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Should Prostate Cancer Test Threshold be Lowered?

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Every year, close to 190,000 men are diagnosed with prostate cancer. Around 30,000 will die from it.

One of the best ways to screen for prostate cancer is with the PSA blood test. When the result is greater than four, a biopsy is generally recommended to look for cancer.

Now a study in the New England Journal of Medicine suggests that cut off may be set too high, that too many prostate cancers are being missed.

Using a mathematical model, researchers from Harvard estimate that using a threshold of four-- 82 percent of cancers in younger men, those under 60, and 65 percent of cancers in older men would be missed.

So should the PSA threshold for considering a biopsy be lowered? Not necessarily.

Some argue yes, because earlier detection means earlier treatment. However, an editorial in the same journal questions the overall benefits of such a move.

A lower threshold would mean more biopsies to rule out cancer... an uncomfortable procedure that may turn out to be negative. And while more biopsies could lead to more cancer diagnoses, it does not necessarily increase a man's chance of survival.

Even so, the study suggests that for some men, a PSA under four may warrant a closer look. If the number is rising quickly, or high risk groups like African Americans and those with family history of prostate cancer.

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