Dr. Thomas Hsuehshan Hsu, MD

Would not recommend for prostate cancer screening. Situation: I was referred to Dr. Hsu at Kaiser Permanente after receiving a PSA blood test result of 6.4. Personality: Dr. Hsu was 20 minutes late for the video appointment and gave no apologies. My impressions were that he was not warm, empathetic, nor a good listener. He looked at his computer screen during the majority of the appointment. In my discussion with him, there was no shared decision-making. My takeaway was either I would do what he recommended or he would defer to what I wanted. Knowledge and Recommendations: Dr. Hsu recommended going straight to a 14-core systematic (random) transrectal biopsy from an elevated PSA. I didn't know whether this was Kaiser's screening protocol or Dr. Hsu's. Either way, from my research, this is an outdated recommendation counter to recent AUA, NCCN, and EAU guidelines, which recommend a pre-biopsy MRI and an optional biomarker test. These two tests can rule out prostate cancer… and allow up to 75% of men with an elevated PSA to avoid an unnecessary invasive biopsy. Dr. Hsu's (and/or Kaiser's) prostate cancer screening protocol is severely outdated and counter to patient welfare as 3 out of 4 men would need to endure the unnecessary anxiety, discomfort, pain, bleeding, and infection risk of a 14 large-needle jab in a highly sensitive area, going through the rectum. Dr. Hsu told me he had no insights regarding biomarker tests as none of his patients had ever asked for one. He also told me neither biomarker tests nor MRIs were covered by my Kaiser insurance. I later found out through Kaiser Member Services that both are covered. Conclusion: To Dr. Hsu's credit, he referred me to a different urologist when I asked to see another doctor. The second urologist ordered a "rule-out" biomarker test at my request. Fortunately, the test, which is more accurate than a systematic biopsy for ruling out prostate cancer, came back negative and I was able to avoid the anxiety, discomfort, pain, bleeding, and infection risk of an unnecessary invasive 14-core systematic (random) biopsy.

wonderful job