PSA Test Mostly Useless Without Prostate Ultrasound

© Eric Yarnell, ND, February 1, 2005.

For decades now the prostate specific antigen (PSA) blood test has been considered the best way to determine if a man has prostate cancer. There has long been concerned voiced about the overly simplistic idea that more PSA automatically meant dangerous forms of prostate cancer were present. A series of large clinical trials has now confirmed that in white men at least, a PSA less than 10 essentially cannot tell one anything about whether dangerous prostate cancer is present or not.1

“For white men these observations constitute confirmatory evidence that serum PSA between 2.5 and 10 ng/ml is unrelated to prostate cancer and is most surely caused by benign prostatic hyperplasia (BPH).” Thomas Stamey, MD2

The reasons for this are twofold. First, non-dangerous prostate cancer (it won’t kill you) is extremely common, with 8% of men in their twenties already having it and 83% by age 70!3 Second, enlargement of the prostate (benign prostate hyperplasia or BPH) is also very common, and as the prostate gets larger, more PSA is always made. Also we must realize that prostate cancer is not a single disease but a spectrum of conditions, and that most men with prostate cancer have a mild form that will never be a problem for them.

Therefore without knowing the size of the prostate, there is no way to interpret a PSA below 10, at least in white men (not enough research has been done on men of other races but there are at least hints this is the case with Hispanic men). Only a transrectal ultrasound can reliably document prostate volume. A man with a small prostate and a high PSA may actually have an aggressive tumor and should undergo a biopsy. A man with an enlarged prostate and a PSA below 10 should not have a biopsy and certainly shouldnÕt have his prostate removed unless a biopsy shows very aggressive cancer.

Therefore, as I do, it is imperative to look at multiple factors to determine if a man has an aggressive prostate cancer that requires surgery or other invasive therapies. Come in for a holistic evaluation and honest discussion of all your treatment options, be they natural supportive measures or radiation or surgery.

1. Stamey TA, Caldwell M, McNeal JE, et al. (2004) “The prostate specific antigen era in the United States is over for prostate cancer: What happened in the last 20 years?” J Urol 172:1297-301

2. Stamey TA (2002) “Limitations of serum PSA below 10 to 12 ng./ml” AUA News 7:31.

3. Stamey TA (2003) “Editorial: More information on prostate specific antigen and prostate cancer” J Urol 170, 457Ð458, August 2003