| Leonard Evens 2004-10-04, 2:21 am |
| MB wrote:
> Len:
>
> So far, I've gotten the impression that 4 is the magic number, not 2.5.
> However, that is assuming a continuing low velocity increase!
All these numbers are arbitrary. If you set it at a higher level, a
greater percentage of cancers will be found on biopsy, but more will be
missed. If you set it lower, fewer cancers will be missed, but the
"yield" in cancers from biopsies will be lower, which means more
unnecessary biopsies. Doctors have to choose some cutoff. The
original was 4.0, but that was later changed to age adjusted cutoffs
starting at 2.5 for younger men and rising to 4.0. But now some doctors
think that they should use 2.5 for all men. It does seem more important
to place emphasis on the rate of increase of PSA rather than on any
cutoff, but if it gets too high, your doctor may still think a biopsy is
warranted. There is always an art to medicine in addition to
(uncertain) science. A doctor may have a feeling based on everything he
knows about you that he should order an biopsy in your case where he
wouldn't in another case. I think almost every urologist will want to
do a biopsy in a man under 70-75 if the PSA gets much over 4. But they
may be willing to tolerate higher values in older men. For men past 80
they probably won't do PSA testing at all, and some may drop testing
even for men in their 70s.
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