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Prostate-Specific Antigen Levels Among Participants Receiving Annual Testing.
Nicholas A Pickersgill1, Maria M Peré1, Emily A Vertosick2
1Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, New York.
JAMA Oncology
|September 18, 2025
Summary
Repeating prostate-specific antigen (PSA) tests shows significant variability. Many elevated PSA levels decrease the following year, supporting repeat testing before further prostate cancer workup.
Area of Science:
- Urology
- Oncology
- Clinical Trials
Background:
- Prostate-specific antigen (PSA) testing is crucial for prostate cancer screening.
- Guideline-recommended repeat PSA testing is part of the prebiopsy workup for elevated levels.
- Exempting certain patients from repeat PSA testing requires further investigation.
Purpose of the Study:
- To analyze yearly PSA variability in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial.
- To determine the implications of repeating elevated PSA measurements.
- To identify potential candidates for direct further workup without repeat PSA testing.
Main Methods:
- Retrospective analysis of data from the PLCO Cancer Screening Trial (1995-2006).
- Inclusion of men aged 54-75 years with annual PSA testing and no prior prostate cancer diagnosis.
- Primary outcome: proportion of elevated PSA measurements decreasing below biopsy thresholds (2.5, 3.0, 4.0 ng/mL) at subsequent yearly tests.
Main Results:
- Significant intra-individual PSA variability was observed.
- 22% of PSA measurements ≥2.5 ng/mL decreased below the threshold the following year.
- 54% of men with at least one PSA ≥2.5 ng/mL had a subsequent level below this threshold.
Conclusions:
- Guideline recommendations for repeat PSA testing are supported by observed PSA variability.
- Patients with persistently elevated PSA levels may be candidates for direct further evaluation.
- Repeat PSA testing remains valuable for most patients before prostate cancer diagnostic evaluation.
