Prostate Cancer Detection at Low Prostate Specific Antigen

Abstract

Approximately half of the tumors missed with PSA 0 to 4 ng./ml. had aggressive characteristics (Gleason score 7 or greater, Gleason 4-5 components) and were organ confined. These tumors should be diagnosed and treated according to the present understanding of their natural history. More sensitive and selective screening strategies are needed. Presently a wrong "window of opportunity" is used for early detection of prostate cancer.

Potential predictive factors of positive prostate biopsy in the Japanese population

“…Recent population-based screening reports showed that only one in ten men with prostate cancer will be identified with an elevated PSA level at initial presentation [5,7]. However, of these 10 men, only up to one in four will be identified as having cancer, because most intermediate elevations of PSA are the result of benign disease such as benign prostate hyperplasia or chronic prostatitis.…”

“…Recent trends indicate a decreased number of deaths due to prostate cancer in the United States, which may indicate that early detection and intervention are effective [4]. Randomized trials are underway in Europe, the United States, and Asia to examine the value of PSA screening as well as other methods to detect prostate cancer early [5,6].…”

Prospective study of correlations between biopsy-detected high grade prostatic intraepithelial neoplasia, serum prostate specific antigen concentration, and race

“…To help compensate for the potential confounding influence of undetected malignancies, our analyses of HGPIN and PSA were stratified by the three PSA ranges of Ͻ 4.0 ng/mL, 4.0 -9.9 ng/mL, and Ն 10.0 ng/mL. In the PSA range of 0.1-3.9 ng/mL, only 10 -19% of patients with an abnormal DRE will have detectable disease with an initial biopsy, 22,23 and Ϸ 25% will have disease detected with repeat biopsy procedures. 17 Our findings that the unadjusted and age-adjusted PSA levels were significantly greater in the presence of HGPIN than in the absence of HGPIN among men with PSA levels Ͻ 4.0 ng/mL and that HGPIN was remarkably infrequent among men with PSA levels Ͻ 1.0 ng/mL provide circumstantial evidence that HGPIN may cause an increase in the serum PSA concentration.…”

Prostate biopsy in subjects with abnormal transrectal ultrasonography but normal digital examination findings and prostate-specific antigen levels

“…However, one study showed that the rate of detection of clinically important prostate cancer among men with a PSA level of 2.6-4.0 ng/ml was the same as that among men with PSA concentrations of more than 4.0 ng/ml [10]. Catalona et al [11] demonstrated that the majority of cancers detected at serum PSA levels between 2.6 and 4.0 ng/ml showed features characteristic of medically important tumors and Schroder et al [12] also reported that a PSA cutoff level of 4.0 ng/ml would miss large numbers of cancers, about half of which might have aggressive characteristics and may still be organ confined. In addition, Recker et al [13] found that 53.8% of patients with cancer detected within the PSA range 1.0-3.0 ng/ml who underwent radical prostatectomy had cancer volumes greater than 0.5 ml.…”