Moderator, Raoul S. Concepcion, MD, presents a case study of a man whose father was diagnosed with prostate cancer at age 67. When the man is 42 years old, he requests that his primary care physician take a PSA test, which indicates a reading of 1.4 ng/mL.

The discussion on the optimal time to begin PSA screening should be individualized for each patient, Steven E. Finkelstein, MD, believes. There are indications that getting a PSA reading at 40 offers prognostic value for the future. A PSA of 1.4 ng/mL suggests an elevated risk for prostate cancer but a majority of men with this reading do not develop metastatic disease, Stephen J. Freedland, MD, states. At this point, it is important to consider other factors in addition to PSA, such as the depth of family history.

The Prostate Cancer Prevention Trial found that men with a PSA less than 1 had almost a 16% chance of having cancer, E. David Crawford, MD, notes. Additionally, of these men, 25% were likely to have Gleason 7 or higher tumors. Additionally, another study indicated that men with a PSA of 1.4 to 4.0 were significantly more prone to having prostate cancer, when compared to less than that amount.

For these patients, Crawford recommends utilizing other biomarkers, such as detecting PCA3 levels. Additionally, other indicators such as PSA density and percent free PSA may provide a better indication of the patients risk than PSA alone. If these indicators still return in a gray zone, Crawford would order a prostate biopsy. PSA testing alone is no longer sufficient to determine if a biopsy needed, Concepcion reiterates.