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Prostate Cancer in 15% of Men With Normal PSA

Best Test May Be to Follow PSA Levels Over Time, Expert Says
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Prostate Cancer With a Normal PSA

In their study, Coltman and colleagues analyzed data from a clinical trial of nearly 10,000 men. After seven years, they had a prostate biopsy whether they had a high PSA or not.

About 3,000 of these men never had a PSA level of more than 4.0. Fifteen percent of these men turned out to have prostate cancer. And 15% of these cancers were life-threatening, high-grade tumors.

The chances of prostate cancer -- and of high-grade cancer -- went up as PSA levels rose. But high-grade cancers were seen in men at all PSA levels.

Should Doctors Look for Trouble?

How hard should doctors look for prostate cancers? In an editorial accompanying the Coltman team's study, Johns Hopkins researcher H. Ballentine Carter, MD, notes that a man's lifetime risk of prostate cancer is 16%. Yet his risk of dying from prostate cancer is only 3%.

"In the age range of 60 years to 80 years, about 30% to 40% of men have small prostate cancers," Carter tells WebMD. "Now, this article tells us, we have the ability today to detect those."

If doctors look harder for prostate cancers, they will find them. If they do this, a lot of men will have unnecessary surgery or radiation therapy. If they don't, some men who might have been saved by early detection will die.

"We already know we are overdetecting the disease," Carter says. "A lot of men who have prostate cancer are not going to have their disease harm or bother them during their lifetimes. Unless they were biopsied, they never would have known that they had prostate cancer during their life. The lower we set the PSA threshold, the more unnecessary treatments we'll have."

Like Coltman, Carter says a man's risk factors for prostate cancer have to be taken into account. But he would be very careful about sending a man with a midrange PSA level to get a biopsy.

"If I met someone in their 60s at a PSA level of 2.5 or 3.0 or 3.5, I would say, 'Look, there is a high probability you do not have prostate cancer. Let's monitor your PSA over time and see if it changes,'" Carter explains. "There shouldn't be any urgency to try to detect these tumors when PSA is in this range. These tumors grow very slowly. They still will be curable later when their PSA is 4."

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