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PSA TestingHow Much is Too Much?


For more than 20 years, the PSA test has been widely used as the gold standard for prostate cancer screening. In one of the most dramatic reversals in recent diagnostic science, a recent study at Stanford University School of Medicine and findings by other researchers have now put the utility of the procedure in grave doubt.

Indeed, The PSA era is over in the United States, said Thomas Stamey, MD, professor of urology and lead author of the study published in the October 2004 issue of the Journal of Urology. Our study raises a very serious question of whether a man should even use the PSA test for prostate cancer screening any more, Stamey said. The researchers opinion carries great influence, since it was Stameys work in the late 80s that propelled PSA testing into widespread use (and prompted the corresponding practice of routinely removing prostates in response to high PSA levels).

As time has passed, however, Stamey has concluded that PSA testing is unable to predict the extent or severity of prostate cancer but, instead, provides a measure of benign prostatic hyperplasia.

Mark Twain once famously quipped that, The report of my death was an exaggeration. The death knell of PSA may also have sounded too soon, since the assay is likely to continue to provide useful data, albeit in far less universal applications. Stamey and his colleagues identified two important and continuing uses for PSA testing in their recent paper. They noted that PSA levels quite accurately correlate with prostate size and that the test thus serves as a direct measure of benign prostatic hyperplasia. Stamey noted that the assay is also helpful for monitoring patients following prostate removal because it can indicate residual prostate cancer that has metastasized.

As with many disease screens, PSA tests now range from assay reagents used in multi-function clinical laboratory analyzer systems to rapidly performed, self-contained kits suitable for point
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