The introduction is also posted on Spotify as a podcast by “Gerry at The Health Equation”
You can search Spotify for “Gerry at The Health Equation”
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https://podcasters.spotify.com/pod/show/gerrygaj
Below is the specific link
Gerry Gajadharsingh writes:
My late father had prostate cancer but didn’t die of prostate cancer. Prostate cancer is the most common cancer in men.
Incidence: Approximately 52,000 men are diagnosed with prostate cancer each year in the UK. This equates to about 1 in 8 men being diagnosed with the disease at some point in their lifetime.
Age group: Prostate cancer primarily affects older men, with most cases occurring in those over the age of 50, and risk increases significantly with age.
Risk factors: In addition to age, genetics, family history, and ethnicity (especially in Black men, who have a higher risk) play significant roles in the likelihood of developing prostate cancer.
TDL, the laboratory that I use, have launched a new blood test, evaluating prostate cancer risk in men with a PSA >1.5 ng/ml. It is called Stockholm 3 and uses a combination of specific protein markers in the blood with propriety genetic markers and patient data/family history. The result then categorising the patient as low, medium or high risk, necessitating specialist urology referral.
PSA blood tests are often a first line test when exploring a man’s prostate health either after symptom presentation or through screening.
If a patient had a raised PSA level they were previously offered biopsy, but are now increasingly offered MRI and then moving to biopsy, when indicated.
The PSA threshold for offering a prostate biopsy varies depending on factors such as age, family history, race, and overall health. However, a commonly used threshold is PSA ≥ 4.0 ng/mL. At this level, many doctors consider recommending a biopsy to check for prostate cancer, especially if there are additional risk factors.
There is growing recognition that PSA alone may not be sufficient for making biopsy decisions, and doctors often use other strategies, such as:
- PSA velocity: Rapid increases in PSA over time might prompt a biopsy even if the absolute PSA level is below 4.0 ng/mL.
- PSA density: PSA level divided by prostate volume can help assess cancer risk.
- Age-specific PSA: The normal PSA range can vary with age, with younger men having lower thresholds for concern.
- Free PSA: A lower percentage of free PSA (as opposed to bound PSA) can increase suspicion of prostate cancer.
Some experts suggest a lower threshold (e.g., 2.5 ng/mL) for younger men or those at high risk, while others use more sophisticated risk calculators to combine PSA with other factors before recommending a biopsy. Ultimately, the decision is individualized, balancing the benefits and risks of detecting prostate cancer early against the possibility of overdiagnosis.
Based on large studies such as the Prostate Cancer Prevention Trial (PCPT), approximately 15-20% of men with a PSA level below 3 ng/mL were found to have prostate cancer when biopsies were performed, though most of these cancers were early-stage or considered low-risk.
The launch of the Stockholm 3 blood test aims to bridge this gap research suggests, by informing risk stratification before MRI and targeted biopsies in prostate cancer screening and combining Stockholm3 with an MRI-targeted biopsy approach for prostate cancer screening decreases over-detection while maintaining the ability to detect clinically significant cancer.
Research also suggests that screening with Stockholm3 test at a reflex threshold of PSA ≥2 ng/mL for referral of MRI was predicted to be cost effective in Sweden and reduced unnecessary biopsies and MRIs and using Stockholm3 with a reflex threshold of PSA ≥2ng/mL is more cost effective than using a PSA threshold of ≥3 ng/mL for MRI without Stockholm3 and also resulted in a 60% reduction in MRI compared with screening using only PSA before MRI over a patients’ lifetime.
This new specialised test is only offered in the private sector in the UK but I’m sure will be adopted by the NHS in the years to come. We will be incorporating this new Stockholm three blood test into our private health screens and of course offering it to individual patients when clinically appropriate.
PSA stands for Prostate-Specific Antigen, which is a protein produced by both normal and malignant cells in the prostate gland. A PSA blood test measures the level of PSA in a man’s blood and is commonly used as a screening tool for prostate health, including prostate cancer.
Normal PSA levels: PSA levels in the blood are usually low. The typical range for most men is between 0 and 4 nanograms per millilitre (ng/mL), but this can vary with age and other factors.
Elevated PSA levels: Higher-than-normal PSA levels may indicate prostate cancer, but they can also be caused by non-cancerous conditions such as benign prostatic hyperplasia (BPH) (enlargement of the prostate) or prostatitis(inflammation of the prostate).
While an elevated PSA can suggest the presence of prostate cancer, it is not definitive, so further tests like biopsies or imaging studies are often required to confirm a diagnosis. The PSA test is helpful but controversial due to false positives or over-diagnosis.
On average, it’s estimated that between 20% and 40% of men with a raised PSA level (above 3 ng/mL in men over 50, for instance) may undergo a biopsy, depending on individual risk factors, clinical assessment, and additional diagnostic tools such as MRI scans.
Role of MRI Before Biopsy (Increasingly the multi-parametric MRI which is made up of three different MRI scans that target the prostate specifically)
Imaging the Prostate: mpMRI provides detailed images of the prostate, using different sequences to highlight abnormal areas that may indicate cancer. The images give doctors a better understanding of where to focus if a biopsy is needed.
Assessing Cancer Risk: The mpMRI results are often graded on the PI-RADS (Prostate Imaging Reporting and Data System) scale, from 1 (very low suspicion) to 5 (high suspicion of cancer).
Men with a PI-RADS score of 3 or above are typically considered for a biopsy, while those with lower scores might be monitored without invasive procedures.
Costs of mpMRI (prostate) in London varies from £800-£1,300 (2024), depending on the hospital/clinic used.
Reducing Unnecessary Biopsies: MRI scans help identify men with suspicious areas that are more likely to contain clinically significant cancer, allowing men with low-risk or benign conditions to avoid biopsy. Studies suggest that around 25-30% of men with raised PSA levels can avoid a biopsy after mpMRI.
Risks of Prostate Biopsy
While biopsies are a key tool in diagnosing prostate cancer, they carry certain risks:
- Infection: There’s a small risk of infection, particularly urinary tract infections or, rarely, sepsis.
- Bleeding: Some men experience blood in their urine, stool, or semen after the biopsy, though this usually resolves on its own.
- Pain or Discomfort: The procedure can cause some discomfort or pain during and after the biopsy.
- Overdiagnosis: Biopsies can detect low-risk prostate cancers that may never cause harm, leading to potential overtreatment and its side effects.
Costs of prostate biopsy in London varies from £900 to £1,800 (2024), depending on the hospital/clinic used and the type pf biopsy.