NEW YORK--Although it has revolutionized the early detection of prostate cancer, PSA testing can, and must, be improved to become the powerful tool needed in the fight against this disease, H. Ballentine Carter, MD, said at a conference on prostate cancer at Lenox Hill Hospital.

"PSA testing is virtually synonymous with diagnosis today. It is the most sensitive indicator we have, though not the most specific," said Dr. Carter, associate professor of urology, Johns Hopkins Medical School. The main issue is its inability to unerringly distinguish between prostate cancer and benign prostatic hypertrophy (BPH), he said.

Cancer or BPH?

Currently, the most effective way to optimize interpretation of PSA levels is to look at the rate of PSA change, Dr. Carter said. He pointed out that although PSA levels vary with both prostate cancer and BPH, the deviation between consecutive PSA measurements relative to elapsed time is distinctively different between the two conditions.

Less than 5% of men without prostate cancer have increases in PSA greater than 0.75 ng/mL per year; therefore, an increase greater than this should raise suspicion of prostate cancer, Dr. Carter said. Accurate interpretation requires at least three measurements at an interval of no less than 6 months and, ideally, 9 months to a year.

"That means it would take almost 2 years to accumulate a good PSA history," he said, adding that "if more men start having PSA at age 50, it will be reasonable and feasible to do this."

He also promoted age-specific PSA standards (rather than level alone) as a means of decreasing false positives in older men and increasing detection in younger men.

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