That's the conclusion of a new survey of American urologists attending the American Urological Association's annual conference, held last week in Anaheim, Calif. The survey was conducted by the Men's Health Network (MHN), which released the results today during National Prostate Cancer Awareness week.

"The survey suggests many doctors are not yet taking advantage of the risk-assessment information that the free-PSA test provides about how likely prostatic biopsies are to show cancers in individual cases," said Dr. William J. Catalona, of the Washington University School of Medicine.

"That means patients may not have all the information they need to make an informed decision about whether or not to have a biopsy," says Catalona who authored a major study on the free-PSA test that established the test's role and effectiveness in detecting cancer while eliminating unnecessary biopsies.

PSA, which stands for prostate specific antigen, is a protein produced only by the prostate gland. Small amounts of this substance may get into the bloodstream and can be measured by the PSA test.

The free-PSA blood test is a follow-up test to the total PSA and improves the accuracy of prostate cancer testing. The prostate specific antigen can be "bound" to other particles or they can be unbound PSA molecules that float "freely" in the bloodstream. A free-PSA test measures these free PSA molecules.

The free-PSA test was FDA-approved in 1998, and clinically proven to help detect prostate cancer with great accuracy. Leading cancer researchers have concluded the test can eliminate 20 percent of unnecessary biopsies, among men who have moderately elevated levels of total PSA and a negative digital rectal exam (DRE).

Prostate biopsies, in which samples of prostate tissue are examined under a microsope to determine the presence of cancer, routinely cost more than $1,000, involve discomfort and anxiety, and can cause complications such as infection, fever, urinary retention and rectal bleeding.

But the Men's Health Network survey found most urologists do not perform a simple free-PSA blood test before referring these men for biopsy.

American Cancer Society guidelines clearly recognize the test's role in detecting cancer. The guidelines say restricting biopsy "to men with less than 20 percent PSA improves testing accuracy," and that proper use of the free-PSA test "may result in a lower biopsy rate compared with older strategies."

Nearly 90 percent of urologists reported that when they recommend a prostate biopsy, patients at least occasionally ask if there is an alternative.

Even though many urologists do not perform a free-PSA blood test before referring men with moderately elevated PSA levels for biopsy, most urologists do nonetheless employ the test to assess these patients' conditions.

The large majority of responding urologists recommends the test for men who have a negative DRE and moderately elevated PSA levels, and especially for men with moderately elevated PSA, a negative DRE and a negative biopsy.

"PSA is the best cancer tumor marker in all of medicine, but there has been understandable pressure to improve its accuracy," said Dr. Catalona. "Free-PSA is the best available way to improve the accuracy of total PSA tests."

Dr. David Gremillion, of the University of North Carolina School of Medicine, praised PSA and free-PSA testing as providing "an opportunity for men that can rival the benefits of regular preventive care that women receive when they go for their annual Pap smears and screening mammograms."

The survey of U.S. urologists was performed by representatives of the Men's Health Network from June 3-6, 2001. Beckman Coulter, which manufactures the Hybritech free-PSA test, provided an educational grant to conduct the survey.

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