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You Have An Elevated PSA Level — Now What?

Posted Jul 22 2013 7:00am

By Jay Cohen M.D.

11 Steps to Take before Choosing Surgery or Radiation

healthywords In the last few years there have been major breakthroughs in prostate cancer diagnosis and treatment. The problem is, many patients don’t know about them–and neither do their doctors. Studies have shown that it can take 10-15 years for new technologies to reach doctors and change their methods. Men with prostate cancer can’t wait!

An elevated PSA doesn’t necessarily mean you have cancer. Nor should it automatically trigger a biopsy. What’s more, the presence of cancer cells doesn’t always mean you need a radical prostatectomy or radiation therapy. In fact, the opposite is true. Most men with prostate cancer–up to 85 percent–don’t require such radical interventions, yet most of them end up getting surgery or radiation anyway.

Based on the very latest medical knowledge and technologies, here’s a safer, leading-edge approach to take after tests show you have an elevated PSA level.

Step 1: Ask your doctor for a DRE (digital rectal exam) and ultrasound to measure prostate size and to feel for any irregularities, bumps, or elevations. Then…

Step 2: If there is a possible prostate infection, treat with antibiotics. Then…

Step 3: Get a second PSA test. There are a number of factors that can skew PSA numbers, so it’s important to repeat the test. If again elevated, then…

Step 4: Obtain an Advanced Prostate MRI from a center that has the 3.0 Tesla machine. This is a breakthrough technology that is 85-90% accurate in identifying a cancer mass, even small masses of 5 millimeters. Then…

Step 5: Consider getting a Color Doppler Ultrasound test if there’s a center near you that offers it. This test is able to give a high-resolution image and pinpoint where cancer is present. If cancer is found, your urologist will then be able to perform a more accurate, targeted biopsy. Then…

Step 6: If possible, try to obtain a targeted biopsy instead of the typical blind biopsy. Doctors knowledgeable about the advanced prostate MRI and Color Doppler Ultrasound will know about the benefits of a targeted biopsy. Rather than taking random samples as is usually done, your doctor will now be able to guide the biopsy needle to the most suspicious areas, greatly increasing the chance of obtaining highly reliable results. Then…

Step 7: If the targeted biopsy reveals cancer, ask if it would be helpful to obtain a second pathology analysis from a different center or institution. You have nothing to lose from doing this, and labs do make mistakes. Then…

Step 8: Join a prostate cancer support group, where you can obtain valuable information from a patient’s point of view. Sometimes these men are better informed about the newest technologies and treatments than doctors. Also, do your own research, searching the internet for information about tests, treatments, benefits and risks. Then…

Step 9: Collect your data and have all your test results and dates in a single table so you can track changes over time. Discuss your results with your doctor and ask as many questions as you need. You’ll want to know what treatment your doctor suggests for your type of cancer. If he recommends surgery or radiation therapy, ask if you may speak with the surgeon or radiologist, and find out if you’re a candidate for cryotherapy or high-intensity focused ultrasound (HIFU). Then…

Step 10: Consider getting a second opinion. Your urologist is most likely a surgeon, so it’s natural for him to have a surgical point of view. Be sure to find out if there are alternatives to surgery or radiation therapy you should consider. Also ask about dietary changes you should make, medications or supplements you might take. Then…

Step 11: Decide on your treatment based on all your test results and the knowledge you’ve gained. Congratulate yourself for taking an active role in your present and future health, and for making decisions that are well informed and based on the most up-do-date information available.

Note: I am not just a doctor giving advice. I’m also a patient. I was diagnosed with prostate cancer in 2011 and directed toward surgery or radiation, but after undergoing the newest-available tests and conducting dozens of interviews with top doctors, I learned that my test results did not warrant invasive treatment. Today my prostate cancer remains under excellent control without medications.

- Dr. Cohen is a nationally esteemed medical practitioner and researcher, author of eight health books and more than a hundred medical articles, and an expert on medication safety and nutrition. His newest book, Prostate Cancer Breakthroughs: New Tests, New Treatments, Better Options (2013), is the only book that takes readers step-by-step through the evaluation process, informing men of vital new tests and treatment options that can help tens of thousands of men avoid unneeded surgery or radiation. Learn more about Dr. Cohen’s book at Amazon.com .

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