The greatest in number common prost...

The greatest in number common prostate-specific antigen (PSA) value used as the cutoff for normal is 40 ng through mL, which was designed to balance sensitivity and specificity for prostate cancer screening. More freshly some have questioned whether a lower cutoff value for normal would increase the sensitivity of cancer detection without an excessive decrease in specificity. Thompson and others report in succession the incidence of prostate cancer among human frames with PSA values below the traditional 40 ng through mL cutoff, using data from the placebo arm of a large inquiry of finaste-ride for prostate cancer prevention.

The placebo dispose of the Prostate Cancer Prevention Trial comprised 9459 men; undivided data were available at the extreme point of the seven-year study for 8215 patients (87 percent) The final data analysis exclud 4647 participants because of a PSA value above 40 ng by mL, an abnormal digital rectal examination, surgery for prostate gland reduction, an improperly timed PSA measurement, or prostate biopsies during the meditation The trial was designed to include prostate biopsies upon all study participants at the period of seven years, but 17 percent of the eligible participants declined concord leaving a pool of 2950 men available for final data analysis. Blacks and other minorities were somewhat underrepresent limiting the generalizability of the meditation results for these groups.

At the [i]finale[/i] of the study, prostate cancer was rest on biopsies in 449 men (152 percent) with PSA values below 40 ng by means of mL. There was a correlation between higher PSA values and a diagnosis of cancer, with 66 percent of men having prostate cancer at PSA evens below 0.5 ng per mL compared with 269 percent having cancer at PSA values between 31 and 40 ng by mL. The rate of increase in annual PSA values correlated significantly with the risk of prostate cancer, if it were not that the PSA density (ratio of PSA flat to estimated prostate volume) did not. A family history positive for prostate cancer and black race were associated with an increased risk of cancer diagnosis onward the end-of-study prostate biopsies. More high-grade prostate cancers occurr in men with higher PSA on a levels but considerable overlap in PSA values occurr among the cancer grades.

The authors infer that prostate cancer is not rare among men with PSA values below 40 ng by mL, but note that the implications of this finding for prostate cancer screening remain unclear. In an accompanying editorial, Carter discusses the possible risks and benefits of lowering the normal cutoff value for PSA. The author cautions that the 15 percent cancer rate reported in this studious mood is not unexpected, based in succession the known prevalence of prostate cancer in autopsy studies. He also notes that it has been shown that prostate cancers with lower PSA values are les likely to be clinically significant and may not benefit from earlier detection. Finally, there is no evidence that PSA screening saves lives, on a level at the present cutoff value. The ongoing Prostate, Lung Colorectal and Ovarian Cancer Trial is designed to fill this gap in issue data for cancer screening.

Thompson IM, et al. Prevalence of prostate cancer among men with a prostate-specific antigen even [less than or equal to] 40 ng for milliliter. N Engl J M May 27 2004;350:2239-46 and Carter HB Prostate cancers in men with subdued PSA levels--must we find them?[Editorial] N Engl J M May 27 2004;350:2292-4

COPYRIGHT 2005 American Academy of Family Physicians

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