Measuring PSA over time improves diagnostic accuracy

Measurements taken of PSA over time improve the accuracy of aggressive prostate cancer detection when compared to a single measurement of PSA, according to a recent study.

The retrospective study, which was published online in the British Journal of Urology International (Jan. 15, 2013), examined the electronic health records of nearly 220,000 men ages 45 years and older over a 10-year period who had at least one PSA measurement and no previous diagnosis of prostate cancer. The study found that annual percent changes in PSA more accurately predicted the presence of aggressive prostate cancer when compared to single measurements of PSA alone, but only marginally improved the prediction of prostate cancer overall.




"The use of a single, elevated PSA level to screen for prostate cancer is considered controversial given the questionable benefits of PSA screening on prostate cancer mortality. The screening may also result in unnecessary prostate biopsies and subsequent treatments for localized prostate cancer, as it does not distinguish well between slow-growing and aggressive disease," said first author Lauren P. Wallner, PhD, MPH, of Kaiser Permanente Southern California’s Department of Research and Evaluation, Pasadena. "Our study demonstrates that repeated measurements of PSA over time could provide a more accurate-and much needed-detection strategy for aggressive forms of prostate cancer."

Men in the study were also found to experience a 2.9% change in PSA levels per year on average, and the rate of change in PSA increased modestly with age.

"The results of this study could provide clinicians with a better prostate cancer preventive strategy that could help differentiate between men with an aggressive form of the disease and those who have slow-growing, indolent cancer that may not necessarily merit treatment," said Dr. Wallner. "While we do not suggest that patients proactively seek out additional PSA measurements, men who already have had multiple PSAs may consider discussing the change in their PSA levels with their clinician when determining future treatment strategies."

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