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Few Benefits, Many Costs Associated with Changing Definition of "Abnormal" PSA Level

Armen Hareyan's picture

Prostate Cancer

Lowering the current prostate-specific antigen (PSA) threshold for recommending a prostate biopsy may subject millions of men to unnecessary, potentially harmful medical procedures with no evidence that it will improve prostate cancer mortality rates, according to a new study by researchers from Dartmouth Medical School and the VA Outcomes Group. The study appears in the August 3 issue of the Journal of the National Cancer Institute.

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Currently, doctors recommend that men with an "abnormal" PSA level-a level exceeding 4.0 ng/mL-receive a prostate biopsy to test for prostate cancer. However, some men diagnosed with prostate cancer have a PSA level lower than this threshold, prompting some in the medical field to suggest lowering the cutoff to 2.5 ng/mL to possibly detect more cancer cases.

To examine the implications of this suggestion, H. Gilbert Welch, M.D., M.P.H., of the Center for the Evaluative Clinical Sciences at DMS and the Department of Veterans Affairs Medical Center in White River Junction, Vt., and colleagues examined data from the 2001-2002 National Health and Nutrition Examination Survey for 1,308 men of 40 years of age or older with no prior history of prostate cancer, and National Cancer Institute data on the risk of prostate cancer death.