Eleven Steps to Take If Abnormal Prostate Cancer Test

By Dr. Robin Wulfson

prostatecancerbreakthroughsIn recent years much controversy has arisen for the prostate specific antigen (PSA) test that screens for prostate cancer. Last August, the US Preventive Services Task Force (USPSTF) reported that they had finalized their decision that the prostate specific antigen (PSA) cancer screening test did more harm than good. The announcement sparked a prompt rebuttal from the American Urological Association (AUA). Many healthcare professionals, me included, feel that older men should have the test and if it comes back abnormal to fully consider the options with a physician knowledgeable about prostate disease. One such expert is Jay Cohen, M.D. I consulted with Dr. Cohen on the topic and he provided me with a wealth of information.

Dr. Cohen notes that in the last few years there has been a quantum leap in prostate cancer diagnosis and treatment. The problem is, many patients are unaware of these advances—and so too are their doctors.

 

Studies have shown that it can take 10-15 years for new technologies to reach physicians and change their methods. Men with prostate cancer cannot wait! They do not have to because the breakthroughs in prostate cancer care are here and available today.

He explains that an elevated PSA does not necessarily mean you have cancer. Furthermore, it should not automatically trigger a biopsy. What’s more, the presence of cancer cells does not always mean you need a radical prostatectomy or radiation therapy. In fact, the opposite is true. Most men with prostate cancer––up to 85%––do not require such radical interventions; however, most of them end up getting surgery or radiation anyway.

Based on the very latest medical knowledge and technologies, here is a safer, leading-edge approach to take after tests show that you have an elevated PSA level.

Step 1: Ask your doctor for a DRE (digital rectal exam) to feel for any irregularities, bumps, or elevations, and an ultrasound to measure prostate size. Then…

Step 2: If there is a possible prostate infection, treat with antibiotics. Then…

Step 3: Get a second PSA test. There are a number of factors that can skew PSA numbers, so it is important to repeat the test. If again elevated, then…

Step 4: Obtain an Advanced Prostate MRI from a center that has the 3.0 Tesla machine. This is a breakthrough technology that is 85-90% accurate in identifying a cancer mass, even small masses of 5 millimeters. Then...

Step 5: Consider getting a Color Doppler Ultrasound test if there’s a center near you that offers it. This test can show you a high-resolution image and pinpoint where cancer is present. If cancer is found, your urologist will then be able to perform a more accurate, targeted biopsy. Then…

Step 6: If possible, try to obtain a targeted biopsy instead of the typical blind biopsy. Doctors knowledgeable about the advanced prostate MRI and Color Doppler Ultrasound will know about the benefits of a targeted biopsy. Rather than taking random samples as is usually done, your doctor will now be able to guide the biopsy needle to the most suspicious areas, greatly increasing the chance of obtaining highly reliable results. Then...

Step 7: If the targeted biopsy reveals cancer, ask if it would be helpful to obtain a second pathology analysis from a different center or institution. You have nothing to lose from doing this, and labs do make mistakes. Then…

Step 8: Join a prostate cancer support group, where you can obtain valuable information from a patient’s point of view. Sometimes these men are better informed about the newest technologies and treatments than doctors. Also, do your own research, searching the internet for information about tests, treatments, benefits, and risks. Then…

Step 9: Collect your data and have all your test results and dates in a single table so you can track changes over time. Discuss your results with your doctor and ask as many questions as you need. You’ll want to know what treatment your doctor suggests for your type of cancer. If he recommends surgery or radiation therapy, ask if you may speak with the surgeon or radiologist. Then…

Step 10: Consider getting a second opinion. Your urologist is most likely a surgeon, so it is natural for him to have a surgical point of view. Be sure to find out if there are alternatives to surgery or radiation therapy you should consider such as cryotherapy, high-intensity focused ultrasound (HIFU), or laser therapy. Then…

Step 11: Decide on your treatment based on all your test results and the knowledge you’ve gained. Congratulate yourself for taking an active role in your present and future health, and for making decisions that are well informed and based on the most up-do-date information available.

Dr. Cohen notes that he is not just a doctor giving advice. He is also a patient. He was diagnosed with prostate cancer in 2011 and directed toward surgery or radiation, but after undergoing the newest-available tests and conducting dozens of interviews with top doctors, he learned that his test results did not warrant invasive treatment. His doctor could actually see his cancer! It was modest in size, in a safe location, and there was no sign of spread. He is enrolled in active surveillance, repeating the tests and meeting with his doctor regularly. His prostate cancer remains under excellent control without medications. His latest book, published in March 2013 contains more information on the revolutionary new tests and treatment options, the medical centers that offer them, and resources and answers for men diagnosed with prostate cancer. It is entitled Prostate Cancer Breakthroughs: New Tests, New Treatments, Better Options.

About Dr. Cohen:
Jay Cohen M.D. is a nationally respected expert on prescription medications, avoiding side effects, and natural remedies. He is an Adjunct (voluntary) Associate Professor of Family and Preventive Medicine and of Psychiatry at the University of California, San Diego. He is the author of eight health books and more than a hundred medical articles; in addition, he is an expert on medication safety and nutrition.

Robin Wulffson is a graduate of the UCLA School of Medicine. He is a Diplomate of the American Board of Obstetrics and Gynecology and a Lifetime Fellow of the American Board of Obstetrics and Gynecology.

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