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5 Alternatives to the PSA Screening Test

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Paul Turek, MD, FACS - Blogs
By Paul Turek, MD, FACSBoard-certified urologistDecember 31, 2018

Men can’t afford to be in the dark about the state of their prostate. It’s estimated that the average American man has a one in nine chance of having prostate cancer during their lifetime. That’s more common than either lung or colon cancer. Luckily, a screening developed about 30 years ago called the prostate-specific antigen (PSA) test can help detect cancer earlier and better than the old-school-finger-exam of the prostate. In fact, blood PSA testing is estimated to save the lives of thousands of men every year.

But alas, there are two edges to every sword. While an elevated PSA can mean that cancer is present, it doesn’t always mean that cancer is present. That’s because PSA levels are influenced by conditions other than cancer, such as normal, age-related prostatic enlargement as well as inflammation. Even ejaculation and bicycling are suspect when it comes to PSA elevation. Furthermore, some herbals, daily aspirin, being overweight, taking finasteride (to prevent balding), and some cholesterol and blood pressure medications can lower PSA levels, further complicating its ability to detect cancer. So, PSA isn’t really a reliable marker for making the diagnosis of prostate cancer but is much better for following cancer after it is diagnosed. In other words, PSA is more of the prostate’s “weatherman” of what’s happening on all fronts than it is an accurate cancer marker.

Used alone, PSA leads to too many prostate biopsies showing no cancer. And, similar to a root canal, who wants a prostate biopsy when you don’t really need it? The good news is that science has responded to this quandary by developing new and better alternatives to PSA for prostate cancer screening. Yes, there are now “biomarker” tests available that aim to reduce unnecessary prostate biopsies.

Here’s a list of several more sophisticated, biomarker tests that have gained popularity over the last several years:

  • Free and Complexed PSA. It so happens that PSA lives several different lives: one is married to other proteins and the other is freely available. The lower the free PSA, the higher the chance of cancer. Both free and married or “complexed” PSA forms are now measurable and can paint a more accurate picture of the chance of prostate cancer.
  • IsoPSA. This blood test assesses all forms of PSA in blood, including immature and mature PSA and all free and married types. It also looks at the various proteins PSA binds to in blood.  And because of this, it too is a more precise marker of cancer than a simple PSA test.
  • Prostate Cancer gene 3 (PCA3). This looks for the prostate cancer-specific gene PCA3 in prostate cells that are shed in the urine. That means it’s a urine test. It is more accurate than PSA for cancer because it does a better job of screening out the noncancerous reasons for PSA elevation.
  • 4K Score. This algorithm-based blood test measures four prostate-specific biomarkers and adds in the clinical history to calculate a precise risk of having “aggressive” prostate cancer, which is the version you don’t want.
  • Prostate Health Index (PHI). This biomarker-based, mathematical test (that incorporates total, free, and pro-2-PSA) does a better job than traditional PSA screening of predicting both the presence of cancer and also “aggressive” prostate cancer.

Please note that these newfangled biomarker-based prostate cancer tests do not actually diagnose prostate cancer. They simply help determine the risk of having prostate cancer. Still, what’s attractive about these next-gen tests is that, unlike PSA screening which is a tissue-specific marker, these are more cancer-specific. Which one should you have done? Please consult with your treating physician to learn more about whether these have value for your situation.

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About the Author
Paul Turek, MD, FACS

Paul Turek, MD, FACS, is founder of The Turek Clinics, providing state of the art medical treatment to men worldwide. Yale- and Stanford-trained, Dr. Turek has pioneered male fertility techniques including testicular mapping and sperm retrieval and has popularized the no-scalpel vasectomy. To read more from Dr. Turek, visit his award-winning blog.

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