Study: PSA Testing Reduces Unnecessary Prostate Biopsies

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BOSTON―Prostate cancer screening that combines an adjusted blood test with other factors including the size of the gland, the patient’s overall weight and family history, can help up to one-quarter of men avoid biopsies and the risks associated with them, a Beth Israel Deaconess Medical Center-led research team said.

Writing in a study published online by the journal Cancer, the team led by Martin G. Sanda, MD, Director of the Prostate Center at Beth Israel Deaconess Medical Center and Professor of Urology at Harvard Medical School, suggests that instead of using “one-size-fits-all” levels of PSA to determine who should have a biopsy, considering other factors such as prostate size can substantially improve the ability of PSA testing to identify aggressive prostate cancers for which treatment is warranted, while avoiding detection of indolent cancers that are better undiagnosed because they do not require treatment.

A second study led by Sanda, and published online in the journal Urologic Oncology, suggests the presence or absence of genes commonly found in the urine of men, when combined with a PSA test, can also be used to determine whether a biopsy is necessary.

The new suggested approaches come as the United States Preventive Services Task Force expert panel concluded that current PSA-based prostate cancer screening saves few or no lives, but causes harm through treatment or further invasive testing such as biopsies. That’s because prostate cancers can vary in aggressiveness and more men die of other causes aside from that cancer―and because the PSA test alone cannot determine how dangerous any particular cancer may be.

“The US Preventative Services Task Force threw the baby out with the bathwater by their blanket recommendation against prostate cancer screening,” said Sanda, noting that PSA screening can instead be refined to more selectively identify only aggressive cancer for which treatment is indicated by adjusting PSA results for other considerations such as family history, obesity, and prostate size.

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