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Re: Richard Ablin says ibupofen can elevate psa, not reduce it.

I think you are quite correct in what you say.

Perhaps Dr Ablin was referring to the fact the use of nonsteroidal anti-inflammatory drugs (NSAIDs) might alter the PSA reading and thus contribute to its relative ineffectiveness and this became confused in the reporting?

Whilst on the subject of PSA there have been some comments elsewhere about the remark of Dr Ablin saying the PSA test is hardly more effective than a coin toss. I think he may have had in mind studies such as the one I have pasted below that demonstrated that there may well be more men diagnosable with PCa as we define it now whose PSA never reaches the 'trip-wire' of 4.0 ng/ml. I say there may be more men diagnosable under 4.0 ng/ml because the majority of men fail to meet this trip-wire, so the estimated 15% of the men who would be diagnosed with a PSA under 4.0 ng/ml is probably a greater number than 25% (or even the 35% claimed in some studies) of men with a PSA over 4.0 ng/ml. Perhaps 'coin toss' might not be a bad description after all?

Here's the study Abstract

N Engl J Med. 2004 May 27;350(22):2239-46.

Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter.

Thompson IM, Pauler DK, Goodman PJ, Tangen CM, Lucia MS, Parnes HL, Minasian LM, Ford LG, Lippman SM, Crawford ED, Crowley JJ, Coltman CA Jr.

Division of Urology, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Tex, USA.

BACKGROUND: The optimal upper limit of the normal range for prostate-specific antigen (PSA) is unknown. We investigated the prevalence of prostate cancer among men in the Prostate Cancer Prevention Trial who had a PSA level of 4.0 ng per milliliter or less.
METHODS: Of 18,882 men enrolled in the prevention trial, 9459 were randomly assigned to receive placebo and had an annual measurement of PSA and a digital rectal examination. Among these 9459 men, 2950 men never had a PSA level of more than 4.0 ng per milliliter or an abnormal digital rectal examination, had a final PSA determination, and underwent a prostate biopsy after being in the study for seven years.
RESULTS: Among the 2950 men (age range, 62 to 91 years), prostate cancer was diagnosed in 449 (15.2 percent); 67 of these 449 cancers (14.9 percent) had a Gleason score of 7 or higher. The prevalence of prostate cancer was 6.6 percent among men with a PSA level of up to 0.5 ng per milliliter, 10.1 percent among those with values of 0.6 to 1.0 ng per milliliter, 17.0 percent among those with values of 1.1 to 2.0 ng per milliliter, 23.9 percent among those with values of 2.1 to 3.0 ng per milliliter, and 26.9 percent among those with values of 3.1 to 4.0 ng per milliliter. The prevalence of high-grade cancers increased from 12.5 percent of cancers associated with a PSA level of 0.5 ng per milliliter or less to 25.0 percent of cancers associated with a PSA level of 3.1 to 4.0 ng per milliliter.
CONCLUSIONS: Biopsy-detected prostate cancer, including high-grade cancers, is not rare among men with PSA levels of 4.0 ng per milliliter or less--levels generally thought to be in the normal range.
Copyright 2004 Massachusetts Medical Society

All the best to all of you trying to make sense of this disease of ours. Remember - There Are No Rules!!

Prostate men need enlightening, not frightening

Terry Herbert in Australia

Re: Richard Ablin says ibupofen can elevate psa, not reduce it.

Terry,
I wonder if they did a follow up analysis taking age into account. I am always surprised when studies like this, which seem to be flawed, get past the reviewers and get published in reputable journals.
(I think it is flawed because it ignored the fact that PSA goes up with age and then they use data for a very wide range of ages)
It is not just this article. Many have circular arguments and faulty logic.

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