This report suggests that if you are over 55 and have a low PSA score, you may not need much further testing.
PSA Test Cut-off Could Signal Low-Risk Prostate Cancer
TUESDAY, Feb. 15 (HealthDay News) -- Men who have a low prostate-specific antigen (PSA) score when they're first tested may not need to be screened annually and probably don't need to undergo a biopsy, a new study suggests.
Dutch researchers presenting the findings at the Genitourinary Cancers Symposium in Orlando, Fla., said that few men with a PSA below 3.0 ng/ml were likely to develop prostate cancer and die of the disease.
"PSA can identify those at low risk of prostate cancer and once you have done that, you can remove almost 50 percent of men in the age group 55 to 74 [from undergoing biopsies]," said study senior author Monique Roobol, an epidemiologist in the department of urology at Erasmus University Medical Center in Rotterdam.
For this study, about 20,000 men aged 55 to 74 in the Rotterdam area were screened, with those having PSA scores at or above the cut-off of 3.0 sent for biopsies and additional screenings every four years. Eighty percent of men in the group had PSA levels below that threshold.
In this group of men, the higher the PSA level at baseline, the more likely the person was to develop prostate cancer and to die of the disease. Only 1.8 percent of men with PSA scores below 1.0 were diagnosed with prostate cancer, with only 0.04 percent dying of the disease. This compares with 15.7 percent of those with scores from 2 percent to 2.9 percent developing a malignancy and 0.36 percent dying of the disease.
"This gives us some confidence that annual PSA screening is going to soon become a thing of the past," said Dr. Nicholas J. Vogelzang, chair of the Developmental Therapeutics Committee of US Oncology, who moderated the teleconference. "A low PSA, particularly those in men who have less than 1.0, and probably those less than 2.0, certainly could be considered for substantially longer intervals of PSA screening... Personalization of PSA screening is clearly underway."
Update, 2013: Three PSA Tests Over Lifetime Sufficient for Many Men
. Medscape. Apr 18, 2013.
Instead of routine prostate-specific antigen (PSA) screening — which has come under criticism in recent years amid concerns that it leads to overdiagnosis and overtreatment — just 3 PSA tests over the course of a lifetime is sufficient for many men.
In 2010, Dr. Vickers' team reported that a single PSA test at the 60 years of age is all that is needed for many men. That conclusion was criticized as being rather simplistic, because a single PSA test is just a "snapshot in time," whereas PSA is a "continuous variable" and it is important to have a number of data points. In an extension of that 2010 work, Dr. Vickers and colleagues offer a simple algorithm for prostate screening in a study published online April 16 in BMJ. For at least half of all men, it would mean only 3 PSA tests during their lifetime.
In their proposed strategy, all men with a reasonable life expectancy would be invited for PSA screening in their mid to late 40s.
Men who were found to have a PSA level below 1 ug/L on the initial test would be advised to return for screening in their early 50s and again at age 60. At the age of 60, men who still had a PSA level below 1 ug/L would be exempt from further screening.
Given existing data, these 3 PSA tests (mid to late 40s, early 50s, and 60) "are probably sufficient for at least half of men," the team concludes.
However, men who are found to have a PSA level of 1 ug/L or higher on the initial test are at above-average risk of developing life-threatening prostate cancer. These men should regularly undergo screening until around age 70. The literature suggests repeating the PSA test every 2 or 4 years, the researchers write.
For men 40 to 55 years, those with PSA levels in the top 10% of this age group should receive particular focus. This group contributes to close to half of all deaths from prostate cancer that occur before the age of 70 to 75, they add.
BMJ. Published online April 16, 2013.