An elevated PSA, which normalizes, does not exclude the presence of prostate cancer

Abstract

The purpose of this study was to determine the incidence of prostate cancer in patients who have an elevated referral prostate-specific antigen (PSA), which subsequently falls to within their normal age-specific reference range prior to prostate biopsy. The study demonstrated that of the 160 patients recruited, 21 (13%) had a repeat PSA level which had fallen back to within their normal range. Five of these 21 patients (24%) were diagnosed with prostate cancer following biopsy, two of whom had a benign prostate examination. The study, therefore, demonstrates that normalisation of the PSA level prior to biopsy does not exclude the presence of prostate cancer even when the prostate feels benign.

Repeating an abnormal prostate-specific antigen (PSA) level: how relevant is a decrease in PSA?

“…A total of 11.1% of cancers in this study would have been missed had prostate biopsy been deferred in PSA-normalized men. Our findings confirm those of the above studies [13][14] that PSA can decrease and normalize in men with prostate cancer, and that these may be clinically significant cancers.…”

“…The main limitations of the study by Singh et al 6 were that only 47% of men with an initially raised PSA proceeded to biopsy and follow-up was short at 2 years, meaning there may be cancer cases in the non-cancer group which were not identified within the follow-up period. These limitations were addressed by Boddy et al 13 who, using similar inclusion criteria, repeated an initially abnormal PSA test but proceeded to prostate biopsy in all cases. In 13% of men the PSA returned to normal levels however, 23.8% of these had prostate cancer on biopsy, with high-grade prostatic intraepithelial neoplasia (PIN) diagnosed in a further 14.3%.…”

“…The clinical significance of this degree of variability is debated, with some authors considering a single PSA value to be reliable, [13][14][15] whereas others suggest that a single PSA has limited use and recommend repeating the PSA value before proceeding with prostate biopsy. [4][5][6] Eastham et al 4 examined changes in PSA levels in 972 men who had sera stored on five occasions, 1 year apart.…”