A large study demonstrates that a man’s baseline prostate specific antigen (PSA) level may help predict which men would benefit most from additional screening and treatment. These findings were recently published in the journal Cancer.

Men 50 years of age or older in the United States are often offered PSA testing for the early detection of prostate cancer. The test may be offered at a younger age to men at high risk of prostate cancer. The PSA test measures proteins that are produced and shed by the prostate. PSA levels tend to be elevated when prostate cancer is present, but levels can also be elevated in benign (non-cancerous) conditions affecting the prostate. A concern with the use of PSA testing is that it may identify some cancers that do not require treatment. This is sometimes referred to as “overdiagnosis.”

In the current study, over 86,000 men between the ages of 55 to 74 years had their baseline PSA levels measured at the start of the study; all participants had PSA levels below 20 ng/mL. Participants were enrolled between 1993 and 1999 and were followed through 2006 to monitor prostate cancer incidence and mortality.

  • Prostate cancer death rates were elevated in men with higher baseline PSA levels.
  • Among men with low baseline PSA levels (between zero and 1.9 ng/mL), more than 24,000 men would need to be screened and 724 cases of prostate cancer would need to be treated in order to prevent one death from prostate cancer.
  • Among men with baseline PSA levels between 10 and 19.9 ng/mL, only 133 men would need to be screened and 60 would need to be treated in order to prevent one death from prostate cancer.

The researchers concluded that for men with low baseline PSA levels, the benefits of additional screening and treatment may be minimal. This study—along with others—may help physicians and patients individualize prostate cancer screening and treatment decisions.

Reference:


van Leeuwen PJ, Connolly D, Tammela TLJ, et al. Balancing the harms and benefits of early detection of prostate cancer. Cancer. [early online publication]. September 13, 2010.

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