Key takeaways:
- Prostate cancer impacts the lives of thousands of Americans every year.
- The 4Kscore Test is used to determine a man’s risk of having or developing aggressive prostate cancer.
- The 4Kscore Test and prostate MRIs are both noninvasive ways to more accurately screen for prostate cancer.
- The PSA (prostate-specific antigen) test is helpful but can often lead to excessive prostate biopsies.
- Gleason scores help determine the aggressiveness of prostate cancer.
One in eight men will be diagnosed with prostate cancer at some point in their lifetime, according to the American Cancer Society1. This fact has made prostate cancer screening evolve over the years — the sooner prostate cancer is found, the better chance for a cure.
The 4Kscore is a test that medical teams use to evaluate a man’s risk for developing aggressive prostate cancer. The test can help guide additional testing decisions, including prostate biopsies.
PSA Testing Isn’t Perfect
The standard screening blood test for prostate cancer is the prostate-specific antigen (PSA) test2.
The American Cancer Society recommends men have a discussion with their primary care provider when they turn 50 about whether or not to start routine PSA testing3. For African American men or men who have a father or brother who had prostate cancer before age 65, it is recommended to have this talk at age 45.
PSA testing can be very valuable, but it often leads to unnecessary biopsies because results can be difficult to interpret as a stand-alone test4. Many variables can skew a PSA level high or low, causing either concern or confusion when deciding what action to take next.
Oftentimes, a prostate biopsy will be recommended to further evaluate and try to create meaning from an abnormal PSA result. Unfortunately, a prostate biopsy is invasive and can cause adverse events5. However, they are needed when prostate cancer is at risk.
We need a more sensitive, informative, non-invasive way to evaluate a man’s risk of prostate cancer as well as their risk for developing an aggressive form of prostate cancer.
This is where the 4Kscore comes in.
What Is a 4Kscore Test?
A 4Kscore Test is a combination of blood tests and other clinical factors to create a comprehensive risk analysis6.
The results from a 4Kscore Test help determine the risk of developing an aggressive form of prostate cancer.
The Gleason score
Before understanding the value of a 4Kscore Test, it’s important to know why differentiating between aggressive and nonaggressive forms of prostate cancer matters.
Prostate cancers are categorized by how aggressive they are, and this is measured with a Gleason score7. Gleason scores, or grades, are calculated by combining the grades of two different samples of prostate tissue.
This is because prostate cancer is typically made of several different types of grades, ranging from low-grade to high-grade prostate cancer. The grades range from 1-5, so the Gleason score results range from grades 2-108.
An aggressive form of prostate cancer, or high risk, is categorized as a Gleason 7 or greater. If prostate cancer is considered aggressive, it has the potential to grow quickly and spread outside of the prostate.
Many prostate cancers are slow-growing, and a man can live a healthy, active life for many years with slow-growing prostate cancer.
Gleason scores are valuable because they help guide treatment decisions.
Thankfully, there are several treatment options available for prostate cancer, ranging from more frequent follow-ups (active surveillance) to aggressive chemotherapy.
The Gleason score is heavily considered when a urologist or oncologist comes up with their preferred treatment option.
The 4kscore Test Biomarkers
The 4Kscore uses an algorithm after collecting blood samples and clinical information like a man’s age, any prior biopsy results, and results from a digital rectal exam (DRE) to calculate a man’s risk of aggressive prostate cancer.
The four blood tests, or biomarkers, measured are9:
- Total PSA
- Free PSA
- Intact PSA
- Human kallikrein 2 (hK2)
Once the blood tests and other factors are taken into account, the results are sent to a lab to be evaluated. Then, a report is created for you and your healthcare provider to review. Afterward, you can create a more educated plan together.
Do I Need a 4Kscore Test?
If you’ve had a recent abnormal PSA test and/or an abnormal DRE result, you may benefit from learning your 4Kscore before having a prostate biopsy.
Every situation is different, and the final decision to have a 4K test done is made by a patient and their healthcare team.
There are several things to consider when it comes to additional testing, including if the test results will change the current plan. For example, if you and your team have already decided to have a prostate biopsy to further evaluate your elevated PSA or DRE results, the 4K test may not be helpful.
How Do You Complete a 4Kscore Test?
For the patient, a 4Kscore test is no different than any other blood test done at your physician’s office. However, not all physicians carry the 4Kscore testing kit required. Patients should look for a 4Kscore draw center where they can have the testing done.
If your provider wants to know your 4Kscore and they don’t offer testing in their own clinic and lab, they can send an order to a 4kscore location to complete the test. The results will then be sent to your provider for review.
What Happens After a 4Kscore Test?
Once the results of your test are ready to be reviewed, your healthcare provider will explain what they mean.
Your risk for having or developing an aggressive form of prostate cancer is presented as a percentage with the 4Kscore, as a way of predicting the results of a prostate biopsy being a Gleason 7 or higher10.
For example, if the 4Kscore algorithm determines a man’s results as low-risk, the report may say there’s only a 10 percent chance a biopsy would show aggressive prostate cancer. However, if the results are considered high-risk, the percentage would be higher, potentially 80 percent or 90 percent.
It is then up to you and your healthcare team to decide if that percentage is high enough to perform a prostate biopsy, as a 4Kscore Test can be a validation tool that helps make this decision.
If the 4Kscore Test shows a low percentage (or low risk) of aggressive prostate cancer, you and your medical team may decide to hold off on prostate biopsy testing and continue with less invasive monitoring (PSA testing, DRE, etc).
Every patient circumstance is unique, so this is a collaborative decision.
Better Screening, Better Detection, Better Outcomes
Prostate cancer affects thousands of Americans each year, and early detection is the best defense against it.
In addition to monitoring a man’s PSA value, improvements in screening options can help with decision-making about treatment options when the cancer is in its early stages.
In many health insurance systems, coverage for a prostate MRI with IV contrast is often contingent on a prior negative prostate biopsy. This approach is counterintuitive and potentially harmful, as prostate biopsies carry significant risks, including infection, bleeding, and, in some cases, erectile dysfunction11.
Only 11.1 percent of private payers cover prostate MRI in biopsy-naive patients with suspected prostate cancer, while 88.9 percent require a prior negative biopsy. This policy is not aligned with current best practices and evidence-based medicine.
Conversely, a prostate MRI is non-invasive and, therefore, less risky. For this reason, ezra physicians at our New York locations now offer a prostate MRI with IV contrast to men with elevated PSA levels or urinary symptoms.
With our prostate MRI, you can get a head start on prostate cancer — sign up for a consultation today.
