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December 2, 1998

Free PSA for Detecting Prostate Cancer

Author Affiliations

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

JAMA. 1998;280(21):1825. doi:10.1001/jama.280.21.1825

To the Editor.—Dr Catalona and colleagues1 have demonstrated that 20% of biopsies can be eliminated in men whose total prostate-specific antigen (PSA) levels fall in the borderline range (4.0-10.0 ng/mL) and who have a normal digital rectal examination (DRE) by using free PSA monoclonal antibody assays. They reported that of all the patients with total PSA results within this range, only 5% of those with cancers would be missed. Because the likelihood of a positive biopsy finding would increase as the PSA increased within the given range, the authors should analyze their data by looking at only performing biopsies on men with PSA levels between 5.0 and 10.0 ng/mL or between 6.0 and 10.0 ng/mL. It would seem reasonable to assume that a higher proportion of positive biopsies would be found within the group of men still undergoing biopsies, so a smaller number of biopsies would be performed. The cost of performing free PSA assays on 9% of men having a PSA level performed also would be eliminated; thus, health care costs would not be increased unnecessarily.

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