“Not so quick with that prostate biopsy… Doctor!”
December 4th, 2008 Posted in Men's Prostate HealthWe know that prostate cancer is the # 1 cancer in men (after skin cancer), therefore, the rectal-prostate examination along with a PSA blood test has become an accepted ritual that men must endure once they hit middle age.
But what happens when the PSA blood test comes back above normal (PSA > 4.0 ng/ml)?
Most doctors on seeing a PSA above 4.0 ng/ml will have a ‘knee jerk’ reflex and immediately send the patient to the urologist for a prostate biopsy.
The idea of a prostate biopsy can be absolutely nerve wrecking, both the apprehension before the biopsy and the interminable waiting for the results afterwards. Not to mention that the procedure can be painful and accompanied by complications (bleeding & infection).
Moreover, elevated PSA scores in the range of 4.0-10 ng/ml lead to prostate biopsies that are negative in 70% of cases.
A convincing study at Memorial Sloan-Kettering looked at the PSA levels in 972 healthy men (median age 62). It was found that 21% of the men had a PSA score that was elevated (>4.0 ng/ml), and which under normal circumstances would have sent them for a prostate biopsy. However, in this study, the biopsy was delayed until a repeat PSA blood test was performed around six weeks after the first PSA test.
The results have an important message to convey to our family physicians and Internists.
In almost half of the men, the repeat PSA level returned to normal range and remained normal for the remaining subsequent tests. Proving that a prostate biopsy would have been unnecessary in these men.
Too few doctors are exercising this good judgment and also too few doctors consider following up with a more advanced PSA II test. Maybe it is time that men become more involved in the decision process…after all it is their health.
By the way…Waiting an extra six weeks to repeat a PSA will not have any adverse affect on those men who actually have prostate cancer.