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Alternative Prostate Cancer Screening Strategies

Michel Labrecque, MD, PhD; and Armen Aprikian, MD
[+] Article, Author, and Disclosure Information

From Laval University, Québec City, Québec, Canada, and McGill University, Montreal, Québec, Canada.

Potential Conflicts of Interest: Dr. Labrecque: Consultancy: Collège des Médecins du Québec. Dr. Aprikian: Fees for participation in review activities such as data monitoring boards, statistical analysis, end point committees, and the like: Collège des Médecins du Québec; Consultancy: Ferring, Sanofi, AstraZeneca, Amgen, Abbott, Paladin.

Ann Intern Med. 2013;158(10):778. doi:10.7326/0003-4819-158-10-201305210-00019
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Filtering can add specificity to PSA screening
Posted on January 4, 2014
David L. Keller, M.D.
Conflict of Interest: None Declared
PSA is a "noisy" signal; elevations of PSA can be caused by many benign conditions, such as occult urinary tract infections (including prostatitis), mild trauma due to bicycle riding and other sports, vigorous sexual activity or prolonged abstinence, etc. If a patient's PSA increases enough to trigger a prostate biopsy, the first thing most clinicians do is repeat the test (after ruling out or eliminating possible benign causes of PSA increase). The "noise" obscuring the PSA cancer signal has the helpful characteristic of always being positive (tending to increase the PSA). Thus, a simple and effective "filtering" strategy consists of repeating the PSA several times over an interval of a few weeks, and discarding all but the lowest PSA measured. This last value is the closest to the patient's "true" PSA, contains the best information about the possible presence of malignancy, and is the least likely to trigger an unnecessary biopsy. I have not seen any studies which incorporated this filtering technique, which I propose should be done in order to fairly assess the benefits and harms of PSA screening for prostate cancer.
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