When you’re cruising along in good health, it’s easy to take that smooth road for granted. An annual physical with a PSA is a little like stopping at a red light and waiting till the light changes. When the physical ends, you figure it’s a green light and leave the office, expecting to go on cruising. However, if the doc calls to tell you your PSA is abnormally high, you may feel like you just got pulled over when you weren’t doing anything wrong. You hope the officer is just going to tell you that a brake light is out, or something. But suppose he says, “Your car matches the description of a known criminal suspect. Get out of your vehicle. I have a search warrant.” You’re not happy about the random invasion of privacy based on a vague suspicion, but you’re in luck. Your lawyer’s number is in your phone contacts, and you can get professional advice based on specialized legal knowledge before the search starts.
When your PSA is high, you need specialized advice before your doctor refers you to a urologist for a biopsy. That abnormal PSA is merely a vague suspicion of cancer, and an ultrasound-guided prostate biopsy is an invasive but random search for it. Since the PSA blood test is not specific for cancer, there are supplemental tests that can make the suspicion less vague:
- PSA density and free PSA – additional blood test clues as to what might be causing PSA elevation
- PCA3 – a gene-based test carried out on urine
- MiPS – combines the amount of PSA with the amounts of two genes found in urine.
However, none of these tests is diagnostic, though they can help rule the need for a biopsy in or out. But there’s better specialized advise available in the form of imaging.
Our Center overcomes vague suspicion by means of a noninvasive multiparametric MRI of the prostate, done under a powerful magnet called 3 Tesla, or 3T for short. This advanced scan, which is painless and does not involve radiation, clearly shows tumors larger than 4 mm. An experienced radiologist can not only identify the size, shape and location of a tumor, but also rate its aggression based on appearance.
If the images reveal prostate cancer, we use real-time MRI to target one or more biopsy needles directly into the tumor. Nothing is random, and because the tissue samples come from the core of a tumor, the true aggression level of the cancer is known. In clinical studies, there is a very high degree of correlation between the reader’s rating of the aggression level with the actual laboratory analysis of the biopsy specimens. The Sperling Prostate Center provides 3T multiparametric MRI of the prostate, years of expertise in reading the scans, and MRI-guided targeted biopsy if it is indicated. It’s the most specialized advice available, so if treatment is needed, a plan can be developed to match correct information about the disease.
Don’t be the victim of a vague suspicion and a random search. If your urologist “officer” says he has a “PSA warrant” to search your “prostate vehicle,” call your “radiologist lawyer” first.