Marc A. Melser, MD
Prostate Specific Antigen(PSA) came into use around 1990. This biomarker was a breakthrough in the diagnosis and management of prostate cancer. Men were now diagnosed at much earlier stages of the disease and consequently prostate cancer mortality decreased compared to the pre-PSA era. But, many men were diagnosed with cancers that will not be life-threatening. Many of those men received treatment that only lead to side effects and did not make a difference the individual’s life expectancy.
The emphasis has shifted to diagnosing clinically significant cancers and treat those men who are really in need. In the past few years several tests that utilize either blood, urine or tissue have become available to help doctor and patient make sound decisions for the diagnosis and treatment of prostate cancer. These tests will be mentioned in a clinical scenario.
“My PSA is elevated so do I really need a biopsy?”
In the initial prostate biopsy scenario, the goal should be the discovery of significant prostate cancer. These tests improve upon the performance of PSA alone. A detailed description of each test is beyond the scope of this article. SelectMDx(urine); 4k Score and Prostate Health Index(blood) are used for this purpose.
“I had a prostate biopsy 6 months ago, no cancer was found, but my PSA has gone up. Do I need another biopsy?”
Besides not being alot of fun, there is anxiety over the procedure of a prostate biopsy. There is relief when a man is told the biopsy did not have cancer. However, a strong suspicion of cancer remains and a second biopsy has to be considered. The above three tests also help in deciding the need for that repeat biospy. In addition, PCA3 (urine) and ConfirmMDx (tissue) are also employed for this condition.
“My biopsy results show a little cancer. Do I need treatment or can I safely observe on active surveillance?”
You just had a biopsy and were told the bad news you have prostate cancer. But, it is a small amount and likely a Gleason 6 thus a low risk tumor. Impulsively, you may want something done and of course the sooner the better. But maybe you can be safely observed. These tests will give you information about your tumor over and above the Gleason Score and PSA. They will stratify the risk and help guide personalized management. The tissue is analyzed and a report is generated for OncoTypeDx, Prolaris, ProMark and Decipher. When these test are favorable, one can safely be followed.
“I just had my prostate removed for cancer. The report shows an aggressive tumor. Do I really need more treatment or can I be observed?”
The Decipher test on the post radical prostatectomy specimen is helpful. If the genetic profile of the tumor is favorable, then the patient can be safely observed. On the other hand, if unfavorable, then more immediate radiation is indicated.
About Dr. Melser
Dr. Marc Melser completed his Urology Residency and Fellowship at Henry Ford Hospital in Detroit, MI. Dr. Melser manages all aspects of General Urology such as kidney stones, low testosterone, benign prostate problems and prostate cancer. He has lived and worked in Charlotte County since 1994. During that time, Dr. Melser has served as the President of the Charlotte County Medical Society and as Chairman of Surgery for both Fawcett Memorial Hospital and Bayfront Health Punta Gorda. On a national/state level, Dr. Melser is a member of the American Urological, American Medical, and Florida Medical Associations.
21st Centruy Oncology