Repeating PSA Test Reduces Risk of Prostate Biopsy, PCa Diagnosis

Men with a normal PSA upon repeat testing had a 78% lower risk of prostate cancer diagnosis than men with a second abnormal PSA result.
Men with a normal PSA upon repeat testing had a 78% lower risk of prostate cancer diagnosis than men with a second abnormal PSA result.

For men with an elevated PSA, re-testing PSA levels within a year may reduce the risk of prostate biopsy and a prostate cancer (PCa) diagnosis, a new study finds.

“Men with an elevated PSA level should be given a repeated PSA test before proceeding to biopsy,” concluded lead researcher Rodney H. Breau, MD, MSc, of Ottawa Hospital in Ontario, Canada, and colleagues, writing in Mayo Clinic Proceedings, published online ahead of print.

The investigators looked at 1,268 patients referred to the Ottawa Regional Prostate Cancer Assessment Center from April 1, 2008 through May 31, 2013 who had initial PSA levels of 4-10 ng/mL. After repeat PSA testing, a quarter received normal results, a finding consistent with results from other studies.

A multivariable analysis revealed that men with a normal PSA upon re-testing had a 58% lower risk of prostate biopsy, a 78% lower risk of a PCa diagnosis, and an 84% lower risk of a Gleason score of 7 or higher compared with men who received a second abnormal PSA result. Men with normal results tended to be younger (61.5 vs. 65.2 years) and have lower initial PSA results (5.5 vs. 6.6 ng/mL).

A normal PSA result does not rule out the possibility of cancer, the investigators acknowledged, but “repeating a PSA test will avoid or delay many prostate biopsies in patients whose PSA level may have been transiently elevated.”

The researchers noted several study limitations, including an inability to assess the impact of a concerning digital rectal examination finding or a family history of PCa. They also could not comment on patients with PSA results below 2.5 or above 10 ng/mL.

Source

  1. Lavallee LT, Binette A, Witiuk K, et al. Reducing the Harm of Prostate Cancer Screening: Repeated Prostate-Specific Antigen Testing. Mayo Clinic Proceedings; doi: 10.1016/j.mayocp.2015.07.030.
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