Is PSA a valuable indicator ?
PSA is a valuable indicator but it is never a diagnosis. This begs the urgent question: “How likely is it that I have prostate cancer if my PSA level is increased?”.Here is a tool to help you calculate the statistical probability. We recommend that you read the following information to be able to understand the PSA level and what it means.
PSA level as an indicator has been the subject of discussion for years. It can contribute to early detection of prostate cancer, but it also causes massive overdiagnosis and overtreatment with all of the consequences for patients and cost for health care providers.
Calculate your prostate cancer risk based on the PSA value
Please enter your PSA value between 1 and 50 [ng / ml] in the lower field
Studies evaluate PSA screening differently
Large studies in the last few years have come to differing conclusions regarding PSA screening (testing every man's PSA level frequently). While some studies report that PSA screening has no positive effect on the probability of death by prostate cancer (PLOCO), others come to the conclusion that it has reduced the relative death rate caused through prostate cancer by 20% (ERSPC).
This may seem confusing at first, but is understandable in light of the fact that prostate cancer tumors almost always grow slowly. Many men rather die with the cancer than from the cancer. Because of this, the benefits, especially of radical therapy, often do not outweigh the negative side effects, long-term damage and costs. Nevertheless, prostate cancer is one of the most frequent causes of death, and is not to be taken lightly.
Although other, more exact blood markers, such as Liquid Biopsy, PCA3, PHI, EDIM, AMACR, CTC, EPCA, p2PSA - contact us to get access to extended biological tests - are in the trial stage, PSA level is still the standard indicator for reasons related to cost and experience.
MRI - a more precise way to diagnose prostate cancer
A new approach
When the possibility of prostate cancer appears, usually as the result of an elevated PSA level, the next step, traditionally, is to recommend a transrectal punch biopsy—which delivers a success rate of just 30-35%. That’s not good enough for us… or for you.
Here at Vitus, we prefer to use the most up-to-date procedures: MRI (Magnetic Resonance Imaging) and MRI-guided and transperineal 3D mapping, giving a successful detection rate of 85-100%. So we can avoid unnecessary invasive procedures.
The traditional method
In a standard prostate cancer biopsy, the cancer can only be found if it happens to be in one of the places sampled. If no cancer is found, and the PSA level increases again, another biopsy is carried out, and so on, until the cancer is large enough to be detected or it’s detected by chance.
With this sort of transrectal biopsy, it is also possible that the danger of the cancer may be underestimated and, because it is an invasive procedure, there is always the chance of infection.
When is the PSA considered to be high or “increased” ?
To quote a few statistics: the probability of cancer when the PSA level is between 4 and 10 is 25-40%. This means that 60-75% of biopsies would be unnecessary, especially rectal punch biopsies, which have a very low accuracy rate. On the other hand, with a threshold value of 4ng/ml, 20-40% of carcinomas in early stages are overlooked.
This means that it is a question of weighing alternatives. If we set the threshold too low (e.g. 2 ng/ml as in the USA), prostate cancer tumors in early stages will be found more frequently, but more unnecessary biopsies will be performed. Because of today's highly precise and harmless multiparametric magnetic resonance imaging (MRI) though, it is definitely worth discussing whether the threshold could be set at a lower value (<=2 ng/ml).
The ratio of free to complexed (bound) PSA does not increase the diagnostic value of PSA level, but is also the subject of controversy and discussion.
If prostate cancer is suspected, an MRI is the safest method to exclude prostate cancer. "Safe" means not only that it provides statistical certainty but also that it isn’t harmful to the patient’s health.
Source: Roddam, Andrew W., et al.”Use of prostate-specific antigen (PSA) isoforms for the detection of prostate cancer in men with a PSA level of 2-10 ng/ml: systematic review and meta-analysis”. European Urology 48.3 (2005): pp. 386-399.