Biopsy based on PSA: 'The PSA era is alive and well'

November 1, 2005

Vancouver, British Columbia--"The PSA test it is not dead yet," said Joseph C. Presti, Jr, MD, at the AUA Western Section annual meeting, where he presented a study of the performance of PSA levels between 4.0 and 10.0 ng/mL in the era of extended biopsy schemes.

The question of how useful PSA levels in this range are for predicting prostate cancer is controversial, said Dr. Presti, professor of urology at Stanford (CA) University School of Medicine. An earlier report from Thomas A. Stamey, MD, declared that the PSA era was over (J Urol 2004; 172:1297-301). However, these data were extrapolated from a radical prosta-tectomy series.

The current study by Dr. Presti was derived from a contemporary biopsy series from Stanford. A total of 999 patients, 50 to 79 years of age, with PSA levels between 4.0 and 10.0 ng/mL, who had never undergone a biopsy, participated in the study. The patients were stratified for age, digital rectal examination, and PSA levels.

Defining the PSA connection

The PPV of PSA between 4.0 and 10.0 ng/mL in men with an abnormal or normal DRE is illustrated in the figures.

In the 60- to 69-year age group and a normal DRE, a PSA level of 4.0 to 5.9 ng/mL had a PPV of 40% to find cancer and 21% to find high-grade cancer on biopsy. A PSA level of 6.0 to 7.9 ng/mL in the same age group had a PPV of 25% to find cancer and 12% of finding high-grade cancer on biopsy. A PSA level of 8.0 to 9.9 ng/mL in the same age group had a PPV of 43% to find cancer and 30% to find high-grade cancer on biopsy.