I want to make a case, based on my recent situation, of the incredible power of combining the PSA with the 4Kscore, a powerful new blood test that quite accurately predicts the risk of future prostate cancer. The primary criticism of the PSA is that it is not particularly selective of advanced prostate cancer, which allows urologists to often push unnecessary procedures and surgeries. The 4Kscore bridges this gap, and I will illustrate it with a recent personal story that is an excellent illustration. I think you'll see that the 4Kscore is a game changer:
First of all, a little background on myself and you'll see why my doctor thought it was appropriate for me to get a 4Kscore done:
CAUTION: If you have prostate cancer or a high PSA, please discuss any changes with your physician first. I am simply relating MY experience and giving you some good topics to discuss with your physician.
Basically, I was very happy with the progress I had made. My PSA had come down and by all indications I simply had some sort of irritation and inflammation of the prostate and no prostate cancer. By the way, I was tested for the standard bacterial prostatitis and it came back negative.
Now fast forward to last month (8/2015) when I pulled my PSA for a urological checkup: it had crept up to 2.9. Of course, that was quite stressful, most because I envisioned having to go off of TRT again. My urologist also interpreted it as me having a "steadily rising PSA, because my last PSA with his office was 2.4. Fortunately, he did not want to immediately order a biopsy, which is not a fun procedure - just trust me. Why did he not order a biopsy? Because he now had the 4Kscore!
Basically, when your PSA rises it can be from one of five reasons:
1. Inflammation from Unknown Causes. (This is the most common reason.)
2. Bacterial Prostatis. (Quite common.)
3. BPH (enlarged prostate).
4. Low Grade Prostate Cancer. (This is very common. About half of middle-aged men have small prostate cancer nodules, due to the vulnerability of the prostate a Western lifestyle.
5. Advanced (Aggressive) Prostate Cancer.
Now #1-4 should be taken seriously. Obviously, none of these are good for your long term health. However, none of them are likely to kill or incapacitate you immediately. There is even evidence in my opinion that a man regress low grade prostate cancer and here is a strory that likely illustrates that: A Prostate Cancer Cure. In fact, I would argue that #1 through 4 can usually be regressed through lifestyle changes and possibly adding a few supplements.
However, with #5 that is NOT the case, or at least we cannot assume that at this point. Advanced prostate cancer is aggressive and can metasticize easily. And, once it does that, you are suddenly in a life and death situation. I have talked to several men on the forum who have had high PSA's, and all of them have stories from their doctors of men dying within just a couple of months from this situation.
How common is #5. Here is a fact right off 4Kscore's patient information sheet: "Did you know that of the one million prostate biopsies performed each year only 20% are found to show life-threatening cancer?"  So only roughly a fifth of men with elevated PSA are in a true life and death situation.
The problem is that #5 is so difficult to diagnose. Standard biopsies can miss the cancer. There are other methods to look at the prostate, but none of them are perfect in detecting prostate cancer. This is where the 4Kscore comes in. Again, this is straight from 4Kscore informational brochure: "The test is 94% accurate in detecting aggressive cancer." 
Nice! So now if you have a rising PSA, you can check with reasonable accuracy to see if you have a very serious situation. Your doctor can then order a saturation core biopsy - some of the more avant garde urologists no longer believe in these however - and really look for the prostate cancer. And, if they find it, you can come up with a plan.
To my urologist's credit, he offered for me to do a free 4Kscore and had some free samples of the same. Remember that he makes good money off of doing biopsies and the 4Kscore can potentially eliminate between 30 and 58% of prostate biopsies.  Therefore, doing a 4Kscore is not really in his long term financial interest, so kudos to him for putting ethics ahead of cash.
The 4Kscore test was a pretty easy blood draw by the way. Basically, you show up at the lab (Sonoran Quest in my case) with a frozen freezer pack and the rest of the items in the "kit" supplied by the manufacturer (OPKO Lab). The lab then sends your blood sample off for evaluation and you get the results in about a week.
So what happened in my case? I actually received very good news. According to the lab report:
"The patient's 4Kscore Test result is 2%. At a 4Kscore Test result of 2%, about 1 in 50 men biopsied would have high-grade prostate cancer."
"Based on your 4Kscore Test result, your probablity for having an aggressive prostate cancer Gleason Score of 7 or higher is 2%. This means that if 100 men the same4Kscore Test result were to have a prostate biopsy, 2 out of the 100 have a finding of aggressive prostate cancer upon biopsy."
So that's about as good of news as one could expect, and my doctor wrote the following on the report: "No need to biopsy at the time." Woo hoo!
In the meantime, I have resumed taking some anti-inflammatory supplements and consume an anti-cancer diet just to play it safe
Below is how the lab report looks for those interested. My apologies for the lack of clarity, but this is how I received the fax:
NOTE: There is an older and less accurate test called the PCA3, which I covered here: The PCA3 Test.
1) 4Kscore brochure v2 9.5.14, "The only bloos test that accurately identifies risk for aggressive prostate cancer", 2015