Physician Q&A: What I've Learned from More Than 500 PSE Orders

Last updated: 06 Jul 2026

Dr. Garrett Pohlman, a board-certified urologist, discusses how EpiSwitch® PSE fits into real-world prostate cancer evaluation, biopsy decision-making, billing, patient conversations, and clinic workflow.

After ordering EpiSwitch PSE more than 500 times, I have seen where this routine blood test is transformative in practice. Men being evaluated for prostate cancer often come in with elevated PSA, MRI findings, prior biopsy history, anxiety, and uncertainty about whether biopsy is truly necessary. PSE helps bring clarity to that conversation by adding a simple blood-based Low or High Likelihood of prostate cancer result.

Q: What is the EpiSwitch PSE test?

A: EpiSwitch PSE is a blood-based test used to help assess the likelihood that prostate cancer is present. It combines the patient's PSA value with five chromatin-conformation biomarkers measured from whole blood.

One of the key differences is that PSE is not looking for tumor DNA shed directly from prostate cancer cells. Instead, it evaluates systemic epigenetic changes in circulating immune cells. That gives it a different biological approach than many other prostate cancer tests.

From a workflow standpoint, it is also simple to collect. The test requires 3 mL of blood in a standard EDTA tube and does not require centrifugation, refrigeration, or freezing.

Q: How is PSE different from PSA alone?

A: PSA is important, but it is not very specific. In urology practice, we see many men with elevated PSA who do not have prostate cancer. That creates uncertainty for the patient and the physician.

PSE adds molecular information that the standard workup is missing. I do not think of it as replacing PSA, MRI, biopsy, or clinical judgment. I see it as a layer of biology that has consistently helped me clarify the next step when the clinical picture is less obvious than it first appears.

That is where the test has been most useful in my practice.

Q: What do the results mean?

A: PSE gives a binary result: Low Likelihood or High Likelihood of prostate cancer.

That simplicity matters. Patients understand it, staff understand it, and physicians can use it to guide the next conversation.

A Low Likelihood result may support observation, repeat PSA, follow-up testing, or continued monitoring when the clinical picture supports that approach. A High Likelihood result supports moving toward additional diagnostic evaluation, such as MRI and/or biopsy.

The test does not make the decision by itself, but it helps make the risk discussion clearer.

Q: Why do binary results matter in real life?

A: Patients do not just need more data. They need a clearer next step.

Many prostate cancer tools provide percentages or scores that can still be hard to explain. A Low or High Likelihood result is easier to communicate.

That matters when a patient is anxious about biopsy, has had a prior negative biopsy, has conflicting PSA and MRI findings, or needs to understand why biopsy is or is not being recommended.

Q: How do I order the test, and how long does it take to get results?

A: PSE must be ordered by a licensed provider using the requisition form. The completed form can be submitted by a secure upload site (www.obdx.co/upload), or faxed to 240-913-5681 (US) / 01865 504691 (UK). A recent PSA value measured within the prior six months is required as part of the analysis.

For sample collection, the provider draws 3 mL of blood into a K2EDTA tube. No centrifugation is required. The sample is packaged using the specimen kit and can be kept at ambient temperature. As stated in the test documentation, samples remain stable for up to 28 days without refrigeration or freezing.

Results are typically sent back to the provider within about 4-5 days of receiving the sample, either by the online portal or fax. In practice, once the staff understands the requisition, kit handling, and billing pathway, the test becomes easy to work into a routine urology workflow.

Q: How does billing work?

A: Billing is one of the first practical questions clinics ask, and it is important to address it early.

There are generally three pathways: insurance, institutional account, and self-pay. If insurance is used, the patient's insurance information should be submitted with the order. Patients may still be responsible for co-pays, deductibles, coinsurance, or non-covered services depending on their plan.

If insurance is not used and an account agreement is not in place, the self-pay process can be used.

The key is making sure the clinic understands the billing pathway before the sample goes out. That avoids confusion for the provider, staff, and patient.

Q: Is the test validated, and why does specificity matter?

A: Yes, PSE has validation data and published real-world clinical utility data [1][2].

Specificity matters because prostate biopsy is not a trivial procedure. Biopsy can be necessary and lifesaving, but it also carries risk, cost, anxiety, and potential complications.

