Repeat PSA Test Recommended Before Prostate Biopsy

A study has found that levels of prostate-specific antigen (PSA) fluctuate in men, so that a moderately elevated level does not necessarily warrant a prostate biopsy. The finding was reported in the May 28, 2003, issue of the Journal of the American Medical Association (JAMA).

The PSA blood test is part of routine screening for most men over 50, and when moderately elevated levels of PSA are found, a biopsy is currently recommended. In the retrospective study, involving 972 men with a median age of 62, researchers found that while 21% had an elevated PSA (> 4.0 ng/ml) at some point over a four-year period, the level later returned to normal in nearly 50% of the men and remained normal in further tests. As a result, the researchers suggest that a biopsy not be performed until the PSA test is repeated.

"A single, elevated PSA level does not automatically warrant a prostate biopsy,” said lead author Dr. James Eastham, a surgeon in the department of urology at Memorial Sloan-Kettering Cancer Center (New York, NY, USA). "We recommend having the findings confirmed by repeating the PSA test after waiting at least six weeks. Even if the repeat test shows an elevated level, prostate cancer will only be discovered in about one quarter of men who undergo biopsy.”