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Reducing the Harm of Prostate Cancer Screening: Repeated Prostate-Specific Antigen Testing
Luke T Lavallée1, Andrew Binette2, Kelsey Witiuk3
1Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
Mayo Clinic Proceedings
|December 22, 2015
Summary
Repeating a prostate-specific antigen (PSA) test for men with elevated levels significantly lowers the risk of unnecessary prostate biopsies and cancer diagnoses. This simple step can improve patient outcomes and reduce healthcare costs.
Area of Science:
- Urology
- Oncology
- Diagnostic Medicine
Background:
- Elevated prostate-specific antigen (PSA) levels in men often prompt further investigation, including prostate biopsy.
- The decision to biopsy is critical due to potential complications and overdiagnosis.
Purpose of the Study:
- To evaluate the association between a repeated PSA test and the subsequent risk of prostate biopsy and cancer diagnosis.
- To determine if routine PSA re-testing influences prostate cancer detection rates and aggressiveness.
Main Methods:
- A cohort study included 1268 men with initial PSA levels between 4 and 10 ng/mL referred to a prostate cancer assessment clinic.
- Univariate and multivariate analyses examined the link between normal repeated PSA results and the likelihood of biopsy, cancer diagnosis, and high-grade cancer (Gleason score ≥7).
Main Results:
- Of 1268 patients, 24.8% had normal results on a repeated PSA test.
- Men with normal repeated PSA results were younger and had lower initial PSA levels.
- Normal repeated PSA testing was independently associated with a significantly lower likelihood of undergoing prostate biopsy (RR, 0.42) and a reduced risk of cancer diagnosis (RR, 0.22) and high-grade cancer (RR, 0.16).
Conclusions:
- Routinely repeating a PSA test in men with an elevated PSA level is independently associated with a decreased risk of prostate biopsy and prostate cancer diagnosis.
- A repeated PSA test should be considered before proceeding with a prostate biopsy in men with an initial elevated PSA level.
