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Vital Signs

Spring 2005

Results of Prostate Cancer Test Interpreted in New Way

The prostate-specific antigen (PSA) test used to screen men for prostate cancer is being interpreted somewhat differently by many physicians as a result of recent studies suggesting that more important than absolute values of PSA is the rate of change in a person’s PSA over time.

“It has become apparent in the last several years that PSA kinetics give us much better information about whether there is likely to be cancer present, and whether that cancer is likely to be aggressive,” says UCLA urologist Mark Litwin, M.D., M.P.H. He explains that a patient with a PSA of 6.5—well above the range where cancer is typically suspected—might not need a biopsy if that level has remained flat from one year to the next, whereas a man whose PSA has climbed from 1 to 3 in a year’s time would be a strong candidate for biopsy, despite a PSA level generally defined as normal. This new diagnostic approach applies to men who have already been treated for prostate cancer and are being monitored for potential recurrence, as well as men who have never been diagnosed, Dr. Litwin notes.

For most men, annual PSA tests are recommended from age 50 to 70, with African Americans and men who have had a father or brother with prostate cancer advised to begin at age 45. Given the evidence suggesting the value in comparing PSA scores over time, those who pursue PSA screening should do so annually, Dr. Litwin says.

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