Spring 2006 Edition

Dr Thomas Stuttaford defends the PSA test

Dr Thomas Stuttaford

“Not perfect but still vital” says the Times health correspondent.

A recent article in the Times by Dr Thomas Stuttaford made a strong case against the criticism being levelled at the PSA test. This is an extract from his article:

“No one has ever denied that the PSA test has faults. There are false positives – tests in which a patient is shown to have an abnormal PSA, though subsequent tests reveal an apparently normal gland. As a result of these apparently misleading results, some patients have had to undergo tiresome, uncomfortable tests. In other cases an early single PSA test may give a false negative result, suggesting that all is normal although cancer is present. Fortunately, these tests affect only a minority of patients. The mistake is to regard a single PSA test as giving a definitive answer.

Repeated PSA tests at regular intervals – which all men over 40 should have if there is a family history, and all men over 50 regardless – will usually reveal false negatives as the PSA, although low, will be rising abnormally quickly.

The PSA test is like a sieve; it will collect patients who need further investigations, which in turn usually provide a more precise diagnosis and, importantly, prognosis. Likewise, serial PSA testing detects many cancers when there is a false negative PSA.”

Our view in the Prostate Project is that the PSA test is a crucial first line of defence and a vital option for all men over 50. It is not the first measurement of PSA that is important, but what happens to the PSA level over a number of years.