Age Adjustment of
PSA Measures Might Improve Prostate Cancer Screening: Source (Medscape)
| The team concludes that standard PSA and PSA velocity cutoff points could be decreased to 2.0 ng/ml and 0.40 ng/ml per year in order to improve cancer detection in these younger men. The author of an editorial comment, Dr. H. Ballentine Carter of Johns Hopkins School of Medicine, Baltimore told Reuters Health that in studies he and his colleagues conducted ‘men with PSA levels below 4.0 ng/mL who have a PSA velocity exceeding 0.3 to 0.4 ng/mL per year’ have about a fivefold greater risk ‘of being diagnosed with life-threatening prostate cancer over the next 2 decades’ when compared to those with a lower PSA velocity. ‘Thus, these men require more careful monitoring.’ However, in another editorial, Dr. Donna Pauler Ankerst of the University of Munich, Germany and Dr. Ian M. Thomson of the University of Texas Health Science Center at San Antonio, take Dr. Moul and colleagues to task on a number of issues including verification bias. They also find fault with a somewhat comparable study by other investigators that had contrasting results. ‘The biostatistics of this discussion seem far removed from the clinical practice of urology,’ the editorialists conclude. ‘However, they are not, because conclusions reached from studies of PSA have an enormous impact on millions of men annually.’ |
The controversy will go on, but I do admit that for healthy young men, I use 2.5 as my cutoff before I discuss a biopsy.