Options for Prostate Cancer Tests

Interviewer:  You're talking about other tests as well and some that you use, can you talk about some that might help down the road in diagnosing and determining any conditions?

Dr. Phranq Tamburri:  So other tests for prostate cancer that can help?

Interviewer:  Sure.

Dr. Phranq Tamburri:  Absolutely.  Wow.  Hope you have enough memory.  So here we go.  So first you have the PSA itself.  The PSA test, as long as it's a clear number, that can be helpful.  Next is you get multiple PSAs as we said.  And that's not necessarily tests but it's a way of using it called the PSA velocity which is how quickly is it increasing.  Essentially if it goes over a point per year it's kind of a problem.  Two points per year we send the dogs after you it's kind of more of a concern.  That's a way to utilize it.  Then we have what's called the PSA density.  The density is when you get the size of the gland.  It's an ultrasound machine, you can get the volume.  The larger the prostate the higher the PSA normally would be.  So if you have a normal sized prostate and your PSAs high, that's a problem.  But if you have a large prostate, what's the problem?  The real problem is that most urologists will not pay to get an ultrasound done to find the volume to determine if that number is normal for you.  So you run into the system issue again.  Also there's a test called the percent free PSA which is another test that the Mayo Clinic came up with years ago which is a qualitative indicator.  So regular PSA says, all we know is in your blood we found this PSA that's high.  Who knows why?  You could have gone bull riding as far as we know.  And that's true.  We see cowboys and rodeo guys the number one bull in Arizona a few years ago, his name was Doctor Proctor.  Kind of sums up about what it does to your PSA.  So you have to look at that.  The percent free PSA says of your PSA what's the percent chance that your normal PSA is coming from cancer versus something else.  Like Doctor Proctor.  So that's a qualitative tool that's available and your regular lab can run it.  Most people are not are of it.  There's another test called the PAP.  The Prostatic Acid Phosphatase and it's the male PAP not the female PAP I know what guys think.  No probes.  But it's simply a blood test and this is the old PSA test.  Well I should say it's a test of PSA substitute.  The reason we got rid of it is because that test is only elevated when the cancer has already gotten out or has sprung legs.  And the PSA was supposed to replace that.  Of course the PSA has some false positives, it's not very useful.  But the PAP it is useful when someone has a PSA close to 10 or there's cancer in their family and they're concerned.  So that's another test to kind of augment the PSA.  Ultimately there's another test that I want to keep boring you with because there's many options.  Probably the most promising test right now, and we have patients that fly to my office, well for my service but even for this one test.  The PCA3.  Stands for Prostate Cancer Antigen 3 and it's the first in the line of molecular DNA marker tests.  So you're going to see more of these in other areas of cancer, not just prostate cancer.  But what it's looking for is it's a functional genomic test, not a diagnostic.  Diagnostic means that, when you're genetic testing, means someone has the gene for prostate cancer or the gene for baldness which I think I inherited.  Whatever it might be.  But a functional genomic test is one where it says when a certain functional reaction is occurring...so when there is a cancer there that cancer tends to produce DNA that's associated with that cancer.  So you're seeing a whole new line of tests that are tracking DNA that is new to certain body systems or to cancers.  So the first was PCA3 and it is by itself, by most recent standards 65-75% reliable.  To positively predict cancer on an individual test.  And of course as we just discussed, the PSA a visible.  One PSA doesn't tell you anything.  You need multiple tests.  So the PCA3 is the closest we have to a one off test.  And May Clinic and other urologists would use that test when they knew you had prostate cancer...everyone in your family died of it, your PSA's 15, you can feel it with your finger, it almost ate your finger off, all this happens and the biopsy comes back negative.  Now what do you do?  You're the doctor.  You know it's there but now that patient's leaving and he's a walking lawsuit because you didn't catch it.  And if the patient refuses to come back and have another biopsy then they might accuse you that you didn't do your job right.  This actually happens.  So this test will be authorized for $1400.00 for this test to make sure that the doctor knew whether or not he had it or not.  I called it the Pontius Pilot test. It was the way to cleanse the doctor's hands of lawsuits.  So you see that there's a business of medicine as well so the tracking and these tests we're talking about kind of interplay.  But that's the pCA3.  Other tests that you can do that are a little simpler.  A urinalysis.  Just check one's urine.  Find out, is there bacteria in the urine?  If you find evidence of bacteria through different means...white blood cell count, blood that sort of thing.  That could suggest a non-cancerous etiology or cause.  Because if there's infection an infection makes the PSA go up.  So there's simpler ways to find...and actually one other test is simply find out how well a man pees.  When men come in and they have peeing problems.  I'm happy.  I'm ecstatic.  Now, my medial students say it's because I like...it's good for business having guys with peeing problems.   But the real reason is because the more problems you have the more it suggests you do not have prostate cancer.  Because cancer is insidious.  You don't know you have it.  It hides out.  That's the problem.  But BPH which is in the large prostate or prostatitis which is an inflamed or infected prostate, both of those give symptoms.  So when the PSA goes up I want to see that patient go to the bathroom five times, I'm happy.  He's not but I am.  So those are some of the tests we have.