PSA TestingImportance of Multiple Markers
Ian Thompson MDDepartment of Urology
University of Texas HSCSan Antonio, TX
PSA (ng/mL)
Ris
k
0 1 2 3 4
0.0
0.1
0.2
0.3
0.4
0.5
Risk of Prostate Cancer
0 1 2 3 4
0.0
0.1
0.2
0.3
0.4
0.5
Risk of High-Grade Disease
Thompson IM et al. N Engl J Med 2004;350:2239-46
Population Screening with PSATrue Outcomes
4.0+
PSA 4+ 7.6%Positive biopsy 25%High grade 19%
Screen 10,000 Men
PSA 4+ 760Cancer 190High grade 36
PSA <4 9240Cancer 1386 High grade 208
Normal PSA 92.4% Positive biopsy 15%High grade 15%
<4.0
PSASEER, PCAW, Prostate Cancer Prevention Trial Data
Pause for a moment
You read in a throwaway magazine about the benefits of a bASA daily.
You worry about GI upset.You ask your own PCP, should I
take a bASA?How do they assess your risk?
10-year risk of coronary artery disease
So why do we use just PSA?
DRE
Age
Race/ethnicity
Family history
Prior negative biopsy
PSA velocity
Let’s just take some examplesPoint in play: Dichotomy of DRE as a solitary measure of risk
55 yo WM, -FHx, DRE+, no prior bx, PSA 0.3 – recommendation?
– Biopsy, right?
68 yo AAM, +FHx, DRE-, no prior bx, PSA 2.4 – recommendation?
– No biopsy, right?
This example (DRE dichotomy)
55 yo WM, -FHx, DRE+, no prior bx, PSA 0.368 yo AAM, +FHx, DRE-, no prior bx, PSA 2.4
What are these men’s risk of disease?1st man – Cancer=13% High grade
cancer=1%2nd man – Cancer=31%. High grade – 11%.
Doesn’t make any sense, correct?
The Next Step
• Adding Body Mass Index
• Adding Population ‘Norms’
• Adding pro-PSA