Dr. Geffin sat down for a Q&A about prostate cancer screening and treatment options.
As with all content on Greater Boston Urology's blog, the following information is educational in nature, not medical advice. Always talk to your physician about your specific health care questions and conditions.
[Editor's note: This article was reviewed and updated with additional links on 1/4/22.]
Let's discuss prostate cancer screening.
DR. GEFFIN: Screening for men varies. There are many guidelines in general. Most men will start screening at age 50. Essentially, the first line involves two tests. One is what's called the digital rectal examination. That's a physical examination through the rectum where the primary care doctor or the urologist will palpate the prostate to feel the area near the rectum. The second part of screening involves the PSA.
What is the PSA?
DR. GEFFIN: The PSA is a blood test. It stands for prostate-specific antigen, a protein that is eluted by the prostate. It can be elevated for reasons of prostate cancer cells making more of the protein and putting it into the bloodstream. There are other reasons why PSA can be elevated as well. So really, part of the screening of prostate cancer with the PSA is to parse out whether the elevated PSA is due to a more and more likely malignant disease or more likely due to a benign disease.
Are there any pitfalls with PSA tests?
DR. GEFFIN: PSAs, as I mentioned above, can be elevated for non-malignant reasons. Many men with an elevated PSA will be referred to a urologist to see if we think the elevated PSA is more likely due to a cancerous reason or non-cancerous reason.
We have other testing that we can use before the individual would undergo a prostate biopsy. The standard of care had been very much to do a biopsy on any man who has a PSA above four who has a survival of 10 years or greater. But that's clearly shifting with these other tests because they're very helpful in letting us know who not to biopsy.
What are some of these other tests?
DR. GEFFIN: We can use a blood test called the 4Kscore, which helps determine what the chances are that the individual has prostate cancer. The 4Kscore most likely tells if a patient has high-risk prostate cancer.
There is SelectMDx, which is a urine test that helps parse out whether a patient does not have prostate cancer. Another urine test, which we have available at GBU, is called Exosome and answers a similar question.
What's the PHI (Prostate Health Index) test?
DR. GEFFIN: We're the only lab in Massachusetts that has this test. It's a more sensitive test on whether the elevated PSA is due to prostate cancer or not. It's a key piece in helping us determine whether someone needs a biopsy or not. Many times when someone has an elevated PSA and a PHI score that indicates they have a very low risk of prostate cancer, many of those men opt not to have a biopsy. That would be absolutely correct because we would have historically biopsied all those men.
With prostate cancer, we definitely can change the course of the disease by screening men early and often. If they get treated early, their long-term survival will be impacted in a positive way.
[Editor's note: learn more about our in-house lab.]
Discuss prostate cancer treatment options.
DR. GEFFIN: Standard of care for treatment involves multiple options depending on the individual and the prostate cancer, such as surgery and radiation, which there are a number of forms. Some men opt for watchful waiting and doing nothing.
There are newer therapies on the horizon, such as high-intensity frequency ultrasound (HIFU), which is a heating therapy of the prostate to kill the cells. We also have cryotherapy. Those are all methods for treatments. Those are the standards of care.
[Editor's note: check out this roundup of prostate cancer resources.]
Thanks for your insights, Dr. Geffin!
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