Variation of Serum Prostate-Specific Antigen Levels: An Evaluation of Year-to-Year Fluctuations
CONTEXT Serum prostate-specific antigen (PSA) testing is frequently used in early detection programs for prostate cancer. While PSA testing has resulted in an increase in prostate cancer detection, its routine use has been questioned because of a lack of specificity. OBJECTIVE To determine whether y...
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Published in | JAMA : the journal of the American Medical Association Vol. 289; no. 20; pp. 2695 - 2700 |
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Main Authors | , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Chicago, IL
American Medical Association
28.05.2003
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Subjects | |
Online Access | Get full text |
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Summary: | CONTEXT Serum prostate-specific antigen (PSA) testing is frequently used in
early detection programs for prostate cancer. While PSA testing has resulted
in an increase in prostate cancer detection, its routine use has been questioned
because of a lack of specificity. OBJECTIVE To determine whether year-to-year fluctuations in PSA levels are due
to natural variation and render a single PSA test result unreliable. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of an unscreened population of 972 men (median
age, 62 years) participating in the Polyp Prevention Trial (1991-1998). Five
consecutive blood samples were obtained during a 4-year period and were assessed
for total and free PSA levels. MAIN OUTCOME MEASURE Abnormal PSA test result based on a PSA level higher than 4 ng/mL; a
PSA level higher than 2.5 ng/mL; a PSA level above the age-specific cutoff;
a PSA level in the range of 4 to 10 ng/mL and a free-to-total ratio of less
than 0.25 ng/mL; or a PSA velocity higher than 0.75 ng/mL per year. RESULTS Prostate biopsy would have been recommended in 207 participants (21%)
with a PSA level higher than 4 ng/mL; in 358 (37%) with a level higher than
2.5 ng/mL; in 172 (18%) with a level above the age-specific cutoff; in 190
(20%) with a level between 4 and 10 ng/mL and a free-to-total ratio of less
than 0.25 ng/mL; and in 145 (15%) with a velocity higher than 0.75 ng/mL per
year. Among men with an abnormal PSA finding, a high proportion had a normal
PSA finding at 1 or more subsequent visits during 4-year follow-up: 68 (44%)
of 154 participants with a PSA level higher than 4 ng/mL; 116 (40%) of 291
had a level higher than 2.5 ng/mL; 64 (55%) of 117 had an elevated level above
the age-specific cutoff; and 76 (53%) of 143 had a level between 4 and 10
ng/mL and a free-to-total ratio of less than 0.25 ng/mL. CONCLUSION An isolated elevation in PSA level should be confirmed several weeks
later before proceeding with further testing, including prostate biopsy. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0098-7484 1538-3598 |
DOI: | 10.1001/jama.289.20.2695 |