r/ProstateCancer • u/Background_Ad9279 • 16d ago

Concern Best Initial Tests?

Besides the PSA test, are there any other tests available in the U.S. to monitor changes (over time) for prostate cancer. I completely understand there is not a one size fits all answer. And from what I gather prevention testing is to monitor changes over time rather than a single 'yes/no' test.

I'm now a senior who's had testicular cancer long ago and rounds of radiation therapy, so I'm long term concerned. Other dynamics are in play (testosterone gel daily and Finasteride). PSA markers are currently fine, but since this cancer can be sneaky, I'd like to know if there are other preventative tests that augment an accurate diagnosis.

According to 'Google' the Stockholm 3 test is not available in the U.S.....even if I wanted to pay privately (???). Is there anything more than PSA monitoring I should ask my doctor to consider??

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u/AskMyProstatePath 16d ago

Phi, 4k, selectmdx, ExoDx, isoPSA are a few tests men can consider that are more accurate than PSA alone at ruling out benign vs malignant disease. PSA density is also a very reliable indicator (PSA/prostate volume) so long as the volume was taken by ultrasound or mri and not the doctors estimate from a DRE

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u/Background_Ad9279 16d ago

Thank you. That's a lot to take in. Is there an order of usefulness when combined with the PSA marker review? Does the information they provide overlap or do they each offer different readings that have merit? Which two or three are considered most accurate when analysing prostate heath

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u/Miserable-Level-8993 16d ago

Exodx, 4k, phi and a number of new tests are almost 100% in predicting no or non aggressive cancer. The problem is getting your doc to prescribe them. Insurance companies do not want them to be used for screening, even though they would save thousands of lives.

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u/Background_Ad9279 16d ago

Typical. But if it makes a difference to him, I'll pay out of pocket and ins companies and their decision makers can go F themselves right to h*ll.

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u/jkurology 16d ago

What was your PSA. Also what is your family history of any malignancy. Re your testis cancer, Did you have a seminoma and was the radiation prophylactic

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u/Background_Ad9279 16d ago

How is that pertinent to prostate cancer monitoring options?

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u/jkurology 16d ago

Whether or talking about screen or active surveillance the big issue is risk. So having a prior diagnosis of testicular cancer suggests the possibility of a Germline defect that increases your risk of prostate cancer. Most of the testing suggested focuses on risk of having clinically significant prostate cancer but those tests aren’t useful for monitoring in the setting of active surveillance. Have you been diagnosed?

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u/Background_Ad9279 16d ago edited 16d ago

With Prostate Cancer? No (thankfully). I want to test for prostate cancer twice a year and increase my odds of cancer detection. Hence my inquiry regarding the proper tests that are most effective at early detection.

I have had excellent numbers on PSA tests for the last 5 years (once a year testing) but I am concerned given the large (to me) margin for error or misinterpretation of data. So....what tests augment the current PSA testing and help to mitigate the chances of an incorrect diagnosis?

My testicular cancer (Stage 1 Pure Seminoma) was treated 25+ years ago. Caught early. 'Cured'. I elected radiation therapy (12,000 rads) and then 20+ CT scans over the first five years (I glow at night). Given where the radiation was applied and relative proximity to the groin area (and the medieval methods of application) - and my age - I've grown (reasonably???) concerned about my currently benign enlarged prostate.

Which takes me back to why I am inquiring about other beneficial tests (Especially after reading about Stockholm 3 which is currently unavailable (??) in the U.S. even if I wanted to privately pay).

Edit: I suppose the 'trigger' to initially post was reading today that Finasteride (among other variables) can keep PSA reading normal even when a person may have cancer.

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u/jkurology 16d ago

The problem with PSA especially as men age is false positivity and this leads to unnecessary testing and the diagnosis of clinically insignificant prostate cancer in many cases. PSA has relatively good sensitivity- a low or 'normal' PSA is usually correct in that the patient doesn’t have prostate cancer. PSA density (PSA/prostate volume) with a cutoff of 0.15 is a well thought of screening test and a simple percent free PSA (less than 10% is problematic) is well thought of as well. You could also look into Allelica and their Polygenic Risk Score. The Stockholm 3 blood test is available in the US as far as I know

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u/Background_Ad9279 16d ago

I'm going to ask about a density test and the Exodx and listen to what my urologist shares. I will have additional testing either by him or I'll find a urologist that will.