PSA Testing and Prostate Biopsy
PSA - Prostate Specific Antigen - is one of a number of tests used as a method of assessing risk in men over the age of 40 for early prostate cancer.
The rationale is that there is no cure for late stage disease, that PSA screening does detect disease at an early stage, and such screening may account for a reduction in mortality. Detection and treatment was associated with a very significant reduction in prostate cancer specific death in those studied in the European ERSPC trial. A single cutoff point for "normal" PSA is no longer established.
The combination of a serum PSA level, taken in conjunction with a digital rectal examination (DRE), any family history, age group, and PSA velocity (rate of change of your PSA over time) are the best predictors as to your risk of prostate cancer. Discussion of these factors with your urologist may lead to a recommendation for a prostate biopsy, a repeat PSA, or an MRI scan of the prostate to look for any lesions. Multiparametric MRI scans are these days very commonly done before decision making about prostate biopsy. These non-irradiating scans may highlight areas of interest or suspicion on which to base a biopsy. If no lesions are seen, some men may not necessarily need a biopsy. MRI scans of the prostate are not currently rebated under the Medicare system.
A TRUS (Trans Rectal Ultra Sound guided ) prostate biopsy , or a transperineal biopsy , are the gold standards for sampling and detecting clinically significant prostate cancer. They are done as a day case procedure under sedation or general anaesthetic, which allows for optimum imaging, wide sampling, and patient comfort. (Many men sadly put off PSA testing because of the fear of prostate biopsy without anaesthesia !) Prophylactic antibiotics are given to minimise risks of sepsis / infection, which in my hands are less than a 1 in 100 chance fro a TRUS biopsy. Transient blood in the urine, bowel motion and seminal fluid (ejaculate) will be noted, but are rarely problematic. Sepsis is almost zero with transperineal biopsy but the rate of urinary retention and sexual dysfunction is higher. The location of any lesion on MRI scan can lead to my advice as to which method is preferable in an individual.
The specialist pathologists that I use at Douglass Hanly Moir Pathology are expert in analysing the tissue samples and stating a Gleason Grading Score and the new WHO ISUP score in prostate cancer. These scores act as a good guide to clinically significant cancers, and will help in decision making about applicable treatments.
Post treatment, periodic PSA testing is offered to detect any disease recurrence, and can be used to select appropriate salvage therapy.