Prostate Cancer Screening— Simplified

Results from PSA (prostate-specific antigen) tests often raise more questions than they answer. But two new tests may help by providing key clues that the PSA test alone can’t, such as whether a biopsy is warranted or how aggressive a patient’s cancer might be.

This is important because biopsies and cancer treatments, such as radiation and surgery, should be avoided unless absolutely neces- sary, as they come with some real risks, including bleeding, infection, incontinence, and erectile dysfunction, says J. Stuart Wolf Jr., MD, urology professor at the University of Michigan. Here’s the lowdown. —Amanda First

WHO’S A CANDIDATE: A man with a higher- than-normal PSA level
WHAT IT MEASURES: Determines urinary levels of prostate cancer gene 3, which is found only in cancerous prostate cells. A PCA3 score of 25 or lower means a biopsy likely isn’t needed; anything higher warrants a closer look. Unlike PSA levels, PCA3 levels are not influenced by benign conditions such as an enlarged prostate. “PCA3 testing can be very helpful for men in the biopsy gray area,” says Dr. Wolf.
AVAILABILITY: Widely available
COST: $250 to $700 with insurance; $700 without (projected to come down)

WHO’S A CANDIDATE: A newly diagnosed man whose prostate biopsy detects cancer
WHAT IT MEASURES: Analyzes genes of cancer cells removed in a biopsy to predict how aggressive a tumor is (based on how quickly cells divide), which can help a patient and doctor decide if surgery or other treatment is necessary. Clinical studies have shown this lab test to be an accurate estimate of tumor aggressiveness.
AVAILABILITY: Widely available
COST: Less than $375 with insurance; $3,400 without (Medicare coverage expected by 2014)

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