Dear Dr. Motola,
Can sexual activity just before a PSA blood test make PSA results jump from 2 to 12?
PSA testing immediately after sexual activity remains controversial. The most widely held belief is that patients should wait 3 days after sexual activity prior to obtaining a PSA, however some recent studies suggest that sexual activity will not cause a rise. Repeating the PSA after 3 days of abstinence will be the easiest way to resolve this.
Several statistical terms are important to understand when trying to make sense of who should have their PSA tested or their prostate biopsied . The sensitivity of a test refers to the proportion of individuals in a population that will be correctly identified when tested for a particular disease. The specificity of a test refers to the probability that a person who does not have the particular disease and is tested for the disease will be correctly identified as not having the disease. These statistical analyses provide percentages that relate to identifying false negatives (those with a negative test who actually have the disease), false positives (those with a positive test who do not have the disease), true positives (those who test positive and have the disease) and true negatives (those who test negative and do not have the disease). Any strategy to assess PSA and whether or not testing should occur needs to take into consideration these important concepts...
A series of studies were recently published in the New England Journal of Medicine that question the efficacy of widespread PSA testing for the early detection of prostate cancer. One study, The European Randomized Study of Screening for Prostate Cancer (ERSPC Trial), involved 182,000 men in Europe. An American study from the Prostate, Lung Colorectal, and Ovarian (PLCO) Cancer Screening Trial looked at nearly 77,000 men in 10 medical centers.
For the last 20 years, urologists have been practicing in an era that advocates the early detection of prostate cancer . This has led to a decrease in the death rate from prostate cancer. With the decrease in death rates that we have been experiencing, we have to somehow explain what we as physicians are doing that is contributing to this. These studies may suggest that PSA screening may not be responsible for this.
However, several major flaws have been identified with these studies.
1. Most importantly, in the PLCO study, the PSA lev...
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