4KScore used to Avoid Repeat Biopsy in Men with Elevated PSA
If you have any questions, to schedule a consultation or if you need a second opinion, please contact us or call: 646-663-5515
Modern Approach to Elevated PSA
Elevated PSA is one of the most common reasons urologists, like myself, who specializes in prostate cancer treatment see new patients. As one of the first urology practices nationwide to embrace 4KScore, New York Urology Specialists possesses one of the largest institutional experiences in the United States in risk stratifying patients with elevated PSA using 4Kscore.
Who are Good Candidates for 4KScore?
4Kscore Test
For most men, PSA test alone is sufficiently useful. As long as PSA is low (age-appropriate and risk-appropriate ie family history) and stays low, we know that these men have a very low risk of having prostate cancer even 15-20 years down the line.
For example for an asymptomatic man who is 52 years old with a PSA of 1.2 which has not changed significantly over the past few years, and a non-suspicious DRE (digital rectal exam), PSA alone provides sufficient Information to tell us that this man is at the very very low chance of having prostate cancer even years down the line. For this man, 4KScore is not likely to provide information beyond what the PSA test alone tells us.
When 4KScore Makes a Difference
On the other hand, take a 52-year-old man with enlarged but non-suspicious prostate whose PSA has been stable until 3 years ago but went from 2.3 to 4.5 over a period of 2 years, at which point he had a negative prostate biopsy. In the past year, it went to 5.3. When it was repeated, PSA came down to 4.7.
In general, the highest value is most useful in predicting risk, the only exception being elevation caused by bacterial prostatitis. This man will certainly derive much useful information from 4KScore. In particular, it will risk stratify him into whether he is at high risk of low risk for having life-threatening cancer.
4KScore will also help the treating urologist, as well as the patient, to make a more informed decision on whether another biopsy should be performed. In the 4Kscore result predicts a 2% risk of high-grade disease, 50 men would need to be biopsied to find one high-risk disease. In this situation, most men will decide not to have a biopsy at this time. However, if the 4Kscore result is 35%, that means 1 in 3 chances of having a high-risk prostate cancer. Most men with a high 4KScore would choose to have a prostate biopsy.
If you have any questions, to schedule a consultation or if you need a second opinion, please contact us or call: 646-663-5515
