A normal PSA can miss prostate cancer

The mainstream press has caught wind of the NEJM study that was discussed here yesterday. Here are some quotes from the article:

. . . “This study adds to information that perhaps the PSA threshold may be dropped to 2.5 or so,” said Gomella, the Philadelphia urologist. “The number 4 may not be the, quote, normal that we look at anymore.”

. . . Some doctors fear the study findings will lead to even more unnecessary operations in older patients who are more likely to die of other causes before the cancer kills them.

. . . “I have a sneaking suspicion that what’s going to happen is that people are going to start … being more aggressive with low PSAs,” said Dr. Siu-Long Yao, a prostate cancer specialist at the Cancer Institute of New Jersey. “I don’t think it’s warranted at the present time, but I think people will act on it.”



There is no sneaking suspicion on my part – I am sure that this will increase the amount of prostate biopsies which will no doubt lead to unncecessary procedures. As you can see, some have even advocated lowering the threshold for biopsy.

Again, the public does not want to hear about the data (or the lack thereof concerning the measurement of PSAs with a mortality benefit). After listening to this study, men will start pushing for biopsies despite normal PSAs. Remember, physicians get sued for not doing a test – I am not aware of someone being sued for doing too much testing (enlighten me if I am mistaken).

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