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Repeating an abnormal prostate-specific antigen (PSA) level: how relevant is a decrease in PSA?


To examine the practice of repeating an abnormal prostate-specific antigen (PSA) level before proceeding to prostate biopsy, we assessed the pattern of PSA change following an initially raised (4.0 ng ml−1) PSA, and the relationship of this to prostate cancer diagnosis. In 7052 men, 71.2% with initially raised PSA had a reduction in PSA, with values <4.0 ng ml−1 in 37.8%. A total of 43.0% of men with prostate cancer showed a PSA decrease below their baseline level. Short-term decreases in PSA may occur in men with prostate cancer, including high-grade cancer, and so should not influence the decision to proceed to prostate biopsy.

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This research was funded by the Northern Ireland Research and Development Office and by the Men Against Cancer charity. The Northern Ireland Cancer Registry was funded by the Department of Health, Social Services & Public Safety Northern Ireland (DHSSPSNI).

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Correspondence to D Connolly.

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Connolly, D., Black, A., Murray, L. et al. Repeating an abnormal prostate-specific antigen (PSA) level: how relevant is a decrease in PSA?. Prostate Cancer Prostatic Dis 12, 47–51 (2009).

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  • decrease
  • pattern
  • PSA
  • variability

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