Dear Dr. Roach: Due to an elevated PSA (5.3) my urologist recommended a fairly new test prior to deciding on a prostate biopsy. The test is referred to as an ExoDx Prostate (Intelliscore). It is performed on a urine sample and results in a score that indicates a higher or lower probability of high-grade prostate cancer.
Subsequent to taking this test, I received a denial of coverage notice from my insurance carrier because the test is considered experimental or investigational and not known to be effective for my condition. They further stated that the plan covers only proven procedures that are recognized as effective for the diagnosis of a condition based on clinical evidence published in peer-reviewed medical literature. I have been unable to locate any such literature.
I’m wondering if you would offer your opinion on the efficacy of this test in terms of evaluating prostate treatment progression for those with elevated PSA levels.
I reviewed the literature on the ExoDx Prostate (Intelliscore), and my opinion is that this test is likely to improve the accuracy of prostate cancer testing and reduce the number of men who will require a biopsy.
Insurance companies decide for themselves what is experimental and what is standard of care. If Medicare decides it is acceptable, most insurance companies will start paying for it shortly thereafter.
I suspect that as further studies are done, the test is likely to be confirmed as a useful tool in determining whether an abnormal PSA result needs further evaluation, but only time and study results will tell. Until then, your warning is appreciated. I know it is being used already, since readers are writing to me about interpreting the results.
Dear Dr. Roach: Lotion containing vitamin K has become popular to reduce bruises, something we older folks experience frequently. Is any of this vitamin K absorbed into the bloodstream? I was on warfarin for several months following heart valve surgery and a stroke and atrial fibrillation. After a cardioversion several months ago that put my heart back in a normal rhythm, I was able to stop taking the warfarin. I would like to try the lotion, but am concerned about absorbing vitamin K. I’d appreciate your advice.
Vitamin K is necessary for the liver to make four of the blood-clotting factors, and warfarin blocks vitamin K, which thereby reduces the ability of the blood to clot.
Vitamin K is not significantly absorbed into the blood through the skin. However, vitamin K creams have been evaluated as a treatment for bruising. I found several studies showing that although vitamin K cream failed to prevent bruising from mechanical trauma or laser, it did speed resolution of the bruising, through local effects in the skin.
I found another, not exceptionally convincing, study purporting to show that a cream with vitamin K and caffeine improved the appearance of fine lines around the eye.
The amount of vitamin K absorbed through the skin is unlikely to have any effect on blood clotting. Since you are no longer taking warfarin (Coumadin), you don’t have to be concerned even about oral vitamin K.
It’s people taking warfarin who need to avoid taking in excess vitamin K. They should take in consistent amounts of food with vitamin K, such as green leafy vegetables.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.