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September 3, 1997

PSA Thresholds for Prostate Cancer Detection-Reply

Author Affiliations

Johns Hopkins Hospital Baltimore, Md

JAMA. 1997;278(9):701. doi:10.1001/jama.1997.03550090025017

To the Editor.  —Dr Moul has compared a series of black men (at Walter Reed Hospital) who underwent radical prostatectomy for both palpable and nonpalpable prostate cancers with our series of men (at Johns Hopkins Hospital) with only nonpalpable prostate cancers who underwent radical prostatectomy. It is well known that men with nonpalpable prostate cancer have a greater chance of cure with surgery and thus the 2 series are not comparable. The PSA level that will both maintain the detection of curable prostate cancer and minimize the detection of insignificant cancers is unknown. Our data—based primarily on white men—suggest that this level is 4.0 ng/mL in the setting of a nonsuspicious digital rectal examination, and that below this level the risk of detecting small cancers is high. The recently published data demonstrating a 22% cancer detection rate in men (mostly white) with a PSA level between 2.6 and 4.0 ng/mL also demonstrate