Imagine a future with no prostate biopsies!

(The problem with doing MRI & PSMA first is the cost. PSMA is very expensive and most results would be negative - not a very efficient use of technology or dollars. Perhaps in time when the cost of the scan is lower…..)
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Actually, PSA testing wasn’t available until the late-1980’s, and by the early-1990s it was recommended that men ask for PSA testing NLT 45y/50y of age. (See attached news article from 1992.). Today - 30+ years later - men still don’t take that basic advice and ask for PSA testing that early.

Here in the U.S., the practice of “sticking needles randomly into men’s prostate - what is called a “blind biopsy” - is antiquated and only done by old-school urologists.

These days, well before one's prostate is jabbed with a needle, there are many diagnostic tests and scans that can give an indication of whether a prostate cancer might be present and whether treatment may be necessary:
> PSA history
> % Free PSA
> PSA Doubling Time
> PSA Velocity
> MRI (PIRADS: clinical significance)
> PSA Density
> Liquid biopsies (urine or blood)
> Genetic (germline) tests

With that information, one will have much more insight into what one might expect. Only then will one need to get into additional needles and tests:
> Tissue Biopsy (Gleason)
> Results from Bone/CT/PSMA scans
> Artificial Intelligence tests

Unfortunately, here in the U.S. there is no standard protocol (that other nations might have). Here - as with many things - the individual has to first know about and then request these tests.

Advances in medicine are made all the time, as long as funding for research is maintained.

The PSE test is being used more often and that dna test, with 94% accuracy, shows whether one is likely or unlikely to have prostate cancer. Its purpose is to help someone decide whether they should have a biopsy or MRI.

@bens1 Absolutely!! Almost double the accuracy of PSA - but I am sure the slow as molasses medical community - and the insurance companies that control it - will be agonizingly late in adopting PSE as the go-to screening test for PCa…another shame on us!
Phil

@bens1 Thank you…this test is exactly the kind of technology that needs to be more universally adopted, rather than the standard PSA test, by which only 32 of every 100 positive results are subsequently diagnosed with cancer.

I found a recent (June 2025) report that is indicative of the potential of the PSE test to avoid unnecessary biopsies and SAVE enormous amounts of health care money.
https://www.mdpi.com/2072-6694/17/13/2193
“While prostate cancer biopsies play a crucial role in diagnosis and staging, the high false-positive rate associated with PSA testing has led to an estimated 750,000 unnecessary biopsies per year.”

“Among the 187 patients evaluated, predictive modeling showed that up to 79.1% (106/134) of patients could safely defer biopsy based on a low-likelihood EpiSwitch PSE result.”

“PSE has the potential to help avoid up to 593,000 procedures per year, conservatively. At an estimated average cost of USD 2500 per biopsy, including procedural, pathology, and complication-related expenses, this represents a potential annual savings of approximately USD 1.48 billion.”

So a cost savings technology ALREADY exists to prevent having to conduct 600,000 biopsies per year….imagine that!

I suspect I'm the only person in this forum with confirmed long-term prostate cancer who's never had a prostate biopsy (4 years ago, they confirmed prostatic origin via a biopsy of my spinal lesion).

https://aspatients.org/event/mri-a-replacement-for-prostate-biopsy/