Earlier Prostate Specific Antigen Screening Could Potentially Determine Prostate Cancer Risk

Screening men who are 40- to 59-years-old for prostate specific antigen (PSA) levels could potentially identify individuals at a greater risk of developing prostate cancer.

Researchers found that PSA tests in younger patients could better predict the patients at an increased risk of developing prostate cancer to implement proper prevention practices, according to a study published by the Journal of Clinical Oncology.

"We found a single baseline PSA-level measurement during midlife could accurately predict future risk of lethal prostate cancer," said co-lead author Mark Preston, MD, MPH. "These data identify subgroups of men, based on their PSA levels at a given age, who could benefit from screening intervals tailored to their actual magnitude of risk."

The study used data from the Physicians’ Health Study, which examined the risk of cardiovascular health and aspirin use in physicians. The physicians provided blood samples before the trial began, and also filled out questionnaires over 30 years.

Researchers included data about 234 patients diagnosed with prostate cancer and 711 control patients. Investigators measured PSA levels from the blood samples, and found that baseline PSA levels could predict the risk of developing prostate cancer.

According to the study, PSA above the median (1.0 ng/ml) was associated with an 82%, 71% and 86% risk of developing lethal prostate cancer in patients aged 40 to 49, 50 to 54, and 55 to 59, respectively. They also discovered that 60-year-old patients whose PSA level was below the median were unlikely to develop lethal prostate cancer.

Researchers caution that their study is limited due to a primarily Caucasian study population, limited lethal events, and patients who could have potentially had screening prior to the study.

"These data support the recommendation that risk-stratified screening for prostate cancer based on mid-life PSA should be considered in men aged 45 to 59," said senior author Lorelei Mucci, ScD. "Our study does not imply prostate biopsy or definitive treatment is immediately required in younger men with higher PSA levels at baseline, as this could lead to over diagnosis. Rather, these men should undergo more intensive PSA screening to enable earlier identification of cancer and potential cure while still possible."