A recent study from the University of Ottawa and The Ottawa Hospital (Canada) suggests that unnecessary biopsies could be significantly reduced by simply repeating abnormal PSA tests. The results appeared recently in the journal Mayo Clinic Proceedings.
The PSA test has been used to screen for prostate cancer for > 20 years; however, more recently the test has been criticized for prompting unnecessary biopsies. This study is the first to explore the effect of repeat PSA testing in men being screened for prostate cancer.
“A high PSA level is associated with a greater risk of prostate cancer, and PSA screening can help detect cancer at an earlier, more treatable stage,” explained study lead Rodney Breau of the University of Ottawa and The Ottawa. “However, PSA levels can also fluctuate because of infections, physical activity and laboratory error. Because of this variation, we implemented a protocol to always repeat an abnormal test before referring a patient for a biopsy. We had a hunch that this would reduce unnecessary biopsies and our study shows that our suspicion was correct.”
The researchers examined the medical records of 1268 men who underwent screening that resulted in an abnormal PSA test 2008–2013. Twenty five percent of these men received normal results following a second PSA test. The team also reported that 62 % of men with two abnormal tests underwent biopsies compared with 28% of men with conflicting results – a reduction of 55%.
The team found further supporting evidence in that just 3 % of men biopsied following conflicting results received a cancer diagnosis within a year, compared with 19 % of men with two abnormal tests.
“It is clear to me that any man with an abnormal PSA test should have this test repeated before a decision to biopsy,” added Breau. “Some doctors and patients may be worried about missing a significant cancer diagnosis if they forgo a biopsy after conflicting test results, but our study shows this is very unlikely. It is also important to remember that the PSA test is just one factor we evaluate when deciding to do a biopsy, and these decisions are always made together with the patient, and can be revisited if risk factors change.”
“Our study has important implications for patients and the health-care system,” concluded co-lead author Luke Lavallée also of The Ottawa Hospital. “Prostate biopsies can be uncomfortable and inconvenient for patients, and in rare cases, they can lead to infections, so we only want to do these if they are really necessary. Prostate biopsies are also expensive for the health-care system.”