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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

    Should Doctors Look for Trouble? continued...

    Carter warns that it's a different story for men in their 40s. For them, a midrange PSA level may well mean trouble.

    "These are the men we should be concerned about if they have a prostate level of 2.5 or 3," he says.

    Carter suggests that more important than a single PSA test is the speed at which PSA levels change over time. An increase of 0.5 ng/mL to 0.75 ng/mL during the course of a year is worrisome, he says. Coltman, however, says he wonders whether most men would be comfortable waiting for a year to find out whether they have cancer.

    Coltman and Carter agree that better tests for prostate cancer are sorely needed. These yet-to-be-invented tests would find some marker on prostate cancer cells. It is hoped the marker would show not just that the cancer is there, but whether it is a cancer a man has to worry about.

    "All of us men sit on a gland like that and we are all concerned," Coltman says. "We are frantically engaged in attempts to understand the biology of prostate cancer. We frantically want to find markers that would not only be predictive of prostate cancer, but also would help identify those prostate cancers that are at high risk to go on and spread."

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