Study: Free PSA testing should be conducted in men with total PSA of 2 to 10 ng/mL

In this video, Mark A. Preston, MD, MPH, shares the take-home message from the recent Journal of Urology study, “Free PSA and Clinically Significant and Fatal Prostate Cancer in the PLCO Screening Trial.” Preston is a urologic surgeon at Brigham and Women’s Hospital and an assistant professor of surgery at Harvard Medical School in Boston, Massachussets.

Transcription:

What is the take-home message for the practicing urologist?

This was the largest prospective study examining free PSA and clinically significant and fatal prostate cancer outcomes with long-term follow-up over 20 years. We suggest that free PSA testing should be conducted in men with total PSA values between 2 and 10. There are some labs that only report it from 4 to 10. But there's definitely value in our study here at the lower level. [Free PSA is] cheap and easily available, and it can be used to help risk stratify prostate cancer screening and also as a reflex test to help decide whether a patient needs a biopsy or an MRI that can help guide the next steps of their care.

Is there anything you would like to add?

The one other thing that we think might be helpful is that for labs that are reporting free PSA results, the most value seems to be if you report from a PSA of 2 to 10. And also, as opposed to reporting overall prostate cancer actually, having clinically significant prostate cancer as the outcome. Because currently, from a number of labs, if you're reporting overall prostate cancer, those numbers are a lot higher, naturally. But that might be cancers that we don't necessarily need to find, and that can create undue anxiety in physicians and patients and lead to potential unnecessary biopsies. I think having a focus on clinically significant prostate cancer [in the] reporting of these results would be very helpful in guiding care to patients who need it and avoiding biopsies in those who don't.

This transcript was edited for clarity.