Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Dr Eastham and colleagues1 found that many men with abnormal levels of prostate-specific
antigen (PSA) were found to have normal levels when retested 1 year later.
The authors thus concluded that PSA lacks specificity and that a single PSA
test is unreliable. They recommend confirmatory assessment before undergoing
further testing. We disagree with this logic. Specificity can only be improved
by more stringent test criteria, not by further testing. Because the proposed
ancillary evaluation includes biopsy, the interval of a few weeks is unnecessary
for establishing a diagnosis or reducing adverse effects, but the delay is
likely to increase the patient's anxiety and fear.
Hakama M, Auvinen A. Reliability and Validity of Prostate-Specific Antigen—Reply. JAMA. 2003;290(13):1705-1706. doi:10.1001/jama.290.13.1705-a