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PSE test vs biopsy

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Posted 6/22/2024 9:08 PM (GMT -5)
Is the PSE really that accurate ?
Posted 6/23/2024 12:18 AM (GMT -5)
i think it is but elevated PSA does not necessarily mean prostate cancer
Posted 6/23/2024 4:51 AM (GMT -5)
cvc,

PSE is still a screening tool, it claims 94% accuracy in detecting PC. As such, it is not definitive. IMO it still falls into the category of 'check engine light' tools. It says, "something is interesting here", please go get a full workup.

If you're low risk, it probably works like the 'poop in a box' test for colon cancer, which also claims about that level of accuracy. If that one comes back with a probable, they tell you go to to a gastroenterologist and get a full workup including a colonoscopy.

As far as I know, in today, the only definitive way to diagnose any kind of cancer is through biopsy and examination by a pathologist. MRI and PSE and other less invasive things are tools that give an impression of what might be. You won't know for sure until the biopsy.
Posted 6/23/2024 6:36 AM (GMT -5)
But… doesnt a biopsy also miss at times ?
Posted 6/23/2024 6:45 AM (GMT -5)

F8 said...
i think it is but elevated PSA does not necessarily mean prostate cancer

PSE not PSA
I guess I’m asking if my PSA is still elevated in 30 days what’s next to give better or more info before jumping to a biopsy ..which I’ve heard misses some PC too
Thank you
Posted 6/23/2024 6:47 AM (GMT -5)

cvc said...
But… doesnt a biopsy also miss at times ?

Yes, a "random" biopsy may miss existing cancer perhaps 1/3 of the time. MRIs can miss existing cancer also. When these tests come back negative, and your PSA continues to rise over time, these procedures are repeated. If you do the math, the chances of, say, 3 random biopsies all missing existing cancer are pretty slim.

With the advent of MRIs we now have "targeted biopsies" where the uro uses the MRI image to guide the biopsy needle to the suspect area. Note that with most targets biopsies, "random" cores are also take in all prostate zones that don't have MRI-identified targets, for the very reason that an MRI can miss very small lesions.

PSA is often maligned as being non-specific for cancer, but in my book, it's been a great boon. Too many cancers give us no warnings. Put another way, it's uncommon for prostate cancer not to raise one's PSA. This is not disssimilar to a fever: it means you should consider an infection as the cause and investigate as necessary.

BPH (benign growth in size of the prostate) also leads to increased PSA, simply because there is more prostate tissue. However, you can have BPH and prostate cancer at the the same time.

Bottom line: IMO if your uro wants a biopsy and you trust your uro, get the biopsy. If you don't trust your uro's opinion, get another uro. Often a uro will say it's your choice: you can do the biopsy now or delay it and make it contingent on your PSA trend or next result.

Djin
Posted 6/23/2024 7:05 AM (GMT -5)
I do have BPH enlarged prostate but still a 1.5 jump in one year seems excessive
So the retest in 30 days may give a better answer.
But I’ve heard the PHI ? Prostate health blood test or a special kind of MRI is usually done before a biopsy then if these tests show questionable a biopsy …
This uro is fairly new to me…my other one passed away
Posted 6/23/2024 7:44 AM (GMT -5)
You may also want to do some research into PSA density .

See also Prostate-specific Antigen Density Cutoff of 0.15 ng/ml/cc to Propose Prostate Biopsies to Patients with Negative Magnetic Resonance Imaging: Efficient Threshold or Legacy of the Past?

"Patient summary:

In this study, we investigated whether the commonly used prostate-specific antigen density cutoff of 0.15 is justified to identify patients with negative magnetic resonance imaging (MRI) who should proceed to a prostate biopsy. We found that this cutoff is appropriate only in case of very poor MRI quality, and a higher cutoff (≥ 0.20) should be used for the average MRI."

I would use PSA as a topic for conversation with your uro. There are many factors that your uro will use, including your history, rate of PSA climb, test results, their experience & training, etc., and probably not one hard-and-fast metric.
Posted 6/23/2024 8:04 AM (GMT -5)
Yes another member posted that in my other post
I believe about 10 yrs ago I was told my prostate was 55
My PSA is now 3.6 up 1.5 from a yr ago
DREs have been negative
My worry was the jump of that much
He wants re-test in 30 days and see me then
Posted 6/23/2024 10:32 AM (GMT -5)
The PSE test shows promise but was only tested on 147 men and part of the calculation is based on PSA. The PSE test is a ways away from be accepted by medical organizations and authorities so not much help yet in US.

