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Lower PSA Threshold Not Being Used to Recommend Biopsy

Annualized rate of change in prostate-specific antigen level strongly associated with biopsy

WEDNESDAY, Dec. 14 (HealthDay News) -- Men with prostate-specific antigen (PSA) levels of less than 4.0 ng/mL are rarely sent for biopsy, according to a study published online Dec. 13 in the American Journal of Preventive Medicine.

Steven B. Zeliadt, Ph.D., from the Department of Veterans Affairs Medical Center in Seattle, and colleagues described biopsy patterns and investigated whether PSA thresholds below 4.0 ng/mL are used to recommend biopsy. Data from laboratory and biopsy records collected from 59,764 men in a large health plan between 1998 and 2007 were reviewed. In the 12-month period following a PSA test, their follow-up was categorized as biopsy, urology visit without biopsy, additional PSA testing with no urology visit, or no PSA-related follow-up. Data were analyzed between 2010 and 2011.

The investigators found that, within 12 months of PSA testing, biopsy was conducted in 28, 2.9, and 0.4 percent of tests with PSA levels of 4.0 ng/mL or more, between 2.5 and 4.0 ng/mL, and less than 2.5 ng/mL, respectively. Of the elevated tests (PSA ≥4.0 ng/mL), more than 40 percent were followed by a urologist visit without a biopsy, and more than 30 percent had no PSA-related follow-up within 12 months. The annualized rate of change in PSA level (PSA velocity) correlated strongly with biopsy, especially in cases with absolute PSA of less than 4.0 ng/mL. No discernable temporal trends were noted for biopsy thresholds or practice patterns based on lower levels of PSA or PSA velocity.

"The present study highlights a generally low biopsy rate for suspicious PSA values," the authors write.

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