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Prostate Cancer Not Rare in Men with Normal PSA

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High levels of prostate specific antigen (PSA) usually indicate the presence of prostate cancer, but the disease can occur in up to 15 percent of men with normal PSA levels, according to a new report.

The new information, which appears in this week’s New England Journal of Medicine, comes from a study of men who participated in a prostate cancer prevention trial. Nearly 3000 of the participants never had a PSA above the normal level of 4.0 and had normal rectal examinations. Nonetheless, 15.2 percent of these men were found to have prostate cancer when they underwent a prostate biopsy after seven years of participation in the trial. Dr. Ian M. Thompson, from the University of Texas Health Science Center at San Antonio, and colleagues found that the rate of prostate cancer increased as the PSA level rose, ranging from 6.6 percent for PSA levels of 0.5 or lower to 26.9 percent for levels between 3.1 and 4.0 ng/mL. Even with such low PSA levels, high-grade cancers were still seen, the investigators point out. The prevalence of such cancers was directly related to the PSA level. Among patients with the highest levels, 25 percent of the cancers were high-grade malignancies. The finding that prostate cancer is common among men with normal PSA levels “underscores the need to consider fundamental changes in the approach to diagnosing prostate cancer,” the researchers state. Despite these findings, an author of a related editorial does not believe that the usual PSA threshold of 4.0 for performing a prostate biopsy should be lowered — because prostate cancer is often not fatal. Some 16 percent of men are diagnosed with prostate cancer, but only three percent die of the disease. “This, together with the absence of proof that PSA screening saves lives,” writes Dr. H. Ballentine Carter, from Johns Hopkins School of Medicine in Baltimore, “should cause physicians to be circumspect about routinely recommending a prostate biopsy” for men with a PSA level of 4.0 or lower. (SOURCE: New England Journal of Medicine, May 27, 2004: Reuters Health News)


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Dates

Posted On: 28 May, 2004
Modified On: 3 December, 2013

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