September 3, 1997

PSA Thresholds for Prostate Cancer Detection

Author Affiliations

Walter Reed Army Medical Center Bethesda, Md

JAMA. 1997;278(9):699. doi:10.1001/jama.1997.03550090023013

To the Editor.  —I read with great interest the articles by Dr Catalona and colleagues1 and Dr Carter and colleagues2 regarding prostate-specific antigen (PSA) detection for prostate cancer. On one hand, Catalona et al found that the cancer detection rate was 22% when the screening PSA value was between 2.5 and 4.0 ng/mL and implied that vigilance was necessary in these men with lower PSA values. On the other hand, Carter et al found that considering as normal a PSA between 4.0 and 5.0 ng/mL maintains an acceptable ability to diagnose curable cancer and also suggested that men whose initial PSA level is less than 2.0 ng/mL may have screening every other year.Of great concern is that both studies lacked sufficient numbers of black men, who are known to have a higher prevalence of the disease and a propensity for more advanced cancer at diagnosis.3,4 With