Did you know that a PSA test measures the level of PSA (prostate-specific antigen) in a man's blood? Hear from Dr. Keizur about what heightened levels can mean, who should get tested, and how often a PSA test should be repeated.
Selected Podcast
PSA Testing: What All Men Need to Know
Featuring:
John Keizur, MD
Dr. John Keizur's worked as a Board Certified urologist since 1995, and founded Palouse Urology in 1996. In the span leading from his undergraduate studies at Oregon State, Dr. Keizur was accepted into the Health Professions Scholarship program with the U.S. Navy and attended St. Louis Medical School, graduating in 1987. He then spent a year at the US Naval Hospital in Oakland CA on a general surgery internship.
The following year, Dr. Keizur was assigned to the US Marines in Okinawa Japan. Returning from military duty overseas, he began - and completed - a Urology residency at the US Naval Hospital in Oakland CA. In 1993 he became Department Head of Urology at Naval Hospital Okinawa Japan. After returning from Okinawa, Dr. Keizur joined the staff at the US Naval Hospital in Portsmouth, VA where he helped train new Urology residents for a year.
Dr. Keizur now practices at Palouse Urology Center in Pullman, WA.
Transcription:
Deborah Howell (Host): Men are busier than ever these days, so sometimes health checkups land at the bottom of the list. Today, we'll hear from Dr. John Keizur, a board-certified urologist at Palouse Urology Center in Pullman, Washington, about why it's so important for men to get their PSA screenings. Welcome, Dr. Keizur.
John Keizur, MD: Thank you, Deborah. Thank you for having me on.
Host: An utter pleasure. Let's dive right in. What is a PSA test?
John Keizur, MD: Well, PSA test is a blood test that is a screening test for prostate cancer for men. Men who have prostate cancer, the PSA test is generally elevated, and that's how we use to screen to see if there's a possibility of prostate cancer.
Host: Okay. And do patients need to do anything to sort of prepare for this test?
John Keizur, MD: You know, that's the great thing. It's really just a blood test. You don't have to have an empty stomach. You don't have to do anything in preparation. We do recommend that it is done prior to any kind of prostate manipulation or prostate irritation to get a good baseline, but it's just a simple blood test.
Host: And who should get their PSA tested and how frequently should the test be performed?
John Keizur, MD: Well, historically, we would say men who are age 50 to 70 would be recommended to get a PSA test. If you have a strong family history of prostate cancer or you're African American because they have a higher risk of prostate cancer, it is often recommended to start at age 40. Most urologists will also look at health of the patient. So, I would say anybody who has a reasonable 10-year life expectancy, it is then reasonable to get screened. I have a lot of men who are older than 70 who are in very good health and we still recommend to continue screening on them. And I have some younger men who are very poor health and we just recommend to not worry about screening, because screening will not be beneficial in them.
Host: Right. Now, I understand you hold an annual free PSA screening event. why is it so important for men to have their PSA levels tested?
John Keizur, MD: Well, prostate cancer is the leading cancer in men. And it's the second leading cause of cancer death in men. A lot of men get confused because they hear reports that prostate cancer is insignificant and not anything to worry about. So, some men stop worrying about screening. And it is very true that if men have low-grade cancer, we usually recommend not to treat but just simply watch it. But if you have high-grade cancer, that is something you want to catch early versus late, because we have lots of treatments to take care of the cancer when it's early stage. There is no cure for prostate cancer in later stages at this point.
Host: Got it. Now as a urologist, what are you looking for when you see a patient's PSA results? And how quickly are those results available?
John Keizur, MD: So, there's different things we look at. The basic is to look at the overall value. In standard, we would say 0 to 4 is a normal range for PSA. So, anything above 4 we'll look at carefully. But there's other ways of looking at PSA and breaking it down. We will a lot of times do a total PSA, which is the standard number. And then, we'll look at what's called a free PSA, which is another subcomponent, and that can make the test more sensitive. And we also look at what is the change in the PSA over time. So if I have somebody whose PSA is rising significantly every time we check it, that's a little more worrisome than somebody who has a very stable PSA that's not changing very much.
