Rapid rise in PSA level may not point to cancer

NICE guidance that rising PSA levels alone are insufficient to trigger a prostate biopsy has been backed by a US study.

Prostate: PSA test insufficient (Photograph: SPL)
Prostate: PSA test insufficient (Photograph: SPL)

The Prostate Cancer Prevention Trial found no evidence to support prostate biopsy in men with fast-rising PSA levels in the absence of other indicators.

NICE's 2008 guideline on the diagnosis and treatment of prostate cancer recommends that a rising PSA level alone should not necessarily prompt a review of treatment.

NICE says that, in making a decision on whether or not a prostate biopsy is appropriate, clinicians and patients should discuss PSA level, digital rectal examination findings, comorbidities and other risk factors.

For the new US study Andrew Vickers and colleagues from the Memorial Sloan-Kettering Cancer Center in New York analysed data from over 5,500 men.

They found that incorporating PSA velocity added little to the predictive value of a model of prostate cancer.

The researchers also calculated that conducting biopsies on men with fast-rising PSA but no other indication would lead to almost one in seven men having biopsies.

The researchers recommend that organisations issuing policy statements related to PSA and prostate cancer detection remove references to PSA velocity.

Dr Siu-Long Yao and Dr Grace Lu-Yao from the University of Medicine and Dentistry of New Jersey said the findings highlighted the limitation of PSA testing.

In an editorial published alongside the study, they said that even after more than 20 years 'the use of PSA as a screening tool still leaves much to be desired'.

In the UK, there is no national screening programme for prostate cancer due to a lack of evidence for the benefit of PSA testing, although studies have suggested potential benefit in high-risk groups. The UK National Screening Committee is due to issue its next review of the evidence in March.

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