PSA Testing

PSA testing:
Controversial as PSA SCREENING was adopted in the absence of efficacy data from randomized trials
There is a small absolute survival benefit with PSA screening when patients followed for 9 yrs
On the other hand, ED, incontinence, and bowel dysfunction are all risks of aggressive prostate cancer care
When a cutoff level of 4 is used, sensitivity of PSA has been estimated to be about 70 to 80 percent, while the specificity is estimated to be about 60 to 70 percent
PSA velocity and free: bound ratio are 2 new tests, which are being used more frequently
PSA velocity <0.75 if suggestive of cancer as opposed to BPH
Lower free:bound PSA ratio is suggestive of cancer as opposed to BPH

Our patient had PSA as DIAGNOSTIC test to explain his anemia and extensive lymphadenopathy
Causes of elevated PSA include:
Prostate Cancer
Prostate infection/inflammation (PSA as hi as 75)
Perineal inflammation/trauma - prostate biopsy, cystoscopy
BPH
Paraneoplastic ie) PSA producing follicular non-Hodgkin’s lymphoma, breast and ovarian ca

PET is often considered a "diagnostic tool," but there are many limitations to that usage
Remember that PET scans reveal all FDG-avid tissues including many malignancies and infections
PET scans are most frequently used in the evaluation of pulmonary nodules, cancer staging, and cancer surveillance
Likewise, the most evidence exists in these populations
Most recommend against PET scans as a diagnostic modality and would recommend a tissue diagnosis as the next step in our pt

(Ellen Eaton MD, 12/7/10)