might have otherwise received them routinely.
In a nutshell, the lab can run this test on the tissue from a biopsy. If it’s negative, there’s a 90 percent chance you don’t have to worry. And that saves you an awful lot of unnecessary repeat biopsies. In fact, this test has been able to reduce repeat biopsies by ten-fold.
This test is available now. Some insurance plans already cover it, and Medicare coverage is expected to start sometime this year.
Of course, insurance providers are looking at ConfirmMDx as a way to save money. (Biopsies aren’t exactly cheap.) But I look at it as a way of saving lives, by preventing unnecessary invasive procedures that could allow cancer cells to migrate to places where they otherwise wouldn’t be.
“The Prostate Health Index: a new test for the detection of prostate cancer.”Ther Adv Urol. Apr 2014; 6(2): 74–77.
“Reduced Rate of Repeated Prostate Biopsies Observed in ConfirmMDx Clinical Utility Field Study.” Am Health Drug Benefits. 2014 May;7(3):129-34.