Improving Specificity of PSA Screening with Serum and Urine Markers – Who Doesn’t Need a Prostate Biopsy?
Daniel W. Lin, MD, Chief of Urologic Oncology at the University of Washington, discusses improving the specificity of PSA screening using serum and urine markers to determine which patients do not need a prostate biopsy. He lists the ideal biomarker characteristics, including sensitivity and specificity, correlation with disease outcome, reproducibility, low cost, quick and easy assay, and high negative predictive value. He then discusses some of the major studies done on pre-diagnosis biomarkers for prostate cancer, highlighting how PHI score, 4Kscore, and PCA3, among other markers, all significantly reduce the biopsy rate compared with older diagnostics like percent free PSA. Dr. Lin concludes by noting how urologists can further reduce unnecessary biopsies through smart screening strategies, including biennial rather than annual PSA screenings and considering not biopsying men with low early PSA scores.Read More