Re: Validty of PSA Tests

[Guest guest]

I will keep doing the test just to get data for future analysis, but we sure need a better test. The way the protocol is set, you'll need a high PSA to get a biopsy. Only a biopsy defines cancer presence. So to do a good job of screening, IMO, a biopsy should be done at defined intervals.

And that will probably cause more grief to the patient and the payer than it will be deemed worth, except for those that are detected, of course.

The problem is in detecting the fast growing cancer that can be cured/slowed if caught quickly enough, but we don't have a good way to detect it.

Regards.

----- Original Message -----

From: mikesheldrick

Sent: Monday, September 20, 2004 11:40 PM

Subject: [ ] Validty of PSA Tests

I haven't seen this, but maybe I missed a posting. A piece on WebMd (http://tinyurl.com/4vp3d) says Stamey was instrumental in adoption of PSA tests for screening, but he has now decided it may not be useful at all, except when testing is begun at say 40, 5 years between 40 and 50, and at one year intervals thereafter, in order to construct a PSA trajectory.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstract & list_uids=15371827http://tinyurl.com/6ra5sTHE PROSTATE SPECIFIC ANTIGEN ERA IN THE UNITED STATES IS OVER FOR PROSTATE CANCER: WHAT HAPPENED IN THE LAST 20 YEARS?Stamey TA, Caldwell M, McNeal JE, Nolley R, Hemenez M, Downs J.Department of Urology, School of Medicine, Stanford University, Stanford, California.PURPOSE:: We assessed how well preoperative serum prostate specific antigen (PSA) reflects the largest cancer in consecutive untreated radical prostatectomies during the last 20 years at Stanford University. MATERIALS AND METHODS:: A total of 1,317 consecutive radical prostatectomies were divided into 4, 5-year periods between August 1983 and July 2003, and examined sequentially in 3 mm step sections by 1 pathologist. The largest cancer and 5 other histological variables in each prostate were measured. Preoperative clinical stages were tabulated for each 5-year period. Means, Pearson correlation coefficients, % change and multiple regression were used to compare selected variables. RESULTS:: Most parameters decreased linearly during the 20 years, including palpable nodules on digital rectal examination from 91% to 17%, mean age from 64 to 59 years, mean serum PSA from 25 to 8 ng/ml, and index (largest) cancer volume from 5.3 to 2.4 cc. Percent Gleason grade 4/5 of the largest cancer averaged 27% to 35% and prostate weight 44 to 53 gm. Contrasting August 1983 to December 1988 with January 1999 to July 2003, 6 histological cancer parameters had statistically significant relationships to serum PSA in the first period. In the last 5 years serum PSA was related only to prostate size. CONCLUSIONS:: Serum PSA was related to prostate cancer 20 years ago. In the last 5 years serum PSA has only been related to benign prostatic hyperplasia. There is an urgent need for serum markers that reflect the size and grade of this ubiquitous cancer.PMID: 15371827 [PubMed - as supplied by publisher] Mike