title: Reducing the Harm of Prostate Cancer Screening: Repeated Prostate-Specific Antigen Testing.
abstract: OBJECTIVE
  To determine if repeating a prostate-specific antigen (PSA) test in men with an elevated PSA level is associated with a decreased risk of prostate biopsy and cancer diagnosis.
  
  
  METHODS
  A cohort of patients referred to the Ottawa Regional Prostate Cancer Assessment Clinic from April 1, 2008, through May 31, 2013, who had referral PSA levels between 4 and 10 ng/mL were included in the study. Univariate and multivariate associations between a normal result on repeated PSA testing and the risk of prostate biopsy, cancer diagnosis, and Gleason score of 7 or higher were examined.
  
  
  RESULTS
  The study cohort included 1268 patients. Repeated PSA test results were normal in 315 patients (24.8%). Men with normal results on repeated PSA testing were younger (mean ± SD age, 61.5±8.2 years vs 65.2±8.2 years; P<.001) and had lower referral PSA levels (mean ± SD, 5.5±1.4 ng/mL vs 6.6±1.5 ng/mL; P<.001) than men with an abnormal repeated PSA result. In multivariate analysis, men with normal results on repeated PSA testing were less likely to undergo prostate biopsy (relative risk [RR], 0.42; 95% CI, 0.34-0.50) and were at lower risk for cancer diagnosis (RR, 0.22; 95% CI, 0.14-0.34) and Gleason score of 7 or higher (RR, 0.16; 95% CI, 0.08-0.34) compared with men who had an abnormal repeated PSA test result.
  
  
  CONCLUSIONS
  Routinely repeating a PSA test in patients with an elevated PSA level is independently associated with decreased risk of prostate biopsy and prostate cancer diagnosis. Men with an elevated PSA level should be given a repeated PSA test before proceeding to biopsy.
authors.affiliation: Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Luke T
authors.initials: LT
authors.lastname: Lavallée
authors.affiliation: Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Binette
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Kelsey
authors.initials: K
authors.lastname: Witiuk
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Sonya
authors.initials: S
authors.lastname: Cnossen
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Ranjeeta
authors.initials: R
authors.lastname: Mallick
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Dean A
authors.initials: DA
authors.lastname: Fergusson
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Franco
authors.initials: F
authors.lastname: Momoli
authors.affiliation: Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Morash
authors.affiliation: Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Ilias
authors.initials: I
authors.lastname: Cagiannos
authors.affiliation: Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Rodney H
authors.initials: RH
authors.lastname: Breau
mesh_terms: D000368:Aged; D001706:Biopsy / Q000706:statistics & numerical data; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading / Q000706:statistics & numerical data; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D015203:Reproducibility of Results
chemical_list: D017430:Prostate-Specific Antigen