A test that improves specificity can help reduce unnecessary biopsies while still supporting detection of clinically significant disease. That is the practical value. It helps identify patients who are more likely to benefit from further diagnostic workup and patients who may be reasonable candidates for observation or follow-up.

Q: When might PSE be especially helpful?

A: In my practice, PSE has been especially useful when the usual tools do not fully agree with each other. PSE is designed to support real-world clinical decision-making in men being evaluated for prostate cancer, particularly those with an elevated or rising PSA where the next step is unclear.

It can be used across a wide range of patients, regardless of PSA level, age, DRE findings, or BPH status, making it broadly applicable in routine urology practice.

Beyond standard use, PSE is often especially helpful in situations where conventional tools provide conflicting or inconclusive information, such as:

• Elevated PSA with a negative or indeterminate MRI
• Suspicious MRI findings where biopsy decisions remain uncertain
• Persistently elevated PSA despite prior negative biopsies

These are the real-world situations where an additional blood-based molecular signal can help.

Q: Can PSE replace MRI or biopsy?

A: No. PSE is not designed to replace clinical judgment, MRI, or biopsy. PSE adds the missing, blood-based biological information that works hand-in-hand to guide clinical judgment, and help clarify whether MRI, biopsy, observation, or repeat testing should be prioritized.

Biopsy is still required to confirm prostate cancer and determine grade, stage, and other pathologic features. MRI remains an important part of the diagnostic pathway.

The value of PSE is that it helps improve the decision-making process before biopsy. It can help determine whether the next step should be observation, repeat testing, MRI, or biopsy.

In my experience, that is where the test fits best: not as a replacement for the pathway, but as a tool that makes the pathway clearer.

Closing thought

The hardest part of prostate cancer evaluation is often uncertainty. Patients want to know whether they really need a biopsy. Physicians want to make the right recommendation without over-testing or under-testing.

After using PSE more than 500 times, I believe its greatest value is helping to bring clarity. It adds a blood-based molecular signal to the clinical picture, supports shared decision-making, and helps guide the next step in a way patients can understand.

About the Author

Dr. Garrett Pohlman is a urologist with Kearney Urology Center, P.C., in Kearney, Nebraska. He has ordered EpiSwitch PSE for more than 500 patients being evaluated for possible prostate cancer, making him one of the most experienced clinical users of the test in routine urology practice. His use of PSE was recently featured on Fox Business Network.

Dr. Pohlman received his medical degree from the University of Nebraska College of Medicine in Omaha and completed his internship and residency at the University of Colorado School of Medicine in Denver.

He is also the host of The Prostate Health Podcast, where he interviews experts, innovators, and leaders in prostate health to help educate the public about prostate conditions, emerging technologies, and practical advances in urologic care.

References:

1) Berghausen J, Abdo J, Mathis R, Hunter E, Akoulitchev A, Pohlman GD. EpiSwitch PSE Blood Test Reduces Unnecessary Prostate Biopsies: A Real-World Clinical Utility Study. Cancers. 2025; 17(13):2193. https://doi.org/10.3390/cancers17132193

2) Pchejetski D, Hunter E, Dezfouli M, Salter M, Powell R, Green J, Naithani T, Koutsothanasi C, Alshaker H, Jaipuria J, et al. Circulating Chromosome Conformation Signatures Significantly Enhance PSA Positive Predicting Value and Overall Accuracy for Prostate Cancer Detection. Cancers. 2023; 15(3):821. https://doi.org/10.3390/cancers15030821

Disclaimer: Dr. Pohlman's views expressed are his own and reflect his clinical experience with the test. He has a financial relationship with Oxford BioDynamics. The EpiSwitch Prostate Cancer Detection (PSE) Test is a laboratory developed test (LDT). It has not been reviewed or cleared by the US Food and Drug Administration. The laboratory is certified under the Clinical Laboratory Improvement Amendments (CLIA) to perform high-complexity clinical testing. Decisions regarding patient care and treatment should not be solely based on a single test such as this test, rather, on the independent medical judgment of the treating physician taking into consideration all available information concerning the patient's conditions, including other clinical tests, in accordance with the standard of care in each healthcare setting.