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DRE-PSA Data Revisited: PSA Sampling Should Precede DREs-Reply

C. B. Good, MD, MPH; Jeff Whittle, MD, MPH; David S. Macpherson, MD, MPH; Joseph Conigliaro, MD, MPH; Melissa McNeil, MD, MPH
Arch Intern Med. 1996;156(12):1352-1353. doi:10.1001/archinte.1996.00440110124018.
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We appreciate the comments of Douville and Cembrowski, which touch on some of the controversies of routine PSA testing. We maintain our stance that DRE causes a clinically insignificant increase in the serum PSA level, although in our study, 6 of 202 men had increases in PSA levels from normal to abnormal. It is known that PSA values fluctuate, and the absolute cutoff point of 4 μg/L is somewhat arbitrary; thus, we would not recommend that any patient receive invasive urologic procedures based on a single, borderline test result. Rather, our approach for the minority of patients with equivocal results (be it 3.9 or 4.1 μg/L would be to repeat the test unless a mass or nodule was found on DRE. While a few patients might get additional testing with this approach, we believe that it is less costly and inconvenient than having all patients return for PSA testing at


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