These approaches to managing serial PSA levels reflect either a fundamental misunderstanding of — or an unwillingness to acknowledge — PSA’s limitations as a marker for early prostate cancer. Observational studies show clearly that PSA levels fluctuate spontaneously, moving above or below whatever threshold clinicians deem worrisome. In addition, random biopsies can detect prostate cancer in 12% of men with PSA levels below 2 ng per milliliter and in 25% of men with levels between 2.1 and 4.0 ng per milliliter4; the latter figure approximates the prevalence often reported for men with levels between 4.0 and 10.0 ng per milliliter. When the PSA goes up — for example, from 3.0 to 4.0 ng per milliliter — and triggers a biopsy that reveals cancer, clinicians refer to “PSA-detected cancer.” But many of these cancers are not really detected by PSA screening; they are incidental findings against a background of randomly fluctuating PSA levels and an age-related increase in prostate-cancer incidence.

via Prostate-Cancer Screening — What the U.S. Preventive Services Task Force Left Out — NEJM.

Stratifying Risk — The U.S. Preventive Services Task Force and Prostate-Cancer Screening — NEJM.

I realize today is the day after Thanksgiving and I’m working.  But medicine never stops and a life underwriter has to do what a life underwriter does on her day off.  Read medical journals!  Check out these articles from NEJM.  Time to change our PSA underwriting guidelines?  I think so.  Call me if you need help with this.  I have a mortgage, one undergraduate, and one medical student to support.

Speaking of the medical student I was trapped this Thanksgiving in the car and listened to over five hours of lectures on neurology and hematology during the ride.  To tell the truth, I enjoyed the lectures.

Medicine never takes a day off nor do expert life underwriters.