PSA Thresholds for Prostate Cancer Detection

To the Editor. —I read with great interest the articles by Dr Catalona and colleagues¹ and Dr Carter and colleagues² regarding prostate-specific antigen (PSA) detection for prostate cancer. On one hand, Catalona et al found that the cancer detection rate was 22% when the screening PSA value was between 2.5 and 4.0 ng/mL and implied that vigilance was necessary in these men with lower PSA values. On the other hand, Carter et al found that considering as normal a PSA between 4.0 and 5.0 ng/mL maintains an acceptable ability to diagnose curable cancer and also suggested that men whose initial PSA level is less than 2.0 ng/mL may have screening every other year.

Of great concern is that both studies lacked sufficient numbers of black men, who are known to have a higher prevalence of the disease and a propensity for more advanced cancer at diagnosis.^3,4 With