Prostate Cancer Detection: The Old Way
The PSA (Prostate Specific Antigen) blood test was, for many years, the gold standard physicians used to determine the likelihood of a man having prostate cancer. A PSA score higher than 4.0 ng/ml was the magic number to trigger concern. A patient whose PSA was 4 ng/ml or above was generally a candidate for a biopsy to determine whether there was cancer.
In recent years, using a PSA for screening men for prostate cancer has come under attack, as studies showed that too many biopsies were being done on too many men who didn’t have cancer. Furthermore, insignificant prostate cancers were being detected and over-treated. And so there’s been a nationwide push to discourage men from getting PSA tests.
The Bigger Picture
At Intermountain Healthcare, we’ve developed a more precise approach. Our belief is that a PSA test provides important information, but it’s only part of a bigger puzzle. Starting in 2010, we developed a stratified testing approach looking at five pieces of information:
- Age. We recommend men receive a prostate screening at age 50.
- Race. Prevalence of prostate cancer varies fairly significantly among races.
- Prescribed medications. Many men are prescribed a medication as they age called Finasteride, or dutasteride, which primarily is used to treat enlarged prostates. Enlarged prostates are not necessarily cancerous, but can cause issues with urination, etc.
- Digital rectal exam. This test allows us to determine if there are any abnormalities in the prostate.
- PSA blood test score.
We’ve developed an algorithm that combines all five of these factors and creates a score. Based on this score, we are able to determine the likelihood of a patient having prostate cancer. If the score is above a certain level, we’ll recommend a biopsy.
In adopting this approach to prostate cancer detection, we’ve reduced the number of men who undergo biopsies by 30 percent, while at the same time increasing the percentage of biopsied men who are then diagnosed with cancer.
Why does this matter?
Patients often experience a lot of anxiety after learning they might have cancer. We’ve been able to keep a lot of men who aren’t at significant risk of prostate cancer from suffering this undue anxiety. Also we don’t expose people who are cancer-free to the risks associated with a biopsy. While biopsies are very safe, it’s always best to avoid unnecessary surgical procedures.
There’s also cost savings associated to avoiding unnecessary biopsies. The cost of a prostate biopsy is approximately $3,000. We estimate that at Intermountain Medical Center alone, we’ve saved $3.5 million over the past seven years by adopting this new screening process.
For many years the prevailing thought was that if a man had a family history of prostate cancer, screening was recommended more frequently. Our studies show family history isn’t a strong indicator of your likelihood of developing prostate cancer, which has changed the way we approach screening.
So when should a man first get a PSA test? We recommend a PSA test at age 50. If his score is good (using our algorithm), then we suggest a PSA isn’t needed again until age 60.