Who's not Over-Diagnosing Prostate Cancer?

Prostate biopsy referrals not overly aggressive study shows

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) In the prostate cancer world these days, you hear the terms over-diagnosis and over-treatment  being thrown around a great deal. So just how aggressive are physicians in diagnosing the disease? Apparently, not very - at least in one area of the country.

Biopsies are the only way to definitively diagnose prostate cancer, but there's no true consensus on when this should be done. A 10-year study of referral patterns in one area of the United States found physicians tend to be quite conservative in sending men for biopsies.

"Work with your doctor in determining if a prostate biopsy is needed."

Lead author, Steven Zeliadt, Ph.D., of the Department of Veterans Affairs Medical Center in Seattle, Washington, learned that members of Group Health, a health plan in Washington State and Northern Idaho, were not particularly aggressive in referring men for biopsies.

Physicians have long argued about what prostate specific antigen (PSA) level should signal the need for a biopsy. The generally accepted standard has been 4.0 ng/mL.

However, some have suggested lowering the standard to 2.5 ng/mL, measuring PSA velocity (change over time) or having no threshold at all. 

For this study, participants included 54,381 men who were given 111,369 tests between 1997 and 2008. Researchers looked at the PSA level and velocity and the follow-up testing and care given. Here's what they learned that men who had PSA values greater than 4.0 ng/mL:

  • 28 percent were referred to biopsy within a year
  • 38 percent had a follow-up visit with a urologist
  • Biopsies were more common earlier in the study.
  • Thresholds for biopsy referral remained consistent over the study period.
  • PSA velocity, particularly rapidly rising values, was strongly linked to biopsies.

"Even small changes in the PSA threshold can substantially alter the potential harms and benefits of screening. However, providers have limited evidence to help them discuss this with patients," concludes Dr. Zeliadt, who is affiliated with Group Health Research Institute.

Results of this study are published in the January, 2012 issue of American Journal of Preventive Medicine.

Reviewed by: 
Review Date: 
December 12, 2011
Last Updated:
December 15, 2011