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The 10 Great Foibles of PSA Testing
For Prostate Cancer

20 Years Following First PSA Approval by F.D.A.,
Certain Weaknesses (FOIBLES) Now Apparent

Slideshow of
10 PSA Foibles

(or View Slide List)

First Quarter, 2006 - This year marks the 20th anniversary of the PSA test. In 1986, the test was first approved by the U.S. Food and Drug Administration for the purpose of "assisting in prognosis and management of patients with prostate cancer." Rapidly, however, PSA testing was extended to the diagnosis of prostate cancer. PSA screening for the disease was an inevitable consequence, and therein lies the current issue. PSA testing is an imperfect way to find prostate cancer.

2006 Guidelines from ACS
2006 Guidelines from ACS
In the slide presentation above are described the 10 great confounding variables that make PSA testing for prostate cancer an imperfect science. These confounding variables serve to diminish the relationship between serum PSA levels and prostate cancer. They are foibles, ie, weaknesses or failings, which help to explain why PSA is currently a less-than-perfect way to diagnose prostate cancer.

This special report was stimulated in part by two recent reports, denoting changes in prostate cancer over the past 2 decades and helping to establish certain limitations on the current use of PSA testing. The 2 pivotal articles are:

T. A. Stamey, et al.The Prostate Specific Antigen Era in the U.S. is Over for Prostate Cancer: What Happened in the Last 20 Years J.Urol. 172: 1297, 2004.
Conclusion: Serum PSA levels are no longer related to prostate cancer, but only to the volume of BPH present. There is an urgent need for a better serum marker!

I. M. Thompson, et al.Operating Characteristics of Prostate-Specific Antigen in Men with an Initial PSA Level of 3.0 ng/ml or Lower. JAMA 294:66, 2005.
Conclusion: There is no cutpoint of PSA with simultaneous high sensitivity and high specificity for monitoring healthy men for prostate cancer, but rather a continuum of prostate cancer risk at all values of PSA.

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