Prostate Cancer 101: So Your PSA Is High, What Now?

Prostate Cancer 101: So Your PSA Is High, What Now?


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.