Prostate Cancer with Low PSA Levels

To the Editor: Thompson et al. (May 27 issue) 1 have provided a fascinating picture of the prevalence of prostate cancer in men with “normal” prostate-specific antigen (PSA) levels in the Prostate Cancer Prevention Trial. They found surprisingly high rates of prostate cancer in men with PSA values of 4.0 ng per milliliter or less. Many authors have pointed out that PSA screening is flawed because of its relatively poor sensitivity and specificity. 2 One potential strategy to improve the sensitivity of PSA evaluations in the context of metastatic disease includes “PSA velocity,” or PSA doubling times. 3 Since the Prostate Cancer Prevention . . .