Older Men with Low Baseline PSA Do Not Benefit from
Early Prostate Cancer Detection
Prostate cancer is the most commonly diagnosed
malignancy and the third leading cause of death from cancer in men in
Western countries
Sept. 13, 2010 - Men aged 55 to 74 years who have
low baseline blood levels of prostate specific antigen (PSA) are not
likely to benefit from further screening and treatment. That is the
conclusion of a new study published early online in Cancer, a
peer-reviewed journal of the American Cancer Society. The study also
concluded that the PSA level before diagnosis is a strong predictor of
the risk of dying from prostate cancer.
The aim of the study is to help physicians and
patients weigh the pros and cons of prostate cancer screening and early
detection.
Over 90% of prostate cancers diagnosed before they
spread and the 5-year survival rate for these is almost 100%
July 27, 2010 - Most men who are diagnosed with
prostate cancer appear to under undergo aggressive therapy, even if they
have a low prostate-specific antigen (PSA) level and low-risk disease...
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more...
Prostate cancer is the most commonly diagnosed
malignancy and the third leading cause of death from cancer in men in
Western countries. While a man in the United State has about a one in
six chance of being diagnosed with prostate cancer during his lifetime,
his risk of dying from the disease is relatively low (about one in 36).
Pim van Leeuwen, MD, of the Erasmus University
Medical Centre in Rotterdam, the Netherlands, led a team that tried to
identify if the baseline PSA can predict which men have most benefit
from additional screening.
The investigators compared the incidence of
prostate cancer with deaths from prostate cancer as related to PSA
levels in 43,987 men aged 55 to 74 years who were enrolled between 1993
and 1999 in the European Randomized Study of Screening for Prostate
Cancer (ERSPC) study in the Netherlands, Sweden, and Finland.
About Prostate Cancer
The prostate
is the gland below a man's bladder that produces fluid for
semen. Prostate cancer is the third most common cause of death
from cancer in men of all ages, although it is rare in men
younger than 40.
Levels of a
substance called prostate specific antigen (PSA) is often high
in men with prostate cancer. However, PSA can also be high with
other
prostate conditions. Since the PSA test became common, most
prostate cancers are found before they cause symptoms. Symptoms
of prostate cancer may include
● Problems passing urine, such as pain, difficulty starting
or stopping the stream, or dribbling
● Low back pain
● Pain with ejaculation
Prostate
cancer treatment often depends on the stage of the cancer. How
fast the cancer grows and how different it is from surrounding
tissue helps determine the stage. Treatment may include surgery,
radiation therapy, chemotherapy or control of hormones that
affect the cancer.
An additional 42,503 men in the same age range from
Northern Ireland who had their PSA levels measured between 1994 and 1999
were also included. All men had PSA levels that were under 20 ng/ml at
the start of the study, and were followed for prostate cancer incidence
and causes of death through 2006.
A total of 5,861 prostate cancer cases arose during
the study period, and prostate cancer death rates were highest in men
with high PSA levels at the start of the study.
The researchers found that for men with PSA levels
between zero and 1.9 ng/ml, a total of 24,642 men would need to be
screened and 724 cases of prostate cancer would need to be treated to
prevent just one death from prostate cancer.
For men with PSA levels between 10 and 19.9 ng/ml,
the benefits of screening and treatment were more favorable: a total of
133 men would need to be screened to prevent one death from prostate
cancer.
This study indicates that a man's PSA level before
diagnosis is a strong predictor for his risk of dying from prostate
cancer.
For men aged 55 to 74 years who have low PSA
levels, the benefits of aggressive follow-up testing and treatment seem
limited. Without providing benefits, they may increase prostate cancer
diagnoses and lead to overtreatment and increased costs.
"The greatest benefits of early detection programs
may be when men, aged 55-74 years, are diagnosed and treated when their
serum PSA is in the range 4.0-9.9 ng/ml or 10.0-19.9 ng/ml. Furthermore,
following research efforts that recommend more intensive PSA based
screening by lowering the PSA cut-off may greatly increase the number of
men that need additional investigations and treatment, whilst having
little effect on the reduction of prostate cancer mortality," the
authors wrote.
Dr. van Leeuwen cautioned that,"the results
presented in the current study are limited due to the relatively short
follow-up. Consequently the pros of early detection and screening may
increase with longer the follow-up while the cons may relatively
decrease."
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Sept. 13, 2010 - Men aged 55 to 74 years who have
low baseline blood levels of prostate specific antigen (PSA) are not
likely to benefit from further screening and treatment. That is the
conclusion of a new study published early online in Cancer, a
peer-reviewed journal of the American Cancer Society. The study also
concluded that the PSA level before diagnosis is a strong predictor of
the risk of dying from prostate cancer.
