It’s a common scenario: you get a routine screening test for prostate cancer, the prostate-specific antigen or PSA test, and it comes back elevated. What to do?
First, if you have symptoms, it is more likely that you have an enlarged prostate (BPH) or prostatitis causing the elevation. Find out first if this is the case, treat these problems (there are effective naturopathic approaches for both, or else using drugs or surgery if necessary) and repeat the PSA test only after they have been resolved. If they cannot be resolved, then the PSA test is probably useless as a cancer screening test for you. Getting a prostate biopsy in such circumstances does not appear warranted without some other evidence besides PSA that there might be cancer present.
If you don’t have symptoms, then either wait and retest in 1–3 months or get a urine PCA-3 urine test. Up to 50% of repeat PSA levels come back normal without any treatment. The PCA-3 urine test requires a prostate exam, and has the great benefit of not being affected by BPH or prostatitis. It is more expensive than PSA, but this should change as more of them are done. If the PCA-3 comes back <35, then no biopsy should be done. If it comes back >35, then a prostate biopsy is warranted along with either an endorectal MRI or color Doppler ultrasound of the prostate, two imaging tests that give a broader, more holistic view of the prostate than just a biopsy.
There is growing reason to think that urine PCA-3 testing might be a better option than serum PSA testing over all, and that perhaps the PSA test shouldn’t even be used anymore for screening. See other posts for discussions of the many, many problems with the PSA test. Additionally now we can also include a test (the dauntingly named TMPRSS2:ERG gene fusion) that looks at the severity of any cancer that is detected; combined with the PCA-3 test this is known as the Michigan Prostate Score (developed at and run by the University of Michigan).
Before getting a biopsy, be sure to take modified citrus pectin and to have a plan of what you will do depending on the results. Waiting to see what happens and then deciding on a course of action usually leads to poor choices based on fear rather than good choices based on knowledge without emotions clouding the issues. As much as possible, your entire family should be involved in such decision making. Come in for a consultation with Dr. Yarnell if you would like help in making pre-biopsy decisions, for a PCA-3 test/Michigan Prostate Score, or to get help with any aspect of prostate cancer screening
Hessels D, Schalken JA (2009) “The use of PCA3 in the diagnosis of prostate cancer” Nature Rev Urol 6:255-61.
Singh R, Cahill D, Popert R, O’Brien TS (2003) “Repeating the measurement of prostate-specific antigen in symptomatic men can avoid unnecessary prostatic biopsy” BJU Int 92(9):932-5.
Stamey TA, Caldwell M, McNeal JE, et al. (2004) “The prostate specific antigen era in the United States is over for prostate cancer: what happened in the last 20 years?” J Urol 172(4 Pt 1):1297-301.
Tomlins SA, Day JR, Lonigro RJ, et al. (2016) "Urine TMPRSS2:ERG plus PCA3 for individualized prostate cancer risk assessment" Eur Urol 70(1):45-53.