Roscoe Nelson MD: When a man has prostate problems, they are typically going to see their primary care physician. Workup would start with a urine analysis, a PSA, and an exam, digital rectal exams are often forgotten, but about 15% of prostate cancers are diagnosed with an abnormal rectal exam and a normal PSA.
For that reason, it’s very important to have a complete exam. If patients have further symptoms and their primary care doctors not sure what’s going on or if they need extra health, they will send them to urologist.
We may look inside their bladder we may do a flow test where they urinate into a container to measure how fast. These are typical types of tests that we do to workup prostate problems. If a PSA is elevated or there is an abnormal exam that would progress to potential prostate biopsy or maybe even some imaging studies depending on the findings.
Some prostate cancers are high risk, aggressive, and more likely to spread. Others are low risk, least likely to have bad outcomes. The biopsy says cancer, but current diagnostic tools provide limited information about how aggressive a man’s individual disease is, so most men decide to treat prostate cancer immediately.
Once treated, many men experience serious long-term side effects like incontinence and sexual impotence. Immediate treatment is not always needed, but right now a man can’t be sure if his cancer is the kind that is likely to require treatment or if he is okay to wait for now.
What if there was a test that could determine how aggressive prostate cancer is. Genomic health is developing a new test to do just that. By reviewing the underlying biology of the tumor and using genes from multiple biologic pathways, the test can predict the aggressiveness of prostate cancer when diagnosed, allowing a man to make a more informed treatment decision with confidence, taking care of himself with more information and greater peace of mind.