7. The PSA level always determines prostate cancer:
There are numerous myths associated with PSA levels. These include that a PSA of 4ng/ml or less always means that there is no prostate cancer and that a high PSA always means there is prostate cancer. However, there is more to a prostate cancer diagnosis than just the PSA levels. Between 15 and 20 percent of all men with a normal PSA level suffer from prostate cancer, while about only 30 percent of all men with high PSA levels have the disease.
8. A normal DRE means that there is no prostate cancer:
The digital rectal exam (DRE) is about 50 percent accurate in detecting prostate cancer. It lets the physician analyze the presence of induration, a prostatic nodule, abnormal texture or prostate size and tenderness. But the DRE does not confirm whether a patient suffers from prostate cancer, and further examination is often needed.
9. An MRI is a substitute for a prostate biopsy:
An imaging study including an MRI, CAT scan, or ultrasound is not used to diagnose prostate cancer. They may be requested by the physician to evaluate the presence of suspicious areas to be targeted during a biopsy or to evaluate the extent of the cancer. However, it’s a myth that an MRI can substitute a prostate biopsy.
“total PSA only may not be cost effective, evaluation of individual men with the PSA as well as the %free PSA may be”
May be but no one knows yet.
So it’s still the same as PSA screening in general. No-one has ever shown that PSA screening, or even PSA screening of a chosen risk group, leads to an overall saving of lives.
It’s about time someone showed that PSA screening of any risk group at all leads to an overall saving of lives.
Regarding your statement:
“An imaging study including an MRI, CAT scan, or ultrasound is not used to diagnose prostate cancer. They may be requested by the physician to evaluate the presence of suspicious areas to be targeted during a biopsy or to evaluate the extent of the cancer. However, it’s a myth that an MRI can substitute a prostate biopsy.”
I would take major exception with your statement. Imaging before biopsy should become standard of care, the same as it is for women suspected of having breast cancer. What woman do you know who would submit to having 150 needles stuck in her breast to see if maybe they hit something and then go get a mammogram to see if they see something? Urologists have this entirely backwards. Random TRUS biopsies should be relegated to some dark closet of the past. TRUS biopsies regularly miss 40% of clinically significant cancer. Modern mp MRI scans have both a negative and positive predictive value of over 90% for prostate cancer. When a man is suspected of having prostate cancer the first step should be an mp MRI scan. If an area suspicious for clinically significant cancer is found, then an MRI guided biopsy targeting the suspicious area is warranted.
Standard TRUS biopsies regularly cause swelling and inflammation in the prostate which often results in a rise in PSA leading to more unnecessary biopsies. Erectile Dysfunction as a result of biopsy is not uncommon. The infection rate of TRUS biopsies is up to 4.5% and often results in hospitalization.
While a biopsy is the only way to diagnose prostate cancer, it should be a targeted, MRI guided or MRI/US fusion guided biopsy, not a TRUS biopsy.