Do not lower PSA threshold, experts say

Reported by Susan Aldridge, PhD, medical journalist

Lowering the prostate specific antigen threshold will subject men to unnecessary follow up testing with no proven benefit.
Prostate specific antigen (PSA) is a protein secreted by the prostate gland. Elevated levels in blood have been linked to prostate cancer. Accordingly PSA testing is widely used in screening for the disease. Currently, further investigation is warranted if a man has a level exceeding 4 nanograms per milliliter (ng/mL). But sometimes cancer is diagnosed at PSA levels below this. So does this justify lowering the threshold to, say, 2.5 ng/mL?

No, say researchers at the Department of Veterans Affairs Medical Center. They looked at data from the National Health and Nutrition Examination Survey and the National Cancer Institute. This showed that if all US men aged 40 to 69 had a PSA test with a threshold of 4 ng/mL about 1.5 million would have a PSA level high enough to justify biopsy. If the threshold was lowered to 2.5 ng/mL, then a further 1.8 million would need a biopsy.

The death figures for prostate cancer do not justify these extra investigations, the researchers say. There is no clear evidence of the effectiveness of PSA screening in terms of lives saved. Until there is, the threshold should be kept where it is - or even raised.

Source
Journal of the National Cancer Institute 3rd August 2005 Volume 97 pages 1132-1137

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