Miami urologists David Robbins MD and Amery Wirtshafter MD utilize the OPKO Lab 4K score for the detection of high grade prostate cancer and to assist in avoiding unnecessary prostate biopsies.
The US Preventative Task Force has downgraded PSA as a screening test for prostate cancer diagnosis. While contemporary urologists realize that over treatment of low grade and clinically indolent prostate cancers (i.e. gleason 6 low volume disease) has contributed to this recommendation, virtually all clinical urologists know that abandoning screening will lead to delayed and lack of treatment for the 30-40% of men who undergo prostate biopsy and are diagnosed with high grade and aggressive prostate cancers (i.e. gleason 7) who will eventually go on to develop metastatic disease and die from prostate cancer.
The appropriate response to over treatment of low grade disease is not to avoid prostate biopsy all together and condemn those who would benefit from treatment, but rather the responsible response is to biopsy more selectively.
The 4Kscore by OPKO labs is a tool that allows us to accomplish this goal. The 4Kscore can be used prior to biopsy in men who have an elevated PSA or abnormal DRE or men with a prior negative prostate biopsy considering a repeat biopsy. The 4K score uses both clinical data as well as a blood test assessing 4 Kallikrein protein biomarkers including total PSA, free PSA, intact PSA and human kallikrein-related peptidase 2 in an algorithm to predict a patient's risk for high grade prostate cancer (gleason 7). Numerous US and international controlled trials have demonstrated that the 4K test is useful in determining which patients are at risk for high grade prostate cancer while selecting for those with an elevated PSA who do not require biopsy.
At Urological Consultants of Florida we offer the 4Kscore test to help us differentiate which of our patients are at risk for high grade prostate cancers versus those who we could safely follow and avoid prostate biopsy.
For those who would benefit from prostate biopsy based on clinical perimeters and 4Kscore we can further target aggressive prostate cancer with an MRI US Fusion Targeted Prosate Biopsy.