Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor
To the Editor.—Dr Catalona and his colleagues1 suggest that it is acceptable to forgo further workup for patients with total PSA values of between 4 and 10 ng/mL and a free PSA value of greater than 25% because such patients would have an 8% probability of cancer after a PSA screening (their Table 6). However, the authors do not recommend this approach when the probability of cancer is 16% or 20% after a free PSA screening, even though both have a less than 25% probability of cancer before a free PSA screening. This begs the question of what is the appropriate threshold?
Peirce JC, Hoffman RM. Free PSA for Detecting Prostate Cancer. JAMA. 1998;280(21):1825. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-21-jbk1202