DIAGNOSING PROSTATE PROBLEMS: PSAS AND BIOPSIES

Urologists such as Dr. Fred Lee, a clinical professor in radiology and urology at Wayne State University in Detroit, express alarm about the increase in the number of biopsies as a result of using the PSA as" a screening test. While Dr. Lee agrees with the practice of recommending a biopsy to men with PSA blood levels higher than 10 ng/ml, he takes issue with the common practice of ordering ultrasound and an immediate biopsy for men who fall within the gray area between 4 ng/ml and 10 ng/ml (a large portion of the older male population who have BPH are within this range).

According to Dr. Lee, a biopsy, "which is often presented as a harmless approach, does pose a risk to the patient. Because die biopsy sample is taken through the rectum, the process introduces bacteria into the prostate. Although prophylactic antibiotics are given, they don't reach high levels in the prostate.

"[The prostate is] a gland that doesn't concentrate antibiotics very well. Once a man gets a low-grade infection in the prostate, it tends to stay for a long time. Then the PSA goes higher, the patient goes in for another checkup, and what does the doctor do? He biopsies a second time. So they're in a vicious cycle."

A new development in PSA testing may prevent unnecessary biopsies for the 25 percent of men with PSA levels in the 4 ng/ml to 10 ng/ml range. The PSA test spots two kinds of molecules: free and complexed. The latter are associated with cancer and are difficult to spot, whereas the free molecules are easy to spot and are associated with an enlarged prostate or recent ejaculation. When investigators studied the ratio of free to total PSA in 115 men with total levels ranging from 4 ng/ml to 10 ng/ml, they discovered that a ratio greater than 1.5 accurately indicated an absence of cancer. They suggested using this ratio to lower the number of men getting biopsies. A new national trial involving 12,000 patients at eight medical centers around the U.S. has been launched in an effort to verify results.

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