The Urologist's Guide to PSA, Screening, Prostate Cancer Risk, and Sexual Function
Prostate Unlocked is a patient's guide to the prostate written by the founder of this practice, a board-certified urologist who has spent his career evaluating men with a rising PSA and helping them decide what, if anything, to do about it. It was written first as a gift book for patients of the practice, so that the explanation a man hears in the exam room can be read again at home, slowly, and shared with the people who will help him decide. The book states its commercial-interest disclosure plainly: the author treats the conditions he writes about, and the reader should know that going in.
What the book covers
The book walks through the prostate from the beginning: what the gland does, why it grows, how benign enlargement and cancer differ, and why a blood test became the center of detection. From there it sets out the positions we actually practice.
Detection starts with PSA. The digital rectal exam has been retired as a screening tool at this practice. It finds little that PSA and imaging do not, it keeps some men from coming in at all, and it adds little once a PSA result is in hand. It keeps a role in specific situations, but not as the gatekeeper for screening.
MRI comes before biopsy. A prostate MRI shows whether there is a suspicious area and where it is, so a man with a rising PSA and a clean MRI can often be watched rather than biopsied, and a man who does need a biopsy can have it targeted at the area that matters.
When a biopsy is needed, it is ultrasound-guided and done in the office, with an in-person follow-up visit at seven days to go through the pathology together rather than delivering a result by phone or portal message.
Most importantly, finding cancer does not mean treating it. Low-risk and favorable-intermediate-risk cancers are watched: PSA every six months and a periodic repeat biopsy, with treatment reserved for the minority that progress. This is the answer to the overdiagnosis objection to screening. The harm of screening was never the blood test; it was the reflex to treat everything the test found. Remove the reflex and the case for finding cancer early becomes much stronger.
Screening is keyed to life expectancy rather than to a birthday. A healthy man of seventy with a decade or more ahead of him benefits from knowing; a frail man of sixty-two may not. The book explains how we estimate roughly ten years of remaining life expectancy and why that estimate, not age alone, drives the decision to test.
The final chapters deal with sexual function after treatment: what surgery, radiation and hormonal therapy each tend to do to erections and ejaculation, what recovery looks like, and what can be done about it. It is the part men most want to know and are least often told.
Who it is for
Men from about forty-five onward, which is when the screening conversation should begin. Any man with a rising PSA. Any man whose father or brother had prostate cancer. And partners, who often do the reading and ask the better questions. It is also useful for a man who has already been told he has prostate cancer and wants to understand why surveillance was offered, or why it was not.
How it connects to care at NYMD Center
Everything in the book is what we do in the office. PSA testing is drawn on site, and for men whose PSA sits in the gray zone we offer the ExoDx prostate test, a urine test that helps decide whether a biopsy is needed. MRI is arranged before any biopsy, and biopsies are performed in our procedure rooms with the seven-day follow-up described above. Men whose problem turns out to be benign enlargement rather than cancer are offered the least invasive path first, including prostate artery embolization through our interventional radiology program. Prostate screening sits inside our broader cancer screening work in internal medicine, and our dedicated prostate site, 1prostate.com, goes deeper on enlargement and embolization. If you read the book and want the conversation it describes, that is what an appointment here is.
Questions patients ask
Why does the book say the rectal exam has been retired for screening?
Because a PSA blood test followed, when needed, by MRI finds what matters more reliably than a finger can, and because the exam keeps some men from coming in at all. At NYMD Center screening begins with PSA. The rectal exam still has a role in specific situations, such as evaluating certain symptoms, but it is no longer the gatekeeper that decides who gets screened.
Does screening lead to overtreatment?
It did when every cancer found was treated. The book explains why that is no longer how we practice. Low-risk and favorable-intermediate-risk cancers are watched, with a PSA every six months and a periodic repeat biopsy, and treatment is reserved for the minority that progress. Once the reflex to treat is removed, the cost of knowing is small and the benefit of finding a dangerous cancer early is large.
At what age should a man read this?
The screening conversation should begin around forty-five, earlier with a family history or African ancestry. But the book is written for any man with a rising PSA at any age, for men already told they have prostate cancer who want to understand surveillance, and for partners who often do the reading and ask the sharper questions.
Is the book a substitute for a visit?
No. It was written as a gift book for patients of the practice so that the explanation given in the exam room can be read again at home and shared. It sets out how we think and what we recommend, but PSA testing, MRI, biopsy and follow-up are decisions made with your physician against your own results.