PSA Screening and Testing of Men for Prostate Cancer in NYC: 2018-2019 Recommendations
by Alex Shteynshlyuger MD – Fellowship Trained Urologic Oncologist and Robotic Surgeon
PSA (Prostate Specific Antigen) Test
PSA test is a blood test that is often obtained in men with enlarged or abnormal prostate, blood in urine or when men have difficulty urinating. PSA levels correlate with the size of the prostate and biological activity within the prostate. The larger the prostate, the higher the PSA test values tend to be. PSA tends to increase as men age and as the prostate grows in size.
You Have a High PSA or Abnormal PSA Test. What are the Options?
For men with elevated or abnormal PSA test results, it is important to decide what are the risk factors and how high is the PSA level in absolute terms.
Depending on risk factors and the exact value of the PSA test, either active surveillance with repeat PSA test or prostate biopsy would usually be the usual options. Newer tests such as 4KScore and PHI can also be obtained to glean more information.
A number of experimental approaches are being used including prostate MRI and a number of other tests but these have not been shown to be of significant benefit. It should be noted that unless there are a urinary infection and active prostatitis, treatment with antibiotics to lower PSA values is not recommended. Well designed studies have shown that in men with elevated PSA, treatment with antibiotics provides no benefit.
A Better Way: New Options for Men with Elevated PSA
While elevated PSA might mean an increased risk for prostate cancer, many men with slight elevation of PSA do not have prostate cancer. A newer generation of tests, including PHI (Prostate Health Index) and 4KScore, provide additional valuable information to help urologists decide what men are at risk for aggressive prostate cancer.
PSA as a Test for Prostate Cancer
PSA has been found to be increased in men with prostate cancer. It has been used as a test to detect increased prostate cancer risk in men with symptoms that may be caused by prostate cancer. PSA testing has also been used as a screening test for early detection of prostate cancer.
What is the Controversy about PSA Screening?
There is no controversy that men with urinary symptoms such as frequent urination, slow urine stream, blood in urine, back pain or pelvic pain or signs such as abnormal prostate should have PSA checked. In this situation, PSA has been shown without question to benefit men by helping to detect prostate cancer.
The controversy lies in early detection of prostate cancer in perfectly healthy men without any symptoms.
Often the PSA test may be falsely elevated in these men; when prostate cancer is detected, often it is detected at such an early stage that it would not cause any symptoms for 10-15 years. Because most men decide to treat cancers that may never cause symptoms, there is a question of what benefit is accrued to men from such an early detection.
Studies show that certainly there are men who benefit from early detection of prostate cancer with PSA screening. There are other men who do not benefit.
The question boils down to who should be treated and when? Dr. Alex Shteynshlyuger uses a number of innovative approaches including active surveillance for prostate cancer to maximize benefits and to minimize risks to patients.
The Goal of PSA Screening
The goal of PSA screening in the modern era is to separate men who will benefit from PSA screening from those who will not. More important with the introduction of more effective treatment for prostate cancer is to decide which men should have what treatment when prostate cancer is detected.
Improved Options for Prostate Cancer Screening
To overcome the limitations of PSA, a number of improved tests for prostate cancer have been created including the PHI and 4Kscore tests. In addition, molecular and genetic testing of prostate biopsy specimens allows us to detect high-risk disease with more certainty.
New York Urology Specialists, under the leadership of Dr. Alex Shteynshyuger, is the first practice in New York City and one of the first in the world to offer 4KScore and PHI test to their patients.
If you’re interested in testing for prostate cancer or prostate cancer screening, please contact us.
Dr. Alex Shteynshlyuger is a board-certified urologist who is experienced in treating men with abnormal PSA. He has published articles in major urology journals about PSA testing and screening. He is available for consultations for men in NYC with abnormal or elevated PSA levels. He also treats men with all stages of prostate cancer including men with PSA recurrence after prostate cancer treatment (surgery, radiation, HIFU, cryotherapy, immunotherapy, chemotherapy, etc).