Prostate Cancer Testing
Recent Issues

Prostate cancer testing was supposed to be an important part of preventative medicine. Digital rectal exams, together with testing for Prostate Specific Antigen (PSA) were supposed to provide a degree of confidence that a patient being examined if free of cancer if no lumps are found in the rectal exam, and if the PSA value is low. However, two papers in the New England Journal of Medicine (in volumes 350 and 351, 2004) raise questions about these assumptions. The first casts significant doubt on the assumption that low PSA implies being cancer-free. The second finds a strong correlation between the rate at which PSA increases (rather than the absolute value), and the risk associated with the cancer. However, a subsequent study (2011) seems to disprove the validity of using the increase rate as a criterion for treatment. The latest studies show the following:

  1. There is no evidence to support the recommendation that men with high PSA velocity should be biopsied in the absence of other indications;(J Natl Cancer Inst 2011;103:18)

  2. Active surveillance is a reasonable approach to low-risk prostate cancer (JAMA, 2010;Vol 304, No. 21 2373)

  3. There is no evidence of a mortality benefit for organized annual PSA screening (Andriole et al., to be published)



  4. The following pages present these developments.


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    Last Modification - March 30, 2012