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May 13, 1998

Detection of Early Prostate Cancer: Serendipitous or Systematic?

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(18):1439-1441. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-18-jac80006

To the Editor.—Dr McNaughton Collins and colleagues1 report that more than 25% of cancers detected through DRE and PSA testing are detected by serendipity. Their model for serendipity with PSA testing is based on a single autopsy study that reported that cancers smaller than 1 cm3 seldom raise serum PSA levels above 4 ng/mL.

Previous studies have demonstrated that PSA levels do not reliably reflect tumor volume.2 The extent to which a given volume of prostate cancer will increase the serum PSA level of an individual patient depends not only on the tumor volume, but also on other factors, such as the degree of histologic differentiation of the tumor, the hormonal status of the patient, and the patient's total blood volume. The men in the autopsy study described by McNaughton Collins et al were near death when their blood was drawn for PSA testing. Their nutritional status and pituitary-gonadal axis (which can affect serum PSA levels) were far different from those of healthy men who present for prostate cancer screening.

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