More on the link between PSA levels and prostate cancer

Reported by Susan Aldridge, PhD, medical journalist

A study shows that the link between PSA levels and prostate cancer is quite complex.
Prostate specific antigen (PSA) levels have long been used to help screen men for prostate cancer. Elevated levels are often found to indicate the presence of a cancer. Because PSA testing is now widespread, doctors at the University of Texas have carried out a study to try to determine how effective it is.

They analyzed a group of nearly 20,000 healthy men whose PSA levels were 3 nanograms per milliliter or less. The men were followed up for seven years with annual PSA tests and examination. A biopsy was done if the PSA level went above 4 nanograms per millliter. At the end of the study, all men had a biopsy.

The researchers worked out the sensitivity and specificity of different cut off values for PSA from 1 to 4 nanogram per milliliter in detecting prostate cancer. From this, they say it is really difficult to recommend any one cut off value. Although 4 nanograms per milliliter is often used, many cases would be missed if this was rigidly adhered to. At a lower level of 1 nanograms per milliliter more cases would be detected but there would also be more men without cancer subjected to further tests. In other words, PSA levels present a continuum of risk for prostate cancer. No one value is particularly significant. Men and their doctors need to be aware of this when considering going for PSA tests.

Source
Journal of the American Medical Association 6th July 2005 Volume 294 pages 66-70

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