Figure 1- Mortality trends with PSA screening:
Approximately 93% of PSA tests are done by family medicine and internal medicine practitioners. Therefore, it is our task as urologists, to educate these physicians about PSA screening. Dr. Gomella suggest a new algorithm where primary physician refer patients to urologist when PSA rises above 1.5 ng/ml, regardless of age.
When assessing lab results of PSA tests, only 27% of PSA tests were more than the cutoff of 1.5 ng/ml. Dr. Gomella reported a study assessing men under the age of 50, with a single PSA test above 1.5 ng/ml predicting a higher risk for prostate cancer 25 years later.1 Furthermore, another study assessing 21,500 men above the age of 40 with a PSA between 0-4 ng/ml, found that there is a 15-fold increased risk for developing PC, with a 19-fold risk for African-Americans. (Figure 2).2
Figure 2 – Increased risk of prostate cancer with a PSA above 1.5 ng/ml:
PSA above 1.5 ng/ml has also been shown to be a surrogate marker for :
- Long-term PC risk
- Evaluate - does not necessarily mean that all these patients need to be biopsied
- Additional PC markers need to be used to determine whom to biopsy (Figure 3).
Dr. Gomella concluded his presentation with a proposed algorithm incorporating PSA, and PC markers (Figure 4).
Figure 4 – Proposed algorithm for using PSA cutoff of 1.5 ng/ml:
Presented by: Leonard Gomella, MD, FACS, Thomas Jefferson University, Philadelphia, PA, USA
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 FOIU 4th Friends of Israel Urological Symposium, July 3-5. 2018, Tel-Aviv, Israel
1. Djulbegovic Mia, et al. BMJ 2010
2. Ping T et al. J. Urol 2010
3. Lilja H, et al. Cancer. 2011
4. Goldberg H. et al. J Urol 2018
Read the Opposing Side: A PSA Threshold of 1.5 ng/ml for Further Diagnostic Tests - AGAINST