Utility of prostate specific antigen (PSA) as a primary screening test for prostrate cancer at the VA New Jersey health care system (VANJHCS)

Background: Prostate cancer is the most common cancer among U.S. men, accounting for 33% of all cancer cases in males. Primary screening includes a Digital Rectal Exam and a Prostate Specific Antigen (PSA) test in asymptomatic men >=50 year. The current PSA cut off of is at 4.0 ng/ml. However prostrate cancers cases below this cut off are often missed.Objectives: To assess the utility of PSA cut off level of 4 ng/ml as a primary screening test and to evaluate PSA test characteristics at the VANJHCS. Method: Retrospective case-control study. Cases (158 pathology confirmed cases with prostate cancer) and controls (71 pathology confirmed cases without prostrate) were obtained from via electronic medical records at VANJHCS. Data was analyzed using SAS 9.2.Results: Among cases; 9% had PSA < 4.0 ng/ ml, while 43% had PSA between 4 to 9.9 ng/ml and 48% had PSA >=10 ng/ml. Among controls 32% had PSA < 4.0 ng/ ml, 53% had PSA between 4 to 9.9 ng/ml and 15% had PSA >=10 ng/ml. The sensitivity of PSA screening was 91%, the specificity was 32%, predictive value of positive test was 75% and predictive value of negative test was 61%.Conclusion: Based on our study results, 9% of this population would have missed the diagnosis of prostate cancer utilizing the current cut off, thereby missing/delaying opportune management of prostate cancer. Additionally 68% would have been subjected to unnecessary testing/management. Further research into the utility of PSA cut off at 4.0 ng/ml may be warranted. ed.