DIAGNOSING PROSTATE PROBLEMS: SECOND THOUGHTS ON PSA TESTS

The routine use of the PSA test is questioned on five counts:

It has not been used over a long enough period of time to establish its accuracy.

Treating the cancers it discovers may not save lives.

The cost of screening all men over the age of fifty would be high.

About 42 percent of men with early organ-confined prostate cancers (the ones most likely to benefit from early detection) do not have elevated PSA levels.

A high rate of false positive results can lead to unnecessary biopsies in about four out of ten cases (consequently, many health plans are reluctant to finance PSAs).

Research performed in the Department of Radiology at St. Joseph Mercy Hospital in Ann Arbor, Michigan, showed that "as males age, there is a growth of benign glandular tissue that causes an elevation of PSA. The danger of what is happening today is that many men with a high PSA are worried that they have prostate cancer unnecessarily. Therefore, when the PSA is elevated, the next step is to correlate with the size of the gland." The prostate can vary in size from that of a pea to that of an apple; as the prostate enlarges, the PSA level also increases.

Proponents of the PSA test say that it may not be perfect, but at the present time it is the best tool we have. Under the screening strategy, a biopsy is performed when a nodule is found by a DRE or when the PSA value is greater than 10 ng/ml. When die DRE is negative and the PSA is 4 ng/ml to 10 ng/ml, the PSA density (the PSA level divided by the prostate volume) is used to determine the need for a biopsy.

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Men's Health Erectile Dysfunction