As previously noted, PSA Density, PHI test, 4K, PCa3, and so on exist to help quantify PCa risk. However, generally PSA <4 is considered the lower risk zone for men. The somewhat standard procedure now is PSA testing followed by clinical (family history & BPH) and physical testing (DRE) which my lead to MRI followed by biopsy if warranted. If all upfront work is good, the biopsy may be postponed and PSA monitored.

No one point means much in the scheme of things so your next test will help tell the story. Note: make sure blood is taken before DRE exam and no wild monkey sex on a bike the night before.
Posted 6/23/2024 12:33 PM (GMT -5)

cvc said...

F8 said...
i think it is but elevated PSA does not necessarily mean prostate cancer

PSE not PSA
I guess I’m asking if my PSA is still elevated in 30 days what’s next to give better or more info before jumping to a biopsy ..which I’ve heard misses some PC too
Thank you

sorry. i didn't want a biopsy either. in fact i was terrified. the procedure wasn't as bad as my mind made it out to be and the test showed definitively that i had prostate cancer, and a lot of it
Posted 6/23/2024 2:47 PM (GMT -5)
cvc,

Have you had a previous biopsy? I gather you've been watching things for a while. Have you had a prostate MRI? I think, typically these days they do the MRI before biopsy, and then use the MRI findings-assuming there are shadows on the MRI-to guide the biopsy. With an MRI guided biopsy, the false negative percentages drop a lot.

I get it, a biopsy is no fun. Unfortunately, for now, that's what we have.
Posted 6/23/2024 3:31 PM (GMT -5)
Nope I’ve always had an enlarged prostate and have been gettin my PSA since 40
He’s never had a reason to do a scan , this years was up to 3.6 and last year was 2.4
I’m the one freaking not him
He said my prostate is 55 or larger
Guess that’s what the DRE tells his finger 😁
Posted 6/23/2024 4:13 PM (GMT -5)
If and when you get to that point, ask for a transperineal biopsy and if you can be sedated like a colonoscopy. It is not necessary but it is a safer procedure and sidesteps the freaking out part.

My first upper endoscopy was without anything laying on a stainless steel table and just told to keep breathing with a tube down my throat. Now that really sucked and they don’t do it that way anymore. The biopsy was easier since they do some nerve blocking and it sounded worse than it was. Still not fun but you can tolerate about anything for 15 minutes.
Posted 6/23/2024 4:43 PM (GMT -5)
I already made up my mind , if he wants a biopsy and can convince me it’s better than an mri
If he won’t sedate me , I’m going to find a uro that will

I’m thinking if my retest in 30 days shows my PSA going back to like 2. Something he will just watch it IF my DRE is normal
Posted 6/23/2024 5:06 PM (GMT -5)
cvc, we'd suggest the MRI first, to see if there are any hot spots. THEN biopsy if there are hot zones.
Posted 6/23/2024 6:47 PM (GMT -5)

cvc said...
I already made up my mind , if he wants a biopsy and can convince me it’s better than an mri
If he won’t sedate me , I’m going to find a uro that will

I’m thinking if my retest in 30 days shows my PSA going back to like 2. Something he will just watch it IF my DRE is normal

i agree with that approach. i was totally freaked out but all my doctor would do is give me a light sedative that didn't help much. but the biopsy really wasn't that bad
Posted 6/23/2024 7:04 PM (GMT -5)

halbert said...
cvc, we'd suggest the MRI first, to see if there are any hot spots. THEN biopsy if there are hot zones.

