The findings of a new study on prostate screening have sparked a debate among physicians on how to interpret the prostate-specific antigen (PSA) test and how to treat men who are not symptomatic.Whereas several factors play a role in a man's risk of developing prostate cancer, many physicians agree that a score above 4 on the PSA test may indicate cancer.
Yet, the current study reported in the New England Journal of Medicine (May 27, 2004) dispels the theory. The study, which involved 2940 men aged 62 to 91, found cancers in 15% of those with PSA levels below 4. The risk of prostate cancer rose with increasing PSA levels. Some experts believe that the findings illustrate the need for more aggressive cancer screening and treatment. In early 2004, the National Comprehensive Cancer Network recommended that physicians consider biopsies for men with PSA levels above 2.5.
The researchers in the new study, however, said that such thresholds may no longer be very useful. "There is no magic cutoff below which a man can assume he is completely free of risk or above which he must feel compelled to have a biopsy," said study author Howard Parnes, MD. "We need to allow each man, with the help of his physician, to assess his own risk."
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