July 1, 2003

Lynn R. Witherspoon, MD

While the debate about PSA screening for prostate cancer continues to engage the oncology and urology communities, a similar discussion is taking place about the value of ultrasensitive PSA assays for cancer detection and in following patients who have already undergone surgical therapy. Proponents of ultrasensitive PSA assays say that they are valuable tools for assessing residual disease after prostatectomy, allowing earlier recognition of rising PSA, differentiating aggressive disease from indolent disease, and allowing for earlier treatment interventions. Others point out that these third-generation IVDs may be detecting slow-growing tumors that need only a course of “watchful waiting.” Detractors also note that PSA can no longer be considered “prostate specific” because the protein has been detected in female serum and non-prostate cancers, and that positive results on an ultrasensitive assay may lead to invasive testing or unnecessary treatment. This presentation will review PSA testing and examine issues surrounding the use of ultrasensitive assays in clinical applications.