My Dad always had a low PSA score. It meant doctors never thought he had a life threatening illness. At last there seems to be some hope that the PSA test is being refined.
The hoopla about the PSA test has been going on for more than a decade. At first it seemed almost like a panacea - men would be tested, cancer identified and eradicated - all would be good. But in the years since its introduction the PSA test has revealed many more men who have some kind of precursor to cancer which was not about to inevitably lead to death or illness. With so many so called ‘false-positives’ there has been much debate about whether the risks of the test were greater than the benefits of it. As a relatively young man, I’m only 39, its clear that the risks for me are much worse than the benefits. Even though something like twenty per cent of my age group probably already had some kind of precursor to the cancer – though many of these precursors wouldn’t hurt my life.
At last, though, the debate is moving on.
This month’s Journal of the National Cancer Institute has an interesting article about PSA. Rather than just trying to work out an absolute level, it comes to the conclusion that watching the pattern of the PSA is what is perhaps more important.
"In summary, when compared with a single PSA level threshold, the rate at which PSA levels reach a threshold value (PSA velocity) may provide useful information for identifying men who need further evaluation and/or closer surveillance for the presence of life-threatening prostate cancer."
My Dad had a pile of PSA tests. They all came up with numbers less than the supposed threshold of 4.0 ng/mL -whatever that means. Because it was below the threshold nobody thought it was important. But in the end he died.
The final conclusion of this paper, gives some hope that patients like Dad would not be overlooked in the future.
"When PSA levels are below 4.0 ng/mL, even small rises in PSA levels should prompt the consideration of the presence of a biologically important prostate cancer."
There is more discussion in the same journal here or in the New York Times here.