That’s what I would think and if he’s unwilling then I’ll find another Dr
How hard is it to find a place to do that kind of MRI ?
I would assume Syracuse NY would have a place ??
Posted 6/23/2024 7:43 PM (GMT -5)
At Syracuse? You might start at the University medical center. If not there, I know Rochester has some top notch facilities and doctors. (full disclosure, my daughter is a nurse at Rochester Highland hospital)
Posted 6/23/2024 8:22 PM (GMT -5)
Strong is a great hospital in Rochester
My dermatologist told me if I was his brother he would send me there
Posted 6/24/2024 8:12 AM (GMT -5)
CVC, historically 50% of the standard 12 needle biopsies have been negative for cancer. Recently my urologist shared newer information showing that the percentage of negative biopsies has reduced significantly in the last decade. He cites three main reasons. First, routine PSA screening is greatly reduced so fewer men are showing slightly elevated levels leading to fewer biopsies. Second, more urologists are looking for and treating non-cancer issues like infection and enlargement before going to a biopsy. And third, more use of MRI scans are limiting biopsies to the men that show higher probability of lesions using the PIRADS method.

My urologist uses these methods aggressively and his positive biopsy rate is over 90%. He also shared that he sees very few G6 men now compared to 10 years ago and his practice, with more than 80 urologists, has seen its active surveillance program greatly diminished.

I agree with the other comments that you shouldn’t be freaking out over the PSA increase given your history of enlargement, the still relatively low PSA level, and the current position of your urologist. However, I am a firm believer in multiple assessments. If this is of great concern and you think your urologist isn’t doing enough, then seek out another urologist that specializes in prostate work and get another assessment. Also check with your insurance company to see what is required for them to approve the MRI. I seriously doubt any insurance company is going to approve the procedure for a man with PSA in the normal range and nothing found from the DRE other than enlargement. So, my advice is twofold, please don’t freak out or worry, but do step up your investigation of the PSA increase. One way to do that is to increase the testing frequency. Instead of annual testing, go to quarterly and see what trend develops.
Posted 6/24/2024 9:16 AM (GMT -5)
Yea again the PSA increase of 1.5 in a year is what freaked me out
I was also a little upset that when I called the office I had a hard time getting the actual Dr to get on the phone or have a promise he would call me before he left.
I kinda get it but I guess I’m spoiled by being able to talk to my other Drs if need be.
So going forward I’m thinking if the PSA is still elevated or the DRE shows concern , if he suggests a biopsy I’m suggesting prostate health blood test and or MRI before a biopsy
Posted 6/24/2024 10:44 AM (GMT -5)
Thanks for the expanded information. Several years ago a well regarded prostate cancer medical oncologist, Dr Stephen Strum, published information that showed the expected PSA expression based on prostate size and any cancer based on known Gleason grades. He estimated that on average, a non-cancerous prostate should express PSA at a factor of 0.066 per cc of prostate size. For you that would be 0.066 x 55 = 3.63. By this calculation, if you have any meaningful amount of PCa it should produce a higher PSA.

This calculation is in no way a conclusion of whether or not you have PCa. But is is helpful to consider in the investigation. For a PCa positive diagnosis it is also helpful in estimating the amount of cancer by volume. In my case, my docs estimated there was approximately 19 cc of cancer volume based on my PSA, prostate size and Gleason grades. They then compared to the CT images and DRE to estimate to what extent the cancer was local. This all aided in the treatment methods and radiation plans.
Posted 6/24/2024 11:18 AM (GMT -5)
I just read the Oxford-Biodynamics website for the EpiSwitch PSE test. Very interesting and potentially a good diagnostic tool for PCa discovery and monitoring after treatment. I like Halbert’s analogy to ColoGuard. Also, to be clear, the PSE is not a test for cancer. It only estimates the likliehood they there may be any cancer. It remains that the only definitive test for a PCa is a microscopic cellular analysis of tissue samples from a biopsy of the prostate.

I see it costs $950 in the US. Plus your doctor will charge for the blood draw and then delivery of the report to you. Oxford-BioDynamics will only work through your doctor. Currently Medicare does not reimburse for the test and Oxford BioDynamics website says they do not yet have a list of any insurers that reimburse the cost. So, that tells me it is currently self-paying and to expect $1,100-$1,200 in total cost. Typically, an insurer will follow the lead of Medicare in determining the reimbursement. So until Medicare approves it, no insurer will do so. In contrast, the average cost for a stand-alone PSA is $100 and Medicare and all insurers routinely cover the cost.
Posted 6/24/2024 11:49 AM (GMT -5)
So if it’s still elevated then a PHI blood test?
MRI ? Before biopsy ??
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