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October 1, 2003

Reliability and Validity of Prostate-Specific Antigen—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(13):1705-1706. doi:10.1001/jama.290.13.1705-a

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.