...an anonymous reader asked.
A PSA level of 3 does not indicate cancer.
Yet, it is possible to have a PSA of 3 with prostate cancer.
PSA is a very successful screening test, and helped to detect and treat prostate cancer earlier.
However, to make this screening test successful and efficient, thresholds had to be established.
Based on several very large studies these thresholds were set, because it was found, that with PSA levels below 4 the risk for prostate cancer is relatively low (see previous post Jan 28).
With PSA levels above 4 the risk was significantly higher.
These are statistical - empirical values.
However, it is obvious, that by setting a "threshold" (or cut-off) based on statistics (in contrast to personalized medicine), we always will have some patients who fall into the low risk group and do have cancer; and will find many patients with "elevated PSA" who have no cancer.
3 comments:
Greetings,
T1c prostate cancer is diagnosed because of an abnormal PSA in the setting of no palpable abnormality on Digital Rectal Examination and the cancer tumor is found in one or both lobes by needle biopsy.
In population screened situations, where a raised PSA is reported, a common clinical staging, utilizing the TNM classification, is T1c, which is “tumor identified by needle biopsyâ€.
However, when prostate cancer is found prior to biopsy, through the application of newer imaging techniques of the prostate, such as dynamic contrast-enhanced MR imaging and 3D MR spectroscopic imaging, and that prostate cancer is confirmed by subsequent biopsy, would the clinical staging, prior to treatment, still remain T1, or could the clinical stage be up-graded to reflect a T2 or even T3 classification depending on the imaging results?
In other words, given that "magnetic imaging is now widely used for staging before treatment and accumulating data indicate the utility of this technique with magnetic resonance spectroscopy in staging and follow-up" , ( Imaging of Prostate Cancer. Oehr P, Bouchelouche K, Curr Opin Oncol. 2007 May;19(3):259-64) can the staging system reflect this improved imaging so as to better delineate T1 from T2 and T3 classification?
Thank you for your expertise,
David
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