An extremely common scenario these days is that a screening PSA blood test is elevated, and a patient is told they need a prostate biopsy. However, up to a third of these biopsies do not find cancer, presumably because both benign enlargement of the prostate (BPH) and inflammation of the prostate (prostatitis) can both raise the PSA test. Luckily there are now a couple of ways to decide more accurately who should get a prostate biopsy after an elevated PSA.
The urine PCA-3 test (also known as uPM3) is a much more specific test for prostate cancer. BPH and prostatitis do not cause it to go up. So if a positive PCA3 test occurs, it is pretty likely prostate cancer is present and a biopsy is more warranted. This simple test requires a prostate exam and then a urine specimen is collected. Most insurance companies will pay for this test.
Another option is to have a color Doppler transrectal ultasound of the prostate. This can show a whole range of issues that might be affecting the prostate, urethra, bladder, and seminal vesicles. It can help clarify if there are areas suspicious for cancer, and can be used to monitor progress if cancer is ultimately determined to be present (as well as BPH) with a lot less trauma than repeat biopsies. For more information, click on Prostate Ultrasounds in the menu bar. Few insurance companies will pay for this test.
Gone are the days when PSA alone determines whether to have a prostate biopsy. This should greatly reduce the number of unnecessary biopsies.