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Improving selection of patients for prostate biopsy

There is a real, clinically challenging question as to when to perform a prostate biopsy on men whose blood levels of PSA are slightly raised above the upper limit of 4 but under 10. A recent publication in the influential Journal of Clinical Oncology helps in the selection. Those men with marginally raised PSA's in the region of 4-10 are more likely to harbour an early prostate cancer if their PSA density (computed by dividing their total serum PSA by the volume of their gland) is high and if there is a hypo-echoic area in the gland on ultrasound. Patients with a low free-to-total PSA ratio are also more likely to harbour an early cancer.