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One-Time PSA before Age 50 Can Stratify Risk for Subsequent Prostate Cancer

Posted May 23 2011 12:00am

The value of PSA for the diagnosis of cancer of the prostate continues to interest me (see: Solid Advice for Older Men Regarding PSA Screening for Prostate Cancer ). The test has always had its critics but it seems to have met the test of time and no other test has supplanted it in popularity thus far. Now comes the idea that a one-time PSA measurement before age 50 can stratify men at risk for subsequent cancer (see: Single PSA Before Age 50 Stratifies Men at Risk ). Below is an excerpt from the article:

The long-term risk for prostate cancer can be predicted from a 1-time prostate-specific antigen (PSA) test before 50 years of age, according to a study presented here at the American Urological Association (AUA) 2011 Annual Scientific Meeting.  The study, which comes from a population of more than 20,000 Swedish men, indicates that men with a PSA value above 1.5 ng/mL between the ages of 45 and 49 years account for nearly half of the prostate cancer deaths over the next 30 years or so. Only 10% of the men in the study had such high PSA values at this relatively young age, noted lead author Andrew Vickers, PhD....The "take-home message" from the study is that, on the basis of a PSA value obtained in a man's 40s, "you can stratify risk," [according to] Dr. Vickers...."This study shows whom we really need to focus on," he added. The young men in this "top 10%" need "aggressive follow-up," such as reminder phone calls for doctors' appointments, and should have either annual or biennial PSA tests, he said...."Currently, a lot of these men would be told: 'You're fine'," he said. And they are fine, to a large extent. Their absolute risk of dying from prostate cancer is low, said Dr. Vickers.

I don't know if this research will be validated in subsequent studies but it's fascinating in terms of its simplicity. The majority of men who receive periodic physicals will have at least one PSA in their 40's. Patients whose result is "above 1.5 ng/mL between the ages of 45 and 49 years" need to be more closely followed than other men in this cohort for prostate cancer. This, of course, does not mean that the remaining 90% of men should be ignored. They will require routine periodic PSA testing. Another decision point occurs at about age 60 (see: Single PSA Before Age 50 Stratifies Men at Risk ). Here's a quote from this latter note:

If you are a male who is 60 years old and your PSA is 2.0 or higher, you need to be very vigilant and continue to be tested for PSA and also undergo periodic physical exams. If you are the same age and your PSA is 1.0 or lower, you seem to be out of the woods, at least as far as cancer of the prostate is concerned.

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