Most cancers of the prostate are very slow growing and don’t need treatment. PSA in the late 1990’s revolutionized detection of prostate cancer. The levels fluctuated causing false alarms.
Ninety percent are now found early. Of the 185,000 cancers found each year, eighty five percent of you will die of something else. Al these treatments save 20% of men.
Some cancers are very aggressive, killing 28,000 of us annually, and are the second most deadly cancer next to lung cancer.
Which kind of cancer you have is hard to tell. To be on the safe side and not wait, many men are getting radiation, hormonal therapy, and prostate removal, resulting in loss of urinary control and impotence.
If you are now 75, you will not be screened with a PSA test, because the risk of treating would outweigh the benefits. Since there is no better test, what should you do? You probably don’t need the test done each year.
If you have a high PSA test, you will get a biopsy through your rectum with random 6-12 biopsies. They are blind biopsies. Over 1.2 million men get biopsies annually, at a cost of $2000, and only 15% come back positive, and over 20 % of cancers are missed with this blind procedure.
Its rather barbaric what is done to men without good imaging. Some urologists are now doing 50 biopsies from behind the scrotum, called 3 D, covering the entire gland, using a grid. It’s like playing a dart game. If something was found, cryocautery or specialized ultrasound is used. This biopsy will cost you $6000, and may be covered with insurance.
Good imaging would only tell you where to biopsy, since the prostate is very dense.
MRIs are now done to improve the batting average. They are not very definitive, and can’t find small cancers, and add another $1000 to the bill.
A blood test for sarcosine, if elevated will signify you have advanced cancer. It is a waste product of tumors. PET scans and radioactive dyes are now being studied in the pursuit of identifying who needs treatment.