Qualy #53 - Screening for prostate cancer

Today's episode of The Qualys is from podcast <a href="https://peterattiamd.com/tedschaeffer/">#39 – Ted Schaeffer, M.D., Ph.D.: How to catch, treat, and survive prostate cancer</a>. The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for "qualifying round," which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., "fast"), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive. Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now. Learn more: <a href="https://peterattiamd.com/podcast/qualys/">https://peterattiamd.com/podcast/qualys/</a> Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): <a href="https://peterattiamd.com/subscribe/">https://peterattiamd.com/subscribe/</a> Connect with Peter on <a href="http://facebook.com/PeterAttiaMD%5dFacebook">Facebook.com/PeterAttiaMD</a> | <a href="http://twitter.com/PeterAttiaMD%5dTwitter">Twitter.com/PeterAttiaMD</a> | <a href="http://instagram.com/PeterAttiaMD%5dInstagram">Instagram.com/PeterAttiaMD</a>

Actionable Insights

1. Utilize 4K Score for Prostate Cancer Risk

Consider using the 4K score or Prostate Health Index (PHI) test, which discriminates between cancerous and benign prostate cells and provides a percentile chance of having high-grade, aggressive prostate cancer. A 4K score less than 7.5% indicates a low risk (1.6% chance of dying from metastatic prostate cancer in 20 years), while a score greater than 7.5% indicates a higher risk (16-17% chance in 20 years).

2. Monitor PSA Density Thresholds

Be aware that a PSA density greater than 0.1 raises a red flag, and a density greater than 0.15 indicates a higher concern for prostate issues, prompting further investigation.

3. Interpret Free PSA Levels

Understand that a high percent free PSA is associated with a larger prostate and a lower chance of prostate cancer, while a low percent free PSA suggests a higher likelihood that the PSA is produced from a gland with prostate cancer.

4. Seek Workup for Elevated PSA

If you are a younger person and your PSA is more than 2.5, it is generally considered abnormal and warrants further workup, though not necessarily an immediate biopsy.

5. Understand Age-Adjusted PSA Norms

Be aware that normal PSA levels are age-adjusted; for example, a 40-year-old’s normal PSA is around 0.5-0.6 ng/ml, while a 50-year-old’s is around 1 ng/ml, with levels generally increasing by decade.

6. Avoid PSA Test Post-Rectal Exam

Do not check a PSA on a man immediately after a rectal exam, as the exam could artificially raise PSA levels by creating more insult and increasing the flow of PSA into the bloodstream.

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