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Senior Citizen Health & Medicine
Researchers Urge New Approach to Prostate Cancer
Screening with Early PSA Base
Even a slight change
in PSA may indicate a potential for cancer
November 1, 2006 Even a slight change in PSA
(prostate-specific antigen) may indicate a potential for cancer, say
researchers, who recommend that men as young as 40 establish a baseline
PSA. The researchers at the Johns Hopkins University School of Medicine
say that how fast the amount of PSA in a mans blood increases, or PSA
velocity (PSAV), is an accurate gauge of tumor aggression and danger,
even when PSA levels are so low as to not warrant a biopsy.
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Findings of a Hopkins study of PSAV, in this
months Journal of the National Cancer Institute, may add a new level of
predictive accuracy to prostate cancer testing, the value of which has
remained controversial under currently accepted guidelines, the
investigators say.
Our data provide a further argument for PSA
testing that begins relatively early in life, when PSA levels are
usually lower and prostate enlargement is not a confounding factor in
diagnosis, says H. Ballentine Carter, M.D., the director of the Johns
Hopkins Division of Adult Urology at the Brady Urological Institute and
lead author of the study.
We would recommend that men at around age 40, not
50, have their PSA checked to develop a baseline against which to
compare future changes (velocity), since even a slight rise in PSA may
indicate a potential for cancer down the road.
An estimated 234,460 men in the United States will
be diagnosed with prostate cancer this year, according to the American
Cancer Society.
The main debate over how to use PSA has centered
on the choice of the level that is used to trigger a biopsy, says
Carter, a professor at the Johns Hopkins University School of Medicine.
Lowering the level that triggers a biopsy leads to detection of more
harmless cancers, and higher levels could miss the opportunity to detect
an important cancer early. We have found that the rate at which a mans
PSA rises may be more important than any absolute level for identifying
men who will develop life-threatening cancer while their disease is
still curable. In addition, PSA velocity could be a useful method for
identifying those men with a prostate cancer that could be safely
monitored - an approach termed active surveillance.
PSA is a protein found in the bloodstream of men,
produced by the prostate gland and found at increased levels in those
with prostate cancer. In previous research, PSA velocity in the year
before prostate cancer diagnosis has been shown to identify men who are
likely not to be cured by surgery. However, Carters latest findings
show that PSA velocity can also identify men with life-threatening
disease at a time when it is still curable.
Using serum samples dating as far back as 1958,
frozen as part of an ongoing randomized health study of men, Carter and
his team determined PSA velocity in 980 of those study participants (856
without prostate cancer, 104 with the disease and 20 who died from it)
up until May of 2005. They found that the PSA velocity determined at a
time when PSA levels would not have triggered a biopsy were predictive
of death from prostate cancer 20 to 30 years later.
Those men whose PSA velocity was lower had a 92
percent chance of not dying of prostate cancer 25 years later; whereas
those with a higher PSA velocity had a 54 percent chance of not dying of
prostate cancer. The rates of prostate cancer death were 1,240 in
100,000 for subjects with a higher velocity compared to 140 in 100,000
for those with lower velocities.
Carter emphasizes that an important difference
between the current research and previous studies is that the subjects
in the current study were not selected, but rather taken at random from
a large, ongoing study, thus more accurately representing the U.S.
population.
His research was supported by the Intramural
Research Program of the National Institutes of Health, National
Institute on Aging.
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