Host: Okay. That makes perfect sense. Now, do high PSA results always mean cancer, or are there any other conditions that could cause an elevated level?
John Keizur, MD: No, that's the thing. PSA is one of our best screening tools, but it is far from perfect. So when men have an elevated PSA test, we often will use a risk calculator to tell them what's their chance of cancer, and it often is 35-45% chance of cancer, depending on their number. So, there's a lot of men who have an elevated PSA that don't have cancer. And with older men who will start having an enlarged prostate as you get older, that can make the PSA go up. Anything that irritates the prostate gland, so we have some men that have low-grade inflammation, low-grade prostatitis, which is an inflammation in the prostate gland, that can artificially raise the PSA. I get some men that if you had gone out and rode your bike 20 miles before you went in to have your blood drawn, that will artificially raise it up a little bit, things like that.
Host: Now if a patient does have high PSA levels, what's the best course of action?
John Keizur, MD: Well, I think it's important to talk to either your primary care physician or your urologist and just have a discussion. And for everyone, it's different. When we have these discussions, we want to talk about what's the likelihood of prostate cancer, once again, what is the overall health of the patient, what are expectations. We don't always need to act on the elevated PSA, but we just want to be aware of it and follow it. For some men, we may recommend a biopsy to check for cancer. For some men, we may recommend to continue watching it. And for some men, we may opt to obtain an MRI of the prostate gland to further look into it.
Host: So many men and people I know are just afraid, they're just afraid to get their tests.
John Keizur, MD: Well, men are notorious for not wanting to go into the doctor. And, you know, it is just a simple blood test. And that's easy to do. The real trick comes in is if the test is positive, how do we manage it? And ultimately, if we find cancer, how do we manage it? That's where the individual discussions with the patient comes in. In the early days of PSA, there was clearly overtreatment of prostate cancer, and what we've found now is that men with lower grade, lower volume prostate cancer can successfully be managed just by watching them and not treating them. So, it is kind of a scary thing, but the blood test is simple, and then it just involves good discussion with a healthcare provider afterwards.
Host: It's just better to know information is power, right?
John Keizur, MD: Yes, absolutely.
Host: Dr. Keizur, is there anything else you'd like to add to our conversation?
John Keizur, MD: I think just that prostate cancer screening is still important. We had a time when the US Preventative Task Force decided to recommend against PSA screening. And a lot of our primary care providers stopped doing the test. And it's interesting, when we saw that, we then, in the several years after that, started seeing a rise in advanced prostate cancer and a change in the death rate of prostate cancer. So, it's interesting, the family practice group has now reversed a little bit, and now they're saying PSA is indicated after a discussion with the patient, which I think is reasonable. Because, even though there have been some studies that have not absolutely proven screening lowers death rates, it does clearly lower metastatic prostate cancer. And advanced prostate cancer is not a fun thing to go through.
Host: And if you can prevent even one person from coming down with that, boy, you've done something. Well, Dr. Keizur, thank you so much for being with us today to encourage men to get their PSA tests on a regular basis. We really appreciate it.
John Keizur, MD: Thank you. And just to plug that in our area, we have a free clinic that we provide to the community. It's the third Tuesday of September. Our local hospital will be putting out information on this, and anybody is welcome to come and show up. And it involves a free test and a free exam if they want, or both or none.
Host: Great. And then, how quickly do they usually get their results?
John Keizur, MD: We'll get the results fairly quickly and this is a matter of myself going through the results and then we mail it out to patients. So, they usually get the results within a week.
Host: Lovely. You can learn more about this subject, providers and services at Pullman Regional Hospital online at PullmanRegional.org/urology. I'm your host, Deborah Howell. And this has been The Health Podcast from Pullman Regional. Thanks for listening and have yourself a terrific day.