Is PSA a valid indicator of Prostate Cancer risk? According to a recent article in the LA Times, it may not be as significant as thought. However, I disagree with the quick dismissal of this test because it does not take into consideration a few important factors.
1) The authors fail to mention the value of % Free PSA, which helps increase the accuracy of PSA immensely.
2) My other criticism is, even if PSA and %Free PSA was not as helpful as once thought, I do not see what harm having this extra screening test poses. At worst, it tells you nothing. At best, it provides insight what is going on inside. No test should be used by itself as 100% diagnostic. That is where clinical knowledge, symptoms, and physical exam fill in the blanks. Having an man’s PSA and especially % Free PSA tested regularly can only HELP to monitor prostate health. Therefore, I will continue to check, and watch to see the rate of both of these parameters rise when assessing my male patients’ risk for prostrate cancer.
3) In sum, I feel while PSA by itself may not be a test to “hang your hat on”, PSA, taken over time to see rate of increase (PSA Velocity), in addition to testing for % PSA (which, when a PSA is elevated is a GREAT indicator of whether the increased PSA is due to a benign condition i.e. BPH or something more serious like Prostate Cancer), along with following up with a thorough medical evaluation for symptoms, this combination can only help identify problems with the prostate sooner. The sooner diagnosis, the more time one has to investigate treatment options. Time is power. Screening tests provide time.