PSA TestingImportance of Multiple Markers

Ian Thompson MDDepartment of Urology

University of Texas HSCSan Antonio, TX

PSA (ng/mL)

Ris

k

0 1 2 3 4

0.0

0.1

0.2

0.3

0.4

0.5

Risk of Prostate Cancer

0 1 2 3 4

0.0

0.1

0.2

0.3

0.4

0.5

Risk of High-Grade Disease

Thompson IM et al. N Engl J Med 2004;350:2239-46

Population Screening with PSATrue Outcomes

4.0+

PSA 4+ 7.6%Positive biopsy 25%High grade 19%

Screen 10,000 Men

PSA 4+ 760Cancer 190High grade 36

PSA <4 9240Cancer 1386 High grade 208

Normal PSA 92.4% Positive biopsy 15%High grade 15%

<4.0

PSASEER, PCAW, Prostate Cancer Prevention Trial Data

Pause for a moment

You read in a throwaway magazine about the benefits of a bASA daily.

You worry about GI upset.You ask your own PCP, should I

take a bASA?How do they assess your risk?

10-year risk of coronary artery disease

So why do we use just PSA?

DRE

Age

Race/ethnicity

Family history

Prior negative biopsy

PSA velocity

Let’s just take some examplesPoint in play: Dichotomy of DRE as a solitary measure of risk

55 yo WM, -FHx, DRE+, no prior bx, PSA 0.3 – recommendation?

– Biopsy, right?

68 yo AAM, +FHx, DRE-, no prior bx, PSA 2.4 – recommendation?

– No biopsy, right?

This example (DRE dichotomy)

55 yo WM, -FHx, DRE+, no prior bx, PSA 0.368 yo AAM, +FHx, DRE-, no prior bx, PSA 2.4

What are these men’s risk of disease?1st man – Cancer=13% High grade

cancer=1%2nd man – Cancer=31%. High grade – 11%.

Doesn’t make any sense, correct?

The Next Step

• Adding Body Mass Index

• Adding Population ‘Norms’

• Adding pro-PSA