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Liaise with pathologists to refine understanding of the prostate-specific antigen test

To the Editor: Prostate-specific antigen (PSA) testing and prostate cancer, the focus of a number of recent articles in the Journal and a widely debated topic, are also the subject of an imminent position paper by the National Health and Medical Research Council (NHMRC). Given that there is general agreement on the potential for overdiagnosis and overtreatment of prostate cancer, it is important to continue our efforts to identify high-risk patients and patients for whom treatment is beneficial. The tools we have for this are the digital rectal examination, the PSA test and its refinements, and biopsy with Gleason scoring and its refinements.

The PSA test is a widely misunderstood measure for determining prostate cancer risk. Many authors seek to dismiss its value without careful analysis of recent advances, or acknowledgement that past research often has limited current relevance. For example, the article by Del Mar and colleagues acknowledges PSA free-to-total ratios and the rate of increase in PSA,1 but makes no mention of age-related cut-offs, which is the method of refining utility of PSA testing.2 The article by Hugosson and Carlsson3 is well balanced and highlights the problems in trying to compare the evidence…